37 research outputs found
Effect of hyperextension of the neck (rose position) on cerebral blood oxygenation in patients who underwent cleft palate reconstructive surgery: prospective cohort study using near-infrared spectroscopy
Objectives To facilitate the best approach during cleft palate surgery, children are positioned with hyperextension of the neck.
Extensive head extension may induce intraoperative cerebral ischemia if collateral flow is insufficient. To evaluate and monitor
the effect of cerebral blood flow on cerebral tissue oxygenation, near-infrared spectroscopy has proved to be a valuable method.
The aim of this study was to evaluate and quantify whether hyperextension affects the cerebral tissue oxygenation in children
during cleft palate surgery.
Materials and methods This prospective study included children (ASA 1 and 2) under the age of 3 years old who underwent cleft
palate repair at the Wilhelmina Childrenâs Hospital, in The Netherlands. Data were collected for date of birth, cleft type, date of
cleft repair, and physiological parameters (MAP, saturation, heart rate, expiratory CO2 and O2, temperature, and cerebral blood
oxygenation) during surgery. The cerebral blood oxygenation was measured with NIRS.
Results Thirty-four children were included in this study. The majority of the population was male (61.8%, n = 21). The mixed
model analyses showed a significant drop at time of Rose position of â 4.25 (69â74 95% CI; p < 0.001) and â 4.39 (69â74 95%
CI; p < 0.001). Postoperatively, none of the children displayed any neurological disturbance.
Conclusion This study suggests that hyperextension of the head during cleft palate surgery leads to a significant decrease in
cerebral oxygenation. Severe cerebral desaturation events during surgery were uncommon and do not seem to be of clinical
relevance in ASA 1 and 2 children.
Clinical relevance There was a significant drop in cerebral oxygenation after positioning however it is not clear whether this drop
is truly significant physiologically in ASA 1 and 2 patients
Mental health and wellbeing in parents of excessively crying infants: prospective evaluation of a support package
Background
During the first four months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying and its causes, but there is a need for equal attention to the impact of the crying on parents and subsequent outcomes. This study reports the findings
from a prospective evaluation of a package of materials designed to support the wellbeing and mental health of parents who judge their infant to be crying excessively. The resulting âSurviving Cryingâ package comprised a website, printed materials, and a programme of Cognitive Behaviour Therapy - based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for National Health Service (NHS) use.
Methods
Parents were referred to the study by NHS Health Visitors or Community Public Health Nurses. Fifty
seven parents of excessively crying babies received the support package and provided rating scale measures of depression, anxiety, frustration because of the crying, and other measures before receiving the support package, together with outcome measures afterwards.
Results
Significant reductions in depression and anxiety were found with the number of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by changes in infant crying. Reductions also occurred in the
number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parentsâ confidence, knowledge of infant crying and improvements in parentsâ sleep.
Conclusions
The findings suggest that the Surviving Crying package may be effective in supporting the wellbeing and mental health of parents of excessively crying babies. Further, large-scale controlled trials of the package in NHS settings are warranted
Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology
Purpose of review
The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is
The Real Presence reprinted from ""Points of Controversy""
MSM Historical Booklet and Pamphlet Collectio
The role of the tensor veli palatini muscle in the development of cleft palate-associated middle ear problems
Objective: Otitis media with effusion is common in infants with an unrepaired cleft palate. Although its prevalence is reduced after cleft surgery, many children continue to suffer from middle ear problems during childhood. While the tensor veli palatini muscle is thought to be involved in middle ear ventilation, evidence about its exact anatomy, function, and role in cleft palate surgery is limited. This study aimed to perform a thorough review of the literature on (1) the role of the tensor veli palatini muscle in the Eustachian tube opening and middle ear ventilation, (2) anatomical anomalies in cleft palate infants related to middle ear disease, and (3) their implications for surgical techniques used in cleft palate repair. Materials and methods: A literature search on the MEDLINE database was performed using a combination of the keywords âtensor veli palatini muscle,â âEustachian tube,â âotitis media with effusion,â and âcleft palate.â Results: Several studies confirm the important role of the tensor veli palatini muscle in the Eustachian tube opening mechanism. Maintaining the integrity of the tensor veli palatini muscle during cleft palate surgery seems to improve long-term otological outcome. However, anatomical variations in cleft palate children may alter the effect of the tensor veli palatini muscle on the Eustachian tubeâs dilatation mechanism. Conclusion: More research is warranted to clarify the role of the tensor veli palatini muscle in cleft palate-associated Eustachian tube dysfunction and development of middle ear problems. Clinical relevance: Optimized surgical management of cleft palate could potentially reduce associated middle ear problems