Pediatric anesthesia practice has expanded to provide deep sedation or general anesthesia in many... more Pediatric anesthesia practice has expanded to provide deep sedation or general anesthesia in many different locations throughout the hospital. Special considerations of space, patient access, and physical environment are imposed on the anesthesiologist in many of these locations. It is vital that each of these locations is appropriately equipped and staffed to established standards to provide safe and effective anesthesia patient care. Patient monitoring and standards of care should be provided as is current practice in the O.R. Simple anesthesia regimens based on intravenous infusion of propofol will provide optimal results in many cases. In other cases (e.g. Cath Lab and cardiac MRI), there is a need for more complex regimens in order to ensure the success of the planned procedure. Recommendations for protocols to be used in each location are provided.
In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubatio... more In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubation (TI) in the emergency department (ED) of a large urban tertiary care pediatric center in Australia (1). With the majority of the TIs performed by either ED or intensive care registrars, the authors reported a 78% first pass success rate for TI (ranging from 67% for ED fellows and anesthesia registrars to 100% for anesthesia consultants), but only 49% for those without adverse event. The incidence of adverse events was 54%, with hypotension occurring in 21% and desaturation in 14%, despite a small incidence of difficult laryngoscopy or intubation. The authors concluded that system changes and education are required to improve these statistics and provide quality airway management for infants and children in the ED. This work adds to a growing body of literature that suggests that nonanesthesia trainees experience difficulty in managing the pediatric airway, particularly in pediatric emergency department (ED) and critical-care (PICU) settings. The nature of this difficulty may be addressed by considering two questions: (i) What strategies are most effective in achieving proficiency in TI in children? and (ii) What strategies decrease the incidence of adverse events associated with TI in children? At first glance, the answers to these questions may appear obvious and simple, but in reality, the challenges are complex and evolving, necessitating solutions that differ substantially among institutions. How should nonanesthesiologist trainees from the ED, PICU and pediatrics achieve proficiency at TI in children? This requires a dual approach: (i) knowledge and (ii) procedural proficiency. The knowledge aspect requires educating trainees in the anatomy and physiology of the pediatric airway, the equipment necessary including different laryngoscope blades, tracheal tubes, and ancillary airway devices, and familiarity with alternate strategies to secure the airway should direct laryngoscopy fail (e.g., a failed intubation algorithm). Furthermore, the trainee must become very familiar with the pharmacology of the drugs that are used to induce anesthesia and paralyze the child, including their contraindications and adverse effects and management. In terms of procedural proficiency, what are the technical requirements for nonanesthesia trainees to become proficient at TI? In anesthesia, trainees usually begin their airway management by managing adult airways and once proficient in that age group (usually after 1-year experience or approximately 1000 TIs), they advance to managing the airways in infants and children. ED residents may also acquire a degree of proficiency at TI in adults during their early adult rotations, but that is unlikely in pediatrics and neonatal ICU and PICU trainees. At our institution, we occasionally find new ED residents with no prior training in airway management rotating through pediatric anesthesia in one of their first rotations, a practice that we deem not in the trainees’ best interest or education. With the limited prior training in TI in nonanesthesia trainees, it comes as no great surprise that the proficiency of nonanesthesia pediatric trainees at successful first attempt TI in children is disappointing (2,3). ‘Your ability to attain expert performance is clearly constrained if you have fewer opportunities to engage in deliberate practice, and this is far from a trivial constraint’ (4). This statement begs the question: