Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2016
Observational StudyTranspulmonary thermodilution (PiCCO) measurements in children without cardiopulmonary dysfunction: large interindividual variation and conflicting reference values.
The PiCCO system, based on transpulmonary thermodilution, is one of the few tools available for continuous hemodynamic monitoring in children. However, published data for some of the derived variables reveal indexed values that seem questionable. ⋯ Values obtained by the PiCCO system in children have a wide range, and should therefore be interpreted with caution. Current reference values published for GEDVI and EVLWI are not applicable in children; the former is too high and the latter too low, and should not guide clinical practice. Indexing by other physiological indices may reduce this problem. Using current variables, we find GEDVI 280-590 ml · m(-2) and ELWI 7-27 ml · kg(-1) to be typical ranges for children.
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Paediatric anaesthesia · Apr 2016
Evaluation of emergency pediatric tracheal intubation by pediatric anesthesiologists on inpatient units and the emergency department.
There are limited data on pediatric emergency tracheal intubation on inpatient units and in the emergency department by anesthesiologists. This retrospective cohort study was designed to describe the frequency of difficult intubation and adverse events associated with emergency tracheal intubation performed by pediatric anesthesiologists in a large children's hospital. ⋯ A significant rate of difficult intubation and mild-to-moderate intubation-related adverse events were found in emergency tracheal intubations on inpatient units and the emergency department in children performed by a pediatric anesthesiology emergency airway team. Difficult intubation was observed frequently in children with preexisting airway and craniofacial abnormalities and often required the use of an alternative airway device to successfully secure the airway.
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Paediatric anaesthesia · Apr 2016
Observational StudyImprovement in the airway after mandibular distraction osteogenesis surgery in children with temporomandibular joint ankylosis and mandibular hypoplasia.
Temporomandibular joint (TMJ) ankylosis accompanied by mandibular micrognathia can severely obstruct a patient's upper airway. The obstructive sleep apnea and hypopnea syndrome (OSAHS) resulting from TMJ ankylosis and accompanied by mandibular micrognathia, can severely influence the patient's life. ⋯ Mandibular distraction osteogenesis improved laryngeal view. Distraction osteogenesis can be successfully used for the treatment of obstructive sleep apnea in mandibular hypoplasia patients.
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Paediatric anaesthesia · Apr 2016
Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching children's hospital.
Analysis of critical incidents provides valuable information to improve the quality and safety of patient care. This study identified and analyzed pediatric anesthesia-related critical incidents including cardiac arrests in a tertiary teaching children's hospital. ⋯ Despite recent improvements in safety of pediatric anesthesia, many preventable factors still remain that can lead to critical incidents.
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Paediatric anaesthesia · Apr 2016
Tracheal extubation in children with difficult airways: a descriptive cohort analysis.
Tracheal extubation in children with difficult airways may be associated with an increased risk of perioperative adverse events. ⋯ In the studied population of children with difficult airways handled in a tertiary center environment, the majority of tracheal extubations could be performed without the use of airway adjuncts. In a minority of patients, tracheal extubation was associated with severe adverse outcomes.