Postoperative wound infections represent an important source of morbidity and mortality in children. Perioperative antibiotic prophylaxis has been shown to decrease the risk of developing infections and hospital guidelines surrounding antibiotic use exist to standardize patient care. Despite supporting evidence, rates of compliance with guidelines vary. Quality improvement initiatives have been introduced to improve compliance with intraoperative antibiotic guidelines. Thorough infection surveillance, including antibiotic provision in presurgical checklists, computerized voice antibiotic administration prompts, and national feedback systems are now increasingly common. Few studies have been conducted investigating the effectiveness of prophylactic antibiotics in children. Outcome measures such as morbidity and mortality and return to the operating room can be used to examine the relationship between antibiotic use and patient outcome but these measures are limited in that they occur infrequently or are subjective and difficult to measure. Metrics such as days alive out of hospital and length of hospital stay may be useful alternatives for ongoing monitoring of infections and identifying improvements in patient outcomes. Guidelines on antibiotic prophylaxis have facilitated an increase in the correct provision of perioperative antibiotics and a reduction in the incidence of postoperative infection. Measures of patient outcome such as days alive out of hospital and length of hospital stay are easy to collect and calculate but further work is needed to confirm the utility of these measures for monitoring infection rates.
Clonidine administered intraoperatively for (adeno) tonsillectomy or adenoidectomy prolonged emergence from anesthesia. Doses of 0.5-3 mcg·kg(-1) caused greater sedation in the postanesthesia care unit but did not impact on hospital discharge times.
auscultating air entry over the epigastrium, the bowl portion of the PLM was once again tightly approximated to the shaft and gently introduced into the oral cavity from the right side by railroading over the suction catheter (Fig. 1). With minimal manipulation, the laryngeal mask airway could be introduced. Suction catheter was removed and breathing circuit was attached ( Figure S2). With just 3-ml air to inflate the laryngeal mask airway cuff, adequate spontaneous respiration was noted by the movement of the reservoir bag and capnographic curves. Subsequently, the patient was maintained on 1-3% sevoflurane in a mixture of 50% nitrous oxide in oxygen on spontaneous breathing.The attending anesthesiologist attempted fiberscopy through the laryngeal mask airway but failed as the laryngeal mask airway was noted to be poorly positioned, a finding noted by others also (4). Throughout this period, patient had been breathing spontaneously receiving sevoflurane in oxygen via face mask between attempts. Oxygen saturation remained between 98 and 100% and heart rate ranged between 113 and 146/min.As the patient has to come for multiple surgeries over the next few weeks, it was decided to perform surgical tracheostomy prior to the release of various contractures in stages ( Figure S3). Since then, the patient has been anesthetized uneventfully several times using tracheostomy as an airway.This case report highlights the fact that a distorted airway anatomy secondary to scarring may impair both mask ventilation and much advocated fiberoptic tracheal intubation. In addition, traditional rescue methods such as the laryngeal mask airway may fail using the conventional approach. The key to success is adequate planning, preparation, and the ability to improvise to suit the occasion as demonstrated by successful catheterguided placement of the laryngeal mask airway in this patient.
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