Operation airway: the first sustainable, multidisciplinary, pediatric airway surgical mission.

OBJECTIVE: This study aimed to describe the development and implementation of the first sustainable, multidisciplinary, pediatric airway surgical mission in an underserved country. METHODS: This prospective, qualitative study was conducted for the first 4 Operation Airway missions in Quito, Ecuador. The major goals of the missions were to assist children with aerodigestive abnormalities, create a sustainable program where the local team could independently provide for their own patient population, develop an educational curriculum and training program for the local team, and cultivate a collaborative approach to provide successful multidisciplinary care. RESULTS: Twenty patients ages 4 months to 21 years were included. Twenty-three bronchoscopies, 5 salivary procedures, 2 tracheostomies, 1 T-tube placement, 1 tracheocutaneous fistula closure, 2 open granuloma excisions, and 6 laryngotracheal reconstructions (LTRs) were performed. All LTR patients were decannulated. A new type of LTR (1.5 stage) was developed to meet special mission circumstances. Two videofluoroscopic swallow studies and 40 bedside swallow evaluations were performed. One local pediatric otolaryngologist, 1 pediatric surgeon, 3 anesthesiologists, 7 intensivists, 16 nurses, and 2 speech-language pathologists have received training. More than 25 hours of lectures were given, and a website was created collaboratively for educational and informational dissemination (http://www.masseyeandear.org/specialties/pediatrics/pediatric-ent/airway/OperationAirway/). CONCLUSION: We demonstrated the successful creation of the first mission stemming from a teaching institution with the goal of developing a sustainable, autonomous surgical airway program.

A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience.

OBJECTIVE: To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. STUDY DESIGN: Consecutive case series with chart review. SETTING: This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. METHODS: Demographic data, diagnostic and operative details, and operative outcomes were collected. A country's program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. RESULTS: A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. CONCLUSION: This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.

Influencia de los relajantes musculares sobre la presión arterial media, frecuencia y ritmo cardíaco: Estudio comparado

Introducción: La parálisis neuromuscular es un hecho necesario en la mayoría de las técnicas de anestesia general. Los efectos cardiovasculares clínicamente significativos (autonómicos y hemodinámicos) se encuentran presente en algunos de estos fármacos. Objetivos: Identificar si existen modificaciones en la presión arterial media, frecuencia y ritmo cardíaco, durante diferentes momentos, así como identificar si existieran otras reacciones adversas con el uso de estos fármacos. Material y Método: Se realizó un estudio prospectivo, longitudinal y analítico en un total de 80 pacientes (20 integrantes por grupo). El estudio se realizó de forma aleatoria. Se realizó anestesia general intravenosa total. Los relajantes musculares se administró pancuronio 0,1 mg/kg (Grupo I), vecuronio 0,1 mg/kg (Grupo II), atracurio 0,5mg/kg (Grupo III) y en el grupo IV mivacurio 0,17 mg/kg. La medición de la presión arterial media se monitorizó cada 2 minutos, así como la frecuencia y el ritmo cardiaco mediante un monitor modelo NIHON KOHDEN en tres momentos: En el periodo preoperatorio (intubación tráqueal). Momento 2: En el período intraoperatorio (Apertura peritoneal) y Momento 3 En el postoperatorio. (Durante la extubación). Resultados: Todos los grupos presentaron cifras de presión arterial media semejantes durante la intubación traqueal. Durante la apertura del peritoneo y la extubación el Grupo II mostró cifras de presión arterial media estables, así como con la frecuencia cardiaca. Todos mostraron ritmo sinusal. Conclusiones: La presión arterial media en el grupo vecuronio fue 1,2 veces más estable durante el intraoperatorio. La frecuencia cardiaca fue 1,4 veces mayor con el pancuronio y el mivacurio y 1,2 con el atracurio tanto en el intra como en el postopertorio al compararlos con el vecuronio.

Meninguitis Bacteriana en la infancia

Se realizo un estudio retrospectivo de 377 pacientes pediatricos

Bases de pediatría crítica / Bases of pediatría critical

Aanaliza las enfermedades críticas neonatales, infantiles y de los adolescentes, así como los principales cuidados pediátricos intensivos y su farmacología. Presenta un estudio sobre ética en la práctica médica y sus connotaciones dentro de la pediatría...