Riad Tome

Combined spinal-epidural anesthesia in major abdominal surgery in high-risk neonates and infants.

Background:  Combined spinal‐epidural anesthesia (CSE‐A) is reportedly safe and effective for the pediatric population in infraumbilical surgery. Our main purpose was to describe our experience of this technique in neonates and infants undergoing elective major upper abdominal surgery.

The effectiveness and safety of spinal anaesthesia in the pyloromyotomy procedure

Background: Hypertrophic pyloric stenosis is a relatively common disorder of the gastrointestinal tract in infancy, causing projectile vomiting and metabolic abnormalities. Surgical management in the form of pyloromyotomy under general anaesthesia has been reported as safe for relieving the obstructed bowel. A number of studies have demonstrated the advantages of spinal anaesthesia over general anaesthesia in high risk infants undergoing minor infraumbilical surgery. The purpose of this study was to evaluate spinal anaesthesia as an alternative option to general anaesthesia in infants undergoing pyloromyotomy.

Comparison of the CobraPLATM (Cobra Perilaryngeal Airway) and the Laryngeal Mask Airway UniqueTM in children under pressure controlled ventilation

Background:  The Laryngeal Mask Airway‐Unique (LMAU) and CobraPLATM (Cobra Perilaryngeal Airway) are supraglottic airway devices. There are no published studies comparing these devices in children breathing with pressure controlled ventilation (PCV).

Improved outcomes in paediatric anaesthesia: contributing factors.

PurposeTo discuss developments in paediatric anaesthesia and explore the factors which have contributed to improved anaesthetic-related patient outcomes.MethodsNarrative review of findings in the literature retrieved from MEDLINE/Pubmed and manual search.ResultsAdverse perioperative outcomes related to anaesthesia have been extensively debated over the past few decades, with studies implicating factors such as major human error and equipment failure. Case series and event registries have enlightened physicians on sources of error and patient risk factors such as extremes of age, comorbidity and emergent circumstances. Anaesthetic-related deaths in children fell from 6.4 per 10,000 anaesthetics in the early 1950s to as low as 0.1 per 10,000 anaesthetics by the end of the century. Advances in anaesthetic agents, techniques, monitoring technologies and training programmes in paediatric anaesthesia play a vital role in driving this downward trend.ConclusionDespite substantial progress, there is still much room for improvement in areas such as adverse-event reporting, anaesthetic-related risk and late neurocognitive outcomes. Systematic reviews comparing paediatric patient outcomes after neuroaxial block versus general anaesthesia are currently unavailable. The future of paediatric anaesthesia will most likely be influenced by much-needed large prospective studies, which can provide further insight into patient safety and service delivery.

Transient Horner syndrome following epidural anesthesia for labor: case report and review of the literature.

Epidural anesthesia is a widely used method for pain control during labor; nevertheless, it is not without risks. Horner syndrome is an uncommon related complication. We report a case of transient Horner syndrome following epidural anesthesia and a review of the literature. We discuss the pathophysiologic and contributing factors to this syndrome and its potential complications. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this activity, physicians will be able to educate healthcare professionals working on the labor ward to be able to estimate the small incidence of Horner Syndrome following epidural anesthesia administered in labor. This will result in optimal management and will minimize the need for costly and inappropriate diagnostic investigations. The reader will also be able to compare the difference in the incidence of Horner syndrome following epidural anesthesia, as reported in the literature; appraise the clinical presentation, the pathophysiology, and the mechanism of Horner syndrome developing as a complication of regional anesthesia; and analyze the different theories proposed in the reported cases in the literature.

Flexible upper videoendoscopy through a modified endoscopy mask in infants and young children.

Esophagogastroduodenoscopy (EGD) is considered an essential diagnostic and therapeutic procedure in the pediatric population. Although generally safe, EGD has the potential for airway complications. We routinely use general anesthesia to carry out EGD in patients younger than 10 years. In the past, these patients received oxygen either through a nasal cannula or were intubated; both modalities have drawbacks and may be associated with complications. Here we report our experience using a modified endoscopy mask, devised primarily for bronchoscopy, for upper endoscopy in children under general anesthesia. Results: Two hundred forty children (122 boys and 118 girls) participated in the study. Age range was 7 to 135 months (mean 60.7 ± 34.4 months). All patients maintained a stable hemodynamic status throughout the procedure. Ventilation was satisfactory in 230 patients. It was difficult in 9 patients, and external airway maneuvers had to be applied. Ventilation was impossible in only 1 patient (10 months old), and endotracheal intubation was performed. There were no procedure-related complications. Conclusion: The modified endoscopy mask is efficient and safe and should be recommended for routine use for upper endoscopy under general anesthesia in children older than 6 months.

Delayed ventricular fibrillation following blunt chest trauma in a 4-year-old child.

A 4‐year‐old boy who was involved in a motor vehicle accident as a pedestrian and suffered blunt chest trauma was admitted to the emergency room. Unpredictable delayed ventricular fibrillation was diagnosed and treated successfully 2 h later. This case cannot be classified as commotio cordis as the ventricular fibrillation (VF) developed so long after the sustained chest injury. At the same time, other possible etiologies of VF such as cardiac pathology or electrolyte and metabolic disorders had been ruled out. Thus, an etiological link between the chest trauma and the subsequent VF could not be ruled out and is in fact plausible despite the late onset.

Does adding intravenous fentanyl to caudal block in children enhance the efficacy of multimodal analgesia as reflected in the plasma level of catecholamines

Background and objective: Several studies showed that single analgesic modality management can attenuate perioperative stress, but little is known about the effect of multimodal analgesia on catecholamine responses to surgical trauma in children. Methods: Fifty children (American Society of Anesthesiologists Grade I or II) were randomly allocated to one of two groups: one received general anaesthesia and a caudal block (control group), and one group was given general anaesthesia, caudal block and intravenous (i.v.) fentanyl 2 &mgr;g kg−1 (fentanyl group). Plasma epinephrine and norepinephrine concentrations were measured three times during the perioperative period: at induction time (T0), at the end of surgery (T1) and when the children were fully awake in the postanaesthesia care unit (T2). Results: There was a significant reduction in the catecholamine levels in the two groups when (T1) and (T2) were compared with T0. When plasma epinephrine levels (at T0, T1 and T2) between the two groups were compared, a statistically significant reduction at T2 was obtained in the fentanyl group, when compared with the control group. However, plasma norepinephrine levels showed no statistically significant difference between the two groups (at T0, T1 and T2). Conclusion: These findings suggest that the multimodal analgesic approach of adding i.v. low‐dose fentanyl to a caudal block may decrease the plasma epinephrine release in children undergoing inguinal herniotomy.