Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1997
Case ReportsTherapeutic options for severe, refractory status asthmaticus: inhalational anaesthetic agents, extracorporeal membrane oxygenation and helium/oxygen ventilation.
Despite improvements in supportive care, the mortality and morbidity of asthma remain constant. The risks and incidence of morbidity related to barotrauma remain high in patients that require mechanical ventilation. The authors present three alternative strategies including the inhalation of anaesthetic agents, helium/ oxygen ventilation, and extracorporeal membrane oxygenation which may be beneficial when "conventional therapies' fail in the intubated patient with status asthmaticus.
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Paediatric anaesthesia · Jan 1997
Case ReportsBilateral continuous paravertebral block used for postoperative analgesia in an infant having bilateral thoracotomy.
We describe the successful postoperative pain management in an 11-month-old infant who underwent bilateral thoracotomy, using continuous infusions of bupivacaine into two directly placed paravertebral catheters. Haemodynamic parameters and pain scores were measured 1-2 h for 60 h while the infusions were continued and, intermittently, blood samples were taken for subsequent measurement of serum bupivacaine concentrations. ⋯ There were no adverse haemodynamic consequences or complications relating to either catheter placement or drug infusions. Serum concentrations of bupivacaine remained below toxic levels throughout the study period, though accumulation did occur.
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Paediatric anaesthesia · Jan 1997
Case ReportsOral and nasotracheal light wand guided intubation after failed fibreoptic bronchoscopy.
Fibreoptic bronchoscopic guided tracheal intubation is often the first choice for clinicians familiar with the technique, when faced with a patient in whom tracheal intubation presents known or possible difficulties. Regardless of the technique chosen, anticipated and unanticipated problems may arise. We report three patients with known difficult airways that illustrate the utility of light wand guided oral and nasotracheal intubation when tracheal intubation with fibreoptic bronchoscopy proved impossible.
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Paediatric anaesthesia · Jan 1997
Case ReportsA fibreoptic intubation technique for children with mucopolysaccharidoses using the laryngeal mask airway.
Children with mucopolysaccharidoses present the anaesthetist with both a difficult airway and often an impossible intubation using conventional techniques. A technique for airway management and tracheal intubation is described utilizing the Brain laryngeal mask airway, the fibreoptic bronchoscope, a guide wire and a ureteral dilator. Two case reports of children with mucopolysaccharidoses are presented who were managed successfully with this technique. The advantages of the technique are discussed.