Paediatric anaesthesia
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Infants with pyloric stenosis are considered to be at high risk of aspiration on induction of anesthesia. Traditionally, texts have recommended classic rapid sequence induction (RSI) or awake intubation (AI). AI has generally fallen out of favor, while the components of RSI have become increasingly controversial. Infants are at high risk of hypoxemia if ventilation is not maintained while waiting for neuromuscular blockade to establish. The efficacy of cricoid pressure (CP) to prevent aspiration has not been proven. It can impair visualization of the glottis and make intubation difficult. It is debatable whether any RSI technique is needed for pyloromyotomy. A recent review of 235 infants reported no aspiration events. These children were anesthetized with a variety of techniques, including RSI, gas induction, and AI. In our institution, we teach a gaseous induction. The nasogastric tube is used to empty the stomach and anesthesia is induced with sevoflurane. A nondepolarizing muscle relaxant is administered and ventilation maintained until neuromuscular blockade is established and intubating conditions are optimal. We report our experience of this technique. ⋯ Gas induction can be considered for children undergoing pyloromyotomy.
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Paediatric anaesthesia · Jul 2015
Biography Historical ArticleHerbert Rackow and Ernest Salanitre: the emergence of pediatric anesthesia as a specialty in the United States.
Herbert Rackow and Ernest Salanitre were pediatric anesthesiologists at Babies Hospital at the Columbia-Presbyterian Medical Center in New York whose work spanned three decades beginning in the early 1950s. Their pioneering research included studies of the uptake and elimination of inhalational anesthetics and of the risk of cardiac arrest in infants and children. ⋯ In 1990, they were jointly awarded the Robert M. Smith award by the Section on Anesthesiology of the American Academy of Pediatrics.
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Paediatric anaesthesia · Jul 2015
Development of a nurse-assisted preanesthesia evaluation program for pediatric outpatient anesthesia.
Historically, anesthesiologists have conducted preanesthesia evaluation, but more recently, nurse practitioners (NPs) are increasingly assisting with the preanesthesia evaluation of children. In the current economic environment for healthcare, strategies to provide superior outcomes and exceptional patient experience at the lowest possible cost are constantly being explored. We examined whether well trained nurses, working alongside NPs, could safely and effectively assist in preanesthesia evaluation. The aim of this quality improvement project was to implement a new model for preanesthesia evaluation for healthy outpatient pediatric patients: nurse-assisted preanesthesia evaluation (NAPE). ⋯ Using quality improvement methods, we successfully improved the utilization of staff resources by adding an Anesthesia Nurse-assisted preanesthesia evaluation program alongside our NPs to provide outstanding preanesthesia care at the lowest possible cost.
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Paediatric anaesthesia · Jul 2015
The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium.
To evaluate the impact of obesity on adverse events and required interventions during pediatric procedural sedation. ⋯ Obesity is an independent risk factor for adverse respiratory events during procedural sedation and is associated with an increased frequency of airway interventions, suggesting that additional vigilance and expertise are required when sedating these patients.