Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2013
Incidence and causes of perioperative endotracheal reintubation in children: a review of 28,208 anesthetics.
To determine the incidence, risk factors, and causes of endotracheal reintubation in children and identify methods to reduce the occurrence. ⋯ The incidence of endotracheal reintubation in children is low, but can result in significant morbidity. Because of the high frequency of inadvertent extubation, a significant number of reintubations could be prevented with greater care during transfer of patients with endotracheal tubes, and in procedures near the airway. Increased vigilance in younger children is also recommended as children under 3 years old required the majority of the reintubations.
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Paediatric anaesthesia · Jul 2013
Case ReportsUse of the Bonfils intubating fibrescope in a baby with a severely compromised airway.
We report the successful use of a 2-mm rigid Bonfils intubation endoscope as a rescue device in a 5-week-old baby presenting with an unstable airway due to massive macroglossia and multiple hemorrhagic lymphangiomata compressing the airway and resulting in a Cormack and Lehane grade 4 view. The limited intraoral space rendered it impossible to visualize the laryngeal inlet or insert a laryngeal mask, Glidescope or Airtraq blade into the patient's mouth. A 2-mm Bonfils fibrescope passed easily into the patient's mouth and facilitated a grade 1 view of the laryngeal inlet with subsequent successful intubation at first attempt with a 3.5-mm uncuffed endotracheal tube. ⋯ In our case, the infant's airway was compromised as a result of a receding mandible, large protruding tongue, glottic distortion, and limited intraoral space. This prevented the use of bulkier rescue airway devices with the potential for traumatic manipulation, which could have lead to rapid deterioration of an already unstable airway. We feel that many clinicians are unaware of the benefits of the Bonfils fibrescope and suggest further studies to increase its use in elective and emergency situations.
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Paediatric anaesthesia · Jul 2013
Implementation of a transfusion algorithm to reduce blood product utilization in pediatric cardiac surgery.
The goal of this project is to measure the impact of standardization of transfusion practice on blood product utilization and postoperative bleeding in pediatric cardiac surgery patients. ⋯ These results indicate that introduction of an objective transfusion algorithm in pediatric cardiac surgery significantly reduces perioperative blood product utilization and mortality, without increasing postoperative chest tube losses.
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Paediatric anaesthesia · Jul 2013
Biography Historical ArticleAlan Conn; his role in the development of the anesthesia department at Toronto SickKids.