Paediatric anaesthesia
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Infants have a shorter neuraxial length and shorter skin to epidural space than adults. Even small amounts of migration may produce significant and unintended effects. Optimal fixation to prevent migration, bacterial colonization, and leakage is not clear from the literature. We report the case of a thoracic epidural that migrated inward for six centimeters, associated with loss of analgesic effect.
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Paediatric anaesthesia · Mar 2012
Predictive factors for difficult intravenous cannulation in pediatric patients at a tertiary pediatric hospital.
It is generally believed that certain patient characteristics (e.g., Body Mass Index and age) predict difficulty of intravenous cannulation in children, but there is not much literature evaluating these risk factors. In this study, we investigated predictive factors for success rate at first attempt and time needed for intravenous cannulation. ⋯ This study shows that in one-fifth to one-third of the patients, intravenous cannulation required more than one attempt. It is difficult to predict with accuracy the difficulty of intravenous cannulation solely with easily obtainable patient characteristics.
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Paediatric anaesthesia · Mar 2012
Perioperative opiate requirements in children with previous opiate infusion.
Critically ill children often require continuous opiate infusions. Tolerance may develop requiring a weaning strategy to prevent withdrawal symptoms. These children may also require subsequent surgical procedures. This is the first study to investigate whether previously opiate-tolerant patients require higher doses of opiates for adequate pain management perioperatively. ⋯ The perioperative opiate requirements of pediatric patients who were successfully weaned after prolonged opiate use were similar to opiate-naïve patients. A history of prolonged opiate use alone does not necessitate special pain management for future procedures.
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Paediatric anaesthesia · Mar 2012
Case ReportsCase presentation: abdominal compartment syndrome complicating posterior spinal fusion.
Abdominal compartment syndrome (ACS) is a life-threatening entity that requires rapid recognition and treatment. This case report represents the first case report of ACS associated with the correction of a marked scoliosis. Of the many possible causes for respiratory compromise and cardiovascular collapse associated with major spine surgery, ACS should be considered, particularly in instances of profound spinal curvature correction. ⋯ This case report should raise awareness of a rare, life threatening, but imminently treatable entity that can accompany scoliosis surgery. The description of this case should be particularly important for pediatric anesthesiologists and orthopedic surgeons who care for patients undergoing correction of marked scoliosis. We suggest possible mechanisms for the development of ACS in this setting that offer insights into the pathology of this entity, which could be useful in many other clinical situations where visceral venous drainage or bowel perfusion may be compromised.
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Paediatric anaesthesia · Mar 2012
Predictive factors of PACU stay after herniorraphy in infant: a classification and regression tree analysis.
Herniorraphy is a common surgical intervention in infants, particularly in those born prematurely. Prematurity and perioperative sedation have been shown to be risk factors for postoperative apnea. However, their influence upon PACU stay duration has not been evaluated. The goal of this study was to investigate predictive factors for PACU stay in infants undergoing herniorraphy. ⋯ Our study allows construction of an accurate predictive tree for PACU stay during herniorraphy in infants <6 months. Parameters found to influence the duration of PACU stay were related to anesthesia techniques and perinatal outcomes.