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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 9 (1999), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Adrenocortical tumours in children are rare. They produce many changes in haemodynamics and blood chemistry due to hormones of the adrenal cortex. The details of perioperative management and the need for perioperative steroid supplementation are discussed.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 9 (1999), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The Cole tracheal tube is designed for use in neonates. Subglottic stenosis is a recognized complication of prolonged use of the tube. We report a case of tracheomalacia as a further complication of prolonged use of the tube. A 4-month-old infant with a history of repeated failed extubation and multiple medical problems was found to have an unusual region of severe inspiratory collapse localized to the upper 1 cm of the trachea. This was felt to be the result of pressure from the shoulder of the Cole tube which had been used for prolonged intubation. A tracheostomy was performed to bypass the collapse, but the infant subsequently died due to other medical problems.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We compared patient outcomes for propofol vs sevoflurane with the laryngeal mask airway (LMA) using either spontaneous breathing (SB) or pressure controlled ventilation (PCV). One hundred and twenty children undergoing minor surgery below the umbilicus were randomly assigned to receive either (1) propofol 3 mg·kg−1 followed by a maintenance infusion of 5 mg·kg−1·h−1, or (2) induction with sevoflurane 7% followed by maintenance with 1.7%. Following LMA insertion, patients were given atracurium and underwent PCV if surgery was expected to last ≥30 min. The following assessments were made: time to LMA insertion/removal, airway problems, cardiorespiratory effects and recovery characteristics. The first time insertion success rates were similar, but insertion time was shorter with sevoflurane (115±67 s vs 252±107 s, P 〈 0.0001). One patient coughed during placement, but there were no other problems during any phase of anaesthesia in any group. Heart rate was higher in the sevoflurane group following insertion, during maintenance and emergence (all P 〈 0.03). There were no differences in blood pressure and oxygen saturation among groups PECO2 in the SB group was unaffected by the agent used. Emergence was more rapid (232±104 s vs 348±127 s, P 〈 0.0001) and postoperative agitation more common (15%vs 0%, P=0.02) with sevoflurane. There were no differences in the Aldrete scores among groups. Patient outcome was similar for the SB and PCV groups. We concluded that the techniques described here using propofol and sevoflurane are equally suitable for induction and maintenance of anaesthesia with the LMA in children undergoing minor surgery below the umbilicus. Emergence is more rapid, but postoperative agitation more common with sevoflurane.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Misplacement of a central venous catheter may lead to myocardial perforation and dysrhythmia. Atrial electrocardiography (ECG) through a saline column is an effective but complex method to determine the accurate location of catheters. We evaluated a simplified variant of this technique using the guidewire as an internal electrode in 23 children (5–16 years old) undergoing spinal surgery. Catheters were placed using a Seldinger technique after jugular or subclavian venous puncture. Each time the operator recognized the atrial signal, the catheter was found to be correctly placed on the chest radiograph (20/23). In three patients, the atrial signal was not obtained. A technical error was responsible in one case whereas the two others were related to aberrant migrations of the catheter either into a subclavian vein or into the pleura. In this latter case, the complication was unrecognized on the first radiograph despite malposition having been predicted by atrial ECG. We conclude that a method using atrial ECG guidance is sensitive and specific, and may be an alternative to the classical chest radiograph to detect accurate placement of central venous catheters in children.
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 9 (1999), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 9 (1999), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Unilateral epidural anaesthesia occurring in an infant is reported. An epidurogram revealed the presence of a midline structure suggestive of the dorsomedian septum. Epidural anatomy is reviewed and implications for threading epidural catheters in infants are discussed.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 9 (1999), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A critical incident is reported in which ribavirin administered from a small particle aerosol generator (SPAG) into a ventilator circuit became deposited around the humidifier temperature probe with the consequence that it became thermally insulated. This caused overheating of the humidifier and the potential for thermal injury to the respiratory tract. The circuit for aerosolized ribavirin administration is described and modifications suggested to avoid crystal precipitation within the circuit.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 9 (1999), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The physiological basis for the use of helium relates to the relationship described by Poiseuille. During turbulent gas flow, the factors determining the resistance to flow include the density of gas as well as the length and the radius of a tube. While it may not be possible to readily change the latter two, altering the density of the gas is possible by using helium instead of nitrogen. A helium–oxygen combination has been used most commonly to improve air exchange in patients with upper airway obstruction. Anecdotal reports also suggest the beneficial effects of helium during mechanical ventilation in patients with status asthmaticus, hyaline membrane disease, and other pulmonary parenchymal disorders. To date, the clinical reports have utilized helium only with conventional mechanical ventilation. We present a child whose progressive respiratory failure was treated by using high-frequency jet ventilation with a combination of helium and oxygen. The techniques for the delivery of helium and oxygen through the jet ventilator are discussed.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Tracheal intubation through a laryngeal mask airway is one option for securing an airway in the patient with a difficult airway. A variety of techniques and equipment have been used to stabilize the position of the tracheal tube while removing the laryngeal mask airway. We have shown that if a fibreoptic bronchoscope is used to place an tracheal tube through a laryngeal mask in neonates, additional equipment is not needed to remove the laryngeal mask airway without endangering tracheal tube placement. This is possible even in small neonates.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We undertook the anaesthetic management of two children with Hecht–Beals syndrome for orthopaedic surgery under general anaesthesia. Both patients had arachnodactyly, kyphoscoliosis, and multiple congenital joint contractures, but limited mandible excursion was not obvious preoperatively in either, although mental retardation made it difficult for them to cooperate with mouth examination. They had no apparent difficulties with their mouths in daily activities. The anaesthesia records of one patient showed that intubation had been difficult in an earlier procedure. The other patient also had a history of difficult intubation, with slight tearing of the corners of her mouth during an intubation procedure. During slow induction of general anaesthesia with sevoflurane, face mask ventilation was easily performed. We attempted to visualize the larynx under anaesthesia with muscle relaxation, but we were unsuccessful because of the limited mouth opening. After several trials, blind oral intubations were fortunately successful in both patients. There were no postoperative problems with the airway.
    Type of Medium: Electronic Resource
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