Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2003
Case ReportsIntraoperative transoesophageal echocardiography in a low birth weight neonate with atrioventricular septal defect.
An 18-day-old male neonate (45 cm, 1.8 kg) with a history of cyanosis and congestive heart failure from an atrioventricular septal defect (AVSD) with a large left-to-right shunt was scheduled for surgical repair of the AVSD. After routine induction of anaesthesia with fentanyl and vecuronium, a 4.5-mm diameter transoesophageal echocardiography (TOE) probe was inserted into the oesophagus, and systematic echocardiographic evaluation was performed during surgery. After cardiopulmonary bypass was stopped, intraoperative TOE revealed mild residual mitral valve regurgitation. ⋯ The patient's cardiac output was low in the postoperative intensive care unit. TOE was performed the next day to detect the source of this problem, revealed severe regurgitation compared with that observed intraoperatively. TOE was useful for evaluation of the residual mitral valve regurgitation, and we reconfirmed the importance of continuous monitoring even in a low birthweight neonate undergoing repair of a complete AVSD.
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The death of a child is a very sad event in anyone's life. It also affects all staff in paediatric intensive care units in different ways at different times. The publication of standards of bereavement care in paediatric intensive care hopes to be able to assist medical and nursing staff to understand and feel more confident in this emotionally difficult area of medicine. The aim of this article is to summarize some of the major points made in the document.
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Paediatric anaesthesia · Oct 2003
Case ReportsAnaesthetic management in children with metachromatic leukodystrophy.
We present a case of metachromatic leukodystrophy in a child who required surgery for gastro-oesophageal reflux. In spite of his demyelinating disease, we used a lumbar epidural technique with general anaesthesia; the epidural catheter allowed us to continue the analgesia postoperatively and to avoid opioids in this high risk patient.
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Paediatric anaesthesia · Oct 2003
Investigation of the radiological relationship between iliac crests, conus medullaris and vertebral level in children.
The inability of anaesthetists to accurately identify vertebral spaces has been documented. The aim of our magnetic resonance imaging (MRI) study was to find the relationship of vertebral body level with Tuffier's line and the conus medullaris in children. ⋯ Our data confirmed that the iliac crests and conus medullaris were consistently related to the predicted vertebral levels in children. In the absence of a tethered spinal cord, subarachnoid puncture at L4-5 or below should present little risk of conus damage. Tuffier's line corresponded with a radiological level of L4-L5 in our study population.
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Paediatric anaesthesia · Oct 2003
Comment Letter Case ReportsPostintubation tracheal stenosis in an 11-year-old boy: a surgical and anaesthetic challenge.