Paediatric and neonatal anaesthesia

2016 ◽  
Author(s):  
Simon Berg ◽  
Stewart Campbell
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Ductus Arteriosus ◽  
Fluid Management ◽  
Anaesthetic Techniques ◽  
Anaesthetic Management ◽  
Medical Problems ◽  
Nerve Blocks ◽  
Congenital Talipes Equinovarus ◽  
Talipes Equinovarus

This chapter discusses the anaesthetic management of the neonate, infant, and child. It begins with a description of neonatal physiology, then discusses fluid management, anaesthetic equipment, and the conduct of anaesthesia in children, including post-operative analgesia. Regional anaesthetic techniques in children are discussed, including caudal, epidural, spinal, and regional nerve blocks. Surgical procedures covered include repair of diaphragmatic hernia, gastroschisis/exomphalos, tracheo-oesophageal fistula, patent ductus arteriosus, pyloric stenosis, intussusception, herniotomy, penile circumcision, orchidopexy, hypospadias, cleft lip and palate, congenital talipes equinovarus, femoral osteotomy, and inhaled foreign body. It concludes with a discussion of paediatric medical problems, stabilization of the critically ill child, and paediatric sedation.

Paediatric and neonatal anaesthesia

2021 ◽  
pp. 899-966
Author(s):  
Simon Berg ◽  
Stewart Campbell
Keyword(s):  
Cleft Lip ◽  
Life Support ◽  
Cleft Lip And Palate ◽  
Ductus Arteriosus ◽  
Fluid Management ◽  
Anaesthetic Techniques ◽  
Medical Problems ◽  
Nerve Blocks ◽  
Congenital Talipes Equinovarus ◽  
Neonatal Physiology

This chapter discusses the anaesthetic management of the neonate, infant and child. It begins with a description of neonatal physiology, then discusses fluid management, anaesthetic equipment and the conduct of anaesthesia in children, including postoperative analgesia. Regional anaesthetic techniques in children are discussed, including caudal, epidural, spinal and regional nerve blocks. Surgical procedures covered include repair of diaphragmatic hernia; gastroschisis/exomphalos; tracheo-oesophageal fistula (TOF); patent ductus arteriosus (PDA); pyloric stenosis; intussusception; herniotomy; circumcision; hypospadias repair; orchidopexy; cleft lip and palate; congenital talipes equinovarus (CTEV); femoral osteotomy, and inhaled foreign body. It includes a discussion of paediatric sedation, paediatric medical problems, paediatric advanced life support, resuscitation of the neonate, the collapsed septic child, stabilisation of the critically ill child, and paediatric drug doses and equipment.

scholarly journals Overcoming Barriers to Accessing Surgery and Rehabilitation in Low and Middle-Income Countries: An Innovative Model of Patient Navigation in Nepal

2021 ◽  
Author(s):  
Jennifer L. Ibbotson ◽  
Bijata Luitel ◽  
Bikash Adhikari ◽  
Kathryn R. Jagt ◽  
Erik Bohler ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Patient Navigation ◽  
Cleft Lip And Palate ◽  
Surgical Care ◽  
Tertiary Hospital ◽  
Congenital Talipes Equinovarus ◽  
Access To Treatment ◽  
Wide Range ◽  
Talipes Equinovarus ◽  
Staff Meet

Abstract Background Injury and disability are prominent public health concerns, globally and in the country of Nepal. Lack of locally available medical infrastructure, socioeconomic barriers, social marginalization, poor health literacy, and cultural barriers prevent patients from accessing surgical and rehabilitative care. Overcoming these barriers is an insurmountable challenge for the most vulnerable and marginalized, resulting in absence of treatment or even death. Methods Sundar Dhoka Saathi Sewa (SDSS), a non-government organization, provides a patient navigation service which facilitates referrals to tertiary centers from Nepal’s most remote areas. Specific criteria ensure that patient referrals are appropriate in regard to clinical and socioeconomic need, while comprehensive counselling helps guide the patient and family. The SDSS staff meet patients upon arrival in Kathmandu and facilitate admission to the appropriate tertiary hospital. They advocate for the patient, provide medicine, supply food and cover all treatment costs. Results This project has enabled access to treatment for more than 1200 children for conditions leading to long-term disability and/or congenital heart disease. Interventions include a wide range of surgical and rehabilitative procedures such as complex orthopedics, cleft lip and palate, congenital talipes equinovarus, burn contractures, neurological cases, and cardiac surgery for valvular disease, septal defects and other congenital malformations. Discussion The SDSS model of patient navigation is effective in overcoming the barriers to access surgical care and rehabilitation in Nepal. The success is owed to committed international donors, capacity building, effective counselling, advocacy, compassion, and community. We believe that this model could be replicated in other LMICs.

