Paediatric anaesthesia
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Laryngeal mask airway (LMA) placement requires an adequate depth of anesthesia to prevent patient movement and adverse airway responses. Patient movement, coughing, stridor or laryngospasm at LMA placement may result in transient hypoxia, injury to the patient and prolong time spent in the anesthetic room. The Bispectral Index Score (BIS) is a relatively new tool that has not yet established its place in routine clinical pediatric anesthesia practice. One potential use may be to predict an adequate depth of anesthesia for successful intraoperative interventions such as LMA placement in children. ⋯ Bispectral Index Score appears, from this study, not to be a useful tool to help predict complications of LMA placement or to help reduce airway complications during LMA placement. Other markers may be more useful predictors of adverse airway events.
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The aim of this study was to determine the accuracy of standard techniques for estimating oral and nasal tracheal tube length in children and to devise more accurate predictive formulae that can be used at the bedside. ⋯ Current Advanced Paediatric Life Support guidelines underestimate the appropriate tracheal tube lengths for orotracheal intubation in children over 1 year of age. Similarly, the novel weight-based formulae for tracheal tube lengths in children below the age of 1 year proved more accurate than standard reference charts. We therefore recommend that these new formulae are prospectively evaluated.
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Paediatric anaesthesia · Dec 2006
Case ReportsAirway management in two of newborns with Pierre Robin Sequence: the use of disposable vs multiple use LMA for fiberoptic intubation.
In this article, we discuss the use of LMAs as a conduit to intubate the trachea of two Pierre Robin Sequence infants. Multiple use LMAs will admit larger diameter tracheal tubes (TT) than their disposable counterparts. Increased friction with the surface of the TT makes passing even small diameter tubes through the lumen of the disposable LMA difficult.
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Paediatric anaesthesia · Nov 2006
ReviewUltrasonographic guidance in pediatric regional anesthesia. Part 2: techniques.
The benefits of regional anesthesia are well documented. The downsides of such techniques have been a significant failure rate and a potential for serious complications. Nearly, all regional blocks were first described as essentially 'blind' techniques. ⋯ Improved understanding of sonographic anatomy should lessen both the failure rate and the possibility of incurring serious complications. Natural caution has dictated that only a selection of blocks used in adults has been commonly used in pediatric practice, but with the aid of US, the repertoire of blocks for infants and children may be widened. The second part of this review will concentrate on the practice of both peripheral and central blocks.