How many repetitions must a trainee perform before becoming proficient at a task? In music, a trainee may expend approximately 10 000 h of steady practice to approach ‘virtuoso’ proficiency (5). In medicine, most nonanesthesia trainees do not expend sufficient time to develop the virtuoso proficiency in airway management of the stable child with an easy airway, which does present challenges in managing the unstable child and those with difficult airways (6). In medicine, evidence indicates that the number of repetitions required to achieve a mean 90% success rate for a particular procedure is approximately 80 TIs, 60 mask ventilations, 79 peripheral venous cannulation, 60–80 epidural insertions, and 45–80 spinal anesthetics (7–10). However, rather than achieving a mean 90% success rate for a cohort, should we not be striving to achieve a minimum 90% success rate for the cohort, as the former connotes that 50% of the trainees do not achieve the threshold level of proficiency expected? Few studies have achieved these minimum thresholds for TI (11,12). In a study of ED residents, the mean success rate for first attempt at TI increased during their training (6,12), although the mean maximum success rate did not increase after each resident performed 51–75 TIs (12). Success at the first attempt at TI is the quintessential metric for assessing TI proficiency in many nonanesthesia training programs because the rates of complications (including desaturation) increase directly…
To determine the heart rate response to atropine (<0.1 mg) in anaesthetised young infants. Pro... more To determine the heart rate response to atropine (<0.1 mg) in anaesthetised young infants. Prospective, observational and controlled. Elective surgery. Sixty unpremedicated healthy infants less than 15 kg were enrolled. Standard monitoring was applied. Anaesthesia was induced by mask with nitrous oxide (66%) and oxygen (33%) followed by sevoflurane (8%). Intravenous (IV) atropine (5 µg/kg) was flushed into a fast flowing IV. The ECG was recorded continuously from 30 s before the atropine until 5 min afterwards. The incidence of bradycardia and arrhythmias was determined from the ECGs by a blinded observer. The median (IQR) age was 6.5 (4-12) months and the mean (95% CI) weight was 8.6 (8.1 to 9.1) kg. The mean (95% CI) dose of atropine was 40.9 (37.3 to 44) µg. Bradycardia did not occur. Two infants developed premature atrial contractions and one developed a premature ventricular contraction. When compared with baseline values, heart rate increased by 7% 30 s after atropine, 14% ...
Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age... more Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was designed to compare the laryngeal views with the size 1 Miller and MAC blades in children <2 yr. With IRB approval, 50 ASA I and II children <2 yr undergoing elective surgery were enrolled. After an inhalation induction and neuromuscular block with i.v. rocuronium 0.5 mg kg(-1), two laryngeal views were obtained with a single blade (Miller or MAC) in each child: one lifting the epiglottis and another lifting the tongue base. The best laryngeal views in each blade position were photographed with a SONY(®) Cyber-shot camera and rated by a blinded anaesthesiologist using the percentage of glottic opening scale. The scores with the Miller blade lifting the epiglottis and the MAC...
Dexmedetomidine is administered for pediatric sedation for MRI studies. It has the advantage of p... more Dexmedetomidine is administered for pediatric sedation for MRI studies. It has the advantage of preserving respiratory function and producing a sedation state identical to that of natural sleep. It can, however, cause a dose-dependent decrease in systemic blood pressure in children. The purpose of this study was to investigate whether i.v. fluid loading with normal saline solution before the initiation of dexmedetomidine administration would affect the frequency of hypotension. Quality assurance data on consecutively registered children who were sedated with dexmedetomidine for MRI were reviewed. All children received a bolus of 3 μg/kg dexmedetomidine followed by a continuous infusion of 2 mg/ kg/h. A normal saline fluid bolus consisting of 0, 10, or 20 mL/kg was administered to each child within 1 hour before initiation of dexmedetomidine administration. Hypotension was defined as a greater than 20% decrease in mean arterial blood pressure from baseline. Sedation was administered ...
