Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2021
Observational StudyOperations and outcomes of a Hospital-wide Emergency Airway Response Team (HEART) in a quaternary academic children's hospital.
To improve pediatric airway management outside of the operating room, a Hospital-wide Emergency Airway Response Team (HEART) program composed of anesthesiology, otorhinolaryngology, and respiratory therapy clinicians was developed. ⋯ A multidisciplinary emergency airway response team plays an important role in pediatric airway management outside of the operating room. Adverse airway outcomes were more frequent before compared to after HEART arrival.
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Paediatric anaesthesia · Oct 2021
HLA Antibodies and Their Association with Blood Product Exposures in Pediatric Patients Undergoing Cardiac Transplantation.
Previous blood product exposures may result in the development of antibodies to human leukocyte antigens (HLA). Pediatric heart transplant recipients who have these antibodies experience increased morbidity and mortality after transplantation. In this study, our aims were to confirm the association of previous allogeneic blood product exposures with the formation of anti-HLA antibodies, determine which blood components pose the greatest risk of developing antibodies, and assess differences in outcomes after transplantation between patients who had anti-HLA antibodies and those who did not. ⋯ Exposure to previous allogeneic blood products affects the development of anti-HLA antibodies in children presenting for heart transplantation. Previous RBC exposures resulted in HLA antibody positivity more than other blood component exposures. Importantly, the presence of HLA antibodies was associated with the development of DSAs post-transplantation. Developing transfusion strategies to reduce allogeneic blood product exposures in children who may need future cardiac transplantation should be a high priority.
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Paediatric anaesthesia · Oct 2021
Relationship between pre-incision Pupillary Pain Index and post-incision heart rate and pupillary diameter variation in children.
The Pupillary Pain Index is a recent pupillometric index designed to assess the level of analgesia under general anesthesia in children and adults. If analgesia is inadequate, acute nociceptive stimuli such as skin incision may induce significant hemodynamic disturbances. ⋯ In children, pre-incision Pupillary Pain Index was moderately correlated with post-incision nociception. Pre-incision Pupillary Pain Index had good predictive performances for heart rate or pupillary diameter reactivity to skin incision. Pre-incision Pupillary Pain Index <3 might predict the absence of heart rate reaction to incision.
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Paediatric anaesthesia · Oct 2021
Neuraxial anesthesia provides excellent pain control for pediatric burn patients receiving excision and split-thickness skin grafts - a retrospective case series.
Postoperative pain management in pediatric burn patients requiring excision and split-thickness skin grafts remains largely under-studied. ICU care is often necessary due to the level of sedation and amount of opioids required to achieve adequate pain control. ⋯ Spinal anesthesia was most commonly used for split-thickness skin grafting in the pediatric burn population and provides excellent analgesia for patients' immediate postoperative course, including their initial dressing changes, with minimal risk for complications. Pain was well-controlled in all subgroups indicating that this strategy can be used flexibly in a variety of pediatric burn patients.