Femoral nerve blockade using various concentrations of local anesthetic for knee arthroscopy in the pediatric population

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Veneziano G

2016-11-01

�mg/kg (interquartile ranges [IQR]: 0 mg, 0.03 mg/kg compared to 0.02 mg/kg (IQR: 0, 0.08 mg/kg in the ropivacaine 0.2% group and 0.01 mg/kg (IQR: 0, 0.08 mg/kg in the bupivacaine 0.25% group (p=0.009. Median PACU time was shortest in the ropivacaine 0.5% group (47 min; IQR: 36, 68 min compared to the ropivacaine 0.2% (58 min; IQR: 41, 77 and bupivacaine 0.25% (54 min; IQR: 35, 75 min groups (p=0.040. Among groups, there were no significant differences in first postoperative pain scores or incidence of nausea and vomiting. No patient in any group experienced a serious adverse event.Conclusion: The results suggest that ropivacaine 0.5% for FNB offers superior postoperative analgesia in the form of decreased postoperative opioid consumption and earlier PACU/hospital discharge, when compared to ropivacaine 0.2% and bupivacaine 0.25% in the pediatric population.Level of evidence: III, Retrospective Comparative Study. Keywords: anesthesia, regional, nerve block, pain, postoperative, local anesthetic, child, adolescent

Anesthesia and the Developing Brain: Relevance to the Pediatric Cardiac Surgery

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Lisa Wise-Faberowski

2014-04-01

Full Text Available Anesthetic neurotoxicity has been a hot topic in anesthesia for the past decade. It is of special interest to pediatric anesthesiologists. A subgroup of children potentially at greater risk for anesthetic neurotoxicity, based on a prolonged anesthetic exposure early in development, are those children receiving anesthesia for surgical repair of congenital heart disease. These children have a known risk of neurologic deficit after cardiopulmonary bypass for surgical repair of congenital heart disease. Yet, the type of anesthesia used has not been considered as a potential etiology for their neurologic deficits. These children not only receive prolonged anesthetic exposure during surgical repair, but also receive repeated anesthetic exposures during a critical period of brain development. Their propensity to abnormal brain development, as a result of congenital heart disease, may modify their risk of anesthetic neurotoxicity. This review article provides an overview of anesthetic neurotoxicity from the perspective of a pediatric cardiac anesthesiologist and provides insight into basic science and clinical investigations as it relates to this unique group of children who have been studied over several decades for their risk of neurologic injury.

Anesthesia-related mortality in pediatric patients: a systematic review.

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Gonzalez, Leopoldo Palheta; Pignaton, Wangles; Kusano, Priscila Sayuri; Módolo, Norma Sueli Pinheiro; Braz, José Reinaldo Cerqueira; Braz, Leandro Gobbo

2012-01-01

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

COMPARISON OF GLYCEMIC EFFECT OF ADRENALIN CONTAINING LOCAL ANESTHETIC IN DIABETIC AND NON-DIABETIC PATIENTS UNDERGOING MINOR ORAL SURGICAL PROCEDURE

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Pradeep

2015-12-01

Full Text Available AIM To compare the changes in blood glucose level associated with administration of adrenaline containing local anesthetic in diabetic and non-diabetic patients undergoing minor oral surgical procedures. METHODS AND MATERIAL The study included 150 well controlled diabetic patients and 150 non-diabetic healthy patients in age group of 40-60 years who underwent minor oral surgical procedures (trans alveolar extractions, alveoplasty and flap surgeries. Patients in both the group were administered 1.8ml of local anesthetic agent containing 1:100,000 adrenaline for inferior alveolar nerve block and 0.2 ml of anesthetic agent for long buccal nerve block. Blood glucose levels were assessed and compared during pre-operative and one hour post-operative period. STATISTICAL ANALYSIS The comparison of the random blood sugar levels preop and postop in both the groups were compared using paired t test and RBS levels between two groups were analysed using unpaired t test. P value less than 0.05 was considered statistically significant. RESULTS No statistically significant change in post-operative blood glucose level was noted between the diabetic and non-diabetic patients. CONCLUSION The study concluded that it is safe to administer local anesthetic containing 1:100,000 adrenaline in smaller volumes to well controlled diabetic patients.

