Postoperative Care Of Children Research Articles

Assessment of Nurses’ Performance Regarding Postoperative Care of Children with Cardiac Surgery

Assessment of Nurses’ Performance Regarding Postoperative Care of Children with Cardiac Surgery

Postoperative care for children after ventilation tube surgery: A qualitative study of parents' experiences over time in Norway

ObjectiveTo explore the parents' experience of postoperative care during the first two years after ventilation tube (VT) surgery in a setting where the check-ups were conducted either by otolaryngologists or their regular general practitioner (GP). Methods55 individual interviews of parents at up to three different time points (<1, 6, and 24 months) after their child received VT-surgery, analyzed with reflexive thematic analysis. Results1. Parents' trust in the healthcare system and responsibility for booking check-ups. Nearly all parents seemed to maintain trust in the healthcare system and felt safeguarded regardless of where they had their check-ups. Still, they would prefer otolaryngologist-led care if they could choose from the top shelf. They took responsibility for seeking healthcare when needed and experienced that their GP referred their child if necessary. 2. As time goes by, parental worries are reduced. Most experienced that their child stayed healthy after surgery, and their demand for postoperative check-ups decreased. For the children who faced ongoing issues, most parents experienced that their child's challenges had been handled professionally, and they became less worried. Some parents attribute other diagnoses to their child's behavior or speech delays, refining their understanding of their child's condition. 3. The desire for closure. Parents sought reassurance about their child's recovery and desired professional evaluation for closure. While some advocated for audiometry, others trusted their own assessments about hearing. The transition to school marked a pivotal time, prompting concerns about social inclusion. ConclusionOverall, the parents experienced that their child was safeguarded irrespective of whether postoperative care was provided by otolaryngologists or GPs. Still, many preferred check-ups by an otolaryngologist. The parental worries and focus on the VTs were reduced as time went by after surgery, but even so many wanted a ‘closure’ to be sure that the hearing was as good as it could be and the VTs rejected. We advocate for an individualized approach to postoperative care that addresses specific medical needs without imposing unnecessary check-ups.

Beyond surgery: Pre- and post-operative care in children with ankyloglossia.

Surgical intervention for tongue-tie, or ankyloglossia performed by paediatric dentists can alleviate symptoms and improve functional abilities in infants and children. Despite widespread practice, there are currently no established clinical guidelines or consistent approaches for pre- and post-operative care of children. The aim of this study was to explore approaches to pre- and post-operative care for children with ankyloglossia having frenum surgery. A scoping review of peer-reviewed articles in four electronic databases was conducted. Intervention studies that reported on pre- or post-operative regimens for infants, children and adolescents (0 to 18 years) with a diagnosis of tongue-tie or ankyloglossia, who had surgical intervention such as frenotomy or frenectomy, were included and quality assessments performed. Twenty-three studies were identified, with seven studies incorporating both pre- and post-operative care, and 16 studies focussing solely on post-operative care. Tongue exercises were commonly prescribed, and only three studies examined the relationship between post-operative care and recovery outcomes. Considerable variability existed in study design, prescribed care and outcome measures. There was substantial variability in pre- and post-operative care protocols, including dosage, frequency and duration of exercises and other care regimens for infants and children having frenum surgery. Further research is needed to determine the most effective course of pre- and post-operative care for children undergoing frenum surgery.

Effectiveness of an Instructional Module on Knowledge and Anxiety of Caregivers of Children Undergoing Cardiac Catheterization – An Experimental Study

