Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2006
Impact of a nurse practitioner-assisted preoperative assessment program on quality.
The anesthesia manpower shortage in the last few years in the US has limited many hospital pediatric surgical services. We sought to meet an increasing surgical caseload, while providing safe, timely and patient-centered care by instituting a nurse practitioner-assisted preoperative evaluation (NPAPE) program. The strategic goal of this program was to shift anesthesiologists from the preanesthesia clinic to the operating room (OR), while maintaining the quality of preoperative care. Our study sought to evaluate the quality of the NPAPE program. ⋯ Our study revealed that within a year of its implementation, the NPAPE program maintained patient safety, timeliness, and a high level of parent satisfaction as well as increased staff satisfaction, while shifting two anesthesiologists to the OR. A NP-assisted preoperative evaluation program can offer operational advantages without compromising care.
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Paediatric anaesthesia · Jun 2006
Randomized Controlled Trial Comparative StudyTramadol vs morphine during adenotonsillectomy for obstructive sleep apnea in children.
Optimal analgesia for children undergoing adenotonsillectomy for obstructive sleep apnea (OSA) is controversial. Tramadol may represent a superior choice over morphine in this group, with a potential to cause less postoperative sedation and respiratory depression. Optimal perioperative analgesia may allow expensive and time-consuming preoperative work-up and postoperative monitoring to be rationalized. ⋯ Tramadol may be a suitable drug for children undergoing adenotonsillectomy for OSA. Further work is required to investigate this.
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Paediatric anaesthesia · Jun 2006
Comparative StudyConvection heating in pediatric general surgery - a comparison of warming alternatives in a mannequin study.
Numerous methods of patient warming are used to prevent intraoperative hypothermia in children. Commercially available forced air warming blankets are effective, but are single-use items. We tested a custom-designed heat dissipation unit (HDU) against one such commercially available blanket. ⋯ The custom-built HDU compares favorably in our mannequin study with a Bair Hugger forced air warming blanket. As it is reusable, it offers considerable potential savings.
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Paediatric anaesthesia · Jun 2006
Case ReportsEpidural analgesia in the surgery of congenital tracheal stenosis: slide tracheoplasty on cardiopulmonary bypass.
Epidural analgesia in children is highly effective and safe; however, it has not enjoyed great popularity in surgery that requires cardiopulmonary bypass. A major concern is the possibility of damage to blood vessels with the epidural needle or catheter and epidural hematoma formation. ⋯ Improved pulmonary function, suppressed hormonal and metabolic stress responses, easy early tracheal extubation, and good analgesia and sedation that allows neurological examination to alert any possibles hidden complications, are the advantages. A dedicated medical team is essential in the perioperative management to achieve maximum benefit for these patients.