Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2005
Pilot study of neuraxial imaging by ultrasound in infants and children.
Ultrasonography is becoming an important adjunct in regional anesthesia. Epidural anesthesia may pose significant challenges in infants and children because of difficulties in identifying the epidural space. In addition, epidural catheters are sometimes difficult to advance. The present study was performed to evaluate an optimal ultrasound technique for direct visualization of neuraxial structures in children. ⋯ Paramedian longitudinal scans with linear probes are the most favorable method of imaging neuraxial anatomy at lumbar and thoracic cord levels in infants and children, with the best results in neonates up to 3 months of age. Based on these results, and using real time imaging, a practical technique for ultrasound-guided epidural anesthesia for neonates and infants at lumbar and thoracic levels of the spinal cord is planned.
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Paediatric anaesthesia · Aug 2005
Comparative StudyCatheterization of the radial or brachial artery in neonates and infants.
In neonates and small children, percutaneous insertion of arterial catheters may be very difficult because of the small diameter of the arteries. Multiple attempts at cannulation are common and may be a predictor of serious adverse events following arterial cannulation. As an end artery, the brachial artery is usually not recommended for cannulation. However, limited data exist about brachial artery catheterization in neonates and young children. In this retrospective study, we report our experience with arterial indwelling catheters placed in neonates and small children prior to surgery for congenital heart defects. ⋯ Even considering the nature of a retrospective study design, we conclude that the brachial artery could be considered for cannulation in neonates and small children.
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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
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane-remifentanil vs isoflurane-remifentanil for the surgical correction of craniosynostosis in infants.
The aim of the present study was to compare the efficacy of isoflurane-remifentanil and sevoflurane-remifentanil combinations during neurosurgical correction craniosynostosis. ⋯ The rapid recovery of the children (confirmed by their high values of SRS) makes it possible to reliably assess the patient's neurological condition immediately after surgery.