Anaesthetic Management Of Child Research Articles

Anesthetic Management of Children with Moyamoya Disease: A Case Report

Moyamoya disease is a cerebrovascular disease named after its angiographic image diagnosis, the etiology of which is not known and which is characterized by the chronic progressive stenosis of the main internal cerebral arteries that make up the Willis polygon. Ischemic symptoms are at the forefront in this disease which is more frequently observed in children. The definitive treatment of this disease is surgery and cerebral ischemia is a complication that can develop frequently during surgery. That is why, care during the perioperative period is very important. Perioperative anesthetic goal is to ensure the balance between the delivery of oxygen to the brain and the consumption of oxygen. The objective of this presentation is to discuss the anesthesia application in a child case who underwent encephalo-dura-arterio-cynangiozis (EDAS) surgery because of a 15 month moyamoya disease.

Anesthetic Management of a Child with Simpson-Golabi-Behmel Syndrome—A Case Report

Simpson-Golabi-Behmel syndrome (SGBS) is an X-linked recessive condition associated with pre-natal and postnatal overgrowth with visceral and skeletal anomalies. Abnormal airway anatomy may complicate the perioperative management of SGBS. However, there have been few reports regarding the anesthetic management of children with SGBS. We present the preoperative evalua-tion and intraoperative management of a 1.5-year-old child with SGBS undergoing plastic surgery for cleft palate. Sevoflurane-fentanyl anesthesia without a neuromuscular blocker was planned, due to the preoperative evaluation that airway management would be complicated by the macroglossia and short neck characteristic of SGBS. Fortunately, there was no difficulty in endotracheal intubation in the present patient due to careful planning of general anesthesia and meticulous airway management. Appropriate preoperative preparation for a difficult airway by the anesthe-siologist can ameliorate the difficulties inherent to the anesthetic management of patients with SGBS.

Anesthetic Management in Children with Congenital Lobar Emphysema

Background: The cause of congenital lobar emphysema (CLE) is unknown and characterized by hyperinflation of one or more lobes of the lung. The purpose of this retrospective study was to present the anesthetic management of children with congenital lobar emphysema (CLE) receiving treatment in our center.Methods: Ten children underwent CLE-related surgical treatment in our center between March 1995 and August 2014. All cases were diagnosed on the basis of postero-anterior chest radiography and computerized tomography. Age, sex, preoperative clinical findings, location of lesions, surgical and anesthetic procedures, results of anesthesia and duration of hospitalization were evaluated.Results: Six patients were male (60%) and four female (40%). Their ages ranged from 40 days to 6 years. Dyspnea was present in all cases and severe in four of them. Four patients had emphysema in the left upper lobe, three in the right middle lobe, one in the right upper lobe and one in the left lower lobe. All patients were extubated in the operating room and none experienced post-operative respiratory distress. Post-operative analgesia was provided via the previously placed intrapleural catheter. All the patients were extubated in the operation room. There was no post-operative mortality or morbidity.Conclusions: Anesthetic management of patients with CLE is challenging. In these patients the surgical team and anesthetists should collaborate closely and the time between anesthesia induction and thoracotomy should be as short as possible.

The safety of modern anesthesia for children with long QT syndrome.

