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  Citation statistics : Table of Contents
   2012| September-October  | Volume 56 | Issue 5  
    Online since November 28, 2012

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Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery
Jagdish Menghraj Shahani
September-October 2012, 56(5):491-495
DOI:10.4103/0019-5049.103969  PMID:23293389
The objective of this article is to provide an updated and comprehensive review on current perioperative anaesthetic management of paediatric patients with congenital heart disease (CHD) coming for non-cardiac surgery. Search of terms such as "anaesthetic management," "congenital heart disease" and "non-cardiac surgery" was carried out in KKH eLibrary, PubMed, Medline and Google, focussing on significant current randomised control trials, case reports, review articles and editorials. Issues on how to tailor perioperative anaesthetic management on cases with left to right shunt, right to left shunt and complex heart disease are discussed in this article. Furthermore, the author also highlights special considerations such as pulmonary hypertension, neonates with CHD coming for extracardiac surgery and the role of regional anaesthesia in children with CHD undergoing non-cardiac operation.
  9 7,412 2,600
Paediatric airway management: What is new?
S Ramesh, R Jayanthi, SR Archana
September-October 2012, 56(5):448-453
DOI:10.4103/0019-5049.103959  PMID:23293383
Airway management plays a pivotal role in Paediatric Anaesthesia. Over the last two decades many improvements in this area have helped us to overcome this final frontier. From an era where intubation with a conventional laryngoscope or blind nasal intubation was the only tool for airway management, we have come a long way. Today supraglottic airway devices have pride of place in the Operating Room and are becoming important airway devices used in routine procedures. Direct and indirect fibreoptic laryngoscopes and transtracheal devices help us overcome difficult and previously impossible airway situations. These developments mean that we need to update our knowledge on these devices. Also much of our basic understanding of the physiology and anatomy of the paediatric airway has changed. This article attempts to shed light on some of the most important advances/opinions in paediatric airway management like, cuffed endotracheal tubes, supraglottic airway devices, video laryngoscopes, rapid sequence intubation, the newly proposed algorithm for difficult airway management and the role of Ex Utero Intrapartum Treatment (EXIT) procedure in the management of the neonatal airway.
  6 5,561 2,283
Basics of fluid and blood transfusion therapy in paediatric surgical patients
Virendra K Arya
September-October 2012, 56(5):454-462
DOI:10.4103/0019-5049.103960  PMID:23293384
Perioperative fluid, electrolyte and blood transfusion therapy for infants and children can be confusing due the numerous opinions, formulas and clinical applications, which can result in a picture that is not practical and is often misleading. Perioperatively, crystalloids, colloids and blood components are required to meet the ongoing losses and for maintaining cardiovascular stability to sustain adequate tissue perfusion. Recently controversies have been raised regarding historically used formulas and practices of glucose containing hypotonic maintenance crystalloid solutions for perioperative fluid therapy in children. Paediatric intraoperative transfusion therapy, particularly the approach to massive blood transfusion (blood loss ≥ one blood volume) can be quite complex because of the unique relationship between the patient's blood volume and the volume of the individual blood product transfused. A meticulous fluid, electrolyte and blood transfusion management is required in paediatric patients perioperatively because of an extremely limited margin for error. This article reviews the basic concepts in perioperative fluid and blood transfusion therapy for paediatric patients, along with recent recommendations. For this review, Pubmed, Ovid MEDLINE, HINARI and Google scholar were searched without date restrictions. Search terms included the following in various combinations: Perioperative, fluid therapy, paediatrics, blood transfusion, electrolyte disturbances and guidelines. Only articles with English translation were used.
  4 20,390 5,283
Recent developments in paediatric neuraxial blocks
Vrushali Chandrashekhar Ponde
September-October 2012, 56(5):470-478
DOI:10.4103/0019-5049.103964  PMID:23293386
Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Almost all surgeries unless contradicted could be and should be supplemented with a regional block. The main objective of this review is to elaborate on the recent advances of the central neuraxial blocks, such as application of ultrasound guidance and electrical stimulation in the pursuit of safety and an objective end point. This review also takes account of the traditional technique and understand the benefits as well the risk of each as compared with the recent technique. The recent trends in choosing the most appropriate peripheral block for a given surgery thereby sparing the central neuroaxis is considered. A penile block for circumcision or a sciatic block for unilateral foot surgery, rather than caudal epidural would have a better risk benefit equation. Readers will find a special mention on the recent thoughts on continuous epidural analgesia in paediatrics, especially its rise and fall, yet its unique importance. Lastly, the issue of block placements under sedation or general anaesthesia with its implication in this special population is dealt with. We conducted searches in MEDLINE (PubMed) and assessed the relevance of the abstracts of citations identified from literature searches. The search was carried out in English, for last 10 years, with the following key words: Recent advances in paediatric regional anaesthesia; ultrasound guidance for central neuraxial blocks in children; role of electrical stimulation in neuraxial blocks in children; complications in neuraxial block. Full-text articles of potentially relevant abstracts were retrieved for further review.
