Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2013
Comparative StudyComparison of bicarbonate-buffered fluid and isotonic saline solution as Cell Saver washing fluids for packed red blood cells.
Massive transfusion (MT) can cause severe electrolyte and acid-base disturbances in neonates and infants due to the unphysiological composition of packed red blood cells (PRBCs). Washing of the PRBCs using Cell Saver systems prior to MT is recommended for this reason. ⋯ Washing of PRBCs with BB-HS rather than NaCl results in a more physiological composition with improvements of electrolyte concentrations, acid-base balance and erythrocyte stability.
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Paediatric anaesthesia · Nov 2013
The perioperative course of factor XIII and associated chest tube drainage in newborn and infants undergoing cardiac surgery.
Perioperative acquired factor XIII deficiency has been looked upon as a potential cause of postoperative bleeding in adult cardiac surgery. ⋯ Factor XIII activity in infants with congenital heart defects is within the lower range of normal adults, independent of patient's age and the presence of cyanosis. Reconstituted blood prime maintains factor XIII activity at sufficient levels during pediatric cardiac surgery. We could not detect a correlation between FXIII and CTD.
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Paediatric anaesthesia · Nov 2013
ReviewA systematic review and quantitative analysis of neurocognitive outcomes in children with four chronic illnesses.
Concern has been expressed that infants and children exposed to uneventful surgery and anesthesia may incur neurological injury that becomes manifest in poor scholastic performance or future learning difficulties. A recent meta-analysis of seven clinical studies examined the relationship between learning or behavior difficulties and pediatric exposure to anesthesia/surgery and reported an odds ratio of 1.4; however, the level of association and causal factors remain unclear. The purpose of our study is to provide context to the pediatric anesthesia neurotoxicity question by reviewing the evidence linking four childhood illnesses with neurocognitive development. In the present review, we have sought to quantify the magnitude of the impact of chronic illness on neurocognitive development through a systematic review of publications that report the developmental trajectory of patients with four childhood diseases: cystic fibrosis (CF), hemophilia A, end-stage renal disease (ESRD) and end-stage liver disease (ESLD). ⋯ Overall, the results suggest that the burden of chronic childhood illness, by itself, does not impair cognitive development in children with hemophilia A and CF. Children with ESRD and ESLD, despite optimal management, show a mild cognitive deficit compared with the population norm. Given the impact of these four specific chronic illnesses on neurocognitive outcome in children and the improvement in IQ post-transplant in both ESRD and ESLD, the results suggest that the effect of an uncontrolled confounding illness on neurocognitive development is small.
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Paediatric anaesthesia · Nov 2013
Randomized Controlled Trial Comparative StudyEfficacy of subtenon block in infants - a comparison with intravenous fentanyl for perioperative analgesia in infantile cataract surgery.
General anesthesia with opioids provides good perioperative analgesia in infantile ocular surgeries but is associated with the risk of respiratory depression and postoperative emesis. This study aimed to assess the effectiveness of subtenon block for providing perioperative analgesia in infants undergoing cataract surgeries. ⋯ Subtenon block is an effective superior technique for postoperative analgesia compared to intravenous fentanyl in infants undergoing cataract surgery.
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A central venous catheter located in the jugular or subclavian vein provides rapid, reliable vascular access for pediatric heart surgery. However, intravascular catheters are associated with vessel injury. Stenosis or thrombosis of central veins in the upper body can lead to 'superior vena cava syndrome' with markedly elevated venous pressures in the head and neck, causing facial swelling and headaches. This complication may be especially serious for patients with superior cavopulmonary (Glenn) or total cavopulmonary (Fontan) circulation. The authors hypothesized that upper body central line placement would be associated with a low risk of venous thrombosis or stenosis. ⋯ This study describes one institution's experience with routine upper body central venous catheter placement for neonatal and infant cardiac surgery as well as univentricular cardiac palliation (Glenn and Fontan procedures) with minimal risk of clinically significant catheter-associated vessel thrombosis or stenosis. No upper body central venous stenosis or thrombosis was detected in association with perioperative catheter placement in the upper body central venous system, primarily the right internal jugular vein in 156 cases. Right internal jugular central line placement for infant cardiac surgery can be utilized with a low risk of direct venous thrombosis or stenosis.