Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2021
Observational StudyThe performance of the heart rate variability derived Newborn Infant Parasympathetic Evaluation Index as a measure of early postoperative pain and discomfort in infants - a prospective observational study.
The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE™) Index is a continuous noninvasive tool for the assessment of pain and discomfort in infants. Little is known about its performance in the early postoperative setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff. ⋯ The NIPE detected pain and discomfort in infants after general anesthesia with reasonable areas under the ROC curve (±0.8), whereas it was not predictive of clinically detectable pain or discomfort.
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Paediatric anaesthesia · Jul 2021
Safety of an improved pediatric epidural tunneling technique for catheter shear.
Epidural tunneling could help with prolonged catheterization and be effective in preventing infection and dislodgement. However, epidural tunneling techniques carry a risk of catheter shear or needlestick injuries. ⋯ Our improved epidural tunneling technique, which was designed for pediatric cases, could reduce the risk of catheter shear.
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Paediatric anaesthesia · Jul 2021
Nasopharyngeal tubes in paediatric anaesthesia: is the flow-dependent pressure drop across the tube suitable for calculating oropharyngeal pressure?
Nasopharyngeal tubes are useful in pediatric anesthesia for insufflating oxygen and anesthetics. During nasopharyngeal tube-anesthesia, gas insufflation provides some positive oropharyngeal pressure that differs from the proximal airway pressure owing to the flow-dependent pressure drop across the nasopharyngeal tube (ΔPNPT ). ⋯ During nasopharyngeal tube-assisted anesthesia, proximal airway pressure readings on the anesthetic monitoring machine overestimate oropharyngeal pressure especially for smaller-diameter nasopharyngeal tubes and higher flow, and to a lesser extent for large leaks. Given the importance of calculating oropharyngeal pressure in guiding nasopharyngeal tube ventilation in clinical practice, we propose an accurate calculation using Rohrer's equation method, or approximating oropharyngeal pressure from flow and pressure readings on the anesthetic machine using the ΔPNPT charts.