Background: Diagnosis of cardiovascular disorders in children is a very stressful time for the entire family. During this period family caregivers are anxious about their child’s condition. At this time, nurses play an important role to educate the parents or caregivers about the child’s health, procedure that has to be performed, and pre- and post-operative care after procedure. This study was conducted to assess the effectiveness of an “instructional module” on knowledge and anxiety of caregivers of children undergoing cardiac catheterization. Materials and Methods: Caregivers of children with congenital heart disease were randomly enrolled in two groups with 30 caregivers in each control and experimental group. Preoperative knowledge and anxiety in both the groups were assessed by a self-structured questionnaire and the State-Trait Anxiety Inventory. An instructional module in the form of a booklet regarding cardiac catheterization was developed and administered to the experimental group while the control group received routine care instuctions. Caregivers’ postintervention knowledge was assessed by a structured knowledge questionnaire. Results: Median knowledge score was 2 (2–2) in the control group and 2 (1–2) in the experimental group among caregivers of the children during preintervention phase. The median anxiety score of the caregivers of children underwent cardiac catheterization during preintervention phase was 57.50 (47–61) in the control group and 53 (47.75–56) in the experimental group. The results revealed that there was a significant improvement in knowledge score regarding cardiac catheterization procedure and also there was reduction in the level of anxiety among caregivers in the postintervention experimental group (P &lt; 0.001). Conclusion: The study suggests that the “instructional module” is effective in reducing the anxiety and improving the knowledge levels of caregivers regarding the preoperative and postoperative care of children who underwent cardiac catheterization.

Features of postoperative care for children with lymphangioma

Features of postoperative care for children with lymphangioma

A systematic review of the evidence supporting post-operative medication use in congenital heart disease.

Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass. We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass. We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety. In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

Pre and Post-Operative Care of Children with Cleft Lip and Palate

Pre and Post-Operative Care of Children with Cleft Lip and Palate

Establishing Guidelines for Safe and Effective Treatment of Pediatric Sarcoma Survivors: A Mission of the Pediatric Oncology Special Interest Group

Physical therapists have long been involved in the postoperative care of children with a diagnosis of bone and soft-tissue sarcoma. The International Classification of Functioning, Disability and Health model provides a guide to identify impairments, performance limitations, and participation restrictions in this population. The Pediatric Oncology Special Interest Group of the APTA Oncology Section is determined to use this information to facilitate improvements in the treatment of these children. Specifically, a Limb Sparing Committee has been formed to more clearly develop and define the role of physical therapy in the management of pediatric patients with sarcoma.

Post-operative sleep quality and pain in children and adolescents

Background Post-operative sleep is one of the major aspects for rehabilitation and recovery after a surgical intervention. Sleep problems after surgery are common and are mainly triggered by the body’s stress response to the trauma of surgery. This places high demands on the pre and post-operative care of children and adolescents. Our study examines the association between sleep and pain in young patients (11-19 years) during post-operative care.

Pediatric cardiac intensive care at the King Abdulaziz Cardiac Center

Pediatric cardiac intensive care is a subspecialty area that has evolved to address the special need for expert in post-operative care of children requiring heart surgery and interventions. Many hospitals have dedicated units to manage these patients. The ideal model for this care is a subject of debate. This brief paper describes evolution of this program at King AbdulAziz Medical City over the last 12 years.

Adrenocortical function in the postoperative pediatric cardiac surgical patient

Corticosteroids are frequently used in the postoperative care of children with congenital heart disease. This review describes the function of the adrenocortical axis in this population and the effects of corticosteroids on cardiovascular function. In addition, it examines the diagnosis of adrenal insufficiency in this population and provides an overview of recent studies on the use of steroids in treating hemodynamic instability in these children. Corticosteroids improve hemodynamic parameters in children with shock following congenital heart surgery. This improvement may be due to treatment of adrenal insufficiency or from direct cardiovascular effects of corticosteroids. The diagnosis of adrenal insufficiency in this population is challenging as low cortisol levels do not consistently correlate with adverse outcomes. Because of the lack of evidence delineating what the normal adrenocortical function is in this population, cortisol levels alone are not sufficient to justify treating with steroids in this population. Corticosteroids are beneficial in improving hemodynamics in children with shock after congenital heart surgery, but the adverse effects of the therapy in this context are not fully known. Prospective trials are necessary to clarify which patients may benefit from steroid therapy and to examine long-term effects of steroids.

