Paediatric anaesthesia
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Paediatric anaesthesia · May 2014
Comparative Study Observational StudyAccuracy of manual palpation vs ultrasound for identifying the L3 -L4 intervertebral space level in children.
Insertion of needles into the spinal or epidural space is an important component of modern anesthetic practice. Needles are usually inserted at or below the L3-L4 intervertebral space to minimize the risk of spinal cord injury. Manual palpation is the most common method for identifying intervertebral spaces. However, anesthesiologists are increasingly using ultrasonography to guide the placement of regional, including neuraxial, anesthetic, and analgesic blocks. We undertook an observational study to compare the accuracy of manual palpation and ultrasound for determining the L3-L4 intervertebral space level. ⋯ This observational study found no difference in the accuracy of landmark palpation, when performed by a consultant anesthesiologist, and ultrasound for determining the L3-L4 intervertebral space in children.
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Paediatric anaesthesia · May 2014
Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children.
Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting. ⋯ Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.
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Arthrogryposis is characterized by multiple, nonprogressive joint contractures which may be caused by maternal disorders such as oligohydramnios as well as fetal akinesia resulting from primary disorders of muscle, connective tissue, or neurologic tissue. Its prevalence is about 1 : 3000. Distal arthrogryposis (DA) is a heterogenous group of genetic disorders with a characteristic flexion of the joints of the hands and feet divided into different types with additional features. Sheldon-Hall Syndrome (SHS), also known as distal arthrogryposis type 2A (DA2A), has some nonorthopedic features of specific importance to anesthetic care.
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Paediatric anaesthesia · May 2014
Case ReportsUnusual presentation of postdural puncture headache requiring repeat epidural blood patch in a 4-year-old child.
We present the case of a 4-year-old child who required two epidural blood patches (EBPs) to treat a delayed onset postdural puncture headache (PDPH) caused by lumbar cerebrospinal fluid drain. The first EBP was unsuccessful with 0.41 ml·kg(-1) of blood injected. A second EBP with 0.76 ml·kg(-1) of blood was performed 2 days later with the complete resolution of symptoms. The volume of blood necessary for effective treatment for symptomatic cerebrospinal fluid leaks in children remains controversial, and a repeat EBP may be required for resolution of symptoms.
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Paediatric anaesthesia · May 2014
Observational StudyObservational study of perioperative behavior changes in children having teeth extracted under general anesthesia.
Perioperative behavioral disturbance is common in children. Negative behavior changes may be seen during induction of anesthesia, during recovery and following discharge home. There has been little research on this subject in the UK. ⋯ Perioperative behavioral disturbance is common in children undergoing anesthesia. Predicting which children are at increased risk may allow us to adapt the management of these children in order to minimize adverse behavior changes.