Summary
In this randomised controlled trial we examined the effects of four different levels of positive end expiratory pressure (PEEP at 0, 5, 8 or 10 cmH2O), added to the dependent lung, on respiratory profile and oxygenation during one lung ventilation. Forty‐six patients were recruited to receive one of the randomised PEEP levels during one lung ventilation. We did not find significant differences in lung compliance, intra‐operative or postoperative oxygenation amongst the four different groups. However, the physiological deadspace to tidal volume ventilation ratio was significantly lower in the 8 cmH2O PEEP group compared with the other levels of PEEP (p < 0.0001). We concluded that the use of PEEP (≤10 cmH2O) during one lung ventilation does not clinically improve lung compliance, intra‐operative or postoperative oxygenation despite a statistically significant reduction in the physiological deadspace to tidal volume ratio.
SummaryDifferences in the anatomy and physiology of the young child necessitate specialist equipment and anesthetic equipment is constantly evolving. We will review the factors influencing the design of pediatric tubes and highlight those areas of special interest. There have been pleas for more standardization of tube markings, as this would help with positioning of tubes, especially in small babies, and there are recent advances in this area. Anesthetists need to be aware that there are important differences between tubes so that they take this into account when choosing an appropriate tube. In addition, developments in the design of cuffed tubes are increasingly being used both for routine care and specialist surgery.
Adenotonsillar disorders are a frequent complaint in children and adenotonsillectomy is one of the commonest surgical procedures. The two main indications for adenotonsillectomy are recurrent tonsillitis and obstructive sleep apnoea (OSA). Both are associated with significant morbidity. How best to diagnose OSA is currently unclear. Some centres routinely use sleep studies whilst others rely on history alone. Intracapsular subtotal tonsillectomy, as opposed to complete tonsillectomy, is a good choice in OSA. It is as effective in relieving obstruction but typically has lower morbidity with less pain and bleeding. Postoperative complications are relatively common, and good pain management is essential. There is controversy about effectiveness of tonsil and adenoid surgery, with on-going arguments for and against. Appropriate patient selection based on clinical need and evidence, rather than rationing, is essential.
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