Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2015
The impact of targeted therapies for pulmonary hypertension on pediatric intraoperative morbidity or mortality.
Pulmonary hypertension (PHT) is a significant risk factor for major adverse events during anesthesia, with a reported incidence of 5% to 7%, secondary to acute pulmonary hypertensive crises or right ventricular ischemia. Newer therapies for treating PHT have reduced mortality. In this single-center study, we investigated the frequency of major and minor events during anesthesia under the current strategies to manage PHT. ⋯ The risk for adverse events during anesthesia in patients with PHT remains high, despite newer disease-modifying treatments. Risk factors for complications include age and severity of PHT.
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Anesthesia and analgesia · Feb 2015
Randomized Controlled Trial Comparative StudyExcess Costs and Length of Hospital Stay Attributable to Perioperative Respiratory Events in Children.
This prospective matched-cohort study from Thailand found that children experiencing a perioperative respiratory event were subsequently hospitalized twice as long, incurred 30% higher hospital costs, along with 58% higher indirect costs.
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Anesthesia and analgesia · Feb 2015
The Effects of Anesthesia, Muscle Paralysis, and Ventilation on the Lung Evaluated by Lung Diffusion for Carbon Monoxide and Pulmonary Surfactant Protein B.
An increased alveolar-arterial oxygen tension difference is frequent in anesthetized patients. In this study, we evaluated the effect on the lung of anesthesia, muscle paralysis, and a brief course of mechanical ventilation. ⋯ A brief course of anesthesia and controlled ventilation leads to: (1) alveolar damage, which is correlated with lung strain and perfusion, and (2) impaired gas exchange mainly due to volume loss but also to reduced aerated lung perfusion.
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Anesthesia and analgesia · Feb 2015
Observational StudyAn Ultrasound Evaluation of Laryngeal Mask Airway Position in Pediatric Patients: An Observational Study.
In children, the laryngeal mask airway (LMA) is frequently displaced within the hypopharynx, resulting in repositioning of the device. When the tip of the LMA is placed in the esophageal inlet, the arytenoids are moved ventrally. When the LMA is rotated or deviated, the ventral movement of the arytenoids may result in asymmetric elevation of an arytenoid cartilage, which can be detected with ultrasound (US). In this study, we sought to estimate the incidence of LMA malposition detected with US in pediatric patients. The primary end point was to compare the incidence of LMA malposition between US and fiber optic bronchoscopy (FOB). The secondary end points were to find the interrelationship between US-detected and FOB-detected malposition of the LMA and to locate the diagnostic performance of US in detecting LMA malposition. ⋯ Although US could not detect the suboptimal depth of an LMA, US has promise of being an accurate tool in detecting a rotated LMA.
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Anesthesia and analgesia · Feb 2015
Macroscopic Barotrauma Caused by Stiff and Soft-Tipped Airway Exchange Catheters: An In Vitro Case Series.
Many airway management guidelines include the use of airway exchange catheters (AECs). There are reports, however, of harm from their use, from both malpositioning and in particular from the administration of oxygen via an AEC leading to barotrauma. ⋯ Our results are consistent with reports of harm during the use of AECs and demonstrate the risk of administering oxygen through these devices when they are positioned below the carina. An indicator, ideally made on an AEC at the time of manufacture and designed to lie at the same level as the teeth, may be useful in preventing the insertion of that AEC beyond the level of the carina and improve the safety of using such devices.