Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2008
Randomized Controlled Trial Comparative StudyThe Proseal laryngeal mask airway in children: a comparison between two insertion techniques.
The Proseal laryngeal mask airway (PLMA) is a relatively new supraglottic airway device with a drain tube to minimize the risk of gastric insufflation and aspiration. We compared introducer tool (IT) and gum elastic bougie (GEB)-guided techniques for insertion of the Proseal LMA in children. ⋯ A gum elastic bougie-guided insertion technique in children is comparable with the IT technique in terms of success rate and may be useful as a backup technique when the IT technique fails.
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Paediatric anaesthesia · Feb 2008
Comparative StudyEvaluation of cuffed tracheal tube size predicted using the Khine formula in children.
The correct size of cuffed endotracheal tube (CET) limits the risk of postintubation tracheal damage. The aim of this study was to compare the size of the CET used in children with the size predicted by the Khine formula [age (years)/4 + 3]. ⋯ Our data suggest that Khine's formula for predicting the appropriate tracheal tube size underestimates optimal size by 0.5 mm. We therefore recommend the use of the following formula: internal diameter of the CET = [age/4 + 3.5] in children >1 year of age which may be applied without increased risk of complications. The rate of tracheal reintubation as well as the detected leaks supports these recommendations.
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Paediatric anaesthesia · Feb 2008
Clinical TrialSafety and efficacy of patient controlled epidural analgesia following pediatric spinal surgery.
Patient controlled epidural analgesia (PCEA) is uncommon in pediatric anesthesia. Because PCEA offers superior pain control compared with continuous epidural infusions in adults, we prospectively evaluated the analgesia efficacy and safety of PCEA in children and adolescents following extensive spinal surgery. ⋯ The present study demonstrates that PCEA provides excellent pain relief following extensive spinal surgery and is associated with a low incidence of adverse events. The use of PCEA should be encouraged in children and adolescents following extensive spinal surgery.
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Paediatric anaesthesia · Feb 2008
ReviewDuchenne muscular dystrophy: an old anesthesia problem revisited.
Patients with Duchenne and Becker muscular dystrophy suffer from a progressive deterioration in muscle secondary to a defect in the dystrophin gene. As such, they are susceptible to perioperative respiratory, cardiac and other complications, such as rhabdomyolysis. ⋯ This article reviews perioperative 'MH-like' reactions reported in muscular dystrophy patients and groups them into three categories according to clinical presentation. The etiology and underlying pathophysiological process responsible for these reactions is discussed and recommendations are proposed for the safe anesthetic management of these patients.