Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2007
Children who refuse anesthesia or sedation: a survey of anesthesiologists.
Few articles have addressed the issue of the child who refuses anesthesia or sedation for surgery. A survey of members of the Society for Pediatric Anesthesia in the USA was conducted regarding their experience with pediatric refusal and assent for surgery. ⋯ Cancellation of planned surgery because of child refusal is not uncommon. It is important to recognize the potentially uncooperative child, particularly older children with developmental delay or a lack of understanding. Discussion with child and parents, selective use of premedication and different induction agents, distraction, play techniques, gentle restraint and the option of cancellation and review should all be considered.
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Paediatric anaesthesia · Nov 2007
Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants.
Combined spinal-epidural anesthesia (CSE-A) is reportedly safe and effective for the pediatric population in infraumbilical surgery. Our main purpose was to describe our experience of this technique in neonates and infants undergoing elective major upper abdominal surgery. ⋯ Combined spinal-epidural anesthesia could be considered as an effective anesthetic technique for elective major upper abdominal surgery in awake or sedated neonates and infants, and could be used cautiously by a pediatric anesthesiologist as an alternate to general anesthesia in high-risk neonates and infants undergoing upper gastrointestinal surgery.
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Paediatric anaesthesia · Nov 2007
Multicenter StudyAwareness during pediatric anesthesia: what is the position of European pediatric anesthesiologists?
The incidence of awareness in the pediatric population is reported as high as 1 : 125. An online survey was conducted about the current perception and practice of members of the British and French pediatric anesthesia societies regarding awareness during general anesthesia. ⋯ This survey demonstrates that European pediatric anesthesiologists perceive awareness as a major problem. However, none seems to address the issue openly or looks for its presence routinely. The vast majority of pediatric anesthesiologists rely almost exclusively on clinical monitoring and endtidal anesthetic concentrations for its detection.
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Paediatric anaesthesia · Nov 2007
Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses.
The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications. ⋯ Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.