Paediatric anaesthesia
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Paediatric anaesthesia · May 2014
Case ReportsUnusual presentation of postdural puncture headache requiring repeat epidural blood patch in a 4-year-old child.
We present the case of a 4-year-old child who required two epidural blood patches (EBPs) to treat a delayed onset postdural puncture headache (PDPH) caused by lumbar cerebrospinal fluid drain. The first EBP was unsuccessful with 0.41 ml·kg(-1) of blood injected. A second EBP with 0.76 ml·kg(-1) of blood was performed 2 days later with the complete resolution of symptoms. The volume of blood necessary for effective treatment for symptomatic cerebrospinal fluid leaks in children remains controversial, and a repeat EBP may be required for resolution of symptoms.
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Paediatric anaesthesia · May 2014
Observational StudyObservational study of perioperative behavior changes in children having teeth extracted under general anesthesia.
Perioperative behavioral disturbance is common in children. Negative behavior changes may be seen during induction of anesthesia, during recovery and following discharge home. There has been little research on this subject in the UK. ⋯ Perioperative behavioral disturbance is common in children undergoing anesthesia. Predicting which children are at increased risk may allow us to adapt the management of these children in order to minimize adverse behavior changes.
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Paediatric anaesthesia · May 2014
Comparative StudyA comparison of paravertebral nerve block catheters and thoracic epidural catheters for postoperative analgesia following the Nuss procedure for pectus excavatum repair.
Thoracic epidurals (TE) have been advocated as a superior method for controlling postoperative pain after repair of pectus excavatum with a Nuss procedure. However, three recent reports of permanent neurologic injury after the Nuss procedure with concurrent TE analgesia have raised concerns about the safety of this combination. Paravertebral nerve blocks (PVNB) are used successfully for analgesia of the chest, but no studies are available comparing TE and PVNB catheters for postoperative analgesia in this patient population. This study was conducted to compare the efficacy of PVNB catheters with TE catheters for postoperative analgesia in pediatric patients undergoing the Nuss procedure. ⋯ In this small series, bilateral PVNB catheters resulted in equivalent opioid consumption and pain scores when compared to TE for postoperative pain management in pediatric patients undergoing the Nuss procedure. Large prospective studies are needed to further compare the efficacy, incidence of side effects, and complications of TE and PVNB catheters for postoperative analgesia in this pediatric population.
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Paediatric anaesthesia · May 2014
Case ReportsManagement of mediastinal syndromes in pediatrics: a new challenge of ultrasound guidance to avoid high-risk general anesthesia.
Adverse events associated with anesthetic management of anterior mediastinal masses in pediatrics are common. To avoid an extremely hazardous general anesthesia, the use of real-time ultrasonography offers an effective alternative in high-risk cases. We report the anesthetic management including a light sedation and ultrasound guidance for regional anesthesia, surgical node biopsy, and placement of a central venous line in two children with an anterior symptomatic mediastinal mass. For pediatric patients with clinical and/or radiologic signs of airway compression, ultrasound guidance provides safety technical assistance to avoid general anesthesia and should be performed for the initial diagnostic and therapeutic procedures.
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Paediatric anaesthesia · May 2014
Case ReportsAnesthetic management of bronchial rupture following extraction of a fishbone from the bronchus after 5 months.
Bronchial rupture occurred during bronchoscopic visualization and extraction of a fishbone from the bronchus in a 2-year-old male patient with a 5-month history of foreign body aspiration. Emergency thoracotomy was scheduled for examination and surgical repair of the bronchus. ⋯ An endotracheal tube was inserted into one of the main bronchi. Peripheral oxygen saturation improved from 60% to 90%, and subsequent surgery was performed without complications.