Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2020
A Simple Screening Test of Filtration Efficiency for Protecting the Gas Sampling Line from CoronavirusUsing Fluorescent Microspheres.
During the coronavirus pandemic, preventing contamination of the anesthesia machine, critical to avoid cross-contamination between patients, has proven challenging when treating premature infants and neonates. While attaching a HEPA filter to the endotracheal tube will protect the anesthesia machine and the gas sampling line from contamination, this contribution to the dead space makes ventilation of these small patients challenging. Direct filtration of the gas sampling line eliminates this problem; however, appropriate filters are not readily available. ⋯ Although the Food and Drug Administration (FDA) has not approved the Flat Epidural Filter for use as an anesthesia machine gas filter, our simple challenge test suggests that it could be used to effectively filter the anesthesia gas sampling line.
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Paediatric anaesthesia · Nov 2020
ReviewReducing paediatric exposure to environmental tobacco smoke: the effects of paediatric exposure to environmental tobacco smoke and the role of paediatric peri-operative care.
Exposure to environmental tobacco smoke (ETS) has deleterious effects on a child's general health and their perioperative risk; specifically, it doubles a child's perioperative risk of adverse respiratory events, particularly laryngospasm. It increases the risk of sudden infant death syndrome, bacterial meningitis, middle ear infection, asthma, and lower respiratory tract infection. The preoperative assessment of children presenting for procedures under general anesthesia is an opportune moment to screen for exposure to ETS and give information about the risks and cessation support (if applicable). ⋯ Thus, recording a household smoking status and referring to local smoking cessation services targets a public health measure with benefits beyond the individual patient and planned anesthetic. There is no evidence in the literature of the effect of environmental exposure to electronic cigarettes ("vaping") on a child's perioperative health. Further research is needed to establish if preoperative reduction in or removal from exposure to ETS reduces the risk of respiratory adverse events in the child.
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Paediatric anaesthesia · Nov 2020
ReviewMoyamoya disease in children and its anesthetic implications: A review.
Moyamoya disease is a rare, progressive cerebral vasculopathy which most commonly presents in the first and fourth decades of life. The mainstay of treatment is surgical revascularization; without treatment, most patients experience ischemic or hemorrhagic strokes. This report reviews moyamoya disease, its associated conditions, surgical treatment techniques, and anesthetic management of patients with moyamoya disease.
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Paediatric anaesthesia · Nov 2020
Infant peripherally inserted central catheter insertion without general anesthesia.
Avoiding anesthesia for infant peripherally inserted central catheter insertion beyond the neonatal period has been the subject of very little research despite this being a high-risk age group. In our institution, we introduced a "Fast, Feed, and Wrap" technique, previously described for magnetic resonance imaging scans, for infants up to 6 months and weighing under 5.5 kg undergoing peripherally inserted central catheter insertion. ⋯ Infants younger than 6 months and under 5.5 kg can be managed without general anesthesia for peripherally inserted central catheter insertion using a Fast, Feed, and Wrap technique.
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Paediatric anaesthesia · Nov 2020
Use of a Simulation-based Mastery Learning Curriculum to Improve Ultrasound-guided Vascular Access Skills of Pediatric Anesthesiologists.
Pediatric vascular access is inherently challenging due to the small caliber of children's vessels. Ultrasound-guided intravenous catheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency in ultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula. ⋯ Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheter insertion performance in a simulated setting.