Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2002
Case ReportsDifficult paediatric intubation when fibreoptic laryngoscopy fails.
We report an unusual problem with fibreoptic bronchoscopy in an 8-year-old girl with Negar syndrome. She had a history of difficult airway since birth, and had undergone mandibular distraction for severe obstructive sleep apnoea when she was aged 2 years. Nagar syndrome is a Treacher-Collins like syndrome with normal intelligence, conductive bone deafness and problems with articulation. ⋯ Apparently, the healing of the wounds for the mandibular distraction in the mandibular space on the inside of the rami of the mandible had caused differential fibrosis on either side of the hyoid, leading to a triplane distortion of the larynx with a left shift, clockwise rotation to a 2-8 o'clock direction and a slight tilt towards the left pharyngeal wall. The large epiglottis overlying this had precluded a view of the larynx. Finally, the older technique of breathguided intubation facilitated fibreoptic bronchoscopy to achieve tracheal intubation.
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Paediatric anaesthesia · Nov 2002
Randomized Controlled Trial Clinical TrialEffect of ilioinguinal nerve block on the catecholamine plasma levels in orchidopexy: comparison with caudal epidural block.
Both caudal epidural and ilioinguinal/iliohypogastric nerve blocks have been used to provide effective intra- and postoperative analgesia. Stress response hormone levels can be used as an objective method to assess the analgesic efficacy of the anaesthetic techniques used in infraumbilical surgery in children. In this study, we compared catecholamine blood levels in children undergoing these two different supplementary analgesic/anaesthetic techniques. ⋯ The result of this study revealed that caudal epidural block was more effective than ilioinguinal block in suppressing the stress response as reflected in epinephrine and norepinephrine blood levels in orchidopexy patients.
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The definition of childhood obesity has not been standardized in the past, making studies difficult to compare. In spite of this, the increase in the incidence of childhood obesity is evident and has now reached epidemic proportions. Obese children experience few of the medical complications seen in obese adults. ⋯ There is less pathology in the obese child when compared with the adult but some evidence shows a higher likelihood of a critical incident occurring when anaesthetizing such children. This shows that we need to be as worried about anaesthetizing the obese child as we are for the obese adult. This concern should increase with increasing body mass index.
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Paediatric anaesthesia · Nov 2002
Case ReportsLife threatening tension pneumoperitoneum from intestinal perforation during air reduction of intussusception.
We present a case report of a child with intussusception who underwent air reduction which was complicated by bowel perforation. Life threatening tension pneumoperitoneum developed rapidly and immediate needle decompression was life saving in this case. The pathophysiology of hyperacute abdominal compartment syndrome is discussed.
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[corrected] Volumetric infusion pumps are widely used in paediatric practice. Tissue extravasation is a hazard. The occlusion pressure limit alarm, although not intended to detect extravasation, is the only warning sign present to indicate flow faults in the infusion systems. ⋯ Occlusion pressure limit alarm cannot reliably detect extravasation especially at sites with high compliance, low flow rates, even at low occlusion limit. Line pressure depends on interplay of site (compliance) and flow rate and is independent of volume extravasated. Users must be aware of the set occlusion pressure limit. Repeated clinical assessment remains vital.