Paediatric anaesthesia
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Paediatric anaesthesia · May 2012
Review Meta AnalysisCT-guided percutaneous lung biopsy under general anesthesia: a pediatric case series and literature review.
We describe 14 consecutive children who received computed tomography-guided percutaneous lung biopsy (CT-PLB) under general anesthesia over an 18-month period at our institution. Pulmonary hemorrhage (occurring in 36%) and pneumothorax (29%) were the two most common complications; the overall complication rate was 64%. When complications did occur, immediate airway management was facilitated by the presence of an endotracheal tube (ETT). We conclude as follows: (i) CT-PLB in our series is associated with a high risk of both overall and severe complications; (ii) risk of complications is increased by both patient and procedure-related factors; (iii) airway management with ETT may be preferable should a complication arise; (iv) severe complications may necessitate ICU admission, which should be available before proceeding.
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Paediatric anaesthesia · May 2012
Case ReportsWhat other anomalies? Failure to wean post ventricular septal defect repair secondary to anomalous origin of the left coronary artery from the pulmonary artery.
A six week old infant underwent ventricular septal defect and atrial septal defect closure. Preoperative echocardiography showed evidence of pulmonary hypertension. The post operative course was complicated failure to wean from ventilatory and inotropic support. ⋯ While protective to the myocardium this made the preoperative diagnosis of ALCAPA difficult, as there was no flow reversal on Doppler echocardiography. Closure of the septal defects meant this protective effect was lost, with subsequent severe myocardial ischaemia and heart failure. This case highlights the diagnostic challenges of ALCAPA, the 'protective' effects of pulmonary hypertension with ALCAPA, and the importance of early cardiac catheterization in the setting of unexplained failure to wean post cardiac surgery.
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In 1984, David Steward (in Figure 1, front row) and Seizo Iwai (Figure 2) organized a meeting of pediatric anesthetists in Manila during the World Congress of Anesthesiologists. Following the meeting, there was a dinner at which John Zorab, then Secretary of the World Federation of Societies of Anaesthesiologists (WFSA), told the audience that if they wanted to set up a Paediatric Committee in the WFSA, they should request to do so immediately. ⋯ It was established at the WFSA Executive meeting the next day. Eventually, a multiauthored WFSA handbook on Pediatric Anesthesia, initiated by David Steward and finalized by Anneke Meursing, was produced some years later.
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Paediatric anaesthesia · May 2012
An optimum time for intravenous cannulation after induction with sevoflurane in children.
It is a common practice to perform inhalational induction with sevoflurane followed by intravenous cannulation in children. However, there is little information regarding the time at which the intravenous cannulation can be attempted safely after sevoflurane induction. ⋯ We recommend an optimal time of 3.5 min for attempting intravenous cannulation after the loss of eyelash reflex with sevoflurane induction.