Articles: surgery.
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Curr Opin Anaesthesiol · Dec 2005
Clonidine: an alternative to benzodiazepines for premedication in children.
The aim of this review is to summarize the use of clonidine for paediatric premedication and to make a comparison with benzodiazepines. A routine clonidine premedication protocol is also presented. ⋯ Midazolam the most commonly used drug for paediatric premedication worldwide. Despite having a number of beneficial effects it is far from an ideal premedicant, especially concerning its effect on cognition/amnesia, confusion and long-term behavioural disturbances. Clonidine lacks the majority of the negative effects associated with midazolam and is associated with a number of beneficial perioperative effects. Our clinical experience of replacing midazolam with clonidine as premedicant in children, including also outpatients, has been favourable.
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Simulation is frequently cited as the ideal method to improve the training of health care professionals. Studies from specialties such as anesthesia and intensive care report that life-sized mannequins reliably measure acute care skills. Task trainers, such as laparoscopic simulators, effectively improve participants' ability to perform minimally invasive surgery. This review will chart the progress made in defining the role of simulation training in medical education. ⋯ Task trainers are recommended for training physicians for a number of minimally invasive procedures. Life-sized mannequins can be used to train residents to manage a range of critical events in a simulated setting. These exercises train residents to conduct a sequential, logical examination, perform various tasks, interpret clinical findings and use clinical reasoning to resolve the simulated crisis.
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Curr Opin Anaesthesiol · Dec 2005
Anesthetic management of the child with an upper respiratory tract infection.
The decision to proceed with anesthesia for the child with an upper respiratory tract infection is often difficult. Whereas most studies suggest that children who present for elective procedures with an upper respiratory tract infection are at increased risk of perioperative adverse events, these events are typically easy to recognize and treat. This review will discuss the current literature regarding outcome in children who present for elective surgery with an upper respiratory tract infection and suggests approaches to optimize their perioperative management. ⋯ An understanding of the risk factors associated with administering anesthesia to the child with an upper respiratory tract infection is important in identifying elements of the preoperative assessment that merit attention and in optimizing the anesthetic plan as a means to limit any perioperative complications.
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Journal of neurosurgery · Dec 2005
Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery.
The authors prospectively compared a new technique of surgical microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. ⋯ Microscope-based ICG videoangiography is simple and provides real-time information about the patency of vessels of all sizes and about the aneurysm sac. This technique may be useful during routine aneurysm surgery as an independent form of angiography or as an adjunct to intra- or postoperative DS angiography.
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Interventional magnetic resonance imaging (iMRI) allows real-time guidance and optimization of radiofrequency ablation of pathologic tissue. For many tissues, resulting lesions have a characteristic two-boundary appearance featuring an inner region and an outer hyper-intense margin in both T2 and contrast-enhanced (CE) T1-weighted MR images. We created a geometric model-based semiautomatic method to aid in real-time lesion segmentation, cross-sectional/three-dimensional visualization, and intra/posttreatment evaluation. ⋯ Our method provides a precise, semiautomatic approximation of lesion shape for ellipsoidal lesions. Further, the method has clinical applications in lesion visualization, volume estimation, and treatment evaluation.