Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind, controlled study and Preoperative Implementation of Transverse Thoracic Muscle Plane Block and Rectus Sheath Block Combination for Pediatric Cardiac Surgery.
These two single centre studies investigated the effect of Transversus/Transverse Thoracis/Thoracic Muscle Plane (TTMP) blocks, placed pre-incision in cardiac cases done via sternotomy, on post-operative opioid consumption. The rationale for adding the Rectus Sheath Block (RSB) in the second paper was to relieve pain associated with the chest drains. TTM plane blocks provide sensory cover […]
An update on the management of PONV in a pediatric patient.
This article provides a detailed review of postoperative nausea and vomiting (PONV) in the paediatric population, focusing on risk stratification, prophylactic therapies and strategies for management of PONV. The aim was to serve as an update of changes in these areas over the last decade. Given the high incidence of PONV in children, single agent […]
The safety of paediatric surgery between COVID-19 surges: an observational study.
In what is likely to be a protracted global pandemic, there is a need to develop an evidence base to guide re-initiation and continuation of elective paediatric surgery, as well as robust decision making surrounding non-elective surgery where risk benefit ratios must be carefully evaluated. Summary This study sought to describe perioperative patient outcomes in […]
Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia – A prospective observational study.
Summary This is small prospective study examining the effect of clear fluid intake on gastric antral area (GAA), which is used to represent gastric emptying. 26 children on elective surgical lists were recruited at a single university hospital in Germany. They had an initial ultrasound to measure their gastric antral area. The children were given […]
Reducing pediatric exposure to environmental tobacco smoke: The effects of pediatric exposure to environmental tobacco smoke and the role of pediatric perioperative care.
Summary This article reviews the problem of exposure to environmental tobacco smoke (ETS) for paediatric patients and discusses our potential as anaesthetists to help make behavioural change. The risks of exposure to ETS include an increased rate of SIDS, bacterial meningitis, lower respiratory tract infections and presentations with wheeze or asthma. Perioperatively, exposure to ETS […]
Comprehensive Risk Assessment of Morbidity in Pediatric Patients Undergoing Noncardiac Surgery: An Institutional Experience.
Method Data for all noncardiac paediatric surgical patients at Boston Children’s Hospital was collected retrospectively over a defined time period (derivation cohort of 16,724 cases and validation dataset of 9043 cases). Primary outcome was a composite morbidity: unplanned transfer to an intensive care unit within 72 hours, acute respiratory failure requiring intubation, postoperative non-invasive or […]
Implementation of a spinal anesthesia and sedation protocol that reliably prolongs infant spinal anesthesia: Case series of 102 infants who received spinal anesthesia for urologic surgery.
Aim and method A retrospective case study on infants aged 1 to 14 months having urologic surgery on external male genitalia describing this institution’s spinal anaesthesia and sedation protocol and comparing this with their own unmatched historical controls receiving general anaesthesia. Results 102 patients received spinal anaesthesia for urologic surgery and were compared to 128 who […]
Blood pressure in Danish children during general anaesthesia: Hypotension in a paediatric population observational (HIPPO) study.
Prospective observational multicentre assessing blood pressure in 726 Danish children aged 0-12 years during general anaesthesia, measured by oscillometry or invasively (excluding premature infants and children having cardiothoracic surgery). Primary outcome measured was Mean Arterial Pressure (MAP): Not measured at any point during anaesthesia in 81 patients (11%), predominantly in the youngest age groups. A […]
Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology.
The increase in safety in anaesthesia is at least partly attributable to the improvement of intraoperative monitoring. This review examines the literature to ascertain the status of development and evidence around continuous, non-invasive monitoring modalities used in the paediatric population undergoing anaesthesia for non-cardiac surgery. The modalities examined include haemodynamic monitoring (continuous non-invasive blood pressure), […]
De-mystifying the “Mixifusor”.
Total Intravenous Anaesthesia (TIVA) using a combination of propofol and remifentanil in the same syringe has become a common and accepted technique in Paediatric Anaesthesia. This commentary outlines a recent publication in Pediatric Anesthesia from a group of UK paediatric anaesthetists who performed a service evaluation assessing the safety and efficacy of a propofol/remifentanil mixing […]