Masui. The Japanese journal of anesthesiology
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Fever and upper respiratory tract infections (URI) are frequently-encountered preoperative comorbidities. Whether or not to proceed with anesthesia for a child with common cold is still a continuing dilemma for anesthesiologists. We, anesthesiologists often feel uncomfortable in making a decision whether or not to proceed because URI is associated with perioperative respiratory adverse events (PRAEs) and there are no definite rules to proceed with or postpone a case. ⋯ Moreover, because children per se are vulnerable to PRAEs, we cannot reduce the risk to zero even without a URI. Therefore, we should be familiarized with how to cope with PRAEs. In making a decision to proceed with or postpone the case, it is important to take various factors together into account, and the decision ultimately depends on whether or not we feel "Yes, we can".
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Procedural sedation and analgesia comprise an integral part of high quality tertiary care in pediatrics. All patients undergoing procedural sedation should be evaluated as extensively as in patients receiving general anesthesia, and an appropriate fasting time should also be considered. Since cardio-respiratory side effects are inevitably associated with sedative medications, (1) only medical personnel with an expertise in the use of these medications should manage procedural sedation, and (2) additionally, the choice of medication should be decided on a case-by-case basis as no single sedation recipe has proven superior to others. ⋯ Following the procedure, medical staff should also monitor patients until full recovery is achieved. Pediatric anesthesiologists should be involved in the sedation procedure for patients with complicated medical histories. Finally, care should be taken to avoid ferrous equipment when performing sedation in an MRI suite.
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The practice of pediatric pain management has made a great progress in the last decade with the development and validation of pain assessment tools specific to pediatric patients. Adequate pediatric pain management has not been advanced as that of adult analgesia due to a lack of clinical knowledge, insufficient pediatric research and the fear of opioid side effects and addiction. Even pediatric anesthesiologists have believed the myths that neonates and infants do not feel severe pain compared to adults because of immatured development of nervous system. ⋯ Accurate assessment of pain in different age groups and the effective treatment of postoperative pain are constantly being refined. Systemic opioids in patient-controlled analgesia, nonsteroidal antiinflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined in a multimodal approach to treat acute pain in perioperative pediatric patients.
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Retraction Of Publication
Notice of formal retraction of articles by Dr. Yoshitaka Fujii.
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Meta Analysis Comparative Study
[Efficacy of Glidescope video laryngoscope in difficult airways: a meta-analysis of randomized controlled trials].
Increased evidence indicates that the Glidescope video laryngoscope (GVL) is useful for difficult tracheal intubations. The aim of this meta-analysis was to assess the efficacy of the GVL in difficult tracheal intubations, comparing with that of Macintosh laryngoscopy. ⋯ Our meta-analysis showed that GVL has an advantage over Macintosh laryngoscope in respect to the success rate for difficult tracheal intubations.