Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2008
Comparative StudyAn audit of intravenous fluid prescribing and plasma electrolyte monitoring; a comparison with guidelines from the National Patient Safety Agency.
To audit past practice of intravenous (i.v.) fluid prescribing and electrolyte monitoring, prior to the publication of guidelines by the National Patient Safety Agency (NPSA, Ref. NPSA/2007/22) in March 2007, highlighting areas of discrepancy, in a specialist children's hospital. ⋯ Our practice of i.v. fluid prescribing and electrolyte monitoring in children, prior to the publication of guidelines by the NPSA in March 2007, did not fully meet the recommended standards.
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Paediatric anaesthesia · Oct 2008
Lower cuff pressures improve the seal of pediatric laryngeal mask airways.
Hyperinflation of laryngeal mask airway (LMA) cuffs may be harmful because of the exertion of high pressures on pharyngeal and laryngeal structures. Although cuff manometers may be used to monitor cuff pressure, their use is not routine in many institutions and clinical endpoints are used instead. Furthermore, it is common clinical practice to add air to the cuff in the presence of an air leak to obtain a better seal. ⋯ The use of clinical endpoints to inflate LMA cuffs is not only associated with significant hyperinflation in the majority of patients but also with an increased leakage around the LMA cuff when compared with adjusted LMA cuff pressures. Therefore, cuff manometers should routinely be used not only to avoid unnecessary hyperinflation but also to improve cuff sealing of LMA in children.
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Paediatric anaesthesia · Oct 2008
Comparative StudyPlasma volume replacement with HES 130/0.42 obviates negative side effects of pneumoperitoneum in piglets.
Evidence-based guidelines on optimal perioperative fluid management in infants have not been established. Recent randomized trials in major abdominal surgery in adults suggest that large volumes of fluid may increase morbidity and hospital stay. Our own clinical experience in infants undergoing laparoscopic surgery is different. So the aim of this study was to compare a crystalloid vs a plasma volume stabilizing fluid management regime during prolonged pneumoperitoneum (PP) in an experimental setting. ⋯ This study shows that the negative effects of prolonged PP on hemodynamics and acid-base balance can be obviated by a liberal plasma volume stabilization regimen with colloids.
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Paediatric anaesthesia · Oct 2008
A cohort evaluation of the pediatric ProSeal laryngeal mask airway in 100 children.
The ProSeal laryngeal mask airway (PLMA) has been available in pediatric sizes in the UK since 2007. Although several non-UK studies have evaluated PLMAs in children, there are little published data regarding their use in this country. Having decided to introduce the pediatric PLMA into our practice, we chose to prospectively audit the first 100 uses as part of our clinical governance. ⋯ Even without prior experience and using nonconventional insertion, pediatric PLMAs (including size 1.5) can be easily inserted and provide an effective airway.