Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2020
Review Meta AnalysisRespiratory and haemodynamic perioperative adverse events in intravenous versus inhalational induction in paediatric anaesthesia: a systematic review and meta-analysis.
Perioperative respiratory and hemodynamic adverse events are still a cause of morbidity and mortality in pediatric anesthesia. It has been suggested that volatile agents might be associated with more respiratory adverse events compared to intravenous agents (eg, propofol), which have been associated with a higher risk of bradycardia compared to volatile agents. We performed a systematic review and meta-analysis to evaluate the risk of perioperative hemodynamic and respiratory adverse events, comparing intravenous induction with inhalational induction in pediatric anesthesia. ⋯ More respiratory adverse events during and after inhalation induction were found, in particular in children with multiple risk factors for respiratory adverse events. This did not reach significance. Future research should include a large randomized controlled trial comparing inhalation and intravenous induction with respiratory and hemodynamic adverse events as primary outcome and adequately blinded outcome assessors.
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Paediatric anaesthesia · Aug 2020
Flow irregularities from syringe infusion pumps caused by syringe stiction.
The current study aimed to evaluate the extent of the slide-stick phenomenon in differently designed infusion syringes at various infusion rates and filling positions. ⋯ Infusion set rate rather than syringe brand or filling volume was a major predictor for syringe stiction-related amount of variation in the calculated plasma epinephrine concentration.
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Paediatric anaesthesia · Aug 2020
Observational StudyUltrasound-guided Anatomical Evaluation of Right Internal Jugular Veinin Children Aged 0-2 Years: A Prospective Observational Study.
The right internal jugular vein is commonly preferred for central venous cannulation, and ultrasonographic assessment and guidance is the recommended technique for this procedure. Despite the safety and reliability of this technique, it requires specific training and experience as well as thorough knowledge of anatomy. ⋯ Our results support the current data for the high anatomical variability of the right internal jugular vein, highlighting the recommendation of the Rapid Central Vein Assessment (RaCeVA) protocol prior to and ultrasound guidance during catheterization of central veins.
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Paediatric anaesthesia · Aug 2020
How should we approach parental refusals of opioids on behalf of children in the perioperative setting? A practical approach based on ethical theory.
In the midst of the current opioid epidemic, we have encountered more parents who are concerned about the use of opioids in the perioperative setting. Some parents have completely refused the use of opioids on behalf of their children. ⋯ We propose a decision-making framework that focuses on improving communication and considering alternatives. Assessment of harm to the child from avoiding opioids, as well as potential harms from overriding parental autonomy must be undertaken prior to considering overriding parents.
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Paediatric anaesthesia · Aug 2020
Multicenter Study Observational StudyImpact of clear fluids fasting on pulmonary aspiration in children undergoing general anesthesia: Results of the German prospective multicenter observational (NiKs) study.
Shortening clear fluid fasting to 1 hour in children is not associated with increased aspiration incidence.
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