Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2014
Case ReportsHemodynamic instability during anesthesia in an adolescent with Loeys-Dietz syndrome: a case report.
We present a case of a 12-year-old male with Loeys-Dietz syndrome (LDS), a rare life-threatening genetic disorder. Multiple manifestations of LDS were present, including easy bruising, aortic root dilatation, multiple areas of vessel tortuosity, and joint laxity. ⋯ He experienced intraoperative hemodynamic instability and became pulseless during an orthopedic procedure, which had to be abandoned. Anesthesia was reattempted 2 days after cessation of the patient's antihypertensive medications and was successful with only minor postoperative hypertension.
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Paediatric anaesthesia · Dec 2014
Observational StudyEndotracheal intubation in the pediatric emergency department.
Prospective safety data on emergency department (ED) intubation in children are limited. We aimed to describe the practice and adverse events associated with endotracheal intubation in a large urban pediatric ED. ⋯ Intubation of children in the ED is a low-frequency, high-risk procedure. The incidence of adverse events, particularly desaturation and hypotension, is high. The incidence of difficult laryngoscopy is low. First pass success rate without desaturation or hypotension is low. Strategies to avoid desaturation and hypotension in the peri-intubation setting should be prioritized.
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Paediatric anaesthesia · Dec 2014
The effect of convective heating on evaporative heat loss in anesthetized children.
Convective warming is effective in maintaining core temperature under anesthesia. It may increase evaporative water loss (EWL). If significant, further investigation of warming modifications to minimize this impact would be warranted. ⋯ Within the age range 1 month-12 years, EHL is not significantly influenced by convective heating under anesthesia. There is no thermal advantage in exploring technique modifications such as humidifying the warming air. Previous estimates of the contribution of EHL to total heat loss in anesthetized children may require revision.
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Paediatric anaesthesia · Dec 2014
Delivery of anesthesia and complications for children with Fraser syndrome: a review of 125 anesthetics.
To perform a retrospective, anesthesia case note review of patients with Fraser syndrome. ⋯ There was a low incidence of complications with this group of patients. However, there is a relatively high incidence of difficult or impossible tracheal intubation (20%) due to glottic stenosis and one patient required an emergency tracheostomy despite no previous clinical evidence of airway narrowing.
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Paediatric anaesthesia · Dec 2014
Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis.
Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems. ⋯ Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California.