Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2004
Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period.
This study reports the practices and morbidity of 24,165 anaesthetics performed over a 30-month period in a paediatric teaching hospital. ⋯ This observational study confirms previous reports, and indicates that there is still a relative higher rate of adverse events in infants compared with older children even in a teaching paediatric hospital with a high annual caseload.
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Paediatric anaesthesia · Feb 2004
Case ReportsPeripherally inserted central venous catheters in preterm newborns: two unusual complications.
This report describes the case of two newborns who suffered unusual complications after peripheral insertion of a central venous catheter. In one baby a fragment of the catheter tip became embolized in a peripheral branch of the left pulmonary artery. ⋯ The outcome was positive for both babies. A large clinical series is necessary to establish the complications of this procedure, their prevention and management.
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Paediatric anaesthesia · Feb 2004
Case ReportsThe laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome.
We report the successful use of the Classic laryngeal mask airway to provide brief access to the intratracheal space for the administration of surfactant in two neonates with respiratory distress syndrome.
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Cricoid pressure to occlude the upper end of the oesophagus, also called the Sellick manoeuvre, may be used to decrease the risk of pulmonary aspiration of gastric contents during intubation for rapid induction of anaesthesia. Effective and safe use of the technique requires training and experience. Cricoid pressure is contraindicated in patients with suspected cricotracheal injury, active vomiting, or unstable cervical spine injuries. ⋯ The recommended pressure to prevent gastric reflux is between 30 and 40 Newtons (N, equivalent to 3-4 kg), but pressures greater than 20 N cause pain and retching in awake patients and a pressure of 40 N can distort the larynx and complicate intubation. The recommended procedure is, therefore, to induce anaesthesia and apply a pressure of about 30 N, either manually or with the cricoid yoke, to facilitate intubation. Reported complications of cricoid pressure during intubation include oesophageal rupture and exacerbation of unsuspected airway injuries.
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Although significant advances in respiratory care have reduced mortality of patients with respiratory failure, morbidity persists, often resulting from iatrogenic mechanisms. Mechanical ventilation with gas has been shown to initiate as well as exacerbate underlying lung injury, resulting in progressive structural damage and release of inflammatory mediators within the lung. ⋯ As a novel approach to replace gas as the respiratory medium, liquid assisted ventilation (LAV) with PFC liquids has been investigated as an alternative respiratory modality for over 30 years. Currently, there are several theoretical and practical applications of LAV in the immature or mature lung at risk for acute respiratory distress and injury associated with mechanical ventilation.