Apneic oxygenation in pediatric anesthesia.

PURPOSE OF REVIEW Apneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia. RECENT FINDINGS Apneic oxygenation with both low flow and high flow nasal oxygen increases the safe apnea time, but does not lead to increased CO2 elimination. Airway pressures and adverse effects like atelectasis formation, oxidative stress and aerosol generation under apneic oxygenation are not well studied in pediatric anesthesia. Data from adults suggest no important effect on airway pressures when the mouth is open, and no significant formation of atelectasis, oxidative stress or aerosol generation with high flow nasal oxygen. SUMMARY Apneic oxygenation in pediatric anesthesia is mainly used during standard and difficult airway management. It is sometimes used for airway interventions, but CO2 accumulation remains a major limiting factor in this setting. Reports highlight the use of high flow nasal oxygen in spontaneously breathing rather than in apneic children for airway interventions

Tips and Tricks—3 Use Cases of Interdisciplinary Knowledge Transfer in Minimally Invasive Pediatric Surgery

In the pediatric surgical environment, we can enrich our knowledge and improve our skills through interdisciplinary knowledge transfer in exchange with other surgical or even non-surgical disciplines. To demonstrate this, we present in this article three patient cases of method transfer enabling new techniques in minimally invasive pediatric surgery. 1. The somewhat modified application of the AeroStat rigid tip laparoscopic cholangiography catheter during the single-step laparoscopic cholecystectomy facilitates the safe intraoperative cholangiography with common bile duct flushing. 2. A magnetic rod is used during laparoscopic enterotomy to locate and retrieve ingested magnets. 3. Using a patient-specific MRI 3D model representing a syndromic high anorectal malformation improves surgical planning and parental education

Fluid Replacement in Sports Position of the Working Group Sports Nutrition of the German Nutrition Society (DGE)

Recommendations for drinking quantities during all kinds of exercise pro-vide some guidance for athletes on how to avoid health problems and per-formance impairment. Sporting activities should always be commenced with a balanced fluid level (apparent by urine colour, which is light yellow in the case of balanced fluid level). The weighing method to determine individual fluid loss offers guidance as to optimal fluid intake during exer-cise. In principle however, athletes should trust their own feeling of thirst. Generally in the case of activities lasting less than 30–40 minutes, fluid intake is not necessary, minor fluid deficits during exercise are tolerable. In the case of longer-lasting activity (> 1.5 hours) it is advisable to take in beverages rich in carbohydrates and sodium. After sport, fluids and electrolytes must be replace

Minerals and Vitamins in Sports Nutrition Position of the Working Group Sports Nutrition of the German Nutrition Society e.V. (DGE)

An adequate intake of minerals and vitamins is essential for health and performance of athletes. Depending on the type of sport and the inten-sity and scope of physical performance, as well as individual factors (such as dietary behavior, perspiration rate and composition of perspiration), athletes may be at an increased risk of suboptimal micronutrient supply. This position paper will provide an overview of the potential causes of deficient micronutrient supply in athletes, such as increased requirements as a result of enhanced energy metabolism, higher losses associated with physical activity, and special diets associated with sport in general or par-ticular types of sport. This position statement will also present the proven effects of insufficient micronutrient supply on the health and performance of athletes, and the effects on their supply situation. In summary, it can be concluded that with a balanced diet that covers energy requirements, the D-A-CH reference values for micronutrients can usually be attained without any problems. However, in certain situations (such as strenuous endurance exercise or weight reduction, or in the case of lopsided eating habits or hypocaloric diets), iron, calcium, sodium and vitamin D may be critical nutrients for athletes. A diet that is adapted to the individual and covers all requirements is achievable even in the case of high metabolic demands, and such a diet can reduce the risk of nutrient deficiencies

Fats in sports nutrition. Position of the working group sports nutrition of the German Nutrition Society (DGE)

This position statement represents the current state of scientific knowledge regarding the recommended fat intake in ambitious recreational and high-level sports. It also addresses dietary strategies (fat-loading methods) and food supplements that are designed to influence fat metabolism dur-ing physical exercise.So far, no recommendation has been established for sports-specific fat in-take in absolute numbers (g/kg body weight/d), in line with international practices regarding carbohydrates and proteins. However, there is con-sensus among scientific sports medicine associations that fat consumption should not exceed 30% of the energy intake (En%), nor fall below 20 En%, particularly in endurance sports.Before competitions, some endurance athletes practice fat-loading stra-tegies which include a ketogenic diet. This procedure is not advisable, as there is no scientific evidence of improvement in performance. Moreover, this is an unbalanced diet according to DGE recommendations.The current use of dietary supplements which are supposed to improve the availability/oxidation of fatty acids is also generally discourage

Carbohydrates in Sports Nutrition Position of the Working Group Sports Nutrition of the German Nutrition Society e. V. (DGE)

Carbohydrates are an important source of energy during physical exer-cise. Carbohydrates lead to a higher energy yield and higher energy flux per liter of oxygen than the oxidation of fatty acids. However, the storage capacity for carbohydrates in liver and muscles is limited. Therefore, en-durance athletes should include a high proportion of carbohydrates in their daily diet. The individual amount depends on body weight and the extent of physical activity. Energy expenditure during physical exercise results in a gradual depletion of carbohydrate stores. The extent to which carbohydrate stores are depleted is dependent on the duration and inten-sity of exercise. Therefore, in particular during prolonged intense exercise, performance may be improved by consuming an adequate amount of carbohydrates during exercise. In addition, following a long period of in-tensive physical activity, rapid post-exercise intake of carbohydrates can help replenish carbohydrate stores more quickly.This position paper sets out current guidelines for the type, amount and timing of carbohydrate intake in sport. It will also discuss the significance of “carbohydrate loading”, the glycemic index, and training without prior intake of carbohydrate

Energy Needs in Sports Position of the Working Group Sports Nutrition of the German Nutrition Society e.V. (DGE)

This position statement represents the current state of scientific knowledge regarding the recommended fat intake in ambitious recreational and high-level sports. It also addresses dietary strategies (fat-loading methods) and food supplements that are designed to influence fat metabolism dur-ing physical exercise.So far, no recommendation has been established for sports-specific fat in-take in absolute numbers (g/kg body weight/d), in line with international practices regarding carbohydrates and proteins. However, there is con-sensus among scientific sports medicine associations that fat consumption should not exceed 30% of the energy intake (En%), nor fall below 20 En%, particularly in endurance sports.Before competitions, some endurance athletes practice fat-loading stra-tegies which include a ketogenic diet. This procedure is not advisable, as there is no scientific evidence of improvement in performance. Moreover, this is an unbalanced diet according to DGE recommendations.The current use of dietary supplements which are supposed to improve the availability/oxidation of fatty acids is also generally discourage