ABSTRACT
Surgeons performing painful, invasive procedures in pediatric patients must be cognizant of both the potential short- and long-term detrimental effects of inadequate analgesia. This article reviews the available tools, sedation procedures, the management of intraoperative, postoperative, and postprocedural pain, and the issues surrounding neonatal addiction.
Subject(s)
Analgesia/methods , Anesthesia/methods , Pain Management/methods , Surgical Procedures, Operative , Analgesics/therapeutic use , Anesthetics, Local/therapeutic use , Child , Conscious Sedation , Humans , Infant, Newborn , Neonatal Abstinence Syndrome/drug therapy , Pain Measurement , Pain, Postoperative/therapyABSTRACT
BACKGROUND: Hemoglobin levels must be obtained through blood draws, which are invasive, time-consuming, and provide only 1 data point at a time rather than continuous measurements. The Masimo Radical-7 SpHb Station (Masimo Corporation, Irvine, CA) has been shown by its manufacturers to provide accurate noninvasive hemoglobin measurements in physiologically normal patients. The objective of this study was to validate noninvasive hemoglobin measurements using the Masimo Radical-7 device. METHODS: Data were prospectively collected in 2 cohorts of patients: major operations requiring hemodynamic monitoring (operating room [OR]) and critically ill patients (intensive care unit [ICU]). Noninvasive hemoglobin measurements (SpHb) were recorded and were then compared with laboratory hemoglobin measurements. RESULTS: Data were collected on 60 patients (OR = 25 and ICU = 45). The overall correlation of the Masimo SpHb and the laboratory Hb was .77 (P < .001) in the OR group with a mean difference of .29 g/dL (95% confidence interval [CI], .08-.49). The overall correlation in the ICU group was .67 (P < .001) with a mean difference of .05 g/dL (95% CI, -.22 to -.31). CONCLUSIONS: Noninvasive hemoglobin monitoring is a new technology that correlated with laboratory values and supports the continued study of noninvasive hemoglobin monitoring.
Subject(s)
Hemoglobins/analysis , Hemorrhage/blood , Monitoring, Physiologic/instrumentation , Oximetry/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Equipment Design , Female , Follow-Up Studies , Hemorrhage/diagnosis , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Young AdultABSTRACT
The case of a young male patient with a complex admixture lesion who required a comprehensive anatomic evaluation before palliative cardiac surgery is presented. We describe a safe anesthesia protocol for obtaining the late-acquisition, gadolinium-enhanced, magnetic resonance angiographic images necessary to define the complex pulmonary and systemic venous anatomic features of his cardiac admixture lesion. Subspecialty physician staffing implications for the care of military dependants with congenital heart disease who might benefit from evaluation using this safe simple protocol and readily available magnetic resonance imaging technology are addressed.
Subject(s)
Military Medicine , Pulmonary Veins/abnormalities , Cardiovascular Abnormalities/diagnosis , Cardiovascular Abnormalities/pathology , Child, Preschool , Gadolinium DTPA , Heart Defects, Congenital/diagnosis , Humans , Magnetic Resonance Angiography , Male , Pulmonary Veins/pathologyABSTRACT
UNLABELLED: We calculated the effects of the simulated Valsalva (V), liver (L) compression, and Trendelenburg (T) position on the cross-sectional area (CSA) of the right internal jugular vein by using planimetry (Aloka ultrasound machine) in 84 infants and young children. Eight combinations of positions and interventions were studied for each patient, with the patient supine, in the T position, during the simulated V maneuver, with L compression and a combination of maneuvers. Data were analyzed by using Friedman's chi(2) test and Wilcoxon's signed rank test. An increase of >25% in the CSA of the internal jugular vein was considered significant. In infants, the maximal mean increase achieved with the combination of all 3 maneuvers was only 17.4% +/- 16.1%. As a single maneuver, the simulated V was the most effective (11.6% +/- 11.5%). In children, the combination of all 3 maneuvers performed simultaneously produced a mean 65.9% (SD +/- 44.7%) increase in the CSA, which was larger than the increase by all other maneuvers alone or in a single combination (Friedman's test, P < 0.001 and Wilcoxon's test, P < 0.002). As a single maneuver, V produced the most increase (40.4% +/- 32.2%) compared with L compression (14.3% +/- 18.9%) or T position (24.3% +/- 27.1%). IMPLICATIONS: The combinations of simulated Valsalva, liver compression, and Trendelenburg maneuvers produce the maximal mean increase in the size of the internal jugular vein in infants and young children, with the Valsalva maneuver being the most effective single maneuver. This increase is significant in young children, but negligible in infants.
