Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1998
Case ReportsSurvival following cardiac tamponade and arrest in a paediatric patient with penetrating trauma to pulmonary artery.
A seven-year-old child with an airgun pellet injury to the upper part of the anterior chest wall was transported in a state of shock from a nearby hospital to this trauma centre. The nature and site of injury associated with engorged neck veins, hypotension, pulsus paradoxus and an enlarged liver suggested the possibility of acute pericardial tamponade. On arrival in the emergency room the child had a brief period of cardiac arrest revived by basic resuscitation procedures. ⋯ Emergency median sternotomy with pericardiotomy was done to relieve the tamponade which was peroperatively diagnosed to be due to a tear in the pulmonary artery close to its origin. Early clinical diagnosis, rapid surgical intervention in the operating room and efficient anaesthetic management within the 'Golden Hour' saved life. It is believed that this is the first report of survival of a paediatric patient with a gunshot penetrating trauma to the pulmonary artery leading to cardiac tamponade and a brief period of cardiac arrest.
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Paediatric anaesthesia · Jan 1998
Case ReportsAnaesthetic management of a child with Burkitt's lymphoma of the larynx.
An eight-year-old boy with a Burkitt's lymphoma of the upper airway is described. The use of sevoflurane for induction of anaesthesia in patients with airway obstruction is discussed. The logistical problems of upper airway surgery and anaesthesia in this type of patient are considered.
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Paediatric anaesthesia · Jan 1998
Case ReportsJuvenile laryngeal papillomatosis: scary anaesthetic!
We describe three children ages 20 to 33 months who presented for surgical resection of their laryngeal papillomata. Their anaesthetic management revealed the severity of obstruction which these children presented and the obstacles that faced the anaesthesiologist trying to secure the airway and provide adequate ventilation. ⋯ But, they exhibited total obstruction when ventilation was attempted via mask using positive pressure. It is possible to encounter obstruction to ventilation after the trachea has been intubated because of papillomata that were 'shaved off,' filling the tracheal tube lumen.
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Paediatric anaesthesia · Jan 1998
Clinical TrialDistress at induction of anaesthesia in children. A survey of incidence, associated factors and recovery characteristics.
This study analysed the frequency of distress at induction (DAI) in 2122 paediatric patients. The data were analysed to assess predictors of DAI and to examine associations between predictors of DAI and recovery characteristics. Patient age, preoperative behaviour, premedication (oral midazolam, n = 480) and venue for anaesthesia induction were associated with changes in the incidence of DAI. ⋯ Average early recovery time was prolonged 4.4 minutes and average discharge time in day patients was delayed 36 minutes by the use of oral midazolam premedication. Premedication was not significantly associated with arousal distress. We conclude that a policy of optimizing nonpharmacological approaches for minimizing induction distress, combined with selective premedication with oral midazolam, can produce a low incidence of induction distress and adverse effects.
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Paediatric anaesthesia · Jan 1998
Case ReportsProlonged mivacurium neuromuscular block in children.
The authors report two cases of prolonged neuromuscular block after administration of mivacurium in children with previously undiagnosed plasma cholinesterase deficiency related to homozygous atypical genotype. Their anaesthetic management is described as well as determination of the phenotype of both children and their family.