Patients with long QT syndrome (LQTS) may experience a clinical spectrum of symptoms, ranging from asymptomatic, through presyncope, syncope, and aborted cardiac arrest, to sudden cardiac death. Arrhythmias in LQTS are often precipitated by autonomic changes. This patient population is believed to be at high risk for perioperative arrhythmia, specifically torsades de pointes (TdP), although this perception is largely based on limited literature that predates current anesthetic drugs and standards of perioperative monitoring. We present the largest multicenter review to date of anesthetic management in children with LQTS. We conducted a multicentered retrospective chart review of perioperative management of children with clinically diagnosed LQTS, aged 18 years or younger, who received general anesthesia (GA) between January 2005 and January 2010. Data from 8 institutions were collated in an anonymized database. One hundred three patients with LQTS underwent a total of 158 episodes of GA. The median (interquartile range) age and weight of the patients at the time of GA was 9 (3-15) years and 30.3 (15.4-54) kg, respectively. Surgery was LQTS-related in 81 (51%) GA episodes (including pacemaker, implantable cardioverter-defibrillator, and loop recorder insertions and revisions and lead extractions) and incidental in 77 (49%). β-blocker therapy was administered to 76% of patients on the day of surgery and 47% received sedative premedication. Nineteen percent of patients received total IV anesthesia, 30% received total inhaled anesthesia, and the remaining 51% received a combination. No patient received droperidol. There were 5 perioperative episodes of TdP, all in neonates or infants, all in surgery that was LQTS-related, and none of which was overtly attributable to anesthetic regimen. Thus the incidence (95% confidence interval) of perioperative TdP in incidental versus LQTS-related surgery was 0/77 (0%; 0%-5%) vs 5/81 (6.2%; 2%-14%). With optimized perioperative management, modern anesthesia for incidental surgery in patients with LQTS is safer than anecdotal case report literature might suggest. Our series suggests that the risk of perioperative TdP is concentrated in neonates and infants requiring urgent interventions after failed first-line management of LQTS.

The anesthetic management for children with upper respiratory tract infections

Background Upper respiratory tract infections (URIs) frequently occur in childhood,and most infections are viral origin.For those children with URIs,the anesthetic risk is increased because of the increasing perioperative respiratory adverse events.The choice of cancel surgery for children with URIs or not and how long to postpone the procedure are still a dilemma for anesthesiologists.Objective This article summarized recent studies about the anesthesia in children with URIs in order to provide theoretical basis of clinical practice for anesthesiologists.Content This review involved the pathophysiological mechanisms of URIs,risk factors for perioperative respiratory adverse events in children with URIs,preoperative assessment,management of anesthesia,as well as prevention and treatment of frequently observed adverse events.Trend With the increase of pediatric operations,we should decide the right moment of elective surgery for children with URIs. Key words: Upper respiratory tract infections; Pediatric anesthesia; Perioperation; Complications

G351 Outcome of non-cardiac surgery in children with congenital heart disease performed outside a cardiac centre

BackgroundApproximately 30% of children with congenital heart disease (CHD) require surgery within the first year of life for extracardiac anomalies. CHD increases short- and long-term mortality risks for non-cardiovascular procedures1....

Anesthetic Management of Children with Upper Respiratory Tract Infections

Abstract Introduction We developed this resource for anesthesia faculty to train third- and fourth-year anesthesiology residents before they begin their pediatric rotation as well as medical studen...

The effect of rocuronium and sugammadex on neuromuscular blockade in a child with congenital myotonic dystrophy type 1

Myotonic dystrophy type 1 (MD1) is the commonest muscular dystrophy found in adults; however, it may present in the neonatal period with hypotonia, talipes, poor feeding, and respiratory failure. Inheritance is autosomal dominant with a defect in the DMPK gene found on the long arm of chromosome 19 with variable expansion of the cytosine-thymine-guanine (CTG) triplet repeat. A 14-month-old boy with congenital MD type 1 was scheduled for percutaneous endoscopic gastrostomy (PEG) insertion, orchidopexy, and division of tongue-tie. Following induction of anesthesia, acceleromyography was used to monitor neuromuscular function. This revealed a very rapid onset of profound neuromuscular block which lasted significantly longer than would be expected in a child without MD1. Sugammadex reversed the block rapidly. The anesthetic management of children with MD1 has been well described but not the acceleromyographic monitored use of rocuronium and its subsequent reversal with the new cyclodextrin sugammadex.

Anaesthetic management of children with congenital heart disease for non-cardiac surgery

Congenital heart disease (CHD) is the most common birth defect, occurring in approximately one in 125 live births. Advances in medical care have led to 90% of these children surviving to adulthood. Children with CHD are subject to the same childhood illnesses as healthy children and therefore present to their local hospital requiring both elective and emergency surgery. In general, children with CHD undergoing non-cardiac surgery have an increased risk of morbidity, perioperative cardiac arrest, and a higher 30 day mortality. – 6 However, the complexity of cardiac defects and the variety of non-cardiac surgery make it impossible to generalize. A 9-yr-old child with a repaired atrial septal defect (ASD) who requires an emergency appendicectomy presents minimal risk; yet, a 12-yr -old with a failing single-ventricle circulation for the same operation presents a significant challenge even to the most experienced paediatric cardiac anaesthetist.