Pentalogy of Cantrell: A Case Report with Pathologic Findings

2004 ◽  
Vol 7 (6) ◽  
pp. 649-652 ◽  
Author(s):  
María S. Correa-Rivas ◽  
Isabel Matos-Llovet ◽  
Lourdes García-Fragoso
Keyword(s):  
Cleft Lip ◽  
Septal Defect ◽  
Cleft Lip And Palate ◽  
Pulmonary Hypoplasia ◽  
Ductus Arteriosus ◽  
Pentalogy Of Cantrell ◽  
Wall Defect ◽  
Pathologic Findings ◽  
Bilateral Cleft Lip ◽  
Absent Pericardium

We present the case of a 28-h-old female infant born at 37 weeks of gestation with a rare congenital malformation consisting of a pentad of findings: ectopia cordis, a midline supraumbilical wall defect, a defect of the lower sternum, absent pericardium, and an anterior diaphragmatic defect. This constellation of defects is known as the pentalogy of Cantrell. Additional autopsy findings included a bilateral cleft lip and palate, bilateral pulmonary hypoplasia, an atrial septal defect, and a patent ductus arteriosus. We present this case because of its rarity and discuss the pathologic findings.

Coping Strategies and Social Support in the Family Impact of Cleft Lip and Palate and Parents’ Adjustment and Psychological Distress

2009 ◽  
Vol 46 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Sarah R. Baker ◽  
Jan Owens ◽  
Melanie Stern ◽  
Derrick Willmot
Keyword(s):  
Social Support ◽  
Psychological Distress ◽  
Coping Strategies ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Family Impact ◽  
Medical Problems ◽  
Cross Sectional ◽  
Positive Adjustment ◽  
The Family

Objective: To examine the role of parents’ coping strategies and social support in the family impact of cleft lip and palate (CLP) and levels of adjustment and psychological distress and to investigate whether a child's age, type of cleft, or other reported medical problems influenced such outcomes. Design: A cross-sectional study. Participants: One hundred three parents of children or young adults with CLP recruited from families attending a multidisciplinary cleft lip and palate clinic. Outcome measures: Family impact, psychological distress, and positive adjustment were assessed using validated psychological questionnaires. Results: Findings indicated that while there were many impacts of a child's CLP, negative outcomes (family impact, psychological distress) were not high. In contrast, parents reported high levels of positive adjustment or stress-related growth as a result of their child's condition. Participants also reported high levels of social support and relied more on the use of approach rather than avoidance-oriented coping strategies. Having more support from friends and family was associated with less negative family impact, lower psychological distress, and better adjustment. Greater use of approach coping was associated with more positive adjustment; whereas, avoidant coping was associated with a greater family impact and more psychological distress. Having a younger child and/or a child with medical problems in addition to CLP was associated with a greater impact on the family. Conclusions: How parents cope with their child's condition and the levels of support received may have implications for caregivers, the family unit, and the delivery of more family-oriented CLP services.

scholarly journals Spectrum of associated congenital heart defects in patients with “Non-Cardiac Congenital defects at a tertiary care children hospital in Pakistan”

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Muhammad Sohail Arshad ◽  
Muhammad Aslam ◽  
Shahnab Ahmad ◽  
Muhammad Kashif
Keyword(s):  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Vascular Malformations ◽  
Heart Defects ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Primary Diagnosis ◽  
Congenital Defects

Objectives: To assess the frequency and pattern of associated congenital heart disease (CHD) among patients with “non-cardiac congenital defects”. Methods: An observational study was done at Paediatric Cardiology Department, The Children’s Hospital and The Institute of Child Health, Multan, Pakistan, from December 2018 to November 2019. Children from birth to 15 years having non-cardiac congenital defects, referred for cardiac evaluation from surgical unit during the study period were enrolled. Echocardiography was done to confirm diagnosis of CHD by consultant pediatric cardiologist. Results: Out of a total of 323 cases, 176 (54.5%) were male. Out of 323 patients, 160 (49.5%) belonged to age one month to one year. Vascular malformations were the most frequent primary diagnosis among our cases, seen in 69 (21.4%) children followed by cleft lip and palate 55 (17.2%), cleft palate only 52 (16.1%), Cleft lip only 40 (12.4%) and ARM high variety 33 (10.2%). CHD was found among 42 (13.0%) children while patent ductus arteriosus (PDA) and VSD were the commonest finding seen in 14 (33.3%) and 6 (14.3%) children respectively. Conclusion: Frequency of associated CHD among patients with non-cardiac congenital defects was high (13.0%). Children with cleft lip and/or palate should be given more attention because of the high incidence of CHD in this group. Echocardiography must be advised for the timely identification of any possible type of CHD. doi: https://doi.org/10.12669/pjms.37.3.3604 How to cite this:Arshad MS, Aslam M, Ahmad S, Kashif M. Spectrum of associated congenital heart defects in patients with “Non-Cardiac Congenital defects at a tertiary care children hospital in Pakistan”. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3604 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair

