Subject(s)
Pneumothorax , Child , Humans , Iatrogenic Disease , Pneumothorax/diagnostic imaging , Pneumothorax/etiologyABSTRACT
The perioperative care of adult patients undergoing free tissue transfer during head and neck surgical (microvascular) reconstruction is inconsistent across practitioners and institutions. The executive board of the Society for Head and Neck Anesthesia (SHANA) nominated specialized anesthesiologists and head and neck surgeons to an expert group, to develop expert consensus statements. The group conducted an extensive review of the literature to identify evidence and gaps and to prioritize quality improvement opportunities. This report of expert consensus statements aims to improve and standardize perioperative care in this setting. The Modified Delphi method was used to evaluate the degree of agreement with draft consensus statements. Additional discussion and collaboration was performed via video conference and electronic communication to refine expert opinions and to achieve consensus on key statements. Thirty-one statements were initially formulated, 14 statements met criteria for consensus, 9 were near consensus, and 8 did not reach criteria for consensus. The expert statements reaching consensus described considerations for preoperative assessment and optimization, airway management, perioperative monitoring, fluid management, blood management, tracheal extubation, and postoperative care. This group also examined the role for vasopressors, communication, and other quality improvement efforts. This report provides the priorities and perspectives of a group of clinical experts to help guide perioperative care and provides actionable guidance for and opportunities for improvement in the care of patients undergoing free tissue transfer for head and neck reconstruction. The lack of consensus for some areas likely reflects differing clinical experiences and a limited available evidence base.
Subject(s)
Anesthesia/standards , Anesthesiologists/standards , Consensus , Perioperative Care/standards , Plastic Surgery Procedures/standards , Societies, Medical/standards , Anesthesia/methods , Expert Testimony , Head/surgery , Humans , Neck/surgery , Perioperative Care/methods , Plastic Surgery Procedures/methodsSubject(s)
Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Nerve Block/methods , Pain, Postoperative/therapy , Thoracic Nerves/drug effects , Vascular Access Devices/adverse effects , Adolescent , Anesthesia, General , Anesthetics, Local/administration & dosage , Catheterization, Central Venous/instrumentation , Child , Child, Preschool , Humans , Infant , Length of Stay/statistics & numerical data , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with recovery guided by train-of-four monitoring. He was extubated uneventfully without complications. Because sugammadex binds directly to rocuronium rather than interfering with acetylcholine metabolism, it might provide a good option for reversal of neuromuscular blockade in transient neonatal myasthenia gravis.
Subject(s)
Androstanols/administration & dosage , Myasthenia Gravis, Neonatal/drug therapy , gamma-Cyclodextrins/administration & dosage , Androstanols/therapeutic use , Humans , Infant, Newborn , Male , Pyloromyotomy , Rocuronium , Sugammadex , Treatment Outcome , gamma-Cyclodextrins/therapeutic useABSTRACT
We report the use of dexmedetomidine for laryngoscopy, rigid bronchoscopy, and tracheal extubation in the operating room in two children who had undergone tracheal reconstruction 1 week previously. Dexmedetomidine in combination with propofol provided appropriately deep anesthesia during these brief but stimulating procedures without cardiovascular or respiratory depression.
Subject(s)
Adrenergic alpha-Agonists , Bronchoscopy , Dexmedetomidine , Hypnotics and Sedatives , Laryngoscopy , Propofol , Trachea/surgery , Child, Preschool , Female , Humans , MaleABSTRACT
BACKGROUND: Emergence agitation (EA) is a common postoperative problem in young children who have received sevoflurane and isoflurane for general anesthesia. This randomized, double-blinded study evaluated the efficacy of intraoperative clonidine in reducing EA, and describes its recovery profile. METHODS: With Institutional Review Board approval and informed consent, children undergoing brief, minimally painful procedures were studied. All children received preemptive analgesia with acetaminophen and ketorolac, sevoflurane for induction, and isoflurane for maintenance of anesthesia. Children received either 2 microg.kg(-1) clonidine or placebo intravenously (i.v.) following induction of anesthesia. Children were observed postoperatively for behavior and side effects, and their parents were telephoned the next day to determine postdischarge recovery characteristics. RESULTS: One hundred and twenty children were included in this study: 59 of whom received clonidine, and 61 placebo; 41% of those in the placebo group exhibited moderate-severe EA compared with only 22% of those in the clonidine group (P < 0.03). Compared with those who received placebo, children who received clonidine awakened more slowly (22 min vs 14 min), had a longer postanesthesia care unit stay (57 min vs 46 min), and experienced sleepiness more frequently after discharge (75% vs 39%; all comparisons significant at P < 0.03). There were no adverse cardiorespiratory events in either group. CONCLUSIONS: Findings demonstrate that i.v. clonidine administered after induction of anesthesia significantly reduces the incidence of EA in young children, but is associated with sleepiness postoperatively.
