Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2006
Comparative Study Clinical TrialComparison of 'whoosh' and modified 'swoosh' test for identification of the caudal epidural space in children.
Caudal analgesia is widely used in pediatric anesthesia practice. The 'whoosh' test which uses air to identify the epidural space, has been recommended as a guide for successful needle placement. However, the use of air may be associated with an incidence of neurological complications. The 'swoosh' test avoids the injection of air and was originally performed using injection of a local anesthetic solution. A comparison was made between the 'whoosh' test and a modified 'swoosh' test using saline to identify the caudal epidural space in children. ⋯ The modified 'swoosh' test is as reliable as the 'whoosh' test and we recommend it for identification of the caudal epidural space in children as it avoids injection of air into the caudal space.
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Paediatric anaesthesia · Feb 2006
Comparative StudyPostoperative morphine consumption in children with sickle-cell disease.
Effective pain control is a primary goal in the perioperative management of patients with sickle-cell disease. To understand analgesic requirements better, the authors compared postoperative morphine consumption and pain scores in sickle and non-sickle children who had undergone laparoscopic cholecystectomy. ⋯ Sickle children self-administered more than double the amount of morphine, reported more intense pain, and remained hospitalized for more than twice as long as nonsickle children undergoing the same surgical procedure. These findings probably have a multifactorial origin, and might be attributable in part to alterations in pain perception, opioid pharmacokinetics, opioid tolerance, and psychosocial variables.
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Paediatric anaesthesia · Feb 2006
Case ReportsMonitoring cerebral oxygenation in a pediatric patient undergoing surgery for vascular ring.
Regional cerebral oxygenation can be monitored using near-infrared spectroscopy (NIRS). Inadequacy of collateral cerebral circulation and regional cerebral ischemia during cardiac and vascular surgery may be detected by the use of NIRS monitoring. We report a 2-year-old child who underwent surgical repair of vascular ring and subclavian reimplantation, where use of NIRS helped in early detection and timely intervention to prevent prolonged cerebral ischemia.
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Paediatric anaesthesia · Feb 2006
Psychological predictors of postoperative sleep in children undergoing outpatient surgery.
The purpose of this study was to examine psychological predictors of postoperative sleep in children undergoing outpatient surgery. ⋯ We conclude that psychological factors such as parental anxiety/worry and children's aggressive behavior are predictive of children's postoperative sleep above and beyond the influence of preoperative sleep patterns and postoperative pain.
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Paediatric anaesthesia · Feb 2006
Case ReportsThoracic epidural catheter in the management of a child with an anterior mediastinal mass: a case report and literature review.
We describe a case of an anterior mediastinal mass compressing the right main bronchus that required a biopsy through a thoracotomy incision. The anesthetic management of these patients is associated with several risks and challenges, including potential airway compression and cardiovascular collapse. Inhalation induction and maintenance of spontaneous respiration is recommended to preserve normal transpulmonary pressure gradient and improve flow through conducting airways. ⋯ The absolute risk of nerve injury and epidural hematoma for this procedure is unknown and hard to define in this patient population. We reviewed multiple studies and case reports addressing its safety and reported side effects. Finally, we emphasize that a thoracic epidural anesthesia is a reasonable choice that can be applied carefully in special situations even for children under general anesthesia.