Journal of pediatric surgery
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A modified technique of tunnelling for jugular venous catheters in the newborn is described. The technique eliminates cannula-kinking and offers a more convenient position for the catheter.
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Intraosseous infusions (IO) are frequently used for gaining rapid vascular access in critically ill children. Few studies exist evaluating the efficacy of this procedure in the injured child. The objective of this study was to describe one pediatric institution's experience with the procedure of IO in young trauma victims. ⋯ IO has a been established as a rapid, safe, and simple method of obtaining short term vascular access in both critically ill and injured children. This route deserves primary consideration as an alternate route for fluid resuscitation in pediatric trauma patients regardless of age. IO should be placed without delay when venous access is not rapidly obtainable.(ABSTRACT TRUNCATED AT 250 WORDS)
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Commercially prepared cultured epithelial autografts permit closure of deep burn wounds when insufficient uninjured skin is available for split-thickness grafting. This technique was used in seven patients with a mean total body surface area (TBSA) burn of 66% and full-thickness burn of 52%. ⋯ Patients with a TBSA burn greater than 80% required at least a second application of the grafts. We feel our approach to wound preparation and postoperative wound care has contributed to our success with this technique.
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Randomized Controlled Trial Clinical Trial
Caudal bupivacaine for postoperative analgesia in pediatric lower limb surgery.
One hundred children aged 1 to 15 years were randomly allocated to two equal groups. All underwent cold orthopedic surgery to the lower limb, of more than 1 hour's duration with a standard anesthetic technique. ⋯ The caudal block had a duration of effect lasting 5 to 6 hours, and provided better recovery room analgesia (P < .01). The advantages for the child are discussed.
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There is a significant incidence of inguinal hernia in premature infants and the optimal timing of repair is controversial. A high rate of postoperative respiratory complications has been reported in this group. ⋯ Although low gestational age and postconceptual age at operation, low birth weight for gestational age, and preoperative ventilatory assistance were significantly associated with postoperative complications, only a history of respiratory distress syndrome/bronchopulmonary dysplasia (odds ratio 2.3), a history of patent ductus arteriosus (odds ratio 2.5), and low absolute weight at operation (odds ratio 3.5 for 1,000-g decrease) were independent risk factors for postoperative complication. Despite previous reports citing postconceptual age as the factor having the greatest impact on postoperative complications, these results indicate that a history of respiratory dysfunction and size at operation may be more important predictors of postoperative respiratory dysfunction in preterm infants.