Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2005
Case ReportsNoninvasive ventilation options in pediatric myasthenia gravis.
A 10-month-old female infant with congenital myasthenic syndrome suffering from acute respiratory failure was supported using face mask positive pressure ventilation until definitive diagnosis and specific treatment was achieved. A 12-year-old girl suffering from seronegative myasthenia gravis was treated by helmet-delivered noninvasive ventilation during recurrent myasthenic episodes. Noninvasive support was really beneficial in the myasthenic crisis with respiratory muscle weakness, whereas a shift to tracheal intubation was necessary when pulmonary infection and multiple atelectasis occurred. The new helmet interface for noninvasive positive pressure ventilation can represent a valuable means of respiratory support in the early phase of respiratory failure in older children.
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Paediatric anaesthesia · Aug 2005
An evaluation of pain and postoperative nausea and vomiting following the introduction of guidelines for tonsillectomy.
Tonsillectomy and adenotonsillectomy have a high incidence of postoperative pain, and postoperative nausea and vomiting (PONV). Pain is traditionally controlled with morphine but this increases the risk of PONV and may cause respiratory depression. Antiemetics reduce PONV but their routine use has been questioned on safety grounds. ⋯ Guidelines which use a combination of paracetamol, nonsteroidal anti-inflammatory drugs and fentanyl, provide excellent analgesia with minimal PONV after elective tonsillectomy and adenotonsillectomy. As a result the routine use of morphine and antiemetics can be avoided.