Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2020
Observational StudyAnesthetic Management of Catheter-Based Patent Ductus Arteriosus Closure in Neonates Weighing Less Than Three Kilograms: A Retrospective Observational Study.
The patent ductus arteriosus is a cardiac lesion commonly found in premature neonates. Though surgical closure via thoracotomy is the most definitive treatment option, it is associated with significant morbidity. New catheter-based closure options offer a potentially safer alternative treatment, even in premature neonates. However, no literature reports the anesthetic techniques, challenges, and risks associated with this procedure in this population. ⋯ Despite multiple clinical and logistical challenges, anesthetic risk associated with catheter-based PDA closure in small neonates can be effectively managed through standardized and multidisciplinary care.
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Paediatric anaesthesia · Apr 2020
Reducing postoperative pain in children undergoing strabismus surgery: from bundle implementation to clinical decision support tools.
Postoperative pain is a significant cause of morbidity in pediatric anesthesia, which can result in delayed discharge and unplanned hospital admission. Children undergoing strabismus surgery are known to be a particularly high-risk group for postoperative pain. ⋯ Through the implementation and adoption of an evidence-based bundle of care, we successfully decreased the incidence of moderate to severe postoperative pain for children undergoing strabismus repair. We demonstrated that combining nudge theory with QI methodology can be an effective means of delivering positive results in quality improvement projects.
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Paediatric anaesthesia · Apr 2020
Accuracy of dynamic preload variables for predicting fluid responsiveness in patients with pediatric liver cirrhosis: A prospective study.
We have previously reported that dynamic preload variables predicted fluid responsiveness in adult patients with liver cirrhosis. However, pediatric patients with cirrhosis may present with unique hemodynamic characteristics, and therefore, the predictive accuracy of these variables in such patients must be clarified. ⋯ Dynamic preload variables do not predict fluid responsiveness in pediatric patients with liver cirrhosis.
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Knowledge about airway dimensions during child growth is of paramount importance for pediatric clinical practice. Decisions about airway management in children are based on relatively limited, imprecise, or incomplete data about airway size. ⋯ This comprehensive anatomical database of upper airway dimensions provides important data in the field of pediatric airway anatomy, particularly relating to the cricoid. We demonstrated that laryngeal, tracheal, and bronchial parameters correlate better to age and have three different growth phases.
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Paediatric anaesthesia · Apr 2020
Reducing postoperative nausea and vomiting in pediatric patients undergoing anterior cruciate ligament reconstruction: A quality report.
Postoperative nausea and vomiting after elective outpatient surgery can complicate discharge and increase patient suffering. Within our hospital system, there was variability in the use of postoperative nausea and vomiting prophylaxis for patients undergoing anterior cruciate ligament reconstruction, which resulted in variable outcomes. To address this variability, we designed and implemented a standardized postoperative nausea and vomiting prophylaxis guideline for the care of this surgical population. ⋯ Implementation of standard postoperative nausea and vomiting guidelines for adolescents undergoing outpatient anterior cruciate ligament reconstruction was associated with lower emesis rates. This reduction in emesis rate may have been due to the concurrent reduction in opioids we observed following guideline implementation.