Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2018
Case ReportsPerioperative management of tracheocutaneous fistula closure in children: A review of 96 cases.
A tracheocutaneous fistula is a known complication following tracheostomy decannulation. Although surgical techniques for its repair are well described, there is no consensus about perioperative management and this procedure may generate significant airway and respiratory complications intraoperatively, and in the early postoperative period. We aimed to describe variations in perioperative management in tracheocutaneous fistula closure, estimate the incidence of early airway and respiratory complications, and identify any predisposing factors. ⋯ Perioperative care for children undergoing tracheocutaneous fistula closure was not standardized. Advocated tests such as preoperative "mini" sleep studies and "leak test" intraoperatively were not consistently performed. Intraoperative anesthetic complications were uncommon; however, major postoperative respiratory complications were 5%.
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Paediatric anaesthesia · Dec 2018
Comparative StudyA retrospective comparison of propofol to dexmedetomidine for pediatric magnetic resonance imaging sedation in patients with mucopolysaccharidosis type II.
Mucopolysaccharidosis type II patients are reported to have an elevated incidence of difficult airway. Propofol is a commonly used sedative for magnetic resonance imaging in pediatric patients, but patients who receive it may exhibit dose-dependent upper airway obstruction and respiratory depression. Dexmedetomidine also provides adequate procedural sedation with a relatively low risk of airway obstruction. Accordingly, we introduced the use of dexmedetomidine in our practice to reduce the risk of airway obstruction during magnetic resonance imaging procedures. ⋯ Dexmedetomidine provides an adequate level of sedation and is associated with lower rates of artificial airway interventions compared to propofol. Therefore, dexmedetomidine may offer advantages for preserving the native airway compared to propofol when administered during magnetic resonance imaging scans in patients with mucopolysaccharidosis type II.
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Paediatric anaesthesia · Dec 2018
Performance of blow-by methods in delivering oxygen to pediatric patients during transport: A laboratory study.
Providing supplemental oxygen with a blow-by method is used to provide additional oxygen to patients who will not tolerate an oxygen delivery device in direct contact with their face. Blow-by methods are often improvised from parts of standard equipment. The performance is very dependent on the distance to the face and the direction of the gas flow. Blow-by methods are used by anesthetists during transport but their performance in delivering supplemental oxygen has only been tested in static situations. The aim of this nonclinical study was to determine the performance of different blow-by methods in the delivery of additional oxygen to pediatric patients during transport. ⋯ It is concluded that the ability of blow-by methods to deliver a FiO2 >50% depends on the method used and distance from the face.
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Paediatric anaesthesia · Dec 2018
Randomized Controlled TrialComparative evaluation of CMAC and Truview picture capture device for endotracheal intubation in neonates and infants undergoing elective surgeries: A prospective randomized control trial.
Videolaryngoscopy has an established role in difficult airway management in adults. However, there is limited literature to support their efficacy in children. The Truview Picture Capture Device has shown promising results for endotracheal intubation in infants in the past. The CMAC videolaryngoscope has launched its novel infant Miller blade, but its performance has not been assessed clinically for routine intubation in infants and neonates. We hypothesized that the CMAC videolaryngoscope would reduce the total time to intubation as compared to the Truview Picture Capture Device in neonates and infants. ⋯ The CMAC Miller blade reduced the total time taken for tracheal intubation and intubation difficulty as compared to the Truview Picture Capture Device and may be a better tool for intubation in infants.