Paediatric anaesthesia
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Congenital lung lesions are numerous but rare in individual clinical practice. They do require close multidisciplinary collaboration between health care professionals. This educational review will focus on the pathophysiology, clinical manifestations, surgical approaches, and anesthetic management of congenital anomalies of the large intrathoracic airways: congenital tracheal stenosis, tracheal agenesis, tracheal diverticulum, bronchial anomalies (tracheal, esophageal, or bridging bronchus), congenital lung malformations, lung sequestrations and Scimitar syndrome, lobar emphysema, Williams-Campbell syndrome, and pleuropulmonary blastoma. In addition, this review will illustrate common pitfalls and challenges related to the anesthesia management with emphasis on ventilation and correct endotracheal tube positioning.
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Paediatric anaesthesia · Feb 2022
ReviewNoninvasive ventilation in children: A review for the pediatric anesthesiologist.
Preserving adequate respiratory function is essential in the perioperative period. Mechanical ventilation with endotracheal intubation is widely used for this purpose. In select patients, noninvasive ventilation (NIV) may be an alternative to invasive ventilation or may complement respiratory management. ⋯ HFNO delivers humidified and heated oxygen at rates between 2 and 70 L/min using specific nasal cannulas, and flows are determined by the patient's weight and clinical needs. HFNO can be useful as a method for preoxygenation in infants and children by prolonging apnea time before desaturation, yet in children with decreased minute ventilation or apnea HFNO does not improve alveolar gas exchange. Clinicians experienced with these devices, such as pediatric intensivists and pulmonary medicine specialists, can be useful resources for the pediatric anesthesiologist caring for complex patients on NIV.
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Paediatric anaesthesia · Feb 2022
ReviewChest trauma in children-what an anesthesiologist should know.
Injury is the leading cause of death in children, with chest trauma accounting for 25% of this mortality. In addition, these patients often present with multiple system injuries, which require simultaneous management. These concurrent injuries can lead to challenges when prioritizing tasks in the resuscitation room and during anesthetic management. ⋯ Therefore, a clear communication plan with careful monitoring and vigilance is needed for intubation and ventilation in these children. These injuries also require specific strategies to prevent barotrauma which could lead to complications such as respiratory failure, pneumonia, sepsis, and acute respiratory distress syndrome. This educational review aims to guide clinicians managing pediatric chest trauma through some of the critical decision-making regarding intubation, ventilation, and subsequent management of injuries.
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Paediatric anaesthesia · Feb 2022
ReviewAtelectasis and lung recruitment in pediatric anesthesia: An educational review.
General anesthesia is associated with development of pulmonary atelectasis. Children are more vulnerable to the development and adverse effects of atelectasis. ⋯ We discuss the clinical significance of atelectasis, the use and value of recruitment maneuvers, and other techniques available to minimize lung collapse. This review demonstrates the value of a recruitment maneuver, maintaining positive end-expiratory pressure (PEEP) until extubation and lowering FiO2 where possible in the daily practice of the pediatric anesthetist.
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Paediatric anaesthesia · Feb 2022
ReviewThoracic regional anesthesia and the impact on ventilation.
Thoracic surgical incisions can be associated with intense pain or discomfort. Postoperative thoracic pain may be multifactorial in origin. Inadequate analgesia causes respiratory dysfunction. ⋯ Intravenous opioids are widely used but sufficient analgesia is seldom achieved in doses that permit safe spontaneous ventilation. Thoracic regional anesthesia provides profound analgesia, is opiate sparing and has minimal depressant effects on ventilation. Thoracic regional anesthesia is both an effective alternative to systemic analgesics or can be used as part of a multimodal analgesic technique.