Paediatric anaesthesia
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We performed a bench experiment to investigate the extent of start-up delays in fluid delivery for four different syringe pumps after initially placing the infusion syringe in the syringe pump. ⋯ Syringe pump design affects start-up delay times because of free play of the syringe. These delays can be eliminated by a start-up bolus of 2 ml prior to connecting the infusion line to the patient.
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Paediatric anaesthesia · Jan 2001
Fibreoptic nasal intubation in children with anticipated and unanticipated difficult intubation.
The establishment of a tracheal airway with direct laryngoscopy can be either a very difficult or an impossible task in children with congenital or acquired facial malformations. Out of 46 patients categorized as difficult tracheal intubation, fibreoptic laryngoscopy was used successfully in 44 children anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). ⋯ Fibreoptic laryngoscopy was successful in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Therefore, we urge all anaesthesia trainees to become proficient in fibreoptic tracheal intubation.
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Paediatric anaesthesia · Jan 2001
Clinical predictors of anaesthetic complications in children with respiratory tract infections.
Details of the preoperative condition, in particular symptoms of respiratory tract infections (RTI), perioperative management and the occurrence of perioperative complications, were collected in a survey of 2051 children. Logistic regression was used to determine which variables were predictors of anaesthetic adverse events. 22.3% of the children had symptoms of an RTI on the day of surgery, and 45.8% had a 'cold' in the preceding 6 weeks. Logistic regression returned eight variables. ⋯ Orotracheal intubation was associated with an increased probability of complications when compared with laryngeal mask airway and facemask. RTI in the preceding 6 weeks did not increase probability of complications. Wheeze, fever, malaise and age could not be excluded as predictors in this study because children with these symptoms and infants with colds were effectively excluded from the study.
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Paediatric anaesthesia · Jan 2001
Case ReportsAnaesthetic management of an adolescent for scoliosis surgery with a Fontan circulation.
Advances in the treatment of congenital heart disease have led to a new group of adolescents or adults patients with cardiac anomalies. The anaesthetic management of these patients can be challenging especially when they are scheduled for major noncardiac surgery inducing haemodynamic instability. We report the case of a 14-year-old boy scheduled for posterior spinal fusion for idiopathic scoliosis who underwent a Fontan operation in infancy for pulmonary atresia with right ventricle hypoplasia. The preoperative investigations and the anaesthetic management are described.