Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2003
Case ReportsAnaesthesia for a child with Walker-Warburg syndrome.
Walker-Warburg syndrome (WWS) is a rare lethal autosomal recessive disorder manifested by characteristic central nervous system and eye malformations. We have not come across reports of general anaesthesia in a child with WWS in the English literature. ⋯ The child also had bilateral cleft lip, cleft palate, urogenital malformation and hydronephrosis. Despite many potential anaesthesia concerns, anaesthesia was uneventful in this child.
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Paediatric anaesthesia · Sep 2003
Case ReportsOcclusion of the right subclavian artery after insertion of a transoesophageal echocardiography probe in a neonate.
We present a case of occlusion of the right arm's blood supply in a neonate with a lusorian artery, a rare anomaly of the right subclavian artery, after insertion of a transoesophageal echocardiography (TOE) probe and discuss the impact of a lusorian artery on intraoperative TOE monitoring.
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Paediatric anaesthesia · Sep 2003
Case ReportsAnaesthetic consequences for a child with complex multilevel airway obstruction -- recommendations for avoiding life-threatening sequelae.
A boy with a suspected lymphoid malignancy presented with gross head and neck lymphadenopathy, a middle mediastinal mass, and rapidly worsening airway obstruction. General anaesthesia was required for definitive histopathological diagnosis. ⋯ Risk assessment, and the impact of anaesthesia on pharyngeal neuromechanical function and mediastinal masses are discussed. Caution with volatile anaesthetic agents is recommended in the patient with an inherently unstable pharynx and/or trachea, in whom airway patency relies on a spontaneously breathing technique and intact airway reflexes.
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Paediatric anaesthesia · Sep 2003
Efficacy and safety of continuous intravenous infusion of remifentanil in preterm infants undergoing laser therapy in retinopathy of prematurity: clinical experience.
Preterm infants often require surgery. As experimental evidence suggests that premature infants may experience pain and this could even result in fatal complications, the anaesthesiologist must face problems related to lowbirth weight, high risk of hypothermia, concomitant pulmonary disease and metabolic and receptor immaturity. Recently remifentanil has been considered an optimal analgesic drug in a preterm infant undergoing mechanical ventilation and frequent surgical manoeuvres, but no clinical studies have been reported in the literature. The aim of our study was to evaluate the efficacy of a continuous intravenous infusion of remifentanil in premature infants undergoing laser therapy for retinopathy of prematurity (ROP). ⋯ A continuous infusion of remifentanil allowed optimal control of surgical stress and a return to preoperative status and ventilatory settings without side-effects.
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Estimation of the correct depth of insertion of a tracheal tube (TT) in children is extremely important. Insertion of an excessive length may result in endobronchial intubation while an inadequate length of insertion may lead to accidental extubation. ⋯ For optimal placement we can rely on various formulae and manufacturers' markings on the TTs. Clinical judgement, however, remains the cornerstone of optimal placement.