RESUMEN
A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.
Asunto(s)
Conducta del Adolescente/ética , Anestesia Epidural/ética , Dolor Postoperatorio/prevención & control , Relaciones Padres-Hijo , Relaciones Médico-Paciente/ética , Negativa del Paciente al Tratamiento/ética , Adolescente , Conducta del Adolescente/psicología , Anestesia Epidural/métodos , Anestesia Epidural/psicología , Neoplasias Óseas/psicología , Neoplasias Óseas/cirugía , Femenino , Humanos , Dolor Postoperatorio/psicología , Padres/psicología , Sarcoma de Ewing/psicología , Sarcoma de Ewing/cirugía , Negativa del Paciente al Tratamiento/psicologíaRESUMEN
The ideal venue for neonatal surgical procedures has been the subject of a contentious debate between the leading pediatric hospitals throughout the world. Bias toward the location of neonatal surgery tends to be based on institutional practices. The following opposing viewpoints from two leading pediatric institutions in the United Kingdom and the United States highlight the relevant issues.
Asunto(s)
Recien Nacido Prematuro , Pediatría/normas , Procedimientos Quirúrgicos Operativos , Continuidad de la Atención al Paciente , Infección Hospitalaria/epidemiología , Conducto Arterioso Permeable/cirugía , Humanos , Recién Nacido , Cuidado Intensivo Neonatal , Pediatría/ética , Riesgo , Transporte de PacientesRESUMEN
Endotracheal intubation is a common procedure in newborn care. The purpose of this clinical report is to review currently available evidence on use of premedication for intubation, identify gaps in knowledge, and provide guidance for making decisions about the use of premedication.
Asunto(s)
Intubación Intratraqueal , Premedicación , Analgésicos/uso terapéutico , Humanos , Hipnóticos y Sedantes/uso terapéutico , Recién Nacido , Relajantes Musculares Centrales/uso terapéuticoRESUMEN
STUDY OBJECTIVE: To determine the utilization of anesthesia resources by children with complex special health care needs. DESIGN: Observational, inception cohort study of medical records. SETTING: Urban, pediatric, tertiary-care hospital. MEASUREMENTS: All general anesthetic cases were screened for preexisting complex special health care needs. Medical records were reviewed for demographic, clinical, and outcome data. MAIN RESULTS: 435 children with complex special health care needs accounted for 479 delivered general anesthetic cases. This figure represented 14% of the total 3,437 cases presenting during the study period. It also represented 22% (49 of 224) of all cancellations. Down syndrome was the most identifiable developmental disorder (n = 43, 9%). Another 143 (30%) cases showed preexisting technology dependence. Scheduled surgical procedures (n = 425, 89%) comprised the majority of cases. Intraoperative and recovery room complications occurred in 6 (1%) and 133 (28%) cases, respectively. Eleven (2.3%) cases required unplanned post-anesthetic hospital ward or pediatric intensive care unit admission. Documentation of health care proxy or resuscitation status was not identified in any child under 18 years, and in only 4 of 33 children older than 18 years. CONCLUSIONS: Children with complex special health care needs represented one out of 7 of all pediatric general anesthetic cases at a tertiary-care, academic center.
