Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2006
Case ReportsEpidural analgesia in the surgery of congenital tracheal stenosis: slide tracheoplasty on cardiopulmonary bypass.
Epidural analgesia in children is highly effective and safe; however, it has not enjoyed great popularity in surgery that requires cardiopulmonary bypass. A major concern is the possibility of damage to blood vessels with the epidural needle or catheter and epidural hematoma formation. ⋯ Improved pulmonary function, suppressed hormonal and metabolic stress responses, easy early tracheal extubation, and good analgesia and sedation that allows neurological examination to alert any possibles hidden complications, are the advantages. A dedicated medical team is essential in the perioperative management to achieve maximum benefit for these patients.
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Paediatric anaesthesia · Jun 2006
Case ReportsAcute pancreatitis after anesthesia with propofol in a child with glycogen storage disease type IA.
Glycogen storage disorder type 1A (GSD 1A) is an inherited disorder of glycogen metabolism characterized by fasting hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. These children have a higher risk of developing pancreatitis because of hypertriglyceridemia. Drug-induced pancreatitis accounts for a small proportion of cases of pancreatitis. ⋯ We present a 4-year-old girl with GSD 1A, who required tonsillectomy and adenoidectomy under general anesthesia. She developed acute pancreatitis in the postoperative period. Propofol was used as a general anesthetic and the postoperative incidence of pancreatitis is discussed.
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Paediatric anaesthesia · Jun 2006
Estimation of the parameters of cardiac function and of blood volume by arterial thermodilution in an infant animal model.
Experimental studies in adults and in animals have reported that estimation of the intracardiac volumes by arterial thermodilution is a more reliable method of blood volume estimation than pressure measurement. The objective of this study has been to analyze the values of cardiac function and blood volume in an infant animal model using the arterial thermodilution technique. ⋯ Intrathoracic and intracardiac volume values obtained by arterial thermodilution are lower than those considered normal in the adult, whereas the extravascular lung water is higher. These values must be taken into account when the PiCCO method is used in small children.
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There is no direct evidence of any major interaction between immunization and commonly used anesthetic agents and techniques in children, but it is possible that immunosuppression caused by anesthesia and surgery may lead to decreased vaccine effectiveness or an increased risk of complications. In addition, diagnostic difficulty may arise if a recently immunized child suffers from postoperative pyrexia or malaise. ⋯ There is a theoretical risk associated with anesthesia and surgery in recently immunized children. An international postal survey failed to find a consensus to this risk among pediatric anesthetists. From a risk management perspective, a review of the available evidence suggests that it would be prudent to adopt a cautious approach where the timing of elective surgery is discretionary. We therefore recommend that elective surgery and anesthesia should be postponed for 1 week after inactive vaccination and 3 weeks after live attenuated vaccination in children.