Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2023
ReviewPerioperative management of infant inguinal hernia surgery; a review of the recent literature.
Inguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high-risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. ⋯ The questions asked by clinicians include; when should the surgery occur, how should the surgery be performed (open or laparoscopic), how should the anesthesia be conducted, including regional versus general anesthesia and airway devices used, and what impact does anesthesia choice have on the developing brain? There is a paucity of evidence in the literature on the concerns, priorities or goals of the parents or caregivers but clearly their opinions do and should matter. In this article we review the current clinical surgical and anesthesia practice and evidence for infants undergoing inguinal hernia surgery to help clinicians answer these questions.
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Paediatric anaesthesia · Oct 2023
Multicenter Study Observational StudyA prospective comparison of invasive and non-invasive blood pressure in children undergoing cardiac catheterization.
Blood pressure measurement is a standard of monitoring during general anesthesia. Invasive measurement is considered the gold standard but is less commonly used than non-invasive. Automated oscillometric blood pressure devices measure the mean arterial pressure (MAP) and use an algorithm to determine the systolic and diastolic pressures. Few devices have been validated in children, particularly during anesthesia. Few studies have assessed the agreement between invasive and non-invasive blood pressure measurements in children. ⋯ Automated oscillometric blood pressure measurement is unreliable in anesthetized children during cardiac catheterization. Invasive pressure measurement should be considered for high-risk cases.
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Paediatric anaesthesia · Oct 2023
Observational StudyEvaluation of quality of care in neonatal anesthesia using a bundle of intraoperative parameters.
Maintenance of physiological homeostasis is key in the safe conduct of pediatric anesthesia. Achieving this goal is especially difficult in neonatal surgery. ⋯ Although a median of six out of the seven selected intraoperative parameters were monitored during gastroschisis repair, only two of them (oxygen saturation and heart rate) were maintained within the pre-defined range more than 80% of the time. It might be of interest to extend physiologic age- and procedure-based approach to the development of specific preoperative anesthetic planning.
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Paediatric anaesthesia · Oct 2023
The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery.
Bleeding and transfusion remain important concerns during surgical correction of scoliosis even when multiple conservative strategies, such as preoperative recombinant erythropoietin and/or antifibrinolytic agents, are used. The current work aimed to determine the impact of other potential risk factors, especially the volume of intraoperative fluid intake, on the perioperative risk of allogenic transfusion during surgical correction of adolescent idiopathic scoliosis. ⋯ These results indicate a statistical association between the increase in crystalloid intake and the risk of allogenic blood transfusion during surgical correction of adolescent idiopathic scoliosis. Controlled studies are needed to address the causative relation between intraoperative fluid intake and the risk of allogenic transfusion.
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Paediatric anaesthesia · Oct 2023
Benefits and challenges of combined pediatrics-anesthesiology residency programs: A qualitative study.
The combined pediatrics-anesthesiology residency program was created in 2011 for trainees interested in careers within both specialties. Prior studies have cited challenges of combined training, but none have systematically identified benefits. ⋯ This is the first study to describe the perceived educational and professional benefits of combined pediatrics-anesthesiology residency programs. Combined training affords exceptional clinical competence and autonomy in the management of pediatric patients and the ability to skillfully navigate hospital systems, and leads to robust academic and career opportunities. However, the duration of training and challenging transitions may threaten residents' sense of relatedness to colleagues and peers, and their self-perceived competence and autonomy. These results can inform mentoring and recruitment of residents to combined pediatrics-anesthesiology programs and career opportunities for graduates.