Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2022
ReviewThe role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: extrapolation from adult and animal reports.
Allergic reactions are generalized hypersensitivity processes triggered by different antigenic stimuli, resulting in the end effect of mast cell degranulation and adverse physiologic effects. During the perioperative period, the most commonly identified agents include antibiotics, neuromuscular blocking agents (rocuronium and succinylcholine), chlorhexidine, and iodinated dyes for radiologic imaging. ⋯ Its unique mechanism of action, whereby it encapsulates and forms a one-to-one complex with rocuronium, has led to its anecdotal use as an adjunct in the treatment of anaphylactic and anaphylactoid reactions following rocuronium. The current manuscript discusses the potential use of sugammadex in the treatment of allergic reactions following the administration of rocuronium, reviews previous anecdotal reports of its use in these scenarios, and provides recommendations for future care.
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Paediatric anaesthesia · Jun 2022
Randomized Controlled TrialIntraarterial Papaverine For Relief of Catheter Induced Peripheral Arterial Vasospasm During Pediatric Cardiac Surgery: A Randomized Double-Blind Controlled Trial.
Maintaining the patency of peripheral arterial lines in pediatric patients during surgery can be challenging due to multiple factors, and catheter-related arterial vasospasm is a potentially modifiable cause. Papaverine, a potent vasodilator, improves arterial line patency when used as a continuous infusion in the pediatric intensive care setting, but this method is not convenient during surgery. ⋯ In pediatric patients, papaverine injection immediately after peripheral arterial catheter placement was associated with relief of vasospasm and improved initial arterial line patency. Further, papaverine can be used as a rescue to improve and maintain arterial line patency.
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Paediatric anaesthesia · Jun 2022
ReviewImpact of surgery and anesthesia during early brain development: a perfect storm.
Neonatal surgery and concomitant anesthesia coincide with a timeframe of rapid brain development. The speed and complexity of early brain development superimposed on immature regulatory mechanisms that include incomplete cerebral autoregulation, insufficient free radical scavenging and an immature immune response puts the brain at risk. Brain injury may have long-term consequences for multiple functional domains including cognition, learning skills, and behavior. ⋯ With each of these components exacerbating the other, this amalgam incites the perfect storm, resulting in brain injury. When examining the brain, it seems intuitive to distinguish between neonates (i.e., <60 postconceptional weeks) and more mature infants, multiple and/or prolonged anesthesia exposure and single, short surgery. This review culminates in an outline of anesthetic considerations and future directions that we believe will help move the field forward.
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Paediatric anaesthesia · Jun 2022
Randomized Controlled TrialThe effect of end-tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: a randomized trial.
Intraoperative hypercapnia and hypocapnia are common during pediatric anesthesia, and the cerebral blood flow and intracranial pressure may be affected by the partial pressure of arterial carbon dioxide. Transorbital ultrasound measurement of the optic nerve sheath diameter is a simple and non-invasive method for intracranial pressure assessment. The objective of this study was to evaluate the effect of end-tidal carbon dioxide (ET CO2 ) on optic nerve sheath diameter in a healthy anesthetized pediatric population. ⋯ The optic nerve sheath diameter measured by transorbital ultrasound showed rapid reactivity from ET CO2 35 to 45 mmHg in healthy pediatric patients under inhalation general anesthesia.
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Paediatric anaesthesia · Jun 2022
Novel Utilization of Strand-Specific Reverse Transcription Polymerase Chain Reaction in Perioperative Clinical Decision Making for SARS-CoV-2 Polymerase Chain Reaction Positive Patients.
In order to prevent in-hospital transmission and potential complications related to SARS-CoV-2 in the perioperative patient, most healthcare institutions require preoperative testing for SARS-CoV-2 prior to proceeding with elective surgery. The Centers for Disease Control and Prevention (CDC) recommends a time and symptom-based duration of isolation for the presumed infectious period. ⋯ We describe the novel perioperative use of a strand-specific assay to detect minus strand ribonucleic acid (RNA) in a clinical decision-making algorithm to determine optimal timing of elective surgery after a patient tests RT-PCR positive for SARS-CoV-2. This is the first description in the literature of an attempt to further stratify patients who repeatedly test positive for SARS-CoV-2 into infectious versus non-infectious for perioperative planning.