Paediatric anaesthesia
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Paediatric anaesthesia · May 2003
The dynostatic algorithm accurately calculates alveolar pressure on-line during ventilator treatment in children.
Monitoring of respiratory mechanics during ventilator treatment in paediatric intensive care is currently based on pressure and flow measurements in the ventilator or at the Y-piece. The characteristics of the tracheal tube will modify the pressures affecting the airways and alveoli in an unpredictable manner. The dynostatic algorithm (DSA), based on a one-compartment lung model, calculates the alveolar pressure during on-going ventilation. The DSA is based on accurate measurement of tracheal pressure. The purpose of this study was to test the validity of the DSA in a paediatric lung model and to apply the concept in an observational clinical study in children. ⋯ Fibreoptic measurement of tracheal pressure in combination with the dynostatic calculation of alveolar pressure provides an on-line monitoring of the effects of ventilatory mode in terms of volume-dependent compliance, tracheal peak pressure and true positive end expiratory pressure.
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The dorsal penile nerve block (DPNB) is a common form of regional anaesthesia for circumcisions in children. The safety of this block has been questioned following several case reports of potentially serious complications. ⋯ We feel that the DPNB is a safe technique for circumcisions in infants and children.
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Paediatric anaesthesia · May 2003
Case ReportsLife threatening subcutaneous emphysema following surgical repair of tracheocutaneous fistula.
A 9-year-old male child posted for closure of tracheocutaneous fistula developed extensive subcutaneous emphysema resulting in acute respiratory distress immediately after transfer to recovery room. The clinical management, precautions and other complications of closure of tracheocutaneous fistula are discussed.
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Paediatric anaesthesia · May 2003
Case ReportsFlumazenil is innocuous in a paroxysmal supraventricular tachycardia and radiofrequency ablation: a paediatric case report and review of the literature.
The efficacy and safety of flumazenil in reversing midazolam-induced paradoxical reaction in a child suffering from paroxysmal supraventricular tachycardia (PSVT) and undergoing radiofrequency ablation procedure has not been described before. We report a boy who had suffered for years from poorly controlled PSVT because of noncompliance to medications and was being sedated by midazolam and morphine (4 mg each) and prepared for radiofrequency ablation when he began attempting to speak, writhing and flailing his arms, for which physical restraint was required. We also review the current knowledge on the subject. ⋯ After that procedure, he awoke calm and pain free with no recollection of the aggressive episode. He was kept for 24 h in an intermediate cardiac care unit and was then discharged home. This apparent first report on the efficacious use of flumazenil for the reversal of a paradoxical reaction to midazolam during an electrophysiological study suggests that it neither induces abnormal heart rate nor interferes with the electrophysiological study or the ablation procedure.