Paediatric anaesthesia
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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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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
Feasibility of the ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series.
The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in infants weighing less than 1500 g. ⋯ Supracalvicular in-plane real-time ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and feasible option to provide large-bore central venous access for very small and sick babies.
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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
A Retrospective Cohort Study of Predictors and Interventions that Influence Cooperation with Mask Induction in Children.
Uncooperative pediatric mask induction is linked to perioperative anxiety. Although some risk factors for uncooperative inductions have been reported, there are no large cohort studies that identify intrinsic patient characteristics associated with cooperation. ⋯ In this cohort, increasing age was the only patient characteristic found to be associated with increased cooperation with mask induction. Preoperative intervention by a Child Life Specialists was the sole intervention associated with improved cooperation.