Anesthesia of thoracic surgery in children.

Providing anesthesia in children with thoracic disease is a challenging task. The effects of the underlying disease, the surgical interventions, and preexisting condition of the patient need to be considered when planning perioperative care. The perioperative care for children undergoing thoracic surgery requires specific techniques adapted to the pediatric physiology and anatomy. This review is focused on anesthetic strategies for thoracic surgery with an emphasis on perioperative analgesia including neuraxial techniques.

The pressure drop across the endotracheal tube in mechanically ventilated pediatric patients.

BACKGROUND: During mechanical ventilation, the airway pressure (Paw) is usually monitored. However, Paw comprises the endotracheal tube (ETT)-related pressure drop (∆PETT ) and thus does not reflect the pressure in the patients' lungs. Therefore, monitoring of mechanical ventilation should be based on the tracheal pressure (Ptrach ). We systematically investigated potential factors influencing ∆PETT in pediatric ETTs. METHODS: In this study, the flow-dependent pressure drop across pediatric ETTs from four manufacturers [2.0-4.5 mm inner diameter (ID)] was estimated in a physical model of the upper airways. Additionally, ∆PETT was examined with the ETTs shortened to 75% of their original length and at different curvatures. In nine healthy mechanically ventilated children (aged between 9 days and 29 months), Ptrach was compared to Paw . RESULTS: ∆PETT was nonlinearly flow dependent. Low IDs corresponded to high ∆PETT . Differences between ETTs from different manufacturers were identified. Shortening of the ETTs' length by 25% reduced ∆PETT on average by 14% of the value at original length. Ventilation frequency and tube curvature did not influence ∆PETT to a relevant extent. In the pediatric patients, the root mean square deviation between Paw and Ptrach was 2.3 cm H2O. CONCLUSION: Paw and Ptrach differ considerably (by ∆PETT ) during mechanical ventilation of pediatric patients. The ETTs' ID, tube length, and manufacturer type are significant factors for ∆PETT and should be taken into account when Paw is valuated. For this purpose, Ptrach can be continuously calculated with good precision by means of the Rohrer approximation.

[Anaesthesia for children with epidermolysis bullosa]. / Epidermolysis bullosa - Anästhesieführung bei Kindern.

Epidermolysis bullosa (EB) is a heterogeneous group of inherited rare diseases, which are characterized by trauma-induced blister formation of the skin and mucosa. The underlying cause is a functional deficiency of structural proteins of the epidermis or the dermis. Depending on the level of the blister formation, EB is divided into EB simplex (intra-epidermal), junctional EB (within the lamina lucida), dystrophic EB (below the lamina lucida) and Kindler syndrome (variable level of split formation). Besides different distinct blister formation and pain symptoms secondary problems like anaemia, oesophageal stenosis, cardiomyopathy or squamous cell carcinoma may occur. Since causal therapies are not available strict prevention of friction and trauma is essential to avoid blister formation. Anaesthesia challenges exist in the field of bedding procedures, care of the skin, monitoring, airway management und analgesia. This article gives a review over the EB and highlights in detail the corresponding anaesthesia characteristics.