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Open access

Elitsa R. Veneva and Ani B. Belcheva

Abstract

Painless treatment is an integral element of quality pediatric dental care. Recent progress in the field of local anesthesia has led to development of newer agents, delivery devices and also modification in injection techniques. Their aim is to allow the clinician a treatment approach associated with the improved pain control and reduced risk of adverse effect essential for pediatric patients. This article reviews available information on current and alternative means, methods and technologies for achieving local anesthesia in pediatric patients intended to minimize the pain associated with the procedure.

Open access

Saowapark Chumpathong, Petcharat Sukavanicharat, Wassana Butmangkun, Suwannee Suraseranivongse, Manee Raksakietisak, Pranee Rushatamukayanunt and Busara Sirivanasandha

Abstract

Background: Pediatric patients with congenital heart diseases may have pathological airway abnormality and delayed development. To predict the appropriate size of endotracheal tube (ETT), a formula between diameter and age has been widely used for Western normal children. However, it is unclear whether this age-based (AB) formula is applicable to Thai pediatric cardiac patients. Objective: Evaluate the effectiveness of uncuffed ETT size by AB formula for pediatric cardiac patients. Methods: A retrospective study was conducted using 320 cases of non-cardiac and cardiac patients aged 2-7 years old who were orally intubated with a regular uncuffed ETT at Siriraj Hospital, Thailand. The exclusion criteria were history of tracheostomy, upper airway obstruction, and expected difficult intubation. Demographic data and final ETT used were recorded. Results: The tube- size predicted by the AB formula could be applied to 54.4% of non-cardiac and 48.1% of cardiac patients (p= 0.314), whereas three sizes of tubes (one above and one below the predicted size) covered 96.9% and 94.4% of non-cardiac and cardiac patients, respectively (p = 0.413). The ETT with 0.5 mm in ID larger than the predicted size were more often used in 35.0% of cardiac patients compared with 22.5% of non-cardiac patients (p= 0.019). There were no significant differences between methods using age (actual, round-up, and truncated) to calculate the AB formula. The Pearson’s correlation between the ID of the ETT with height in non-cardiac and cardiac patients were 0.430 and 0.683, respectively (p <0.001), whereas correlations with weight were 0.622 and 0.561 (p <0.001), respectively. Conclusion: The AB formula was applicable to non-cardiac and cardiac children aged 2-7 years old. For Thai pediatric cardiac patients, we recommend to use a one-size larger ETT than non-cardiac patients.

Open access

Naiyana Aroonpruksakul, Thaniya Stimanont and Pattira Pianchob

Abstract

Background

Laboratory blood tests rarely detect any abnormalities in apparently healthy patients. Moreover, unnecessary testing may not only upset pediatric patients and their parents, but may harm patients because of overtreatment of borderline or false-positive results.

Objectives

To determine the prevalence and factors correlated with inappropriate preoperative testing of pediatric patients scheduled for elective surgery.

Methods

We conducted a 6-month retrospective chart review of all children <15 years of age who underwent elective surgery at Siriraj Hospital in Bangkok, Thailand. Demographic and clinical data were recorded, including age, sex, physical status class according to the American Society of Anesthesiologists (ASA), underlying diseases, diagnosis, operation, service unit, and grade of surgery. The requested preoperative laboratory tests were based on the surgeon’s decision. We assessed whether each test was appropriate based on the recommendations for preoperative testing from our Department of Anesthesiology.

Results

We included data from 130 patients. The overall prevalence of inappropriate preoperative testing was 55%. Grade of surgery and service unit significantly affected inappropriate testing (P = 0.01 and P = 0.001 respectively). The highest prevalence of inappropriate test requests was for a complete blood count (37%), and all the risk factors, including ASA class I (P = 0.015), minor operation (P < 0.001), and nonpediatric surgery unit (P < 0.001), were significantly associated with this test.

Conclusions

The prevalence of inappropriate preoperative testing was high, especially for healthy patients who underwent minor operations. Therefore, we recommend that surgical staff be educated to request laboratory tests only when indicated.