Paediatric anaesthesia
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Paediatric anaesthesia · May 2017
ReviewPerioperative considerations for the food-allergic pediatric patient.
Patients with a history of food allergy and food intolerance are common in the pediatric population and are encountered frequently in the perioperative setting by pediatric anesthesiologists. Perioperatively, food allergy can present on a spectrum ranging from minor acute urticaria to more severe hypovolemia and anaphylactic shock. ⋯ This educational review will provide a brief overview of classic immunoglobulin E (IgE)-mediated food allergies, less common non-IgE food allergies, and present perioperative considerations for these patients. An audio summary of this topic is included as Supplementary Audio S1.
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Paediatric anaesthesia · May 2017
Randomized Controlled TrialCuffed endotracheal tubes in children: the effect of the size of the cuffed endotracheal tube on intracuff pressure.
In children, the size of the cuffed endotracheal tube is based on various age-based formulas. However, such formulas may over or underestimate the size of the cuffed endotracheal tube. There are no data on the impact of different-sized cuffed endotracheal tubes (ETT) on the intracuff pressure in children. ⋯ If the cuffed endotracheal tube is too small, the trachea can still be sealed by inflating the cuff with additional air. However, this transforms the cuff from the intended high-volume, low-pressure cuff to an undesirable high-volume, high-pressure cuff.
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Paediatric anaesthesia · May 2017
Anterior rectus sheath blocks in children with abdominal wall pain due to anterior cutaneous nerve entrapment syndrome: a prospective case series of 85 children.
Chronic abdominal pain in children may be caused by the anterior cutaneous nerve entrapment syndrome. Local nerve blocks are recommended as an initial treatment in adults. Evidence on effectiveness and safety of such a treatment in children is lacking. ⋯ Anterior rectus sheath blocks using local anesthetics and steroids are safe and long-term successful in more than one-third of children suffering from abdominal pain due to anterior cutaneous nerve entrapment syndrome.
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Paediatric anaesthesia · May 2017
Observational StudySedation methods for transthoracic echocardiography in children with Trisomy 21-a retrospective study.
Many children with Trisomy 21 have neurologic or behavioral problems that make it difficult for them to remain still during noninvasive imaging studies, such as transthoracic echocardiograms (TTEcho). Recently, intranasal dexmedetomidine sedation has been introduced for this purpose. However, dexmedetomidine has been associated with bradycardia. Children with Trisomy 21 have been reported to have a higher risk of bradycardia and airway obstruction with sedation or anesthesia compared to children without Trisomy 21. ⋯ Intranasal dexmedetomidine sedation was not associated with a significantly higher risk of bradycardia in patients with Trisomy 21, compared with other sedative or anesthetic regimens.
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Recent studies suggest that the pediatric airway is elliptical with the subglottis rather than the cricoid as the narrowest part contrary to the old belief of a funnel-shaped airway. The shape of the airway in neonates and infants has not been studied separately. This study seeks to define the shape of the upper airway in neonates and infants, and determine if there are differences in airway shape between infants and older children. ⋯ The present study demonstrates that the airway in neonates and infants between the subglottic area and the cricoid remains elliptical. The cricoid is not round as has been observed in older children. The airway is wider anteroposteriorly and narrows in the transverse dimension from the subglottis to the cricoid in infants.