PROBLEMS IN ANAESTHESIA PAEDIATRIC ANAESTHESIA Dedication We would like to dedicate this book to our spouses Helen and Simon and to our children Michael, Sophie, Isabelle, Matthew, Shona, Roslyn and Johnny. ii PROBLEMS IN ANAESTHESIA PAEDIATRIC ANAESTHESIA Edited by Peter A Stoddart MB BS BSc MRCP FRCA Consultant Anaesthetist Bristol Royal Infirmary for Children Bristol UK Gillian R Lauder MB BCh FRCA Consultant Paediatric Anaesthetist Bristol Royal Infirmary for Children Bristol UK © 2004 Martin Dunitz, an imprint of the Taylor & Francis Group plc First published in the United Kingdom in 2004 by Martin Dunitz, an imprint of the Taylor & Francis Group plc, 11 New Fetter Lane, London EC4P 4EE Tel.: +44 (0) 20 7583 9855 Fax.: +44 (0) 20 7842 2298 E-mail: Contents Contributors ix Foreword xiii Preface xiv 1 Anaesthesia for closure of gastroschisis/exomphalos 1 Dylan Parry Prosser 2 Anaesthesia for repair of oesophageal atresia and tracheo- 7 oesophageal fistula Angus McEwan 3 Anaesthetic management for pyloromyotomy in a district 13 general hospital Alison S Carr 4 Herniotomy in the ‘ex-premie’ 19 Jane M Peutrell 5 Anaesthesia for the kasai procedure (portoenterostomy) 29 Miguel Plaza-Barrera and David William Green 6 Anaesthesia for repair of cleft palate 35 Judith Dunnet 7 Muscle biopsy in the ‘floppy’ infant 39 Jennifer E O’Flaherty 8 Intussusception in a 6 month old baby 43 JA Nolan 9 Anaesthesia for adenotonsillectomy in a patient with a 49 total cavopulmonary circulation (fontan) Andrew R Wolf 10 Hypoplastic left heart syndrome 55 Hamish M Munro 11 Management of an adolescent with chronic knee pain and 63 severe disability John M Goddard v CONTENTS 12 Management of pain in patients with sickle cell disease 67 Julia Ely and Anthony Moriarty 13 Laparoscopic fundoplication in a child with cerebral palsy 73 Louise Aldridge 14 Craniotomy for medulloblastoma 81 AER Young 15 Nephroblastoma (Wilms’ tumour) 87 Peter A Stoddart 16 Laser therapy for laryngeal papillomas 93 Paul Reynolds and Robert Weatherly 17 Anaesthesia for a child with Apert syndrome and a congenital 99 abnormality of the hand Philip MD Cunnington and Robert Bingham 18 Multilevel Orthopaedic Surgery in a child with cerebral palsy 107 JA Nolan 19 Scoliosis repair in a child with Rett syndrome 113 Gillian R Lauder 20 Magnetic resonance imaging in an infant with a cystic hygroma 121 MRJ Sury 21 Empyema in a 4-year-old boy 127 Peter A Stoddart 22 Day case anaesthesia for orchidopexy (including the snotty child) 131 Liam J Brennan 23 Problems in recovery (postanaesthesia care unit) 137 Michelle White and Gillian R Lauder 24 The screaming child 145 Andy Tatman 25 Anaesthesia for strabismus surgery 153 Stephen J Mather 26 Difficult intubation in an 18-month-old child 157 Ann E Black vi CONTENTS 27 Foreign body aspiration 163 Patricia M Weir 28 Major orthopaedic surgery in a child of Jehovah’s Witness parents 167 Gillian R Lauder 29 Revision ventriculoperitoneal shunt in a child with spina bifida 173 (complicated by latex allergy) Deborah J Harris 30 Adenotonsillectomy in a 5-year-old child with obstructive 179 sleep apnoea Anthony Pickering and Alexander Mayor 31 Bronchospasm complicating internal fixation of humerus in a 183 3-year-old asthmatic Kathy Wilkinson 32 Appendectomy in a child with insulin dependent diabetes mellitus 191 Anna Johnson and Gillian R Lauder 33 Cholycystectomy in a child with sickle cell disease 197 Isabeau Walker 34 Management of head injury in a child 205 Lauren Barker and Peter J Murphy 35 Paediatric transport medicine: retrieval of a 2-year-old girl 213 with meningococcal septicaemia Stephen C Marriage Index 221 vii Contributors Louise Aldridge MBChB FRCA DCH Philip MD Cunnington MB BS FRCA Consultant in Paediatric Anaesthesia Consultant Paediatric Anaesthetist Department of Anaesthesia Great Ormond Street Hospital for Children NHS Trust Royal Hospital for Sick Children Great Ormond Street Edinburgh London UK UK Lauren Barker MB BCh FRCA Judith Dunnet MB ChB MRCP FRCA Consultant Anaesthetist Consultant Paediatric Anaesthetist Royal Devon and Exeter Hospital Frenchay Hospital Barrack Road Bristol Exeter UK UK Julia Ely MB ChB FRCA Clinical Research Fellow Robert Bingham MB BS FRCA Birmingham Children’s Hospital NHS Trust Consultant Paediatric Anaesthetist Birmingham Great Ormond Street Hospital for Children NHS Trust UK Great Ormond Street London John M Goddard MB BS MRCP FRCA UK Consultant in Paediatric Anaesthesia and Pain Management Ann E Black MB BS FRCA Sheffield Children’s Hospital Consultant Paediatric Anaesthetist Western Bank Great Ormond Street Hospital for Children NHS Sheffield Trust UK Great Ormond Street London David William Green MB BS FRCA MBA UK Consultant Anaesthetist Kings College Hospital Denmark Hill Liam J Brennan BSc MB BS FRCA London Consultant in Paediatric Anaesthesia and Director of UK Paediatric Day Surgery Addenbrooke’s Hospital Deborah J Harris LMS FRCA Cambridge Consultant in Anaesthesia and Intensive Care UK Frenchay Hospital Frenchay Park Road Alison S Carr MBBS FRCA Bristol Consultant Paediatric Anaesthetist UK Directorate of Anaesthesia, Critical Care Medicine and Pain Management Anna Johnson BSc MBChB FRCA Plymouth Hospitals NHS Trust Consultant paediatric anaesthetist Derriford Hospital Derriford Hospital Plymouth Plymouth UK UK ix