Paediatric anaesthesia
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The incidence of postoperative sore throat (POST) following intubation is not well defined in the pediatric population. The etiology is multifactorial and includes impairment of subglottic mucosal perfusion and edema as a result of the pressures exerted by cuffed or uncuffed tubes. ⋯ Children intubated with uncuffed ETTs are more likely to have POST. ETT CP is positively correlated with the incidence of POST. When using cuffed ETTs, CP should be routinely measured intraoperatively.
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Paediatric anaesthesia · Mar 2012
Biography Historical ArticleHistorical vignette: Dr Charles Robson; pioneer Canadian pediatric anesthetist.
Charles Robson (Figure 1) was born in New Westminster, British Columbia (now a suburb of Vancouver), in 1884 and graduated in medicine from McGill University in Montreal in 1913. Having interned and with some anesthesia training at the Royal Victoria Hospital in Montreal, he was sent overseas to work in a Canadian Army Hospital where he founded a school to train military anesthetists. Returning to Canada in 1919, he joined the staff of the Hospital for Sick Children in Toronto as chief anesthetist, a position he held until 1951 (1). During most of this time, he was the sole full-time anesthetist at the hospital; administration of anesthesia at this hospital was not limited to staff anesthetists until 1950 (1).
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Many ad hoc fasting guidelines for pre-anesthetic patients prohibit gum chewing. We find no evidence that gum chewing during pre-anesthetic fasting increases the volume or acidity of gastric juice in a manner that increases risk, nor that the occasional associated unreported swallowing of gum risks subsequent aspiration. ⋯ Gum chewing during the pre-anesthetic nil per os (NPO) period would also permit the development of gum-delivered premedications and should be permitted in children old enough to chew gum safely. Gum chewing should cease when sedatives are given and all patients should be instructed to remove any chewing gum from the mouth immediately prior to anesthetic induction.
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Paediatric anaesthesia · Mar 2012
ReviewPerioperative management of the child on long-term opioids.
The strategies used to manage children exposed to long-term opioids are extrapolated from adult literature. Opioid consumption during the perioperative period is more than three times that observed in patients not taking chronic opioids. A sparing use of opioids in the perioperative period results in both poor pain management and withdrawal phenomena. ⋯ While chronic pain or palliative care teams and other staff experienced with the care of children suffering chronic pain may have helpful input, many pediatric hospitals do not have chronic pain teams, and many patients receiving long-term opioids are not palliative. Acute pain services are appropriate to deal with those on long-term opioids in the perioperative setting and do so successfully in many centers. Staff caring for such children in the perioperative period should be aware of the challenges these children face and be educated before surgery about strategies for postoperative management and discharge planning.
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Paediatric anaesthesia · Mar 2012
Multicenter StudyAn audit of anesthetic management and complications of tracheo-esophageal fistula and esophageal atresia repair.
Many different anesthetic techniques have been suggested for the management of tracheo-oesophageal fistula/oesophageal atresia (TOF/OA) although the incidence of ventilation difficulty is not well known and it is unclear which technique is best in managing this. The aim of our audit was to determine the incidence of ventilation difficulty during repair of TOF/OA. We also recorded the current practice for anesthesia and analgesia in these children as well as the incidence of comorbidities and surgical complications. ⋯ This audit adds to the data already published about incidences of complications and comorbidities associated with TOF/OA repair. Defining anesthetic practice with regard to ventilation and analgesic strategies is important in comparing the adequacy and risk of techniques used. Our audit shows that a range of differing anesthetic techniques are still employed by different anesthetists and institutions and details some of the techniques being used for managing difficult ventilation.