Working as a team in airway surgery: History, present and perspectives.

Teamwork is one of the most important trend in modern medicine. Airway team were created in many places to respond in a multidisciplinary and coordinated way to challenging clinical problems which were beyond the possibility of an individual management. In this chapter, we illustrate the historical steps leading to the development of an airway team in a pediatric referral hospital, describe the present teamwork activity defining the key points for the creation of a team and discussing different organization models; finally we delineate possible future directions for the airway teams in the globalized world.

Noninvasive ventilation and low-flow veno-venous extracorporeal carbon dioxide removal as a bridge to lung transplantation in a child with refractory hypercapnic respiratory failure due to bronchiolitis obliterans.

OBJECTIVE: To report the successful management of end-stage hypercapnic respiratory failure through the association of noninvasive mechanical ventilation and a novel automated device (Decapsmart) of low-flow veno-venous extracorporeal CO2 removal. DESIGN: Case report. SETTINGS: Pediatric intensive care unit at a tertiary care children's hospital. PATIENT: A pediatric patient affected by bronchiolitis obliterans with refractory hypercapnic respiratory failure. The patient received successful lung transplantation after respiratory support with noninvasive mechanical ventilation and a novel automated device of low-flow veno-venous extracorporeal CO2 removal. INTERVENTIONS: Treatment of end-stage hypercapnic respiratory failure with the association of noninvasive ventilation and low-flow veno-venous extracorporeal CO2 removal as a bridge to lung transplantation. MEASUREMENTS AND MAIN RESULTS: Respiratory support controlling hypercapnia, limiting volutrauma, barotraumas, and preventing the incidence of ventilator-associated pneumonia/lung colonization. CONCLUSION: Noninvasive mechanical ventilation and Decapsmart have proven efficacious in managing refractory hypercapnic respiratory failure in a pediatric patient awaiting lung transplantation.

Spinal anaesthesia in paediatric patients.

PURPOSE OF REVIEW: Spinal anaesthesia has seldom been employed in paediatric patients. Its use has been suggested mainly in former preterm newborns and infants who are known to be exposed to high perioperative apnoea risk. There is currently some evidence that spinal anaesthesia could be considered as an equal alternative to general anaesthesia as it is in adults. RECENT FINDINGS: New drugs and adjuvants recently introduced in clinical practice, more-detailed knowledge of spread anaesthetic modalities and larger databases, now available, could today make paediatric spinal anaesthesia a more suitable technique for many anaesthetists. SUMMARY: We will review recent literature focusing the latest techniques, drugs, dosages, and complications in order to define the limits and advantages of employing spinal anaesthesia in all paediatric ages, in routine and emergency surgery.

Use of spinal anaesthesia in paediatric patients: a single centre experience with 1132 cases.

BACKGROUND: Spinal anaesthesia has been used in children for over 100 years and in the last two decades its popularity for newborns and infants has increased, but there are still unanswered questions with the technique. METHODS: We evaluated the characteristics of spinal block including ease of performance, efficacy, adverse effects and complications in 1132 children, aged 6 months to 14 years, undergoing surgery in the lower part of the body. Local ethical committee approved the protocol of this prospective study, and parents gave written informed consent and older children their assent. All patients were sedated with midazolam, thiopental or propofol intravenously during spontaneous ventilation. No inhalation anaesthetics were used. Spinal block was performed with 0.5% hyperbaric bupivacaine at a dose of 0.2 mg x kg(-1). RESULTS: Efficacy, safety and ease of performance of the spinal block were shown to be satisfactory in most children. Only 27 of the 1132 children needed any supplementation. The incidence and severity of complications was low. Only nine of 942 children, < 10 years of age and eight of 190 children, 10 years or older, developed hypotension. The incidences of postdural puncture headache, in five of the 1132 children, and backache, in nine of the 1132, were low. No other neurological complications were reported. CONCLUSIONS: Spinal anaesthesia with hyperbaric bupivacaine is a feasible anaesthetic method in children for surgery in the lower part of the body.