Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2021
Multicenter StudyPerioperative management and considerations in pediatric patients with connective tissue disorders undergoing cardiac surgery.
Marfan syndrome and Loeys-Dietz syndrome are connective tissue disorders associated with cardiac and vascular disease. Patients often require surgical repair, but limited data exist to describe their perioperative management. ⋯ Despite undergoing similar surgical procedures, patients with Marfan and Loeys-Dietz syndrome have different intrinsic patient characteristics and comorbidities that may affect their perioperative care. This retrospective cohort study identified some factors, but additional collection and reporting of patient data based on multicenter experience are essential for the ongoing optimization of perioperative care in these patient populations.
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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.
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Paediatric anaesthesia · Jul 2021
Observational StudyImpact of a revised postoperative care plan on pain and recovery trajectory following paediatric tonsillectomy.
A previous cohort of adenotonsillectomy patients at our institution demonstrated moderate-severe post-tonsillectomy pain scores lasting a median (range) duration of 6 (0-23) days and postdischarge nausea and vomiting affecting 8% of children on day 1 following surgery. In this subsequent cohort, we evaluate the impact of changes to our discharge medication and parental education on post-tonsillectomy pain and recovery profile. ⋯ Despite extensive changes to our discharge protocols parents continued to report a prolonged period of pain, post operative nausea and vomiting, and behavioral changes. Further work is required to examine barriers to compliance with simple analgesia and education in appropriate methods of opioid disposal.