  4 6,752 2,071
Depth of general anaesthesia monitors
D Devika Rani, SS Harsoor
September-October 2012, 56(5):437-441
DOI:10.4103/0019-5049.103956  PMID:23293381
  2 4,062 1,827
Anaesthesia for biliary atresia and hepatectomy in paediatrics
Rebecca Jacob
September-October 2012, 56(5):479-484
DOI:10.4103/0019-5049.103965  PMID:23293387
The scope of this article precludes an 'in depth' description of all liver problems and I will limit this review to anaesthesia for biliary atresia - a common hepatic problem in the very young - and partial hepatectomy in older children. I will not be discussing the problems of anaesthetising children with hepatitis, cirrhosis, congenital storage diseases or liver failure. Extrahepatic biliary obstruction is an obliterative cholangiopathy of infancy which is fatal if untreated. Diagnosis involves exclusion of other causes of neonatal jaundice and treatment involves a hepatico portoenterostomy carried out at the earliest. This is a review of current concepts in anaesthesia and postoperative management of neonates with extrahepatic biliary atresia. Anaesthesia for hepatic resection has seen great changes in recent times with the improvement in surgical techniques, technology and a better understanding of the underlying physiology. These are reviewed along with the problems of postoperative pain management.
  1 5,632 1,846
Anaesthesia for neurosurgical procedures in paediatric patients
Girija Prasad Rath, Hari H Dash
September-October 2012, 56(5):502-510
DOI:10.4103/0019-5049.103979  PMID:23293391
Recent advances in neurosurgery, neuromonitoring and neurointensive care have dramatically improved the outcome in patients affected by surgical lesions of central nervous system (CNS). Although most of these techniques were applied first in the adult population, paediatric patients present a set of inherent challenges because of their developing and maturing neurological and physiological status, apart from the CNS disease process. To provide optimal neuroanaesthesia care, the anaesthesiologist must have the knowledge of basic neurophysiology of developing brain and effects of various drugs on cerebral haemodynamics apart from the specialised training on paediatric neuroanaesthesia. This article highlights on the perioperative management of paediatric neurosurgical patients.
  1 25,077 4,404
Prof. Shyamal Kumar Roy
Anjan Datta
September-October 2012, 56(5):511-511
  - 1,575 234
Recent advances in paediatric cardiac anaesthesia
Mahesh Vakamudi, Harish Ravulapalli, Ranjith Karthikeyan
September-October 2012, 56(5):485-490
DOI:10.4103/0019-5049.103967  PMID:23293388
Paediatric cardiac anaesthesia involves anaesthetizing very small children with complex congenital heart disease for major surgical procedures. The unique nature of this patient population requires considerable expertise and in-depth knowledge of the altered physiology. There have been several developments in the last decade in this subspecialty that has contributed to better care and improved outcome in this vulnerable group of patients. The purpose of this review is to present some of the recent advances in the anesthetic management of these children from preoperative evaluation to postoperative care. This article reviews the role of magnetic resonance imaging and contrast-enhanced magnetic resonance angiography in preoperative evaluation, the use of ultrasound to secure vascular access, the use of cuffed endotracheal tubes, the optimal haematocrit and the role of blood products, including the use of recombinant factor VIIa. It also deals with the advances in technology that have led to improved monitoring, the newer developments in cardiopulmonary bypass, the use of centrifugal pumps and extracorporeal membrane oxygenation and the role of DHCA. The role of new drugs, especially the α-2 agonists in paediatric cardiac anesthetic practice, fast tracking and effective postoperative pain management have also been reviewed.
  - 2,811 1,363
Common post-operative complications in children
Dilip Pawar
September-October 2012, 56(5):496-501
The exact incidence of common post-operative complications in children is not known. Most common one is post-operative nausea and vomiting followed by respiratory complications leading to hypoxia. Cardiac complications are less in children without associated congenital cardiac anomaly. Post-operative shivering, agitation and delirium are seen more often in children anaesthetised with newer inhalational agents like sevoflurane and desflurane. Urinary retention in the post-operative period could be influenced by anaesthetic drugs and regional blocks. The purpose of this article is to review the literature and present to the postgraduate students comprehensive information about the current understanding and practice pattern on various common complications in the post-operative period. Extensive literature was searched with key words of various complications from Pubmed, Google scholar and specific journal, namely paediatric anaesthesia. The relevant articles, review article meta-analysis and editorials were the primary source of information for this article.
  - 4,389 1,826
Anaesthetic consideration for neonatal surgical emergencies
Nibedita Pani, Chinmaya K Panda
September-October 2012, 56(5):463-469
DOI:10.4103/0019-5049.103962  PMID:23293385
A newborn requires constant vigilance, rapid recognition of the events and swift intervention during anaesthesia. The anaesthetic considerations in neonatal surgical emergencies are based on the physiological immaturity of various body systems, poor tolerance of the anaesthetic drugs, associated congenital disorders and considerations regarding the use of high concentration of oxygen. The main goal is for titration of anaesthetics to desired effects, while carefully monitoring of the cardiorespiratory status. The use of regional anaesthesia has shown to be safe and effective. Advancements in neonatology have resulted in the improvement of the survival of the premature and critically ill newborn babies. Most of the disorders previously considered as neonatal surgical emergencies in the past no longer require immediate surgery due to new technology and new methods of treating sick neonates. This article describes the common neonatal surgical emergencies and focuses on factors that affect the anaesthetic management of patients with these disorders.
  - 7,677 2,800
Separation of thoraco-omphalopagus twins in a rural secondary hospital: Perioperative management
Madhurita Singh, Rebecca Jacob, Vibhavari Naik, David Baines
September-October 2012, 56(5):442-447
DOI:10.4103/0019-5049.103957  PMID:23293382
Providing anaesthesia for the separation surgery of conjoined twins presents unique challenges to the managing anaesthesiologists. The low incidence of such surgeries and anatomical variations in each type of conjoined twins makes each separation surgery a unique experience. This report features the anaesthetic plan and challenges faced in performing the separation surgery of a set of thoraco-omphalopagus twins in a rural secondary hospital in a remote location in India.
  - 3,449 632