Masui. The Japanese journal of anesthesiology
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Two recently recognized issues are reviewed ; one is a hospital acquired hyponatremia in children treated with intravenous hypotonic maintenance fluids and the other is the pros and cons of glucose addition to these fluids. Children in the perioperative period are at risk for nonosmotic secretion of ADH and stress-induced insulin resistance, which necessitate reducing the volume of maintenance fluid to half the previously recommended volume, and the concentration of additive glucose to approximately 2%. While isotonic fluids are recommended intraoperatively, controversies still exist on the constitution of maintenance fluids in the postoperative period, where the choice of an isotonic solution should be more pertinent to that of a hypotonic solution, but evidence is weak ; further investigations are needed to make a decision.
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Uncuffed endotracheal tubes have been commonly used in pediatric patients, but cuffed pediatric endotracheal tubes are recently introduced and stirred up a controversy. Uncuffed tubes may require multiple laryngoscopies, pollute the environment, and cause pulmonary aspiration as well as unstable ventilation. A recent study revealed that the contours of the airway and the tracheal tube are different, so that the pressure exerted on some parts of the cricoid mucosa may not be appropriate. ⋯ It is also used for a conduit for fiberoptic intubation and emergent airway with patients in the prone position. The lightwand (Trachlight) is another device for pediatric intubation and is recommended as the first-line option in patients who can be ventilated but in whom laryngoscopic intubation has failed. AirWayScope (Pentax-AWS) is a novel intubation device which combines an airway, camera and monitor It can be an epoch-making intubation device for infants and children if a smaller size is available in the future.