61 research outputs found
What is important?
Central venous access is an essential part of perioperative management for infants
and children undergoing cardiac surgery for congenital heart disease. In addition, a
thorough knowledge of the techniques for cannulation and placement of venous lines
from the various percutaneously accessible sites is an important aspect of cardiac
catheterization in this patient population. In the first of a series of papers describing
the various approaches to venous access, we describe percutaneous cannulation of
the subclavian vein. The standard approach, as well as potential difficulties, and how
to overcome them, are described, as also the complications associated with this
approach.peer-reviewe
Access via the femoral vein
Central venous access via the femoral vein (FV) is safe, relatively easy and
very usual in infants and children undergoing cardiac surgery for congenital
heart disease. It has a low insertion-related complication rate.
It is therefore a good choice for short-term central venous lines and a
preferred insertion site for less experienced staff. The maintenance-related
complications of thrombus formation and infections are higher compared to
the internal jugular and the subclavian venous access. Some of these complications are reduced by the use of heparin bonded catheters, routine use of antibiotics, and timely removal of these lines in patients with persistent signs of infection but without another focus being defined.peer-reviewe
Access via the internal jugular vein
Central venous access via the internal jugular vein (IJV) is safe, relatively
easy and very commonly used in infants and children undergoing cardiac
surgery for congenital heart disease. Because of the wide range of anatomical
variations an ultrasound-guided technique is advantageous in many cases, in
particular in patients who have had previous punctures or those in whom
difficulties are anticipated for various reasons. The right internal jugular vein is
the preferred vein for central venous access as it offers straight access to the
superior vena cava. The rate of complications - insertion-related as well as
long term - are lower compared to the femoral and the subclavian access.peer-reviewe
Ion energy distribution functions behind the sheaths of magnetized and non magnetized radio frequency discharges
The effect of a magnetic field on the characteristics of capacitively coupled
radio frequency discharges is investigated and found to be substantial. A
one-dimensional particle-in-cell simulation shows that geometrically symmetric
discharges can be asymmetrized by applying a spatially inhomogeneous magnetic
field. This effect is similar to the recently discovered electrical asymmetry
effect. Both effects act independently, they can work in the same direction or
compensate each other. Also the ion energy distribution functions at the
electrodes are strongly affected by the magnetic field, although only
indirectly. The field influences not the dynamics of the sheath itself but
rather its operating conditions, i.e., the ion flux through it and voltage drop
across it. To support this interpretation, the particle-in-cell results are
compared with the outcome of the recently proposed ensemble-in-spacetime
algorithm. Although that scheme resolves only the sheath and neglects
magnetization, it is able to reproduce the ion energy distribution functions
with very good accuracy, regardless of whether the discharge is magnetized or
not
Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study
Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348
Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study
BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event
- …