Use of the ProSeal laryngeal mask airway in an infant with a repaired H-type tracheoesophageal fistula and tracheomalacia.

The ProSeal laryngeal mask airway (PLMA) is a relatively new airway device with design features that improve the quality of positive pressure ventilation (PPV) and may decrease the risk of gastric aspiration. We describe the use of this device for the anesthesia management of an infant with an esophagocutaneous fistula following repair of an H-type tracheoesophageal fistula and tracheomalacia, in which avoidance of tracheal intubation was desired. This case report demonstrates that the PLMA may be a useful and practical alternative to tracheal intubation in an infant with a tenuous airway.

Air-gun injuries: initial evaluation and resultant morbidity.

Severity of injuries from air-powered weapons can be underappreciated. Transformation of these weapons into toys makes them available to children. Our experience reveals the underestimated injury severity and emphasizes need for prompt trauma evaluation. Retrospective chart review of children sustaining air-gun injuries and evaluated at a single, pediatric hospital from 1991 to 2002 was performed. Medical record numbers were retrieved from a trauma data base. Data included age, weapon type, firing distance, injury site, radiographic studies, operative intervention, length of stay, and long-term disability. Ocular injuries were excluded secondary to known severity. All other injuries and treatments are described. Thirty-four children, average age 10 years +/- 3.3 years, sustained 35 injuries from 1991 through 2002. Twenty-one children required admission, 19 children required surgery, and 5 children experienced long-term disability. Average time to definitive care was 3 hours 12 minutes. Sites of injury included head, neck, chest, abdomen, and extremities. Average hospital stay was 4.3 days. In the pediatric population, air-gun injuries can be underestimated. Lack of collateral tissue damage makes wounds appear innocuous to unsuspecting medical personnel resulting in delayed care. During initial evaluation, injuries from air guns deserve the same respect as those caused by conventional firearms.

Evolution of staged versus primary closure of gastroschisis.

OBJECTIVE: Since the introduction of a preformed silo to the authors' practice in 1997, there has been a decrease in primary closure of gastroschisis. To clarify the impact of this change, the authors reviewed their results over the past 10 years. METHODS: From patient records, the authors abstracted the closure method, mechanical ventilation days, time to full feeds, mechanical and infectious complications, and length of stay. The authors compared groups using the Student t test and the Mann-Whitney test, as appropriate. RESULTS: Between 1993 and the present, 124 patients were identified. Between 1993 and 1997, 38 children presented with gastroschisis. Thirty-two (84.2%) closures were primary and six (18.8%) were staged. After 1997, the authors treated 80 children with gastroschisis. There were 27 (33.8%) primary and 53 (66.2%) staged closures. Six patients with other lethal anomalies were excluded. Length of stay and ventilator days were higher for the staged closure group, but infection and mechanical complications were less common in the staged closure group. The time to full feeds did not differ. CONCLUSIONS: A lower incidence of infection and complications related to abdominal compartment syndrome has made staged closure of gastroschisis more common in the authors' practice. While it has resulted in a longer hospital stay, staged closure decreases the risk of long-term bowel dysfunction and need for reoperation.