In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubatio... more In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubation (TI) in the emergency department (ED) of a large urban tertiary care pediatric center in Australia (1). With the majority of the TIs performed by either ED or intensive care registrars, the authors reported a 78% first pass success rate for TI (ranging from 67% for ED fellows and anesthesia registrars to 100% for anesthesia consultants), but only 49% for those without adverse event. The incidence of adverse events was 54%, with hypotension occurring in 21% and desaturation in 14%, despite a small incidence of difficult laryngoscopy or intubation. The authors concluded that system changes and education are required to improve these statistics and provide quality airway management for infants and children in the ED. This work adds to a growing body of literature that suggests that nonanesthesia trainees experience difficulty in managing the pediatric airway, particularly in pediatric emergency department (ED) and critical-care (PICU) settings. The nature of this difficulty may be addressed by considering two questions: (i) What strategies are most effective in achieving proficiency in TI in children? and (ii) What strategies decrease the incidence of adverse events associated with TI in children? At first glance, the answers to these questions may appear obvious and simple, but in reality, the challenges are complex and evolving, necessitating solutions that differ substantially among institutions. How should nonanesthesiologist trainees from the ED, PICU and pediatrics achieve proficiency at TI in children? This requires a dual approach: (i) knowledge and (ii) procedural proficiency. The knowledge aspect requires educating trainees in the anatomy and physiology of the pediatric airway, the equipment necessary including different laryngoscope blades, tracheal tubes, and ancillary airway devices, and familiarity with alternate strategies to secure the airway should direct laryngoscopy fail (e.g., a failed intubation algorithm). Furthermore, the trainee must become very familiar with the pharmacology of the drugs that are used to induce anesthesia and paralyze the child, including their contraindications and adverse effects and management. In terms of procedural proficiency, what are the technical requirements for nonanesthesia trainees to become proficient at TI? In anesthesia, trainees usually begin their airway management by managing adult airways and once proficient in that age group (usually after 1-year experience or approximately 1000 TIs), they advance to managing the airways in infants and children. ED residents may also acquire a degree of proficiency at TI in adults during their early adult rotations, but that is unlikely in pediatrics and neonatal ICU and PICU trainees. At our institution, we occasionally find new ED residents with no prior training in airway management rotating through pediatric anesthesia in one of their first rotations, a practice that we deem not in the trainees’ best interest or education. With the limited prior training in TI in nonanesthesia trainees, it comes as no great surprise that the proficiency of nonanesthesia pediatric trainees at successful first attempt TI in children is disappointing (2,3). ‘Your ability to attain expert performance is clearly constrained if you have fewer opportunities to engage in deliberate practice, and this is far from a trivial constraint’ (4). This statement begs the question: How many repetitions must a trainee perform before becoming proficient at a task? In music, a trainee may expend approximately 10 000 h of steady practice to approach ‘virtuoso’ proficiency (5). In medicine, most nonanesthesia trainees do not expend sufficient time to develop the virtuoso proficiency in airway management of the stable child with an easy airway, which does present challenges in managing the unstable child and those with difficult airways (6). In medicine, evidence indicates that the number of repetitions required to achieve a mean 90% success rate for a particular procedure is approximately 80 TIs, 60 mask ventilations, 79 peripheral venous cannulation, 60–80 epidural insertions, and 45–80 spinal anesthetics (7–10). However, rather than achieving a mean 90% success rate for a cohort, should we not be striving to achieve a minimum 90% success rate for the cohort, as the former connotes that 50% of the trainees do not achieve the threshold level of proficiency expected? Few studies have achieved these minimum thresholds for TI (11,12). In a study of ED residents, the mean success rate for first attempt at TI increased during their training (6,12), although the mean maximum success rate did not increase after each resident performed 51–75 TIs (12). Success at the first attempt at TI is the quintessential metric for assessing TI proficiency in many nonanesthesia training programs because the rates of complications (including desaturation) increase directly…
In 1961, in the journal &#x27;Anesthesia and Analgesia&#x27;, Dr. Digby Leigh, one of the... more In 1961, in the journal &#x27;Anesthesia and Analgesia&#x27;, Dr. Digby Leigh, one of the &#x27;Fathers&#x27; of American pediatric anesthesia, was asked how to secure the airway in the preterm neonate. His answer was &#x27;if active as with the fulltermÂ…anesthetize with cyclopropane, Â… ...
We prospectively assessed the efficacy and side effects of four sedation techniques in our dental... more We prospectively assessed the efficacy and side effects of four sedation techniques in our dental clinic: oral midazolam, intranasal (IN) midazolam, IN midazolam combined with oral transmucosal fentanyl citrate (OTFC), and IN midazolam combined with IN sufentanil.
Background Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. ... more Background Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. The authors compared the severity of epistaxis after nasotracheal intubation in children with tubes at room temperature, warm tubes, and tubes telescoped into catheters. Methods Children who were scheduled for elective dental surgery were randomly assigned to undergo nasotracheal intubation using a tube at room temperature (control), warmed in saline, or whose distal end had been telescoped into a red rubber catheter. After an inhalational induction and intravenous propofol, a lubricated tube or red rubber catheter was inserted into the right naris. Tracheal intubation was achieved by direct laryngoscopy and tube placement using Magill forceps. The pharynx was swabbed for blood by an observer who was blind to the treatment. The severity of bleeding was rated using reference figures. Data were analyzed using Kruskal-Wallis and Fisher exact tests. P < 0.05 was accepted. Results The demo...
