Paediatric anaesthesia
-
Paediatric anaesthesia · Aug 2008
ReviewContinuing medical education in pediatric anesthesia--a theoretical overview.
The importance of continuing medical education (CME) as a method of improving the quality of care of children undergoing anesthesia is universally recognized. This article, which is based on a presentation at the FEAPA European Conference on Paediatric Anaesthesia in September 2007 in Amsterdam, gives a theoretical overview of continuing education and introduces some generic educational concepts, such as the CRISIS-criteria and Kirkpatrick's evaluation model, which are as relevant to pediatric anesthesia as to other areas of medical practice. ⋯ Some consideration is given to how anesthesiologists can assess the potential worth of an educational activity for their practice. No attempt will be made to judge particular educational activities, as the choice of the most appropriate activity rests primarily with the individual.
-
Age influences the potency of anesthetic agents, but there is little information on how age influences MAC-awake. MAC-awake may be an important aspect of anesthesia potency for the prevention of awareness during anesthesia. The aim of this study was to measure MAC-awake in a range of ages in children. ⋯ Although MAC-awake changes with age, in the ages where awareness has been reported, MAC-awake was found to be relatively low, and therefore it seems unlikely that age-specific changes to MAC-awake are a cause for awareness in children aged 5-12 years.
-
Paediatric anaesthesia · Aug 2008
Anatomic relationship between the internal jugular vein and the carotid artery in preschool children--an ultrasonographic study.
Central venous cannulation in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. ⋯ This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.
-
Paediatric anaesthesia · Aug 2008
Internal jugular vein diameter in pediatric patients: are the J-shaped guidewire diameters bigger than internal jugular vein? An evaluation with ultrasound.
This study investigates whether the diameters of right internal jugular vein (RIJV) are suitable for the use of 'big radius curved J-tip' Seldinger wires in pediatric patients. ⋯ The diameter of the IJV in pediatric patients, especially infants, is often smaller than the diameter of the J-tip guidewire curve. We speculate that this may lead to impeded guidewires and failed cannulation. It must also be kept in mind that the Trendelenberg position might not facilitate IJV cannulation in children <2 years of age.
-
Paediatric anaesthesia · Aug 2008
Case ReportsManagement of an unusual pediatric difficult airway using ketamine as a sole agent.
We present the case of a 9-year-old boy who suffered a fall while brushing his teeth. This resulted in impalement of the lateral pharyngeal wall by the toothbrush with its head becoming firmly lodged adjacent to the internal carotid artery as demonstrated by CT scan. ⋯ These were compounded by the possibility of damage to the carotid artery and potential catastrophic hemorrhage with manipulation of the toothbrush at any point. We detail the problems and outline our management.