A discrepancy between left and right brain BIS exists, especially when the patient is stimulated. COMFORT score and BIS correlate well between light and moderate sedation.
SummaryThis review summarizes the evolution of the pediatric laryngoscope using some of the established landmarks in the history of anesthesia. Children were rarely intubated before 1940 though the subsequent 30 years saw a proliferation of pediatric laryngoscopes in part driven by the developments in pediatric anesthesia and surgery, manufacturing techniques and materials and a change in airway management philosophy exemplified by Jackson Rees's argument against the notion that intubation was to be avoided in children. A perspective on the present day describes the modifications to popular straight and curved blade laryngoscopes and the development of new devices that enhance direct visualization of the larynx. There are an everincreasing number of laryngoscope devices that assist in indirect visualization of the larynx such as rigid optical stylets and flexible fiber-optic scopes. Images from many of these devices may be enhanced by digital camera or real-time video technology. The prospect of future laryngoscope development is glimpsed in the arrival of light emitting diode light source technology and questions remain regarding the consequences of equipment disposability and at the fidelity of disposable equipment manufacture.
Summary
The aim of this study was to determine the filtration performance of five commonly used paediatric breathing system filters following exposure to desflurane, isoflurane and sevoflurane. It has been suggested that oil may degrade the performance of filter material. Volatile anaesthetic vapours are organic and hence may affect the filtration performance of breathing system filters during anaesthesia. This has not been tested for various concentrations of volatile agent, type and duration of exposure. The filtration performance of the filters was measured following exposure to desflurane, isoflurane and sevoflurane at 1 and 2 minimum alveolar concentration (MAC) for 1 and 4 h. Penetration of particles through the Clear‐Therm Micro, Clear‐Therm Mini and Humid‐Vent Filter Pedi increased by between 2.4 and 2.8 times after exposure to desflurane at 2 MAC for 4 h compared to that through unexposed filters (p < 0.0001 for all three filters). Further investigation is required to determine whether this reduction in filtration performance by desflurane is clinically significant.
Over the past two decades, a plethora of new airway devices has become available to the pediatric anesthetist. While all have the laudable intention of improving patient care and some have proven clinical benefits, these devices are often costly and at times claims of an advantage over current equipment and techniques are marginal. Supraglottic airway devices are used in the majority of pediatric anesthetics delivered in the U.K., and airway-viewing devices provide an alternative for routine intubation as well as an option in the management of the difficult airway. Yet hidden beneath the convenience of the former and the technology of the latter, the impact on basic airway skills with a facemask and the lack of opportunities to fine-tune the core skill of intubation represent an unrecognised and unquantifiable cost. A judgement on this value must be factored into the absolute purchase cost and any potential benefits to the quality of patient care, thus blurring any judgement on cost-effectiveness that we might have. An overall value on cost-effectiveness though not in strict monetary terms can then be ascribed. In this review, we evaluate the role of these devices in the care of the pediatric patient and attempt to balance the advantages they offer against the cost they incur, both financial and environmental, and in any quality improvement they might offer in clinical care.
and reduced complication rates. In particular, transient femoral nerve palsy is less likely. The principle described is applicable to any block where loss of resistance or 'pops' need to be felt with a blunt needle as it penetrates fascial layers such as the iliacus compartment block and the rectus sheath block.
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