Bisphosphonate use, in particular pamidronate, improved pain scores, analgesic requirement and musculoskeletal function in patients with osteonecrosis occurring as a complication of childhood ALL therapy. Objective radiologic benefit of bisphosphonate treatment could not be demonstrated. Risks, benefits and long-term outcome of bisphosphonate use in this population should be addressed in a larger prospective, randomised trial.
Respiratory complications, including atelectasis, are a common cause of adverse events in pediatric anesthesia. 1,2 Infants and children, have a more compliant chest wall, smaller functional residual capacity, and higher metabolic rate, and are more susceptible to atelectasis and hypoxemia, particularly during general anesthesia. 3,4 Recruitment maneuvers can be used to restore normal aeration of the lung.
Introduction
When performing computerized tomography chest imaging in children, obtaining high quality, motion‐free images is important in the accurate diagnosis of underlying pathology. General anesthesia is associated with the development of atelectasis, which can impair accurate diagnosis by obscuring or altering the appearance of the lung parenchyma or airways. Recruitment maneuvers, performed by anesthesiologists, can be used to effectively re‐expand atelectatic lung.
Methods
The computerized tomography chest imaging in 44 children aged between 2 months and 7 years, undergoing serial imaging for monitoring of cystic fibrosis, were reviewed and graded for atelectasis. The first scan performed on each child was performed with a supraglottic airway device and a non‐standardized recruitment maneuver. The second scan on each child was performed with a cuffed endotracheal tube and a standardized recruitment maneuver.
Results
When a supraglottic airway device and a non‐standardized recruitment maneuver were used, 77% of patients demonstrated atelectasis of any degree on their computerized tomography chest imaging, compared with only 39% when a cuffed endotracheal tube and standardized recruitment maneuver were used. The percentage of computerized tomography chest scans that were scored acceptable (with either a total combined lung atelectasis score of 0 or 1) improved from 37% to 75% when a cuffed endotracheal tube and standardized recruitment maneuver were used. In particular, the mean atelectasis score for both lungs improved from 2.91 (SD ± 2.6) to 1.11 (SD ± 1.9), with a mean difference of 1.8 (95% CI 0.82–2.77; p: .0004).
Conclusion
The use of a cuffed endotracheal tube and a standardized recruitment maneuver is an effective way to reduce atelectasis as a result of general anesthesia. Anesthesiologists can actively contribute toward improved image quality through their choice of airway and recruitment maneuver.
BackgroundWhether preterm infants born with breech presentation are at similar risk of developmental dysplasia of the hip (DDH) as the term breech infants is not known. The information will be vital for DDH screening guidelines.MethodsA retrospective audit of infants born in the breech position was performed to compare the incidence of DDH in the following gestational age groups: 23–27, 28–31, 32–36 and ≥37 weeks.ResultsA total of 1144 neonates were included in the study. The incidence of DDH did not differ between the groups (11.6%, 9.4%, 13.6% and 11.5%, in 23–27, 28–31, 32–36 and ≥37 weeks, respectively, p=0.40). Sixty infants required intervention for DDH. Multiple logistic regression after correcting for potential confounders showed that gestational age group did not influence the risk of DDH, and requirement of therapy.ConclusionPreterm infants born with breech presentation appear to have a similar incidence of DDH to term breech infants.
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