RESUMEN
General anesthesia is associated with development of pulmonary atelectasis. Children are more vulnerable to the development and adverse effects of atelectasis. We review the physiology and risk factors for the development of atelectasis in pediatric patients under general anesthesia. We discuss the clinical significance of atelectasis, the use and value of recruitment maneuvers, and other techniques available to minimize lung collapse. This review demonstrates the value of a recruitment maneuver, maintaining positive end-expiratory pressure (PEEP) until extubation and lowering FiO2 where possible in the daily practice of the pediatric anesthetist.
Asunto(s)
Atelectasia Pulmonar , Extubación Traqueal , Anestesia General/efectos adversos , Niño , Humanos , Pulmón , Respiración con Presión Positiva , Atelectasia Pulmonar/etiología , Atelectasia Pulmonar/prevención & controlRESUMEN
INTRODUCTION: When performing computerized tomography chest imaging in children, obtaining high quality, motion-free images is important in the accurate diagnosis of underlying pathology. General anesthesia is associated with the development of atelectasis, which can impair accurate diagnosis by obscuring or altering the appearance of the lung parenchyma or airways. Recruitment maneuvers, performed by anesthesiologists, can be used to effectively re-expand atelectatic lung. METHODS: The computerized tomography chest imaging in 44 children aged between 2 months and 7 years, undergoing serial imaging for monitoring of cystic fibrosis, were reviewed and graded for atelectasis. The first scan performed on each child was performed with a supraglottic airway device and a non-standardized recruitment maneuver. The second scan on each child was performed with a cuffed endotracheal tube and a standardized recruitment maneuver. RESULTS: When a supraglottic airway device and a non-standardized recruitment maneuver were used, 77% of patients demonstrated atelectasis of any degree on their computerized tomography chest imaging, compared with only 39% when a cuffed endotracheal tube and standardized recruitment maneuver were used. The percentage of computerized tomography chest scans that were scored acceptable (with either a total combined lung atelectasis score of 0 or 1) improved from 37% to 75% when a cuffed endotracheal tube and standardized recruitment maneuver were used. In particular, the mean atelectasis score for both lungs improved from 2.91 (SD ± 2.6) to 1.11 (SD ± 1.9), with a mean difference of 1.8 (95% CI 0.82-2.77; p: .0004). CONCLUSION: The use of a cuffed endotracheal tube and a standardized recruitment maneuver is an effective way to reduce atelectasis as a result of general anesthesia. Anesthesiologists can actively contribute toward improved image quality through their choice of airway and recruitment maneuver.
Asunto(s)
Atelectasia Pulmonar , Anestesia General , Niño , Humanos , Lactante , Pulmón , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/terapia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
A 9-year-old girl was reviewed by a tertiary ophthalmology service after being hit in her right upper eyelid by a fish whilst swimming. Initial wound exploration demonstrated fish scales in the wound. She was first treated conservatively with washout of the 5-mm wound and was discharged with oral ciprofloxacin. Five days later, the patient re-presented with a worsened ptosis due to periorbital swelling. Ultrasound of the upper lid demonstrated a foreign body in the upper lid. The patient was taken to theatre and, with the assistance of intraoperative ultrasound, the jaws of a needle fish were removed from the upper lid. The case highlights the importance of ultrasound and its intraoperative utility in cases of trauma and a suspicion of retained foreign bodies as well as the potential danger of fish injuries off the West Australian coast.
Asunto(s)
Beloniformes/lesiones , Cuerpos Extraños en el Ojo/etiología , Lesiones Oculares Penetrantes/etiología , Párpados/lesiones , Animales , Australia , Niño , Cuerpos Extraños en el Ojo/diagnóstico por imagen , Cuerpos Extraños en el Ojo/cirugía , Lesiones Oculares Penetrantes/diagnóstico por imagen , Lesiones Oculares Penetrantes/cirugía , Párpados/diagnóstico por imagen , Femenino , Humanos , UltrasonografíaAsunto(s)
Absceso/diagnóstico por imagen , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Divertículo Esofágico/complicaciones , Fístula Esofágica/complicaciones , Enfermedades del Mediastino/diagnóstico por imagen , Absceso/etiología , Biopsia con Aguja Fina/métodos , Terapia Combinada , Divertículo Esofágico/diagnóstico por imagen , Divertículo Esofágico/cirugía , Fístula Esofágica/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Lactante , Imagen por Resonancia Magnética/métodos , Masculino , Enfermedades del Mediastino/etiología , Enfermedades del Mediastino/terapia , Enfermedades Raras , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
INTRODUCTION: There is variability in clinical practice regarding the number of radiographic views required to accurately determine umbilical venous catheter (UVC) tip position. Some units prefer performing a single anteroposterior (AP) view and others do both AP and lateral views. The aim of this study was to compare the need for one versus two radiographical views to accurately determine UVC tip position. METHODS: Radiographs of 382 infants (all gestations) from two level six neonatal units were included in the study. Patients with congenital anomalies and those who had adjustment of UVC position between AP and lateral films being performed were excluded. Six clinicians reviewed anonymized AP only images and documented UVC tip position. Subsequently, they reviewed both AP and lateral views and again documented the UVC tip position. Results were compared to the expert consensus which was taken from the consensus of two paediatric radiologists. RESULTS: The study population had a mean gestational age of 32.8 weeks and birth weight of 2190 g, with 58% males. The UVC tip positions were accurately determined 76% times by the AP view alone and 82% times by using both the AP and lateral views (P < 0.001). The low placed UVC tip position which is the most inappropriate for use was more accurately determined by two images (78% times) rather than single image (70% times) (P < 0.001). CONCLUSIONS: Utilising both AP and lateral views was superior in accurately determining UVC tip position to AP view alone.
