Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2001
Comparative StudyRegional anaesthesia decreases the need for postoperative mechanical ventilation in very low birth weight infants undergoing herniorrhaphy.
We were interested to know whether regional anaesthesia allowed improved respiratory function postoperatively in very low birth weight babies. ⋯ Regional anaesthesia decreases the need for postoperative ventilatory support requirements in very low birth weight infants undergoing herniorrhaphy.
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Paediatric anaesthesia · Nov 2001
Use of albumin, blood transfusion and intraoperative glucose by APA and ADARPEF members: a postal survey.
A postal survey was mailed to the members of Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) (n=187) and French-Language Society of Paediatric Anaesthesiologists (ADARPEF) (n=220) to primarily investigate the impact of a recently published Cochrane report on the clinical use of albumin solutions in paediatric anaesthetic practice. At the same time, information regarding blood transfusion strategies and the use of intraoperative glucose containing maintenance solutions was gathered. ⋯ The response rate of the survey was 38% and 25% for APA and ADARPEF members, respectively. Forty-one percent of APA members reported a reduced use of albumin containing solutions following the publication of the Cochrane report compared to eight percent in the ADARPEF group (P < 0.0001). Albumin continues to be the most frequently used plasma expander in premature babies and neonates, whereas many colleagues use alternative colloids in infants and older children. A clear difference was observed in the 1-12-year-old age group between APA members favouring the use of gelatines and ADARPEF members who instead frequently use hetastarch solutions. ADARPEF members appeared to have a slightly more restrictive attitude towards blood transfusion and also reported more widespread use of erythropoetin (56% versus 9%, P < 0.0001) and predilution techniques (40% versus 23%, P < 0.04) compared with APA members. Regarding intraoperative maintenance solutions, a large proportion of both APA and ADARPEF members still use high concentrations of glucose intraoperatively, even in older children.
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Caffeine, which has a wide range between therapeutic and toxic levels, is a widely used medication for prevention and treatment of apnoea of prematurity. Despite its safety, caffeine overdose and intoxication has been previously reported in the literature. ⋯ No seizure activity was observed. The effects of intoxication lasted for 96 h and then completely resolved.
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Paediatric anaesthesia · Nov 2001
Clinical TrialTransoesophageal echocardiographic monitoring during paediatric cardiac surgery: obtainable information and feasibility in 532 children.
We hypothesized that transoesophageal echocardiography (TOE) performed by the anaesthesiologists would be beneficial for monitoring purposes during paediatric cardiac surgery. We present the results for the first 5 years in 532 consecutive children. ⋯ These data stress the safety and ease of performing TOE in children undergoing cardiac surgery. There is evidence for benefit from TOE findings to potentially enhance the therapeutic basis.
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Paediatric anaesthesia · Nov 2001
Case ReportsThe anaesthetic management of a deliberately created bronchoatmospheric fistula in bilateral pulmonary hydatids.
Postoperative empyema and bronchopleural fistula are well known complications after surgery for pulmonary hydatid disease. The pneumonostomy technique of deliberately creating a bronchoatmospheric fistula after removal of the parasite has been used to prevent these complications. This technique, however, is an added anaesthetic challenge, especially if the child presents again for surgery before this fistula has healed. We describe the anaesthetic management of such a case where controlled increase of the resistance to the air leak via the fistula during intermittent positive pressure ventilation helped circumvent these problems.