Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2009
ReviewIatrogenic damage to the pediatric airway. Mechanisms and scar development.
Iatrogenic damage to the pediatric airway occurs rather often. Most injuries will heal without any sequelae because larynx and trachea of children tolerate considerable trauma. ⋯ A selection of photo documents of airway endoscopy out of more than 5000 photos from the years 1987-2007 were used to explain the development of injuries from minor lesions to large areas of necrosis of the mucosa of larynx and trachea of infants and children. The visualization of airway lesions might help to prevent iatrogenic damage.
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Paediatric anaesthesia · Jul 2009
Review Historical ArticleA critique of elective pediatric supraglottic airway devices.
In 1988, when the Laryngeal Mask Airway-Classic (Intavent Orthofix, Maidenhead, UK), was introduced there were only two choices of airway management: tracheal tube or facemask. The supraglottic airway, as we now understand the term, did not exist. Yet, 20 years later, we are faced with an ever increasing choice of supraglottic airway devices (SAD). ⋯ Therefore, most safety data comes from extended use rather than high quality evidence which inevitably biases against newer devices. For reason of these factors, claims of efficacy and particularly safety must be interpreted cautiously. This narrative review aims to present the evidence surrounding the use of currently available pediatric SADs in routine anesthetic practice.
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Paediatric anaesthesia · Jul 2009
Use of premedication for intubation in tertiary neonatal units in the United Kingdom.
Endotracheal intubation and laryngoscopy are frequently performed procedures in neonatal intensive care. These procedures represent profoundly painful stimuli and have been associated with laryngospasm, bronchospasm, hemodynamic changes, raised intracranial pressure and an increased risk of intracranial hemorrhage. These adverse changes can cause significant neonatal morbidity but may be attenuated by the use of suitable premedication. ⋯ In comparison with data from a 1998 survey, our study demonstrated an increase in the number of units that have adopted a written policy for premedication use, and in the number routinely using premedication drugs for elective intubation. There remains little consensus as to which drugs should be used and in what dose.
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Paediatric anaesthesia · Jul 2009
Effects of norepinephrine on dynamic variables of fluid responsiveness during hemorrhage and after resuscitation in a pediatric porcine model.
The effect of vasopressors on pulse pressure variation (PPV), stroke volume variation (SVV) and on the volumetric variable global end-diastolic volume (GEDV) during changing loading conditions is currently under debate. The aim of our study was to investigate the effect of norepinephrine (NE) on PPV, SVV and GEDV in a pediatric animal model of hemorrhage and resuscitation. ⋯ Eight anesthetized piglets were studied at normovolemia, after stepwise blood withdrawal (25 ml x kg(-1)), after infusion of NE to restore mean arterial pressure (MAP), after NE titration was stopped and shed blood was retransfused and finally again after NE titration. Stroke volume (SV) was measured using a thermodilution pulmonary artery catheter. GEDV was measured by transpulmonary thermodilution. PPV and SVV were monitored continuously by pulse contour analysis. In response to NE administration during hemorrhage, MAP significantly increased (P < 0.01), PPV significantly decreased (P = 0.02), whereas SVV, SV and GEDV remained unchanged. After retransfusion, SVV and GEDV significantly correlated with volume induced percentage change in SV. This significant correlation was reversed after NE administration for SVV and persisted for GEDV. In conclusion, NE administration significantly affected PPV and SVV, whereas the volumetric variable GEDV remained unchanged.