Gastroschisis

Abstract

SIR IR-I was interested in the paper by Ngwenyama et al. (1) which demonstrated and discussed a 30-40% propofolsparing effect of a concurrent dexmedetomidine infusion in children undergoing spinal surgery. The paper also discussed the problems of propofol infusion syndrome and it is extremely important that users of total intravenous anesthesia techniques are aware of this syndrome and take measures to limit the dose of propofol emulsion infused in pediatric patients undergoing anesthesia. I think, however, it is useful to think of this in terms of lipid load and this did not really come across in this paper. The authors do not tell us which formulation of propofol they used and whether this was a 1% (10 mgAEml )1 propofol) solution or a 2% (20 mgAEml )1 propofol) solution. A simple method of reducing the lipid load is to use 2% propofol emulsion formulations in pediatric patients. This immediately results in a halving of the lipid load. The main disadvantage of this formulation is more frequent and severe injection pain. In the UK and parts of Europe we now have available open targetcontrolled infusion devices which contain validated pediatric pharmacokinetic models for 2% propofol solutions which can be used in children from age 1 year. Injection pain can be ameliorated by use of a larger vein, preinjection of lignocaine and preinjection of a short or ultrashort-acting opioid.

Thoracoabdominal and General Surgery

“…These techniques allow gradual compression of the bowel into the abdomen over a period of days and facilitate early extubation. The neonate undergoes planned surgical closure 3-5 days later, or closure of the defect using adhesive strips once the bowel is fully reduced, depending on the silo technique used [ 207 ]. Use of the preformed silo may be associated with reduced ventilator days in the NICU [ 97 ], but this approach may also be associated with specifi c technical complications leading to venous congestion of the intestine and bowel ischemia [ 208 ].…”