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BACKGROUND: Pediatric airway management traditionally emphasizes strict adherence to age-based laryngoscope blade size recommendations, despite limited empirical validation. OBJECTIVES: To evaluate whether intubation performance varies across a range of blade sizes, and whether a Macintosh 2 blade performs comparably across multiple pediatric age groups in a simulation setting. METHODS: We conducted a randomized crossover simulation study using three pediatric airway manikins (neonate, infant, and child age groups). Emergency medicine residents and faculty physicians performed intubations using multiple laryngoscope blade types and sizes, including standard and nonstandard options. Primary outcomes were intubation time and first-attempt success. Secondary outcomes included complications and operator-rated ease of glottic view and tube passage. Between-blade differences were estimated with 95% confidence intervals. RESULTS: Across manikin sizes and blade types, intubation times were short and first-attempt success rates exceeded 98% in most conditions. Performance remained consistent even with blade sizes outside conventional age-based recommendations. Between-blade differences in intubation time were small, and complication rates were low across conditions. The Macintosh 2 blade performed comparably across all manikin sizes, with similar intubation times, high success rates, and favorable ease ratings. CONCLUSIONS: Intubation performance in pediatric manikin models was similar across a wide range of blade sizes. These hypothesis-generating findings warrant prospective clinical evaluation of simplified blade selection strategies for pediatric intubation.
The pediatrician's function as a comprehensive family health practitioner has frequently been ignored. A major problem is that pediatric residents are not trained or are inadequately trained to assess emotional, behavioral, and family problems that may be an integral part of the patient's symptoms. At the Children's Hospital of Philadelphia, a pediatric-psychiatric liaison program has evolved in which pediatric residents learn the principles and skills necessary to manage these problems. Ultimately, the liaison program will enable the staff pediatricians who use these principles to assume appropriate responsibility for educating the pediatric trainees.
A descriptive statistic study about journals and pediatric articles at international level is presented. Three of the main international repetories of medical bibliography, have been used as sources, collecting a total of three hundred periodical pediatric publications. A distribution of these publications by languages, places or impression, periodicity of appearance and percent of sub-specialization is made. In relation with pediatric papers, we have studied their presence in non medical scientific journals, medical but non pediatric journals and in those of the speciality, analizing the percentage of these papers in each one of them.
Although telephone calls comprise almost one fourth of all childhood patient-physician contacts, the content of telephone care is not emphasized in most educational and service programs. In response to the need to improve management of telephone calls to our pediatric emergency room, we developed 28 protocols to deal with the 25 most common complaints presented by phone. This paper describes the content of these protocols, the training of the health assistants who administered them, and the measures we took to assure their safety and general utility in pediatric practice settings. The study demonstrates the feasibility of an organized system for telephone care based on protocols which include: (1) basic data to be collected for each chief complaint category; (2) a range of appropriate dispositions; and (3) advice for home management when the patient does not require an immediate medical visit. Potential uses of these protocols for medical and nursing education and for clinical service needs are discussed.
The authors report 98 cases of cardiac arrhythmia observed in the course of 2,500 pediatric anesthesias performed with constant electrocardiographic monitoring. The patients, aged 0 to 18 years, were in most cases healthy. Anesthesia was performed by different techniques for both surgical and non-surgical interventions for a variety of conditions, both serious and routine. Other than 3 cases of cardiac arrest (1 death) cardiac arrhythmias usually followed a benign course without hemodynamic repercussions. The authors emphasize the value of early detection of cardiac arrhythmias as well as vigorous treatment of predisposing conditions such as inadequate ventilation, acidosis and pain. The absence of correlation between the degree of rick, as estimated preoperatively (related to patient or procedure risk factors), and the frequency of occurrence seems to point to the value of more widespread use of ECG monitoring of pediatric patients undergoing anesthesia.
Anesthetic management of the pediatric patient is a challenge which can give rise to a most rewarding anesthetic management if one takes into consideration the normal physiological function of the pediatric patient. One should choose the appropriate medications which may safely be administered to an animal of this age. Control of anesthesia through the use of appropriate anesthetic equipment and the use of appropriate monitoring will aid safe management. The selection of adjunct medications can achieve control of complications and aid ultimate uncomplicated recovery.
The findings reported in this article are based on a nationwide survey of the attitudes and practices of pediatric surgeons and pediatricians with respect to some of the difficult ethical choices confronting them in medical practice. Four hundred fifty-seven physicians completed a questionnaire in the spring of 1975 in which they reacted to a wide range of issues that have been of increasing concern to the public, as well as to the medical profession. The survey attempts to identify some areas of physician consensus as well as some of the factors, personal and professional, influencing physicians' attitudes. The survey and its statistical analysis are intended to provide current sociological data and are not intended by the authors as an endorsement of any particular point of view or course of action.
Circulation of pediatric journals through the main twenty international index on medical bibliography is analized.
A descriptive statistic analysis of general pediatric books and pamphlets, mentioning the number of titles in circulation at international level, and their distribution by languages, places of impression and countries with the main index of production is exposed.
S-6437 is a preparation of sustained release cefalexin consisting of non-enteric coated granules and enteric coates ones and it is reported that the drug shows good effectiveness with b.i.d. regimen. Various infections in pediatrics were treated with S-6437 and the following results were obtained. Dose used was 40 approximately 100 mg/kg/day at 2 divided doses after breakfast and dinner. 1) Twenty patients (87.0%) of the 23 with respiratory tract infections and 3 (60.0%) of the 5 with the other infections responded to the drug. Overall effectiveness was 82.1% (23/28 cases). 2) As for side effects, tentative diarrhea was observed in 5 patients (17.2%) of the 29 but no other severe side effects were found. 3) S-6437 is considered to be a drug which overcomes inconvenience of giving regular cefalexin four times a day.
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