Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2004
Review Case ReportsManaging sedation withdrawal in children who undergo prolonged PICU admission after discharge to the ward.
Children who undergo a prolonged stay within the intensive care unit require adequate sedation and analgesia. During the recovery phase there will need to be a period of sedation withdrawal to prevent occurrence of an abstinence syndrome. We present a strategy developed within our hospital for managing this process which uses the resource of the Pain Service, along with guidelines to help prevent the development of withdrawal, and a plan for managing any signs of abstinence which occur.
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Paediatric anaesthesia · Mar 2004
Review Comparative StudyComparing the efficacy of NSAIDs and paracetamol in children.
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Paediatric anaesthesia · Feb 2004
ReviewConjoined twins--the anaesthetic management of 15 sets from 1991-2002.
The Red Cross War Memorial Children's Hospital, Cape Town, South Africa is the only dedicated children's hospital in sub-Saharan Africa and, as such, is the referral hospital for complex procedures from this region. Fifteen sets of conjoined twins have presented for separation from 1991 to 2002, and a total of 34 sets since 1964. Anaesthesia for procedures on conjoined twins is a demanding, exacting and meticulous exercise, whether prior to or during separation. ⋯ Planning for the postseparation period and the reconstruction and rehabilitation of the babies is essential from the time of their initial admission. Meticulous attention to detail, monitoring and vigilance are mandatory. Successful management of conjoined twins relies on close communication and cooperation of all members of the multidisciplinary team.
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It has been traditionally taught that only uncuffed endotracheal tubes (ETTs) should be used for intubation in children younger than 8, or even 10, years old. However, recent literature suggests that the advantages of using uncuffed ETTs in children may be just another myth of paediatric anaesthesia. ⋯ Longer duration of intubation and a poorly fitted ETT are risk factors for mucosal damage, whether the ETT is cuffed or uncuffed. Furthermore, a properly sized, positioned, and inflated modern (low-pressure, high-volume) cuffed ETT can offer many advantages over an uncuffed ETT, including greater ease of intubation, better control of air leakage, lower rate and better control of flow of anaesthetic gases, and decreased risk of aspiration and infection.