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- Volume 18, Issue 5, 2012
Southern African Journal of Anaesthesia and Analgesia - Volume 18, Issue 5, 2012
Volumes & issues
Volume 18, Issue 5, 2012
Source: Southern African Journal of Anaesthesia and Analgesia 18 (2012)More Less
Children, even if they are very young and small, sometimes need surgery. This necessitates mostly general anaesthesia, sometimes regional anaesthesia, or a combination. As children are different to adults, there have been calls that only people trained and experienced in paediatric anaesthesia should provide anaesthetic services to children.
Author Jennifer ThomasSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 226 –227 (2012)More Less
The definition of risk is "the chance or possibility of danger, loss or injury". Assessing risk in paediatric anaesthesia depends on the angle from which the problem is approached: the patients and their parents, doctors, hospital managers, policy makers or insurance companies. For the child (the patient), the risks involve a variety of factors, including the medication choices that the anaesthetist makes, the potential for neurodegeneration (high on the risk list for neonates and infants), whether the anaesthetist is satisfactorily qualified and experienced to provide adequate perioperative care so that the infant wakes up safely, and monitoring of the operation in accordance with local and international safety standards of care.
Source: Southern African Journal of Anaesthesia and Analgesia 18, pp 230 –239 (2012)More Less
There are few areas of anaesthesia management more frightening and more difficult than the child with acute respiratory distress. In addition to the anatomical differences among infants, children and adults, the problem is compounded by the inability to reason with the child to obtain his or her cooperation. The object of this presentation is to define the important anatomical differences that make the paediatric patient unique. An understanding of normal airway anatomy and physiology facilitates better management of difficult airways.
Author J. TaylorSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 242 –247 (2012)More Less
Recently, concerns regarding anaesthesia-induced developmental neurotoxicity (AIDN) have emerged. The aim of this review was to summarise the available information on AIDN, and to assist the practising anaesthetist in making safe decisions with regard to the administration of anaesthesia in the young child.
Source: Southern African Journal of Anaesthesia and Analgesia 18, pp 249 –253 (2012)More Less
Author A. NgSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 255 –256 (2012)More Less
Paediatric anaesthesia presents unique challenges. High-risk patients, premature babies, neonates, infants, small toddlers and children with multiple congenital anomalies are included in this group of patients. Infants and neonates are more at risk of an adverse incident perioperatively and also suffer higher morbidity and mortality than older children.
Author A.R. WolfSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 258 –261 (2012)More Less
Infants and children who are admitted to the intensive care unit (ICU) require treatment for their primary disease and maintenance of their bodily functions (fluid balance, energy intake and temperature control) to optimise recovery. Additional treatments provide analgesia, reduction of the level of consciousness, and when indicated, muscle relaxation. While this triad forms the basis of classical anaesthesia, in paediatric intensive care it is used for longer periods, often below the levels required for surgery and with different goals. This brings to the fore specific problems that relate to the drugs. These include differing pharmacokinetics and drug responses because of age and individual pathophysiology, tolerance and withdrawal, toxicity associated with long-term use and the need to effectively monitor drug effect against delivery. Regrettably, administration of sedative drugs in the paediatric ICU (PICU) is often approached in a generic way and as an afterthought. Instead, more attention is paid to the primary disease. This can lead to morbidity that could have been avoided.
Author M.J. MotiangSource: Southern African Journal of Anaesthesia and Analgesia 18, pp 263 –266 (2012)More Less
The basic function of a tracheal tube is to provide a reliable connection between the patient's airway and the anaesthetic circuit (bag or ventilator). Ideally, this connection should allow a leak at 15-20 cmH2O to prevent pressure-related mucosal perfusion, which varies with age. The anatomy of the paediatric airway differs from that of the adult, until it matures between approximately eight and 14 years of age. For this reason, standard teaching has been to avoid placement of cuffed endotracheal tubes (CETTs) in children who are younger than eight years old. Most paediatric anaesthetists continue to safely use uncuffed endotracheal tubes (UETT) on a daily basis, with a belief that they make an adequate seal as they pass through the cricoid ring. The use of CETTs and UETTs has been reviewed and the advantages and safety of CETTs are outlined in this article.
Airway management in an infant with congenital trismus : the role of retrograde intubation : case studySource: Southern African Journal of Anaesthesia and Analgesia 18, pp 267 –269 (2012)More Less
Congenital trismus is a serious anomaly, and establishment of an airway for surgical correction is a challenge. In the case of limited mouth opening, the nasal route is the only available option to secure the airway via the supraglottic route. Various airway management options include blind intubation, retrograde intubation and fibre-optic intubation, failing which a tracheostomy might be needed. We present the airway management of a seven-month-old infant with congenital trismus who was scheduled for corrective surgery. After several unsuccessful attempts at blind nasal intubation, with the infant on spontaneous ventilation, breathing sevoflurane in oxygen, we managed to secure the airway successfully by retrograde intubation.
Source: Southern African Journal of Anaesthesia and Analgesia 18, pp 270 –272 (2012)More Less
Crouzon syndrome is a rare hereditary disorder, characterised by marked craniofacial dysostosis from birth or early childhood. Typically, patients present in early childhood for craniofacial reconstruction surgery. Presentation in early adulthood is unusual. The most challenging aspect, for an attending anaesthesiologist, is the management of the difficult airway that is usually present in these patients, due to various craniofacial abnormalities of the neck region. Regional anaesthesia may be complicated in these patients, because of vertebral abnormalities. Here, we describe the successful neuraxial anaesthetic management of a 17-year-old male with Crouzon syndrome, who presented to us in the orthopaedic emergency outpatient department with a fracture of the left tibia, sustained during an accident.