2019 ◽  
Vol 36 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Gaston Echaniz ◽  
Marcos De Miguel ◽  
Glenn Merritt ◽  
Plinio Sierra ◽  
Pranjal Bora ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Nerve Blocks ◽  
Maxillary Nerve ◽  
Palate Repair

New Syndrome in Three Affected Siblings

PEDIATRICS ◽  
1981 ◽  
Vol 68 (2) ◽  
pp. 235-237
Author(s):  
James P. Crane ◽  
Robin L. Heise
Keyword(s):  
Prenatal Diagnosis ◽  
Autosomal Recessive ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Cervical Vertebrae ◽  
Autosomal Recessive Inheritance ◽  
Recessive Inheritance ◽  
Talipes Equinovarus ◽  
Mode Of Transmission ◽  
Ocular Hypertelorism

A previously undescribed syndrome is reported. Major features include: (1) poorly mineralized calvarium, (2) dysmorphic facies (cleft lip and palate, micrognathia, upturned nares, apparent ocular hypertelorism), and (3) extracranial musculoskeletal anomalies (absence of cervical vertebrae and clavicles, talipes equinovarus, and soft tissue syndactyly). Autosomal recessive inheritance is the most likely mode of transmission. Prenatal diagnosis via ultrasonography was successful in two fetuses at risk.

Novel neurodevelopmental disorder in the case of a giant occipitoparietal meningoencephalocele

2012 ◽  
Vol 10 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Timothy W. Vogel ◽  
Sunil Manjila ◽  
Alan R. Cohen
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Ductus Arteriosus ◽  
Neurodevelopmental Disorder ◽  
Coarctation Of The Aorta ◽  
Chromosome Band ◽  
Genetic Syndromes ◽  
Neurological Outcomes

Giant occipitoparietal encephaloceles are rare forms of neurodevelopmental defects whose etiologies remain uncertain. Their occurrence can lead to variable neurological outcomes depending on the extent of cerebral cortex involved and the ability to repair the defect. In addition, encephaloceles may be associated with various genetic syndromes and familial inheritance. Here, the authors describe a unique constellation of malformations associated with the case of a giant occipitoparietal meningoencephalocele with herniation of cortical tissue and continuity with the ventricular system. The patient had a cleft lip and palate, hemivertebrae of the thoracic spine, a patent ductus arteriosus, a ventricular septal defect, and coarctation of the aorta. To identify the genetic underpinnings of these malformations, fluorescence in situ hybridization and microarray analysis were performed and revealed an 80.65-kb gain within chromosome band 2p11.2. Duplications of this region involving RMND5A, whose product contains a C-terminal to lis homology (LisH) domain, have not previously been associated with a defined phenotype but may present insight into encephalocele formation. Surgical repair and follow-up for the neurological malformations are also discussed.

scholarly journals Coronal clival cleft in CHARGE syndrome

2017 ◽  
Vol 30 (6) ◽  
pp. 574-577 ◽  
Author(s):  
Eman Mahdi ◽  
Matthew T Whitehead
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Genetic Disorder ◽  
Ductus Arteriosus ◽  
Choanal Atresia ◽  
Charge Syndrome ◽  
Craniocervical Junction ◽  
Undescended Testes ◽  
Ear Anomalies ◽  
Patent Ductus

CHARGE syndrome is a genetic disorder with multi-systemic congenital anomalies, most commonly including coloboma, heart malformations, choanal atresia, developmental delay, and genital and ear anomalies. The diagnostic criteria for CHARGE syndrome has been refined over the years. However, there are limited reports describing skullbase and craniocervical junction abnormalities. These osseous malformations are often under recognized, especially on MRI. We report here a case of CHARGE syndrome with colobomas, cleft lip and palate, patent ductus arteriosus, undescended testes, and a coronal clival cleft which has not been previously depicted in CHARGE syndrome. The presence of a coronal clival cleft should alert the radiologist to examine the ears, eyes, palate, choana, and olfactory centers for other signs of CHARGE syndrome.

Combined Use of Infraorbital and External Nasal Nerve Blocks for Effective Perioperative Pain Control during and after Cleft Lip Repair

2009 ◽  
Vol 46 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Mariah L. Salloum ◽  
Kyle R. Eberlin ◽  
Navil Sethna ◽  
Usama S. Hamdan
Keyword(s):  
Pain Control ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Intravenous Sedation ◽  
Nerve Blocks ◽  
Perioperative Analgesia ◽  
Combined Use ◽  
Adolescents And Adults ◽  
Cleft Lip Repair ◽  
Palate Repair

Perioperative analgesia in patients undergoing cleft lip and palate repair is complicated by the risk of postoperative airway obstruction. We describe a technique of combined infraorbital and external nasal nerve blocks to reduce the need for opioid analgesia. Using this technique, we have successfully performed cleft lip repair under local anesthesia alone, without general anesthesia or intravenous sedation, in adolescents and adults. In children, this technique can reduce the need for postoperative opioids. We describe this novel analgesic approach to decrease opioid requirements and minimize perioperative risk.

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