Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2008
Letter Case ReportsAnesthesia for orthopedic surgery in Pallister-Killian syndrome.
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Paediatric anaesthesia · Jul 2008
Randomized Controlled TrialEfficacy of ketamine and midazolam as co-induction agents with propofol for laryngeal mask insertion in children.
Use of midazolam and ketamine lowers the induction dose of propofol (co-induction) producing hemodynamic stability. ⋯ In children, the combination of propofol with ketamine or midazolam produces stable hemodynamics and improved LM insertion conditions but is associated with delayed recovery.
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Paediatric anaesthesia · Jul 2008
Feasibility of ultrasound-guided peripheral nerve block catheters for pain control on pediatric medical missions in developing countries.
Continuous peripheral nerve blocks (CPNB) are effective for postoperative pain management in children in the hospital and at home. CPNB techniques are particularly advantageous when compared with systemic or oral opioids on medical missions to unfamiliar environments with minimal monitoring capacity. In addition, ultrasound-guidance facilitates the placement of perineural catheters in anesthetized children even in the absence of commercially packaged regional anesthesia equipment. We present a series of successful cases employing ultrasound-guided CPNB for postoperative analgesia on medical missions and discuss the impact of this technology on present and future patients in underserved countries.
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Paediatric anaesthesia · Jul 2008
Case ReportsEmergency use of a size 1 laryngeal mask airway in a ventilated neonate with an undiagnosed type IV laryngotracheo-oesophageal cleft.
The perioperative management of a neonate with a type IV laryngotracheo-oesophageal cleft and exomphalos major is described. Following an otherwise uncomplicated exomphalos repair, this baby became increasingly and inexplicably difficult to ventilate through an endotracheal tube. The emergency use of a laryngeal mask airway as a rescue maneuver allowed positive pressure ventilation, and subsequent diagnosis of the airway abnormality. The difficulties in management of the two co-existing conditions are discussed.
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Paediatric anaesthesia · Jul 2008
Quality improvement: implementation of a pain management policy in a university pediatric hospital.
Until recently, individual doctors and nurses in our pediatric hospital made decisions about the application of pain relief in patients, resulting in a wide variety of practice. The main task of our pain group was to develop hospital-wide practice standards for acute pain management to improve care. One of the key points of the pain policy was the introduction of pain assessment tools (COMFORT and Visual Analogue Scale). ⋯ Implementation of a pain policy in a pediatric hospital is a difficult process. Pain management in the PACU fell just short of the set target performances. In the surgical ward, embedding the importance of pain assessment remains a challenge and a prerequisite for quality of care in pain management.