Pediatric anesthesia practice has expanded to provide deep sedation or general anesthesia in many... more Pediatric anesthesia practice has expanded to provide deep sedation or general anesthesia in many different locations throughout the hospital. Special considerations of space, patient access, and physical environment are imposed on the anesthesiologist in many of these locations. It is vital that each of these locations is appropriately equipped and staffed to established standards to provide safe and effective anesthesia patient care. Patient monitoring and standards of care should be provided as is current practice in the O.R. Simple anesthesia regimens based on intravenous infusion of propofol will provide optimal results in many cases. In other cases (e.g. Cath Lab and cardiac MRI), there is a need for more complex regimens in order to ensure the success of the planned procedure. Recommendations for protocols to be used in each location are provided.
In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubatio... more In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubation (TI) in the emergency department (ED) of a large urban tertiary care pediatric center in Australia (1). With the majority of the TIs performed by either ED or intensive care registrars, the authors reported a 78% first pass success rate for TI (ranging from 67% for ED fellows and anesthesia registrars to 100% for anesthesia consultants), but only 49% for those without adverse event. The incidence of adverse events was 54%, with hypotension occurring in 21% and desaturation in 14%, despite a small incidence of difficult laryngoscopy or intubation. The authors concluded that system changes and education are required to improve these statistics and provide quality airway management for infants and children in the ED. This work adds to a growing body of literature that suggests that nonanesthesia trainees experience difficulty in managing the pediatric airway, particularly in pediatric emergency department (ED) and critical-care (PICU) settings. The nature of this difficulty may be addressed by considering two questions: (i) What strategies are most effective in achieving proficiency in TI in children? and (ii) What strategies decrease the incidence of adverse events associated with TI in children? At first glance, the answers to these questions may appear obvious and simple, but in reality, the challenges are complex and evolving, necessitating solutions that differ substantially among institutions. How should nonanesthesiologist trainees from the ED, PICU and pediatrics achieve proficiency at TI in children? This requires a dual approach: (i) knowledge and (ii) procedural proficiency. The knowledge aspect requires educating trainees in the anatomy and physiology of the pediatric airway, the equipment necessary including different laryngoscope blades, tracheal tubes, and ancillary airway devices, and familiarity with alternate strategies to secure the airway should direct laryngoscopy fail (e.g., a failed intubation algorithm). Furthermore, the trainee must become very familiar with the pharmacology of the drugs that are used to induce anesthesia and paralyze the child, including their contraindications and adverse effects and management. In terms of procedural proficiency, what are the technical requirements for nonanesthesia trainees to become proficient at TI? In anesthesia, trainees usually begin their airway management by managing adult airways and once proficient in that age group (usually after 1-year experience or approximately 1000 TIs), they advance to managing the airways in infants and children. ED residents may also acquire a degree of proficiency at TI in adults during their early adult rotations, but that is unlikely in pediatrics and neonatal ICU and PICU trainees. At our institution, we occasionally find new ED residents with no prior training in airway management rotating through pediatric anesthesia in one of their first rotations, a practice that we deem not in the trainees’ best interest or education. With the limited prior training in TI in nonanesthesia trainees, it comes as no great surprise that the proficiency of nonanesthesia pediatric trainees at successful first attempt TI in children is disappointing (2,3). ‘Your ability to attain expert performance is clearly constrained if you have fewer opportunities to engage in deliberate practice, and this is far from a trivial constraint’ (4). This statement begs the question: