Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2004
ReviewAirway structure, function and development in health and disease.
Until they are fully mature, the airways are highly susceptible to damage. Factors that may contribute to vulnerability of immature airways and the occurrence of bronchopulmonary dysplasia (BPD) in preterm neonates include decreased contractility of smooth muscles of the airway, which leads to generation of lower forces, and immaturity of airway cartilage, leading to increased compressibility of developing airways. ⋯ Imaging has demonstrated an excessively decreased airway cross-sectional area during exhalation in infants with BPD and acquired tracheomegaly in very preterm infants who had received mechanical ventilatory support. To further advance our understanding of how the airways develop, and to design less damaging protocols for mechanical ventilation in preterm neonates, basic laboratory studies of airway ultrastructure need to be performed and the results correlated with clinical pulmonary function studies.
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Paediatric anaesthesia · Jan 2004
ReviewPrevention and management of complications of airway surgery in children.
Preventing and managing complications of airway surgery in children requires proactive attention to both surgical and anaesthetic aspects of the planned procedure. Preoperative evaluation should include a thorough physical examination and, especially in children with multiple congenital anomalies, flexible fibreoptic nasopharyngolaryngoscopy, direct laryngoscopy and rigid or flexible bronchoscopy. The goal is to identify dynamic abnormalities such as laryngomalacia or vocal cord paralysis, tracheal or bronchial lesions, gastro-oesophageal reflux disease (GORD), aspiration, laryngotracheal stenosis, totally obstructing tracheostomy-associated granulation tissue and Noonan syndrome preoperatively, and then to plan surgical management to achieve the best possible outcome for each patient.
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Airway management for patients with craniofacial disorders poses many challenges. The anaesthesiologist must be familiar with the normal bony and soft-tissue anatomy in the airway and how anatomy is altered by various congenital disorders. Specific areas to assess include the oral cavity, anterior mandibular space, maxilla, temporomandibular joint and vertebral column. Congenital conditions that may alter normal anatomy and therefore anaesthetic management include cleft lip and palate with or without Pierre Robin syndrome, craniofacial dysostosis, mandibulofacial dysostosis/Treacher Collins syndrome, hemifacial microsomia, Klippel-Feil syndrome, Beckwith-Wiedemann syndrome, trisomy 21/Down's syndrome, Freeman-Sheldon/whistling face syndrome/craniocarpotarsal dysplasia, fibrodysplasia ossificans progressiva, mucopolysaccharidosis and vascular malformations.
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Paediatric anaesthesia · Jan 2004
ReviewMicrolaryngoscopy-airway management with anaesthetic techniques for CO(2) laser.
Carbon dioxide laser microlaryngoscopy requires planning and cooperation of both the anaesthesiologist and surgeon. While there are potentially significant complications, such as fire and difficulty ventilating the patient, laser microlaryngoscopy techniques provide the benefit of allowing for precise management of a wide range of upper airway conditions. Laryngoscopy and bronchoscopy require that the surgeon and anaesthesiologist cooperate in order to maximize exposure for the surgeon and allow for adequate ventilation of the patient. ⋯ The major complication to be avoided is airway fire. Each technique has advantages and disadvantages for avoiding fire and providing adequate ventilation. Fire is not a concern when the carbon dioxide laser bronchoscope is used, but the humidifier must be eliminated from the anaesthesia circuit to avoid vapour obstructing the bronchoscope coupler.