Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2022
ReviewEducational Review: Error Traps in Anesthesia for Pediatric Liver Transplantation.
Anesthetic and surgical techniques for the liver transplantation have progressed considerably over the past sixty years; however, this procedure is still fraught with substantial morbidity. To increase the safety culture associated with the liver transplantation, we detail nine error traps associated with anesthesia for pediatric liver transplantation. These potential pitfalls are divided into the operative phases: pre-operative preparation (Failure to have a dedicated anesthesia team for pediatric liver transplantation); pre-anhepatic (Failure to prepare for massive blood loss, Failure to monitor for coagulation abnormalities); anhepatic including reperfusion (Failure to prepare for clamping of the inferior vena cava, Failure to recognize metabolic changes, Failure to maintain homeostasis for reperfusion, Failure to prepare for Post-reperfusion syndrome); and post-anhepatic (Failure to optimize liver perfusion, Failure to maintain hemostatic balance). By offering practical advice on the preparation and treatment of these error traps, we aim to better prepare anesthesiologists to take care of pediatric patients undergoing the liver transplantation.
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Paediatric anaesthesia · Dec 2022
Review Meta AnalysisVirtual Reality in Pediatrics, Effects on Pain and Anxiety: A Systematic Review and Meta-Analysis Update.
Medical procedures are often accompanied by pain and anxiety in pediatric patients. A relatively new technique to reduce pediatric pain and anxiety is virtual reality. Virtual reality is both applied as a distraction tool and as an exposure tool to prepare patients for medical procedures. Research into the application of virtual reality in medical settings is rapidly evolving. This meta-analysis is an update of the meta-analysis of Eijlers et al. investigating the effectiveness of virtual reality as an intervention tool on pain and anxiety in pediatric patients undergoing medical procedures. ⋯ The current updated systematic review and meta-analysis indicates that virtual reality is a useful tool to reduce pain and anxiety in pediatric patients undergoing a range of medical procedures as it significantly decreases pain and anxiety outcomes when compared to care as usual.
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Paediatric anaesthesia · Dec 2022
Multicenter StudySafety of Antifibrinolytics in 6583 Pediatric Patients Having Craniosynostosis Surgery: A Decade of Data Reported from the Multicenter Pediatric Craniofacial Collaborative Group.
Antifibrinolytics such as tranexamic acid and epsilon-aminocaproic acid are effective at reducing blood loss and transfusion in pediatric patients having craniofacial surgery. The Pediatric Craniofacial Collaborative Group has previously reported low rates of seizures and thromboembolic events (equal to no antifibrinolytic given) in open craniofacial surgery. ⋯ This multicenter international experience of pediatric craniofacial surgery reports no increase in seizures or thromboembolic events in those that received antifibrinolytics (tranexamic acid and epsilon-aminocaproic acid) versus those that did not. This report provides further evidence of antifibrinolytic safety. We recommend following pharmacokinetic-based dosing guidelines for administration.
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Paediatric anaesthesia · Dec 2022
A magnetic resonance imaging study of the sciatic nerve variation in the pediatric gluteal region: implications for the posterior approach of the sciatic nerve blockade.
In pediatric patients, the sciatic nerve is one of the most commonly blocked peripheral nerves during orthopedic procedures of the lower limb. Ultrasound guidance is the current standard for a successful localization of the sciatic nerve in the gluteal region. Relevant anatomical landmarks are also used to determine the nerve location when ultrasound is not available or inadequate. However, reports have demonstrated paucity of information regarding the sciatic nerve location and variation in the hip throughout pediatric development. This imaging study aimed to document and analyze the relative morphometric relationship of the sciatic nerve in the pediatric gluteal region throughout development. ⋯ Despite the small sample size of younger age group, this study is the first to document the morphometric changes of the sciatic nerve in the gluteal region across pediatric development and may be useful for providing confirmatory guidelines for nerve location when ultrasound is not accessible or cannot be utilized for practice.
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Paediatric anaesthesia · Dec 2022
A Standardized Approach to Airway Management During Abbé Flap Reconstruction.
The Abbé flap is a two-staged procedure to address upper lip tightness, creating a surgically closed mouth during the first stage. Airway manipulation and management in the setting of a surgically closed mouth presents a challenge from an anesthetic standpoint. ⋯ The proposed standardized approach to airway management during Abbé flap reconstruction was safe and effective in this limited series of patients.