How many repetitions must a trainee perform before becoming proficient at a task? In music, a trainee may expend approximately 10 000 h of steady practice to approach ‘virtuoso’ proficiency (5). In medicine, most nonanesthesia trainees do not expend sufficient time to develop the virtuoso proficiency in airway management of the stable child with an easy airway, which does present challenges in managing the unstable child and those with difficult airways (6). In medicine, evidence indicates that the number of repetitions required to achieve a mean 90% success rate for a particular procedure is approximately 80 TIs, 60 mask ventilations, 79 peripheral venous cannulation, 60–80 epidural insertions, and 45–80 spinal anesthetics (7–10). However, rather than achieving a mean 90% success rate for a cohort, should we not be striving to achieve a minimum 90% success rate for the cohort, as the former connotes that 50% of the trainees do not achieve the threshold level of proficiency expected? Few studies have achieved these minimum thresholds for TI (11,12). In a study of ED residents, the mean success rate for first attempt at TI increased during their training (6,12), although the mean maximum success rate did not increase after each resident performed 51–75 TIs (12). Success at the first attempt at TI is the quintessential metric for assessing TI proficiency in many nonanesthesia training programs because the rates of complications (including desaturation) increase directly…
To determine the heart rate response to atropine (<0.1 mg) in anaesthetised young infants. Pro... more To determine the heart rate response to atropine (<0.1 mg) in anaesthetised young infants. Prospective, observational and controlled. Elective surgery. Sixty unpremedicated healthy infants less than 15 kg were enrolled. Standard monitoring was applied. Anaesthesia was induced by mask with nitrous oxide (66%) and oxygen (33%) followed by sevoflurane (8%). Intravenous (IV) atropine (5 µg/kg) was flushed into a fast flowing IV. The ECG was recorded continuously from 30 s before the atropine until 5 min afterwards. The incidence of bradycardia and arrhythmias was determined from the ECGs by a blinded observer. The median (IQR) age was 6.5 (4-12) months and the mean (95% CI) weight was 8.6 (8.1 to 9.1) kg. The mean (95% CI) dose of atropine was 40.9 (37.3 to 44) µg. Bradycardia did not occur. Two infants developed premature atrial contractions and one developed a premature ventricular contraction. When compared with baseline values, heart rate increased by 7% 30 s after atropine, 14% ...
Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age... more Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was designed to compare the laryngeal views with the size 1 Miller and MAC blades in children <2 yr. With IRB approval, 50 ASA I and II children <2 yr undergoing elective surgery were enrolled. After an inhalation induction and neuromuscular block with i.v. rocuronium 0.5 mg kg(-1), two laryngeal views were obtained with a single blade (Miller or MAC) in each child: one lifting the epiglottis and another lifting the tongue base. The best laryngeal views in each blade position were photographed with a SONY(®) Cyber-shot camera and rated by a blinded anaesthesiologist using the percentage of glottic opening scale. The scores with the Miller blade lifting the epiglottis and the MAC...
Dexmedetomidine is administered for pediatric sedation for MRI studies. It has the advantage of p... more Dexmedetomidine is administered for pediatric sedation for MRI studies. It has the advantage of preserving respiratory function and producing a sedation state identical to that of natural sleep. It can, however, cause a dose-dependent decrease in systemic blood pressure in children. The purpose of this study was to investigate whether i.v. fluid loading with normal saline solution before the initiation of dexmedetomidine administration would affect the frequency of hypotension. Quality assurance data on consecutively registered children who were sedated with dexmedetomidine for MRI were reviewed. All children received a bolus of 3 μg/kg dexmedetomidine followed by a continuous infusion of 2 mg/ kg/h. A normal saline fluid bolus consisting of 0, 10, or 20 mL/kg was administered to each child within 1 hour before initiation of dexmedetomidine administration. Hypotension was defined as a greater than 20% decrease in mean arterial blood pressure from baseline. Sedation was administered ...
