Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2020
Dimensional compatibility of balloon-tipped bronchial blockers with the pediatric airway anatomy using different recommendations for age-related size selection.
Age-related recommendations for size selection of bronchial blocker devices are based on a few dated anatomical autopsy and radiological studies determining lower airway dimensions in children. These recommendations are based on anterior-posterior internal bronchial diameters, which are smaller than the more relevant lateral internal bronchial diameters. ⋯ This analysis demonstrates that irrespective of the recommendation for size selection used, neither the two balloon-tipped vascular catheters included nor the Arndt endobronchial blockers are ideal for lung isolation in children are compared with the age-related relevant dimensions of pediatric airway anatomy. A redesign of bronchial blocker equipment with age-related anatomically based high-volume, low-pressure blocker balloons made from ultrathin membranes and with smaller catheters would be desirable.
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Paediatric anaesthesia · Nov 2020
Anaesthesia management of laser photocoagulation for retinopathy of prematurity. A retrospective review of perioperative adverse events.
The aim of this study was to report the incidence of perioperative adverse events occurring in infants undergoing diode laser photocoagulation of retinopathy of prematurity and to identify clinical risk factors that may affect the incidence. ⋯ The incidence of perioperative adverse events was not associated with patient's age, current weight, timing, or location of the procedure. Extubating infants at the end of the procedure is however associated with a high rate of apneas and bradycardia, and consideration should be given to keeping low weight infants undergoing prolonged procedures out-of-hours intubated.
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Paediatric anaesthesia · Nov 2020
The anatomical features of an ultrasound-guided Erector Spinae Fascial Plane block in a cadaveric neonatal sample.
Since its inception, the erector spinae plane block has been used for a variety of truncal surgeries with success in both adults and children. However, the anatomical features, route of spread, and dermatomal coverage are still not fully understood in a pediatric population. ⋯ Contrast material was found in the paravertebral, epidural, and intercostal spaces over an average of 5 vertebral levels when using 0.1 mL/kg.
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Bronchial asthma is the most pervasive chronic disease among children in the United States. Pneumonia, an acute pulmonary disorder, is also quite common, affecting individuals with chronic respiratory conditions. Despite the widespread recognition of bronchial asthma as a common, potentially life-threatening disease, its impact on the risk of serious pulmonary infections such as postoperative pneumonia is under-appreciated. We examined the association of bronchial asthma with postoperative pneumonia in a matched cohort of children who underwent inpatient surgical procedures. ⋯ Children with bronchial asthma had a significantly greater risk of postoperative pneumonia. Further studies are needed to understand the mechanisms underlying these associations and determine if perioperative interventions can mitigate this association.
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Paediatric anaesthesia · Nov 2020
Preventing inadvertent Endobronchial intubation: Upper incisor to manubriosternal joint length as a predictor of airway length in children.
Malpositioning of the endotracheal tube within the airway can lead to serious complications. The estimated insertion depth of the endotracheal tube should be accurate and reliable. ⋯ The upper incisor-carina length shows a positive correlation with the patient's upper incisor-manubriosternal joint length and the patient's standing height, while the degree of maximum head extension has no significant bearing on this relationship. The upper incisor-manubriosternal joint length can be used as a predictor of airway length and the depth of insertion of endotracheal tube in children.