Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2013
A retrospective audit to examine the effectiveness of preoperative warming on hypothermia in spine deformity surgery patients.
Hypothermia (core body temperature <36°C) during surgery has been associated with surgical site infection, a major risk in all spine deformity surgeries. Forced air warming is an important method of intraoperative temperature maintenance in children. In mid-2010, we empirically introduced preoperative warming as a strategy to reduce intraoperative hypothermia. ⋯ Preoperative warming of children undergoing spine deformity surgery significantly reduces the percentage of case spent hypothermic, thereby potentially reducing risk of perioperative complications.
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Paediatric anaesthesia · Nov 2013
Current UK practice of pediatric supraglottic airway devices - a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland.
Over half of general anesthetics in the UK involve supraglottic airway devices (SADs). The National Audit Project 4 undertaken by the Royal College of Anaesthetists demonstrated that aspiration was the most frequent complication relating to SAD use. SADs designed to reduce this risk (second-generation devices) are increasingly recommended in both adults and children. As well as routine use, SADs are recommended for use in cases of 'difficult airway'. This survey assessed current usage of SADs in routine practice and difficult airways. Sixteen questions, approved by the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) survey committee, were distributed to all its members. ⋯ Pediatric anesthesiologists appear slow to embrace second-generation SADs. The role of SADs in the management of difficult airways is widely accepted. Research currently has little influence over the choice of which SAD to use, which is more likely determined by personal choice and departmental preference. There is a risk that some SADs are unsafe.
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Paediatric anaesthesia · Nov 2013
Observational StudyAnesthesia management with single injection paravertebral block for aorta coarctation in infant.
Thoracotomy causes severe pain in the postoperative period. Perioperative thoracic paravertebral block reduces pain score and may improve outcome after pediatric cardiac surgery. This prospective study was designed for the efficacy and duration of a single level, single injection ultrasound-guided thoracic paravertebral block (TPVB) for fifteen infants undergoing aortic coarctation repair. ⋯ We believe that TPVB, as part of a balanced anesthetic and analgesic regime, provides effective pain relief in patients undergoing aortic coarctation repair.
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Paediatric anaesthesia · Nov 2013
Ultrasound-guided parasacral approach to the sciatic nerve block in children.
The parasacral (PS) approach to sciatic nerve blockade has the potential for safe and effective use in children, but has never been studied in this population. Its potential advantages include increased posterior cutaneous nerve block reliability, potential for hip joint analgesia, and decreased nerve depth, making ultrasound guidance easier. ⋯ The PS approach is an effective option for sciatic nerve blockade to provide postoperative pain relief in children having lower extremity surgery.
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Paediatric anaesthesia · Nov 2013
Inspired gas humidity and temperature during mechanical ventilation with the Stephanie ventilator.
To measure inspired gas humidity and temperature delivered by a Stephanie neonatal ventilator with variations in (i) circuit length; (ii) circuit insulation; (iii) proximal airway temperature probe (pATP) position; (iv) inspiratory temperature (offset); and (v) incubator temperatures. ⋯ Long insulated Stephanie circuits should be used for neonatal ventilation when the infant is nursed in an incubator. The recommended inspiratory temperature (offset) of 37(-0.5)°C produced inspired humidity and temperature below international standards, and we suggest an increase to 39(-2.0)°C.