Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2016
Randomized Controlled TrialEffect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study.
Resistance to the passage of the endotracheal tube (ETT) is frequently encountered in children as it is advanced over the fiberoptic scope for placement into the trachea because it gets hung up at the laryngeal inlet. Literature in adults indicates that a 90° counterclockwise rotation (CCR) of the ETT before advancing results in smooth passage. We found no literature in children. ⋯ A change in ETT tip orientation from bevel facing left to facing down by 90° CCR, leads to a significantly higher first-attempt success rate by nasal approach in children. We believe the ETT should be rotated before insertion into the nostril to ensure that full 90° CCR of the tip has been accomplished.
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Paediatric anaesthesia · Apr 2016
ReviewPreoperative evaluation and comprehensive risk assessment for children with Down syndrome.
Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. ⋯ The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.
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Paediatric anaesthesia · Apr 2016
Case ReportsTension pneumothorax during flexible bronchoscopy in a nonintubated infant.
We describe the case of a tension pneumothorax occurring during flexible bronchoscopy in a nonintubated infant. The pneumothorax likely occurred secondary to wall source oxygen insufflation via the bronchoscope without sufficient gas egress. The use of wall source oxygen via the bronchoscope working channel is inherently dangerous and should be avoided.