Surgical management of muscular trabecular ventricular septal defects

Despite recent advances in diagnosis, surgical techniques, and postoperative care of children with congenital cardiac defects, muscular trabecular ventricular septal defects (VSDs) are still a therapeutic challenge. Among these defects, it is more difficult to achieve secure and complete closure of low trabecular or apical VSDs because of the presence of numerous muscular trabeculations overlying the defect. When they are associated with "Swiss cheese"-type of VSDs, it is almost impossible to visualize the true edges of the defect through the transatrial approach. Consequently, there remains an unacceptable incidence of mortality and morbidity when compared to those that occur with closure of the usual perimembranous VSD. Although various techniques for closure of these difficult trabecular VSDs have been attempted, there is still a significant incidence of complications in the surgical management of trabecular VSDs, mostly significant residual shunts, a need for multiple reoperations, and severe left ventricular dysfunction. This article describes the anatomical details and classification of muscular trabecular VSDs. It also reviews several techniques currently utilized and their outcomes.

Hereditary spherocytosis and partial splenectomy in children: review of surgical technique and the role of imaging

The risks associated with total splenectomy, including overwhelming postsplenectomy infection, have led to an interest in the use of partial splenectomy as an alternative surgical option for children with congenital hemolytic anemias and hypersplenism. Partial splenectomy, a procedure designed to remove enough spleen to improve anemia and avoid complications of splenic sequestration while preserving splenic function, has shown promise in children. Radiologic imaging is essential for the preoperative evaluation and postoperative care for children undergoing partial splenectomy and offers a broad range of critical clinical information essential for care of these complex children. It is imperative for radiologists involved in the care of these children to be familiar with the surgical technique and imaging options for these procedures. This article reviews the surgical technique as well as the current status of various diagnostic imaging options used for children undergoing partial splenectomy, highlighting technical aspects and specific clinical information obtained by each modality.

Outcomes following thoracoabdominal resection of neuroblastoma

To evaluate the intraoperative and postoperative care of children following thoracoabdominal resection of neuroblastoma. Retrospective chart review. Pediatric intensive care unit (PICU) of major pediatric cancer center. Eighty-eight patients undergoing thoracoabdominal resection of neuroblastoma over a 6-year period. None. Demographic and clinical data were collected, including: length of PICU stay (LOS-P), duration of mechanical ventilation (MVD), mean arterial blood pressure, central venous pressure (CVP), fluid management, pressor use, and mortality. Twenty-one patients required inotropic/vasopressors support pressors following surgery. Patients who received pressors had longer operative times (p < .05) and received less intraoperative fluid (p < .05), but had the same estimated blood loss and urine output as nonpressor (NP) patients. Among the patients who received pressors, the MVD was 57 hrs, compared with 24 hrs in the NP group (p < .01). The LOS-P was 118 hours in the pressors group, vs. 69 hrs in the NP group (p < .01). The mean arterial blood pressure was lower and the CVP was higher in the pressors group compared with the NP group, and pressors patients received significantly more fluid postoperatively (p < .01). When pressors were initiated at a low CVP (<8), MVD was 39 hrs compared with 71 hrs when pressors were started at a higher CVP (p = .08). LOS-P was only slightly shorter in the low CVP group, 112 hrs vs. 123 hours (p = NS). The PICU mortality rate was 0%. Patients who received pressors had longer operative times and received less intraoperative fluid. Subsequently, they required more postoperative fluid, which is likely the result of hemodynamic instability leading to longer MVD and LOS-P. A prospective study evaluating operative fluid management and optimal time for initiation of pressors, in addition to the role of catecholamines and cytokines in this unique postoperative patient population is indicated.

Outcome of Children with Pentalogy of Cantrell Following Cardiac Surgery

Although single individual reports have documented outcomes in children with pentalogy of are few data available for postoperative outcome of this cohort of patients after cardiac surgery. The aim of this study was to retrospectively review the clinical details of patients with pentalogy of Cantrell managed at two centers. Two cardiac surgical institutions retrospectively studied all patients with pentalogy of Cantrell and significant congenital heart disease who underwent surgical intervention, excluding PDA ligation, between 1992 and 2004. Seven children with pentalogy of Cantrell underwent surgical intervention at a median age of 60 days (range, 1-11 months). Three patients had tetralogy of Fallot, two double outlet right ventricle, one patient had tricuspid atresia, and one patient a perimembranous ventricular septal defect. The mean duration of postoperative ventilation was 112.8 days (range, 4-335 days) but three patients required ventilation for more than 100 days. Patients who had a preoperative diaphragmatic plication required a longer duration of ventilation (mean = 186.5 days [range, 100-273 days] compared with mean = 132 days [range, 4-335 days]). Four patients survived, with three patients weaned from ventilation. Three patients had withdrawal of care following failure to wean from ventilation, following multisystem organ failure, and at the request of their parents. In conclusion, the postoperative care of children with pentalogy of Cantrell after cardiac surgery is often complicated by prolonged need for ventilatory support and multiple postoperative complications. Earlier surgical intervention does not necessarily reduce morbidity and mortality. These data may help in the counseling of parents prior to surgical intervention.