In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubatio... more In this issue of Pediatric Anesthesia, Long et al. present their experience of tracheal intubation (TI) in the emergency department (ED) of a large urban tertiary care pediatric center in Australia (1). With the majority of the TIs performed by either ED or intensive care registrars, the authors reported a 78% first pass success rate for TI (ranging from 67% for ED fellows and anesthesia registrars to 100% for anesthesia consultants), but only 49% for those without adverse event. The incidence of adverse events was 54%, with hypotension occurring in 21% and desaturation in 14%, despite a small incidence of difficult laryngoscopy or intubation. The authors concluded that system changes and education are required to improve these statistics and provide quality airway management for infants and children in the ED. This work adds to a growing body of literature that suggests that nonanesthesia trainees experience difficulty in managing the pediatric airway, particularly in pediatric emergency department (ED) and critical-care (PICU) settings. The nature of this difficulty may be addressed by considering two questions: (i) What strategies are most effective in achieving proficiency in TI in children? and (ii) What strategies decrease the incidence of adverse events associated with TI in children? At first glance, the answers to these questions may appear obvious and simple, but in reality, the challenges are complex and evolving, necessitating solutions that differ substantially among institutions. How should nonanesthesiologist trainees from the ED, PICU and pediatrics achieve proficiency at TI in children? This requires a dual approach: (i) knowledge and (ii) procedural proficiency. The knowledge aspect requires educating trainees in the anatomy and physiology of the pediatric airway, the equipment necessary including different laryngoscope blades, tracheal tubes, and ancillary airway devices, and familiarity with alternate strategies to secure the airway should direct laryngoscopy fail (e.g., a failed intubation algorithm). Furthermore, the trainee must become very familiar with the pharmacology of the drugs that are used to induce anesthesia and paralyze the child, including their contraindications and adverse effects and management. In terms of procedural proficiency, what are the technical requirements for nonanesthesia trainees to become proficient at TI? In anesthesia, trainees usually begin their airway management by managing adult airways and once proficient in that age group (usually after 1-year experience or approximately 1000 TIs), they advance to managing the airways in infants and children. ED residents may also acquire a degree of proficiency at TI in adults during their early adult rotations, but that is unlikely in pediatrics and neonatal ICU and PICU trainees. At our institution, we occasionally find new ED residents with no prior training in airway management rotating through pediatric anesthesia in one of their first rotations, a practice that we deem not in the trainees’ best interest or education. With the limited prior training in TI in nonanesthesia trainees, it comes as no great surprise that the proficiency of nonanesthesia pediatric trainees at successful first attempt TI in children is disappointing (2,3). ‘Your ability to attain expert performance is clearly constrained if you have fewer opportunities to engage in deliberate practice, and this is far from a trivial constraint’ (4). This statement begs the question: How many repetitions must a trainee perform before becoming proficient at a task? In music, a trainee may expend approximately 10 000 h of steady practice to approach ‘virtuoso’ proficiency (5). In medicine, most nonanesthesia trainees do not expend sufficient time to develop the virtuoso proficiency in airway management of the stable child with an easy airway, which does present challenges in managing the unstable child and those with difficult airways (6). In medicine, evidence indicates that the number of repetitions required to achieve a mean 90% success rate for a particular procedure is approximately 80 TIs, 60 mask ventilations, 79 peripheral venous cannulation, 60–80 epidural insertions, and 45–80 spinal anesthetics (7–10). However, rather than achieving a mean 90% success rate for a cohort, should we not be striving to achieve a minimum 90% success rate for the cohort, as the former connotes that 50% of the trainees do not achieve the threshold level of proficiency expected? Few studies have achieved these minimum thresholds for TI (11,12). In a study of ED residents, the mean success rate for first attempt at TI increased during their training (6,12), although the mean maximum success rate did not increase after each resident performed 51–75 TIs (12). Success at the first attempt at TI is the quintessential metric for assessing TI proficiency in many nonanesthesia training programs because the rates of complications (including desaturation) increase directly…
In 1961, in the journal &#x27;Anesthesia and Analgesia&#x27;, Dr. Digby Leigh, one of the... more In 1961, in the journal &#x27;Anesthesia and Analgesia&#x27;, Dr. Digby Leigh, one of the &#x27;Fathers&#x27; of American pediatric anesthesia, was asked how to secure the airway in the preterm neonate. His answer was &#x27;if active as with the fulltermÂ…anesthetize with cyclopropane, Â… ...
We prospectively assessed the efficacy and side effects of four sedation techniques in our dental... more We prospectively assessed the efficacy and side effects of four sedation techniques in our dental clinic: oral midazolam, intranasal (IN) midazolam, IN midazolam combined with oral transmucosal fentanyl citrate (OTFC), and IN midazolam combined with IN sufentanil.
Background Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. ... more Background Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. The authors compared the severity of epistaxis after nasotracheal intubation in children with tubes at room temperature, warm tubes, and tubes telescoped into catheters. Methods Children who were scheduled for elective dental surgery were randomly assigned to undergo nasotracheal intubation using a tube at room temperature (control), warmed in saline, or whose distal end had been telescoped into a red rubber catheter. After an inhalational induction and intravenous propofol, a lubricated tube or red rubber catheter was inserted into the right naris. Tracheal intubation was achieved by direct laryngoscopy and tube placement using Magill forceps. The pharynx was swabbed for blood by an observer who was blind to the treatment. The severity of bleeding was rated using reference figures. Data were analyzed using Kruskal-Wallis and Fisher exact tests. P < 0.05 was accepted. Results The demo...
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