Paediatric anaesthesia
-
Paediatric anaesthesia · Mar 2007
Case ReportsAnesthesia for repair of gastroschisis in thoracopagus twins: a case report.
The first pair of live conjoined twins in Fiji were delivered in June 2004. Their union was unexpected and in addition they had gastroschisis requiring urgent surgery. With limited resources available there was uncertainty about the degree of sharing of the major organs. ⋯ Surgical repair of the abdominal defect was performed using a combined general and regional anesthesia technique. The thoracopagus twins died 3 days postoperatively in the Neonatal Intensive Care Unit. Perioperative management is discussed.
-
Paediatric anaesthesia · Mar 2007
Randomized Controlled TrialThe efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy.
A few previous studies have suggested the efficacy of i.v. ketamine for postoperative pain relief in children after adenotonsillectomy, but none has investigated the efficacy of peritonsillar infiltration of ketamine in these children. ⋯ Low dose ketamine given i.v. or by peritonsillar infiltration perioperatively provides efficient pain relief without side-effects in children undergoing adenotonsillectomy.
-
Paediatric anaesthesia · Mar 2007
Randomized Controlled TrialBupivacaine caudal epidural anesthesia: assessing the effect of general anesthetic technique on block onset.
The primary objective of this prospective, randomized trial was to compare the effect of propofol and sevoflurane on effectiveness of regional anesthesia. As a secondary objective, we aimed at evaluating the influence of age on neuraxial block profile. ⋯ This study has demonstrated that general anesthesia with sevoflurane decreases the time to onset of surgical anesthesia relative to propofol anesthesia. This effect was most marked when sevoflurane anesthesia preceded caudal epidural blockade. The basis for this effect is most likely to be related to differential binding of the two anesthetic agents to receptors in the spinal cord that mediate immobility in response to surgical stimuli.
-
Paediatric anaesthesia · Mar 2007
Use of the ASA Physical Status Grading System in pediatric practice.
The American Society of Anesthesiologists (ASA) Grading System is widely used to describe preoperative physical status. Inconsistency of grading between anesthetists has been demonstrated in studies using hypothetical adult patient scenarios. We aimed to investigate the use and interrater reliability of the ASA Grading System in pediatric anesthesia practice. ⋯ The ASA Grading System shows poor interrater reliability in pediatric practice, as it does in adults. This should be borne in mind when using the ASA System for clinical or scientific work in pediatrics. A physical status grading system developed specifically for use in pediatrics may reduce inconsistency.
-
The purpose of this study was to determine if inspiratory pressure from intermittent positive pressure ventilation may be sufficient to inflate the cuff (thus 'auto-inflation') and thereby seal the trachea. ⋯ Auto-inflation in the Mallinckrodt Seal Guard with high volume-low pressure polyurethane cuff can produce adequate tracheal sealing in the model trachea used. The implication is that such auto-inflation should decrease the risk of tracheal injury from acute or persistent cuff hyperinflation.