Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2022
Enhanced Recovery After Cleft Palate Repair: A Quality Improvement Project.
Children undergoing cleft palate repair present challenges to postoperative management due to several factors that can complicate recovery. Utilization of multimodal analgesic protocols can improve outcomes in this population. We report experience designing and implementing an enhanced recovery after surgery (ERAS) pathway for cleft palate repair to optimize postoperative recovery. ⋯ Opioid reduction and improved timeliness of oral intake is possible with an ERAS protocol for cleft palate repair, but our protocol did not alter PACU or hospital length of stay.
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Paediatric anaesthesia · Oct 2022
ReviewInduction of anesthesia with sevoflurane in children: curiosities & controversies.
Inhalational inductions with sevoflurane (up to 8% inspired concentration) have been the standard for inducing anesthesia in children for over three decades. However, when sevoflurane was first introduced, clinicians reported isolated cases of unexpected myoclonic jerking movements during the induction in children without epilepsy. ⋯ More recently, a shift away from the use of nitrous oxide has prompted some to question whether sevoflurane has a role as an induction agent in children. The preponderance of evidence supports the practice of safely inducing anesthesia with 8% sevoflurane with or without nitrous oxide in children but recommended strategies to mitigate against epileptiform discharges may be more harmful than beneficial.
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Paediatric anaesthesia · Oct 2022
Reflecting back to move forward: Lessons learned about COVID-19 safety protocols from pediatric anesthesiologists.
The COVID-19 pandemic brought about the immediate need for enhanced safety protocols in health care centers. These protocols had to evolve as knowledge and understanding of the disease quickly broadened. ⋯ The findings of this study highlighted the importance of listening to and empowering anesthesiology staff working in the field during crises, the implications of shifting from patient-centered care to community-centered care, and the fine line between sharing as much emerging information as possible and overwhelming staff with information.
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Paediatric anaesthesia · Oct 2022
ReviewInteractions of the Protease Inhibitor, Ritonavir, with Common Anesthesia Drugs.
The protease inhibitor, ritonavir, is a strong inhibitor of CYP 3A. The drug is used for management of the human immunovirus and is currently part of an oral antiviral drug combination (nirmatrelvir-ritonavir) for the early treatment of SARS-2 COVID-19-positive patients aged 12 years and over who have recognized comorbidities. The CYP 3A enzyme system is responsible for clearance of numerous drugs used in anesthesia (e.g., alfentanil, fentanyl, methadone, rocuronium, bupivacaine, midazolam, ketamine). ⋯ That anesthesia approach denies children of drugs with considerable value. It is better that the inhibitory changes in clearance of these drugs are understood so that rational drug choices can be made to tailor drug use to the individual patient. Altered drug dose, anticipation of duration of effect, timing of administration, use of reversal agents and perioperative monitoring would better behoove children undergoing anesthesia.
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Paediatric anaesthesia · Oct 2022
Case ReportsIntravenous cannula for percutaneous rescue needle gastrostomy in a neonate with tracheoesophageal fistula - A case report.
Tracheoesophageal fistula offers concrete difficulties for anesthesiologists, which comprise associated congenital anomalies and more importantly the problems concerning ventilation and oxygenation. Among all the types of tracheoesophageal fistula, ventilatory problems are frequently encountered with type C fistula. ⋯ We report a case of a 3-day-old neonate, diagnosed with type C tracheoesophageal fistula and esophageal atresia posted for thoracoscopic repair. We want to highlight our experience of percutaneous needle gastrostomy done using an intravenous cannula, as a rescue measure for stomach decompression, to manage life-threatening hypoxia.