Anesthetic management in children with Hurler′s syndrome undergoing emergency ventriculoperitoneal shunt surgery

Mucopolysaccharidoses (MPSs) are a group of lysosomal storage disorder characterized by progressive multiorgan accumulation of glycosaminoglycans. Patients with MPS I (Hurler's syndrome) present as one of the most difficult airway problems to be managed by anesthesiologists. Hydrocephalus with increased intracranial pressure is a frequent complication seen in these patients. The rarity of the syndrome accounts for the small number of case reports and anecdotal information on the intracranial manifestations of this syndrome. We describe the successful anesthetic management of 2 children with Hurler's syndrome who underwent ventriculoperitoneal shunt surgery for acute hydrocephalus.

General Anesthesia for Children With Severe Heart Failure

Severe heart failure in children is uncommon. The anesthetic management of children with this condition is challenging. The authors aimed to identify the frequency with which anesthesia for short noncardiac surgical procedures or investigations was complicated by life-threatening hemodynamic instability and to describe the anesthetic techniques used. This study retrospectively reviewed the anesthetic charts and notes of children admitted acutely with a diagnosis of severe heart failure (fractional shortening of 15% or less) who received general anesthesia for noncardiac surgical or diagnostic interventions during the 3-year period from September 2005 to September 2008. In this study, 21 children received a total of 28 general anesthetics. Two patients (10%) experienced a cardiac arrest, and both required unplanned admission to the authors' pediatric intensive care unit (PICU) postoperatively. A variety of anesthetic techniques was used. In 27 (96%) of the 28 cases, perioperative inotropic support was required. General anesthesia for children with severe heart failure is associated with a significant complication rate and should be administered by anesthetists familiar with managing all aspects of circulatory support for children in an appropriate setting.

“Pratap JN, Wilmhurst S: Anesthetic management of children with in situ Berlin Heart Excor: Pediatric Anesthesia: 2010: 20: 812-820”

“Pratap JN, Wilmhurst S: Anesthetic management of children with in situ Berlin Heart Excor: Pediatric Anesthesia: 2010: 20: 812-820”

Anesthetic management of children with in situ Berlin Heart EXCOR™

Modern mechanical devices can support children with severely impaired cardiac function until a donor heart is found for transplantation or native function recovers. Pediatric heart transplantation offers a good chance of survival with a high quality of life to individuals with limited life expectancy and/or severe limitation to daily activities, but many die on the transplant list or are not listed because of a shortage of donor organs. In recent cohorts, there is better outcome when ventricular assist devices (VADs) rather than extracorporeal membrane oxygenation are used as a 'bridge' to transplantation. Anesthesiologists working in centers where VADs are available may increasingly be asked to provide anesthesia to children with such devices in situ, including procedures outside the cardiac surgical operating room. The Berlin Heart EXCOR device is a VAD system with increasing popularity in pediatric practice and has system components available in sizes suitable even for neonates. Postimplantation considerations include hemodynamics, thromboembolic complications and their prevention by anticoagulation, antimicrobial therapy, and the rehabilitation and mobilization of recipients. VAD-specific emergencies must be recognized and managed appropriately by anesthesiologists looking after Berlin Heart recipients. These include malignant dysrhythmias, sudden loss of VAD output, air or clot embolism, and sudden cyanosis. Provision of anesthesia for patients with an in situ Berlin Heart requires attention to particular considerations in preoperative assessment, induction, maintenance, and postoperative care.

