Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management.

Minimally invasive surgery during abdominal, thoracic and urological procedures has become the standard management of many surgical interventions in adults. Recent development of smaller devices has allowed the management of many paediatric surgeries using these minimally invasive techniques. However, the lack of knowledge of (a) adequate management of haemodynamic and respiratory alterations occurring during those procedures and (b) postoperative advantages of these techniques over open surgeries, still impairs their development.

Postoperative complications following neonatal and infant surgery: Common events and predictive factors.

Background: Data on major non-surgical postoperative complications following neonatal and infant surgery is lacking. The goal of the present study was to describe common major complications and their predictive factors.

Material And Methods: The study consisted of a retrospective review of medical charts of patients less than 6months of age operated in our institution over one calendar year, excluding herniorraphy surgery.

Intraoperative changes in blood pressure associated with cerebral desaturation in infants.

Background: Intraoperative hypotension has been linked to poor postoperative neurological outcomes. However, the definition of hypotension remains controversial in children. We sought to determine arterial blood pressure threshold values associated with cerebral desaturation in infants.

Postoperative decrease in plasma sodium concentration after infusion of hypotonic intravenous solutions in neonatal surgery.

Background: Hypotonic i.v. solutions can cause hyponatraemia in the context of paediatric surgery.

A review of 5434 percutaneous pediatric central venous catheters inserted by anesthesiologists.

Objective: To review the results of an anesthesiologist led pediatric percutaneous central venous access service.

Methods: Prospective data on percutaneous pediatric central venous catheter (CVC) insertions were collected over 22 years. Data included age, gender, weight, previous central CVCs, venous thromboses, investigations for great vein patency, type of CVC, external diameter, previous CVC insertions, intended use, operator identity, and the vein into which the CVC was inserted.

Evaluation of intestinal absorption after longitudinal intestinal lengthening for short bowel syndrome.

Purpose: The aim of this study was to answer if the longitudinal intestinal lengthening and tailoring (LILT) by Bianchi, modified by Aigrain, can allow the child to be weaned from parenteral nutrition (PN) and if the length of the bowel after the procedure can influence the results of the absorption test such as Schilling or D-xylose test.

Patients And Methods: We reviewed the files of 7 children who have had LILT from 1980 to 2003. We performed to explore 2 intestinal function tests: the D-xylose and the Schilling tests.

Laparoscopic approach as primary treatment of common bile duct stones in children.

Background: Preoperative endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy (ES) are an effective strategy for choledocholithiasis, but complications such as pancreatitis and outcome in children are unknown. The laparoscopic cholecystectomy became the new gold standard in children for cholelithiasis. For the choledocholithiasis in children, the attitude is more controversial.

Reimplantation of oesophageal bronchus following a type III oesophageal atresia repair.

Oesophageal atresia can be associated with communicating bronchopulmonary foregut malformations, the most common being the oesophageal bronchus. Lung resection may be mandatory, but conservative treatment correcting the abnormal airway has been proposed, raising the difficult issue of perioperative ventilatory support. The authors report a case of successful reimplantation of oesophageal bronchus revealed after surgical cure of an oesophageal atresia with tracheo-oesophageal fistula.

Pulmonary sequestration children: is the thoracoscopic approach a good option?

Background: The thoracoscopic approach for pulmonary sequestration in children seems to be feasible and reproducible. To date, there have been no studies comparing the thoracoscopic approach with the conventional technique in this indication. Therefore, the aim of this study was to compare these two approachs.

Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients.

The use and complications of totally implantable vascular access devices (TIVADs) were examined during multiple courses of antibiotics in cystic fibrosis (CF) patients. This retrospective study involved 36 CF centres. Risk factors for removal and septicaemia were sought by survival analysis of censored data.

Separate-lung ventilation strategy for reimplantation of esophageal bronchus.

We describe an original ventilation method designed to optimize lung recruitment and gas exchanges during surgery in a newborn with congenital esophageal atresia and ectopic esophageal implantation of the left mainstem bronchus. This strategy ensured constant adaptation of the mechanical ventilatory regimen to the surgical procedure-linked constraints.

Do prognostic factors exist for total colonic aganglionosis with ileal involvement?

Background/purpose: Total colonic aganglionosis with ileal involvement is estimated at 1 case in 50,000 living births. This pathology has a very variable prognosis, and patients often need long-term parenteral nutrition. The aim of this study is to define prognostic factors for this disease.

Mediastinal pancreatic pseudocyst in a child. A thoracoscopic approach.

Mediastinal pancreatic pseudocyst is a rare occurrence in children and may be difficult to diagnose. Internal drainage via a cystenterostomy and a simple external drainage are two of the treatment options that are currently employed. We describe the case of an 11-year-old boy with a mediastinal pseudocyst who was treated via a thoracoscopic approach using an original pulmonary exclusion.

[Laparoscopic splenectomy in children: experience and results].

Unlabelled: Pediatric laparoscopic splenectomy is a relatively new surgical procedure. Advances in instrumentation and technique now make this procedure possible. Splenectomy is frequently performed in children for various hematologic and autoimmune diseases.

[Use of GEE for modeling censored correlated data: application to the study of risk factors for withdrawal of totally implantable vascular access devices in cystic fibrosis].

Background: The proportional hazards model proposed by Cox for modeling censored data is not suited for correlated delays, for instance when several events can be observed on each subject.

Methods: To analyze correlated delays, we propose to use a log-linear marginal model equivalent to Cox model. Correlations are taken into account through the use of Liang and Zeger's Generalized Estimating Equations (GEE) and of their robust variance estimator.

Cardiovascular changes during deep halothane anaesthesia in infants and children.

Cardiac output, blood pressure and heart rate were measured with noninvasive techniques before, during and after induction of anaesthesia with halothane and after intubation in unpremedicated infants and in diazepam-atropine premedicated children presenting for elective surgery. Cardiac output was measured with pulsed doppler echocardiography. Left ventricular shortening fraction was estimated with M-mode echocardiography during induction.

Cardiovascular responses to induction of anaesthesia with thiopentone and suxamethonium in infants and children.

Cardiac output, systolic blood pressure and heart rate were measured with non-invasive techniques before, during and after induction of anaesthesia with thiopentone (7.5-8.5 mg/kg) and suxamethonium (1.

[Hemodynamic effects of fentanyl and sufentanil combined with flunitrazepam in coronary artery surgery].

Because sufentanil has been reported as being able to prevent or treat peroperative hypertensive crises during aorto-coronary artery graft surgery, a study was carried out to compare the haemodynamic effects of sufentanil with those of fentanyl. 20 patients who were to undergo aortocoronary bypass grafting (CABG) were randomly allocated to two equal groups, sufentanil (Sf) and fentanyl (F) groups. A 1 to 5 dose ratio was used so as to have equipotent doses of sufentanil and fentanyl.

Oral intubation v. nasal intubation in adult cardiac surgery.

Time for intubation, incidence of mechanical complications, occurrence of bacteraemia caused by intubation, and postoperative discomfort were assessed in relation to nasal and oral tracheal intubation in adult cardiac surgery. The time for placement of the tube was 2.5 times longer for nasal intubation.

[Anesthesia in patient with the ventricular pre-excitation syndrome].

The Wolff-Parkinson-White syndrome or its variant, the pre-excitation syndrome, are described in about 1.2 per 1000 of the population, so the anaesthetic management of patients with this syndrome is important. Our experience is reported in 15 elective operations on seven patients with pre-excitation syndrome.