Journal of pediatric surgery
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Case Reports
Relief of subglottic stenosis by anterior cricoid resection: an operation for the difficult case.
Anterior cricoid resection is an effective procedure to relieve subglottic stenosis. This is well documented in adults, although reports of the procedure in growing airways are limited. Over an 11-year period, seven pediatric patients underwent anterior cricoid resection for recalcitrant subglottic stenosis. ⋯ There has been minimal morbidity and no mortality. Follow-up from 1 to 11 years shows no recurrence of stenosis. There has been normal laryngeal and airway growth.
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Extracorporeal membrane oxygenation (ECMO) has been used for 20 years in neonates and children with cardiac and respiratory failure. The number of neonates treated with ECMO has increased exponentially, but the number of older children treated is small. The selection and exclusion criteria for pediatric ECMO are poorly defined, and the results vary because of variable selection criteria and institutional experience with the technique. ⋯ Eleven of the 22 patients survived (50%); nine of the last 12 survived (75%). These results suggest that ECMO may be a useful technique in selected pediatric patients with respiratory failure. Survival and complication rates improve as experience with the technique increases.
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Partial drainage of a hepatic hydatid cyst into a pericystic blood vessel caused anaphylactic shock following minimal blunt abdominal trauma in a child. A case report including diagnostic procedures and treatment is presented.
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Extracorporeal membrane oxygenation (ECMO) improves survival in appropriately selected full-term neonates with severe respiratory failure. The clinical course and outcome of infants placed on ECMO after sustaining a cardiac arrest is not known. This study reviews the characteristics and outcome of 10 neonates, identified by retrospective review, placed on ECMO at Children's Hospital Medical Center (CHMC), Cincinnati, OH, after sustaining a cardiac arrest. ⋯ Despite these radiographic findings, early clinical follow-up suggests adequate growth and development with no individuals demonstrating a severe neurological deficit. Thus, ECMO can play a role in the resuscitation of neonatal ECMO candidates sustaining cardiac arrest prior to or at the time of cannulation. Early clinical follow-up suggests adequate preservation of neurological function in this extremely high-risk group.
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Twenty premature or high-risk infants received caudal epidural anesthesia for inguinal herniorrhaphy, orchiopexy, and circumcision. Mean gestational age at surgery was 48 +/- 12 weeks; mean weight at surgery was 4,100 +/- 1,400 g. Caudal anesthesia, performed with 1 mL/kg of 0.375% bupivacaine, was successful in 19 of 20 infants. ⋯ Surgical conditions were generally excellent and the infants tolerated anesthesia and surgery well. No postoperative complications were observed. Caudal epidural anesthesia is an acceptable alternative to general or spinal anesthesia in premature and high-risk infants.