Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2015
ReviewThrough the Glass Darkly: searching for safety signals in physiological monitoring.
Perioperative monitoring of ventilation, gas exchange, heart rate, blood pressure, and other basic physiological measures give important information on the well-being of the child in the perioperative period. However, despite this level of surveillance, perioperative events that appear to be unheralded still occur. Improvements in alarms and alarm design combined with integrated analysis of monitored parameters that map to adverse outcomes may provide earlier warning of potential danger. Near real-time analysis of heart rate and blood pressure variability can provide information on autonomic function and cardiac reserve, while devices such as tissue oximetry may be beneficial to optimize regional and global blood flow.
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Paediatric anaesthesia · Jan 2015
ReviewTreating perioperative anxiety and pain in children: a tailored and innovative approach.
Millions of children undergo outpatient surgery in the United States each year; the overwhelming majority will experience significant perioperative anxiety and pain. Behavioral preparation programs focused on skills acquisition and modeling, considered essential for effective preparation, are no longer offered to most children and families in the outpatient surgery setting. ⋯ The rapid growth of the World Wide Web and increasing access to Internet by families across the country provide an opportunity to develop tailored, Web-based behavioral preparation programs that can be accessed repeatedly at times convenient to the child and family, that include coping skills training and modeling, and that can provide unique output based upon child and parent characteristics known to impact perioperative pain and anxiety. In this review article, we present a conceptual framework for a computer-based intervention that may transform the way we manage children and parents before and after surgery.
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Paediatric anaesthesia · Jan 2015
ReviewPerioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice.
Recent studies have reported perioperative pulmonary aspiration in pediatric practice to be an uncommon problem associated with low morbidity and mortality. This paper examines the recent publications in both the adult and pediatric literature and looks at some of the potential risk factors involved, both patient and anesthetic, in the development of aspiration of gastric contents. We also look at the risk of severe morbidity following pulmonary aspiration and speculate on possible reasons behind the assertion that pulmonary aspiration in pediatric anesthetic practice is rare and a low-risk event.
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Paediatric anaesthesia · Jan 2015
Editorial CommentRaising the bar for pediatric sedation studies and trials.