Eine Standortbestimmung zum Einsatz von inhalativem Stickstoffmonoxid

Since the first clinical use of inhaled nitric oxide (iNO) as a selective pulmonary vasodilator, the concept of NO inhalation has been investigated for various indications. Used in the therapy of acute respiratory distress syndrome (ARDS), it has shown positive effects on intrapulmonary shunting and oxygenation, but no change on ARDS mortality has been demonstrated so far. Perhaps the combination of iNO with other therapeutic interventions, such as the increase of the hypoxic pulmonary vasoconstriction response through almitrine, will lead to a reduction in the mortality of the ARDS. In the treatment of persistent pulmonary hypertension of the newborn, iNO has been shown to be advantageous. Although the influence on the mortality rate has not yet been proven, a reduced need for extracorporeal membrane oxygenation (ecmo) through the use of iNO has been demonstrated. In addition, NO inhalation has been successful in the postoperative care of children after repair of congenital heart defects. There may be a special role for inhalation of NO in the prophylaxis of early complications after heart or lung transplantation if right heart failure after heart transplant or edema due to reperfusion injury after lung transplant becomes the main problem. Due to the different effects of NO, e.g., in clotting and the immunsystem, further investigations will be needed to complete our knowledge on the clinical use of NO inhalation.

Experiences with a reference directory for the perioperative care of children with rare diseases

SummaryA computerized reference data bank for the anaesthetic management and postoperative care of children with syndromes and rare disorders was established two years ago. It contains data on some 2000 syndromes and rare diseases. Updating of the directory is done by regular review of the literature and dialogue with the users. Between January 1991 and January 1993 this interdisciplinary service received 169 telephone, fax or postal calls for advisory service from physicians of all specialities connected with the field of operative paediatrics. The consultations concerned 79 patients with dysmorphias, 58 infants with metabolic disorders and 32 patients with complex or unclassified syndromes. About 58% of the patients were aged under three years. Although the structure of the data bank allows for an advisory service tailored to the individual needs, only 63% of the consultations could be given based upon published anaesthetic experiences of similiar cases. In the absence of anaesthetic case reports, advice for the other cases had to derived from the principles of general paediatric anaesthesia practice. In only 48 of the consultations (28%) was the user's experience reported and could then be stored in the directory.

Urinary prophylaxis and postoperative care of children at home with an indwelling catheter after hypospadias repair

This study represents our observations of 50 pediatric patients who underwent urethroplasty for hypospadias and chordee. An indwelling Silastic Foley catheter remained indwelling postoperatively for ten to fourteen days, connected to an antireflux leg drainage bag. Prophylactic antimicrobial therapy was given to all patients from the day of operation until one week after removal of the catheter. Cultures obtained from urine specimens taken directly from the drainage bag revealed that only 16 percent of the cases had a significant bacterial colony count (greater than 100,000/cc). We describe the efficacy of a closed drainage system combined with prophylactic antimicrobials in the management of children after hypospadias surgery.

The Neglected Inguinal Hernia

The pediatric indirect inguinal hernia is by far the most common anomaly requiring surgical correction. Modern advances in pediatric surgical and anesthetic techniques and the improved preoperative and postoperative care of children have made the elective pediatric herniorrhaphy a remarkably safe procedure. Many centers in this country and abroad are treating the uncomplicated inguinal hernia in infants and children in the outpatient clinic. The safety of this practice is impressive even in the very young.