Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2007
Randomized Controlled TrialKetamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia.
Emergence agitation or delirium is a known phenomenon that may occur in children undergoing general anesthesia with inhaled agents. Our aim was to test the hypothesis that the addition of a small dose of ketamine at the end of sevoflurane anesthesia will result in a decrease in the incidence and severity of such phenomenon. ⋯ We conclude that the addition of ketamine 0.25 mg.kg(-1) can decrease the incidence of emergence agitation in children after sevoflurane general anesthesia.
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Paediatric anaesthesia · Sep 2007
Case ReportsA rapidly advancing mediastinal mass--overcoming tracheobronchial obstruction.
We report the case of a 7-year-old boy who presented with rapidly advancing airway obstruction secondary to mediastinal T-cell non-Hodgkins lymphoma. His brisk deterioration required transfer to the pediatric intensive care unit and intubation of the trachea. ⋯ We report the manufacture of a proximal 'Murphy's eye' which allowed ventilation of the contralateral lung to proceed. To the best of our knowledge this is the first time that this technique has been described in a pediatric patient.
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Paediatric anaesthesia · Sep 2007
Decrease in functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized preschool children in the lateral position.
While functional residual capacity (FRC) is reduced in children undergoing general anesthesia, the lateral position leads to an increase in FRC compared with the supine position. The impact of neuromuscular blockade remains unknown. We tested the hypothesis that neuromuscular blockade leads to a decrease in FRC and increase in lung clearance index (LCI) while the application of positive endexpiratory pressure (PEEP) of 6 cmH(2)O leads to a restoration in both parameters. ⋯ In the lateral position, neuromuscular blockade led to a significant decrease in FRC associated with a small increase in ventilation inhomogeneity. FRC and LCI were restored to baseline levels with the application of PEEP 3 cmH2O that is in addition to a background of PEEP 3 cmH2O giving a total of 6 cmH2O PEEP.
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Paediatric anaesthesia · Sep 2007
Infraclavicular coracoid approach brachial plexus block for radial club hand repair.
Radial club hand is a congenital deformity in which the radius is absent, the metacarpophylangeal and interphalayngeal joints are fused and muscles arising from the radius are absent. This can alter the motor response to peripheral nerve stimulation. The classical motor response to median nerve stimulation (contractions of the fingers) cannot be elicited, hence fine twitches in the hand, at the wrist or in the surgical area or pronation-supination at a current of 0.5 mA were taken as endpoints. The aim of this study was to assess the feasibility of achieving successful infraclavicular coracoid approach block in the intra- and postoperative periods when ideal responses to electrical nerve stimulation are absent because of congenital anomalies. ⋯ Despite the limitation of absence of an ideal response to nerve stimulation in radial club hand, endpoints such as fine twitches in the hand, at the wrist or in the surgical area or pronation-supination were sufficient to achieve a successful block. This block gives satisfactory intra- and postoperative analgesia.
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Paediatric anaesthesia · Sep 2007
Deep propofol sedation for vacuum-assisted bite-block immobilization in children undergoing proton radiation therapy of cranial tumors.
Vacuum-assisted bite-block immobilization of the head is a reliable technique for reproducible precise head positioning as used for proton radiation in adults. We report preliminary experience using deep propofol sedation without an artificial airway in children undergoing proton radiation of cranial tumors requiring vacuum-assisted bite-block immobilization. ⋯ Deep propofol sedation without the use of an artificial airway is an interesting technique for vacuum-assisted bite-block immobilization in young children undergoing precise radiation therapy of cranial tumors. However, simultaneous individual anesthetic challenges require pediatric anesthesiologists highly experienced with the pediatric airway, clinical alertness and closed monitoring.