Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2023
Safety of Pediatric Sedation and Analgesia during Burn Dressing Changes by Pediatric Residents.
Acute pain and anxiety management during pediatric burn dressing change is very challenging. There are limited data regarding feasibility and safety of sedation administration by nonanesthesiologists. We sought to describe the implementation of a sedation protocol for pediatric residents during burn dressing changes in the pediatric ward. ⋯ We designed and implemented an analgesia and sedation protocol for pediatric residents to be applied in patients during burn dressing change. The implemented protocol in the pediatric wards was found to be feasible and with a low incidence of adverse events.
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Paediatric anaesthesia · Jul 2023
Observational StudyAlpha-1-acid glycoprotein and its potential impact on local anesthetic dose in neonates.
Alpha-1-acid glycoprotein is an acute-phase protein with a high affinity for amide local anesthetics. Compared to adults, neonates have lower concentrations of this glycoprotein in plasma, and are therefore at higher risk of developing local anesthetic toxicity. Alpha-1-acid glycoprotein concentrations rise in adults after surgery as a response to stress as well as in inflammatory conditions. Previous studies have shown that concentrations of alpha-1-acid-glycoprotein in neonates vary postpartum, influenced by gestational age and mode of delivery. ⋯ Alpha-1-acid-glycoprotein concentrations increase in neonates as a response to surgery regardless of gestational age, sex, or mode of delivery.
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Paediatric anaesthesia · Jul 2023
ReviewError Traps in the Perioperative Care of Children with Chronic Pain.
Pediatric patients with a history of chronic pain frequently have complex health needs that are challenging to meet in the perioperative period. Error traps are consequences or errors that are known to occur due to either gaps in knowledge or cognitive errors. ⋯ Cognitive errors may play a role in these error traps. Recognizing and avoiding them may improve and optimize pain care and outcome.
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Paediatric anaesthesia · Jul 2023
ReviewPerioperative Management of Pediatric Patients Undergoing Juvenile Angiofibroma Resection. A Case Series and Educational Review Highlighting Patient Blood Management.
Juvenile nasopharyngeal angiofibromas are one of the most enigmatic, bloody tumors encountered by otorhinolarygnologists, head and neck surgeons, neurosurgeons, and anesthesiologists. Juvenile nasopharyngeal angiofibromas are rare, benign, highly vascular tumors with a propensity towards aggressive local invasion. Surgery, open or endoscopic, to remove the growth is the primary treatment of choice for Juvenile nasopharyngeal angiofibromas. Historically, surgical resection was associated with massive, rapid blood loss, traditionally managed by blood product transfusion and deliberate hypotension. Preventative management employing multimodal blood conservation strategies should be an essential standard of perioperative care for patients with Juvenile nasopharyngeal angiofibromas. ⋯ The perioperative approach to elective surgery for Juvenile nasopharyngeal angiofibromas management is presented from a multidisciplinary patient blood management perspective.