Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2006
Case ReportsAirway management of three cases of congenital cervical teratoma.
Cervical teratomas are rare congenital tumors derived from all three germ cell layers. The vast majority are histologically benign, but the significant size they may attain can potentiate life-threatening upper airway obstruction. All cases require the specialist airway skills of the pediatric anesthetist. ⋯ Furthermore, after elective surgical excision, airway compromise is possible, which may again require anesthetic intervention. The aim of this study is to report the authors' experience in managing the airway in three cases of congenital cervical teratoma in the study institution over the last 24 months. These cases highlight the possible airway scenarios that may confront the anesthetist in the immediate postpartum, elective surgery and postoperative stages and the variety of techniques that may be employed in order to overcome the potential difficulties encountered.
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Paediatric anaesthesia · Jul 2006
Anesthetic management of preschool children with penetrating eye injuries: postal survey of pediatric anesthetists and review of the available evidence.
Pediatric anesthetists were surveyed regarding their anesthesia management of a screaming child with a penetrating eye injury. The results are reviewed in relation to the available evidence in the literature. ⋯ Few people have extensive experience managing a penetrating eye injury in a child. A variety of anesthesia techniques are used for induction with anesthetists avoiding suxamethonium, despite there being little evidence in the literature that the use of suxamethonium is harmful to the open globe.
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Paediatric anaesthesia · Jul 2006
Randomized Controlled Trial Comparative StudyLevobupivacaine caudal anesthesia in children: a randomized double-blind comparison with bupivacaine.
Levobupivacaine is the pure S-enantiomer of bupivacaine. Despite obvious benefits in the event of accidental intravascular injection there has been no studies demonstrating a clinically significant benefit to levobupivacaine over racemic bupivacaine for pediatric regional anesthesia. Given the similar pharmacokinetic profiles of both drugs the studies to date have been underpowered to demonstrate what is likely to be a small difference in clinical effectiveness. Our aim was to determine if there are significant differences in the clinical effectiveness of levobupivacaine compared with racemic bupivacaine for caudal anesthesia in children having lower abdominal surgery. A secondary aim was to determine if there are differences in the incidence of postoperative motor blockade between these agents. ⋯ Levobupivacaine is an effective agent for caudal anesthesia in children at a recommended dose of 2.5 mg x kg(-1). The rapidity of onset was suitable for establishment of surgical anesthesia and postoperative analgesia was achieved in greater than 97.5% of patients. It appears to be of equivalent potency to racemic bupivacaine in children requiring lower abdominal surgery.
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Paediatric anaesthesia · Jul 2006
Randomized Controlled Trial Comparative StudyA comparative study of hemodynamic responses to orotracheal intubation with fiberoptic bronchoscope and laryngoscope in children.
The purposes of this study were to further identify the hemodynamic responses to orotracheal intubation in children, using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS), and to validate whether the FOB can attenuate the hemodynamic response to orotracheal intubation compared with the DLS. ⋯ Orotracheal intubation using FOB and DLS in children may cause similar increases in SBP and HR. Compared with the DLS, the FOB had no advantage in attenuating the hemodynamic responses to orotracheal intubation.
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Paediatric anaesthesia · Jul 2006
Case ReportsBilateral monitoring of cerebral oxygen saturation results in recognition of aortic cannula malposition during pediatric congenital heart surgery.
Congenital heart surgery is associated with a 2-25% reported incidence of neurological complication. Near-infrared spectroscopy (NIRS) can detect changes in regional cerebral saturation index (rSO2i) during cardiac surgery. ⋯ We report a case in which bilateral NIRS monitoring detected an abrupt decrease in rSO2i (right greater than left) after initiation of bypass without abnormalities detected by standard monitors. This resulted in prompt surgical intervention that restored rSO2i, potentially preventing neurological injury.