Asunto(s)
Venas Umbilicales , Humanos , Recién Nacido , Estudios Retrospectivos , Venas Umbilicales/diagnóstico por imagen , Masculino , FemeninoRESUMEN
BACKGROUND: Osteonecrosis is a well-recognised complication of current childhood acute lymphoblastic leukaemia (ALL) therapy. There are few studies on the medical management of osteonecrosis in this setting. We studied the therapeutic and radiological effects of oral and intravenous bisphosphonate use compared with standard care as treatment for osteonecrosis in this population. METHOD: Patients who developed osteonecrosis as a complication of ALL therapy between 1994 and 2007 were treated at a single paediatric institution. Of 17 patients, 9 were commenced on bisphosphonates and 8 treated conservatively. Both groups were observed with time. Pain, analgesic requirement and musculoskeletal function were assessed monthly. Affected joints were radiologically imaged at set intervals. Each scan was graded using an ellipsoid method to give the total volume of osteonecrosis, by blinded radiologic examination. RESULTS: Three of six patients treated with oral alendronate showed clinical improvement. The three patients that had no improvement were subsequently treated with intravenous pamidronate. All six patients treated with intravenous pamidronate showed clinical improvement. Seven of eight conservatively treated patients deteriorated clinically. All patients demonstrated reduction in the radiological burden of osteonecrosis with time. There was no difference in the rate of reduction between conservative and bisphosphonate arms. CONCLUSION: Bisphosphonate use, in particular pamidronate, improved pain scores, analgesic requirement and musculoskeletal function in patients with osteonecrosis occurring as a complication of childhood ALL therapy. Objective radiologic benefit of bisphosphonate treatment could not be demonstrated. Risks, benefits and long-term outcome of bisphosphonate use in this population should be addressed in a larger prospective, randomised trial.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Difosfonatos/uso terapéutico , Osteonecrosis/inducido químicamente , Osteonecrosis/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Administración Oral , Adolescente , Corticoesteroides/uso terapéutico , Alendronato/administración & dosificación , Calcio/uso terapéutico , Niño , Preescolar , Terapia Combinada , Difosfonatos/administración & dosificación , Femenino , Humanos , Incidencia , Infusiones Intravenosas , Masculino , Osteonecrosis/epidemiología , Dolor/tratamiento farmacológico , Dolor/etiología , Pamidronato , Radioterapia , Factores de Riesgo , Vitamina D/uso terapéuticoRESUMEN
BACKGROUND: Whether preterm infants born with breech presentation are at similar risk of developmental dysplasia of the hip (DDH) as the term breech infants is not known. The information will be vital for DDH screening guidelines. METHODS: A retrospective audit of infants born in the breech position was performed to compare the incidence of DDH in the following gestational age groups: 23-27, 28-31, 32-36 and ≥37 weeks. RESULTS: A total of 1144 neonates were included in the study. The incidence of DDH did not differ between the groups (11.6%, 9.4%, 13.6% and 11.5%, in 23-27, 28-31, 32-36 and ≥37 weeks, respectively, p=0.40). Sixty infants required intervention for DDH. Multiple logistic regression after correcting for potential confounders showed that gestational age group did not influence the risk of DDH, and requirement of therapy. CONCLUSION: Preterm infants born with breech presentation appear to have a similar incidence of DDH to term breech infants. .
Asunto(s)
Presentación de Nalgas/epidemiología , Luxación Congénita de la Cadera/epidemiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Modelos Logísticos , Masculino , Embarazo , Estudios RetrospectivosRESUMEN
It was anticipated that the recent reforms to private health insurance arrangements would reduce the demand pressures on Australian public hospitals. However, this has not been demonstrated by trends in elective surgery waiting lists in Victorian public hospitals. Moreover, it appears that the increased caseload assumed by Victorian private hospitals since the reforms took effect mainly reflects an increase in low cost same day episodes.