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
Monitored anesthesia care with a combination of ketamine and dexmedetomidine during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea.
We present a series of three children with trisomy 21 and obstructive sleep apnea who required sedation during magnetic resonance imaging of the upper airway. In an effort to provide effective sedation with limited effects on cardiovascular and ventilatory function, sedation was provided by a combination of ketamine and dexmedetomidine. Sedation was initiated with a bolus dose of ketamine (1 mg x kg(-1)) and dexmedetomidine (1 microg x kg(-1)) and maintained by a continuous infusion of dexmedetomidine (1 microg x kg(-1) x h(-1)). ⋯ All three patients developed some degree of hypercarbia with maximum P(E)(CO2) values of 6.4, 6.9, and 6.8 kPa (49, 53, and 52 mmHg), respectively. To date, this is the first report regarding the use of this combination in pediatric patients. Given the preliminary success noted in our three patients, prospective trials evaluating the efficacy of a dexmedetomidine-ketamine combination appears warranted.
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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.