Ravi Shah

A randomized equivalence trial comparing the i-gel and laryngeal mask airway Supreme in children

The laryngeal mask airway Supreme (Supreme) is a new single‐use supraglottic device with gastric access capability now available in all sizes for children.

A randomized trial comparing the Ambu® Aura-i™ with the air-Q™ intubating laryngeal airway as conduits for tracheal intubation in children

To assess the clinical performance of the Ambu Aura‐i (Aura‐i) in children.

Applications of regional anaesthesia in paediatrics

Advances in the field of paediatric regional anaesthesia have specific applications to both acute and chronic pain management. This review summarizes data regarding the safety of paediatric regional anaesthetic techniques. Current guidelines are provided for performing paediatric regional techniques, with a focus on applications for postoperative pain management. Brief descriptions of relevant anatomy followed by indications for commonly performed blocks are highlighted along with the potential of adverse side-effects.

A randomized comparison of the laryngeal mask airway supreme™ and laryngeal mask airway unique™ in infants and children: does cuff pressure influence leak pressure?

The cuff pressure for optimal airway sealing with first‐generation laryngeal mask airway has been shown to be 40 cm H2O in children. Currently, there are no data regarding the ideal intracuff pressure for the laryngeal mask airway Supreme (Supreme) in children.

A randomised comparison of the self-pressurised air-Q TM intubating laryngeal airway with the LMA Unique TM in children*

We conducted a randomised trial comparing the self‐pressurised air‐QTM intubating laryngeal airway (air‐Q SP) with the LMA‐Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. Median (IQR [range]) time to successful device placement was faster with the air‐Q SP (12 (10–15 [5–18])) s than with the LMA‐Unique (14 (12–17 [6–22]) s; p = 0.05). There were no statistically significant differences between the air‐Q SP and LMA‐Unique in initial airway leak pressures (16 (14–18 [10–29]) compared with 18 (15–20 [10–30]) cmH2O, p = 0.12), an airway leak pressures at 10 min (19 (16–22 [12–30]) compared with 20 (16–22 [10–30]) cmH2O, p = 0.81); fibreoptic position, incidence of gastric insufflation, or complications. Both devices provided effective ventilation without the need for airway manipulation. The air‐Q SP is an alternative to the LMA‐Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.

The Effect of Systemic Magnesium on Postsurgical Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial.

BACKGROUND:Tonsillectomy is a frequently performed surgical procedure in children; however, few multimodal analgesic strategies have been shown to improve postsurgical pain in this patient population. Systemic magnesium infusions have been shown to reliably improve postoperative pain in adults, but their effects in pediatric surgical patients remain to be determined. In the current investigation, our main objective was to evaluate the use of systemic magnesium to improve postoperative pain in pediatric patients undergoing tonsillectomy. We hypothesized that children who received systemic magnesium infusions would have less post-tonsillectomy pain than the children who received saline infusions. METHODS:The study was a prospective, randomized, double-blinded, clinical trial. Subjects were randomly assigned using a computer-generated table of random numbers to 1 of the 2 intervention groups: systemic magnesium infusion (initial loading dose 30 mg/kg given over 15 minutes followed by a continuous magnesium infusion 10 mg/kg/h) and the same volume of saline. The primary outcome was pain scores in the postanesthesia care unit (PACU) measured by FLACC (Face, Legs, Activity, Cry, Consolability) pain scores. Pain reduction was measured by the decrement in the area under the pain scale versus 90-minute postoperative time curve using the trapezoidal method. Secondary outcomes included opioid consumption in the PACU, emergence delirium scores (measured by the pediatric anesthesia emergence delirium scale), and parent satisfaction. RESULTS:Sixty subjects were randomly assigned and 60 completed the study. The area under pain scores (up to 90 minutes) was not different between the study groups, median (interquartile range [IQR]) of 30 (0–120) score × min and 45 (0–135) score × min for the magnesium and control groups, respectively (P = 0.74). Similarly, there was no clinically significant difference in the morphine consumption in the PACU between the magnesium group, median (IQR) of 2.0 (0–4.44) mg IV morphine, compared with the control, median (IQR) of 2.5 (0–4.99) mg IV morphine (P = 0.25). The serum level of magnesium was significantly lower in the control group than in the treatment group at the end of the surgery (P < 0.001). CONCLUSIONS:Despite a large number of studies demonstrating the efficacy of systemic magnesium for preventing postsurgical pain in adults, we could not find evidence for a significant clinical benefit of systemic magnesium infusion in children undergoing tonsillectomies. Our findings reiterate the importance of validating multimodal analgesic strategies in children that have been demonstrated to be effective in the adult population.

Interventional Procedures for Chronic Pain in Children and Adolescents: A Review of the Current Evidence

This review discusses the role of interventional procedures in the treatment of chronic pain in children and adolescents. Due to lack of scientific evidence, significant controversy surrounds the utility of invasive techniques for managing pediatric chronic pain states. Interventional procedures are a widely accepted modality for pain management in adults. The use of such techniques in children is supported only by case reports, case series, and very few randomized controlled studies. In addition, the potential for severe complications leaves open a debate on the safety of these invasive procedures, which must be confirmed by more extensive and accurate prospective studies.

Ultrasound for Regional Anesthesia in Children

The use of regional anesthesia in children is increasing. Rapid advancement in the use of ultrasound guidance has allowed for a greater ease in performing peripheral regional anesthesia in pediatrics. Successful peripheral nerve blockade provides children with analgesia that will improve their operative experience.

Management of pediatric tonsillectomy pain: a review of the literature

© 2016 Hansen et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Ambulatory Anesthesia 2016:3 23–26 submit your manuscript | www.dovepress.com Dovepress 23

Interventional Treatment of Chronic Abdominal Pain in Children

Chronic abdominal pain is a commonly encountered complaint amongst children and adolescents. Pediatric chronic abdominal pain syndromes frequently involve a somatosensory component, for which peripheral nerve blockade has become an important therapeutic modality. The evolution of ultrasound guidance has made such techniques more popular and effective. Peripheral nerve blocks can serve as useful adjuncts to managing chronic abdominal pain conditions in children in cases that are refractory to noninvasive treatments. In this chapter, we summarize the current knowledge and reported practices of peripheral nerve blocks in managing pediatric chronic abdominal pain. A brief description of commonly performed nerve blocks, including anatomy, indications, and potential complications, is provided.