Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2007
Case ReportsRapid sequence intubation without a neuromuscular blocking agent in a 14-year-old female patient with myasthenia gravis.
The anesthesia care of a 14-year-old female patient with an acute exacerbation of myasthenia gravis (MG) and a full stomach who required emergency surgery for placement of a hemodialysis catheter is described. A nonventilated rapid sequence induction was successful with the use of propofol, lidocaine, remifentanil, cricoid pressure and no neuromuscular blocking agent. Although the use of combinations of i.v. anesthetic agents have been suggested for tracheal intubation without the need for neuromuscular blocking agents, none of these techniques has been advocated for rapid sequence intubation. We review existing literature on the topic of tracheal intubation using remifentanil and propofol without a neuromuscular blocking agent and on the topic of tracheal intubation of patients with MG using i.v. anesthesia and no neuromuscular blocking agents.
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The purpose of this study was to determine if inspiratory pressure from intermittent positive pressure ventilation may be sufficient to inflate the cuff (thus 'auto-inflation') and thereby seal the trachea. ⋯ Auto-inflation in the Mallinckrodt Seal Guard with high volume-low pressure polyurethane cuff can produce adequate tracheal sealing in the model trachea used. The implication is that such auto-inflation should decrease the risk of tracheal injury from acute or persistent cuff hyperinflation.
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Paediatric anaesthesia · Mar 2007
Case ReportsEffectiveness of Arndt endobronchial blockers in pediatric scoliosis surgery: a case series.
Pediatric scoliosis surgery may require single lung ventilation for surgical access. Current methods of lung isolation are inadequate for some or all of these children. The Arndt endobronchial blocker (EBB) has been described for use in pediatric thoracic surgery to enable single lung ventilation (SLV). There are few data on its use in pediatric spinal deformity surgery. We report the successful use of the Arndt EBB in a series of these patients. ⋯ In our case series, Arndt EBB provided a safe and highly effective means of single lung isolation for children undergoing pediatric scoliosis surgery.