Anesthetic management of children with an anterior mediastinal mass

Study Objective To review the anesthetic management and perioperative course of children with an anterior mediastinal mass. Design Retrospective review. Setting University-affiliated children's hospital. Measurements The records of 46 children presenting with an anterior mediastinal mass between October 1, 1998 and Octobber 1, 2006 were studied. Preoperative symptoms, diagnostic imaging and physical examination findings, anesthetic techniques, and perioperative complications were recorded. Main Results Spontaneous ventilation was maintained in 21 of 46 cases. Five patients had mild intraoperative complications, including upper airway obstruction, mild oxyhemoglobin desaturation, wheezing, partial airway obstruction, and a pneumothorax after mediastinal mass biopsy. There were no serious complications or perioperative deaths. Conclusions Children with a symptomatic anterior mediastinal mass underwent general anesthesia without serious complications. Spontaneous ventilation was preferred for all patients with severe airway compression.

Case Report: Langerhans Cell Histiocytosis Presenting as Massive Cervical Adenopathy and Retropharyngeal Thickening

To demonstrate the importance of chest radiography and special anesthetic management in children with massive cervical adenopathy. Case report of an 8-month-old infant who presented to the emergency department with fever, drooling, and massive cervical and mediastinal adenopathy. Safe anesthetic management allowed for cervical lymph node biopsy, which showed Langerhans cell histiocytosis. Chest imaging and special anesthetic techniques (intravenous anesthesia and positioning in the lateral decubitus position) should be considered for children with massive cervical and mediastinal adenopathy. Interdisciplinary airway, radiographic, and anesthetic management is recommended for children who present with massive and cervical and mediastinal adenopathy.

Dental and anaesthetic management of children with dystrophic epidermolysis bullosa

Epidermolysis bullosa (EB) is a genetic disease associated with fragility and bullous lesions of the skin and mucous membranes. There are various patterns of inheritance and histopathology. The disease is associated with systemic and oral manifestations, among which may be dental decay necessitating oral rehabilitation. General anaesthesia is frequently required for oral rehabilitation in children with dystrophic EB. Paediatric dentists should be aware of the implications of dystrophic EB for dental and anaesthetic management. Two siblings with moderate to severe systemic and oral manifestations of dystrophic EB requiring extensive oral rehabilitation for rampant decay are described, including special anaesthetic techniques required for airway management and maintenance of skin integrity. Dystrophic EB is a rare genetic disorder in which vesiculobullous lesions occur with erosions and scarring of cutaneous and extracutaneous surfaces in the oral cavity. Poor oral hygiene results from efforts to avoid mucosal trauma, resulting in decay. The comprehensive care of children with dystrophic EB impacts not only dental management but anaesthesia administration as well.

Anesthetic management of children with Beckwith-Wiedemann syndrome : Two cases report.

Beckwith-Wiedemann syndrome consists of various abnormalities, including macroglossia, visceromegaly, omphalocele, and neonatal hypoglycemia. These abnormalities frequently require operative correction and careful anesthetic management. Principal problems associated with anesthetic management in this syndrome are congenital heart disease, hypoglycemia, and difficult airway combined with macroglossia. We report two cases of general anesthetic management in children with Beckwith-Wiedemann syndrome.

Anesthetic Management of Children With Pulmonary Arterial Hypertension

Survey of Anesthesiology: October 2008 - Volume 52 - Issue 5 - p 229-230 doi: 10.1097/SA.0b013e318185463d

The anaesthetic management of children with anterior mediastinal masses

Children with anterior mediastinal masses may experience serious complications during general anaesthesia. We retrospectively surveyed the records of children with an anterior mediastinal mass who had been admitted to our hospital over a 7 year period. The presence of pre-operative symptoms or signs, findings of any special investigations performed and the anaesthetic outcome were noted. All radiological investigations were studied and tracheal compression measured. The majority of patients presented with severe clinical signs. There was a poor relationship between clinical signs and size of tumour or tracheal compression on CT scan. Corticosteroids were used prior to diagnosis in 33% of patients, all of whom were considered high risk. A clear diagnosis was made in 95% of these patients. The overall complication rate was 20% and 5% of patients had a serious complication related to anaesthesia. Stridor was the only sign that predicted an anaesthetic complication. Peri-operative respiratory complications were confined to patients with an isolated tracheal cross-sectional area less than 30% normal or less than 70% and associated with bronchial compression.

Anesthetic management of children with pulmonary arterial hypertension

Anesthetic management of children with pulmonary arterial hypertension