Anesthetic considerations for a pediatric patient with Wolf-Hirschhorn syndrome: a case report

OpenAIRE

Tsukamoto, Masanori; Yamanaka, Hitoshi; Yokoyama, Takeshi

2017-01-01

Wolf-Hirschhorn syndrome is a rare hereditary disease that results from a 4p chromosome deletion. Patients with this syndrome are characterized by craniofacial dysgenesis, seizures, growth delay, intellectual disability, and congenital heart disease. Although several cases have been reported, very little information is available on anesthetic management for patients with Wolf-Hirschhorn syndrome. We encountered a case requiring anesthetic management for a 2-year-old girl with Wolf-Hirschhorn ...

Pediatric regional anesthesia: what is the current safety record?

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Polaner, David M; Drescher, Jessica

2011-07-01

The use of regional anesthetics, whether as adjuncts, primary anesthetics or postoperative analgesia, is increasingly common in pediatric practice. Data on safety remain limited because of the paucity of very large-scale prospective studies that are necessary to detect low incidence events, although several studies either have been published or have reported preliminary results. This paper will review the data on complications and risk in pediatric regional anesthesia. Information currently available suggests that regional blockade, when performed properly, carries a very low risk of morbidity and mortality in appropriately selected infants and children. © 2010 Blackwell Publishing Ltd.

Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related Cardiac Arrest.

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Zgleszewski, Steven E; Graham, Dionne A; Hickey, Paul R; Brustowicz, Robert M; Odegard, Kirsten C; Koka, Rahul; Seefelder, Christian; Navedo, Andres T; Randolph, Adrienne G

2016-02-01

Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon but potentially preventable adverse event. Infants and children with more severe underlying disease are at highest risk. We aimed to identify system- and anesthesiologist-related risk factors for ARCA. We analyzed a prospectively collected patient cohort data set of anesthetics administered from 2000 to 2011 to children at a large tertiary pediatric hospital. Pre-procedure systemic disease level was characterized by ASA physical status (ASA-PS). Two reviewers independently reviewed cardiac arrests and categorized their anesthesia relatedness. Factors associated with ARCA in the univariate analyses were identified for reevaluation after adjustment for patient age and ASA-PS. Cardiac arrest occurred in 142 of 276,209 anesthetics (incidence 5.1/10,000 anesthetics); 72 (2.6/10,000 anesthetics) were classified as anesthesia-related. In the univariate analyses, risk of ARCA was much higher in cardiac patients and for anesthesiologists with lower annual caseload and/or fewer annual days delivering anesthetics (all P risk adjustment for ASA-PS ≥ III and age ≤ 6 months, however, the association with lower annual days delivering anesthetics remained (P = 0.03), but the other factors were no longer significant. Case-mix explained most associations between higher risk of pediatric ARCA and anesthesiologist-related variables at our institution, but the association with fewer annual days delivering anesthetics remained. Our findings highlight the need for rigorous adjustment for patient risk factors in anesthesia patient safety studies.

Anesthetic considerations for a pediatric patient with Wolf-Hirschhorn syndrome: a case report.

Science.gov (United States)

Tsukamoto, Masanori; Yamanaka, Hitoshi; Yokoyama, Takeshi

2017-09-01

Wolf-Hirschhorn syndrome is a rare hereditary disease that results from a 4p chromosome deletion. Patients with this syndrome are characterized by craniofacial dysgenesis, seizures, growth delay, intellectual disability, and congenital heart disease. Although several cases have been reported, very little information is available on anesthetic management for patients with Wolf-Hirschhorn syndrome. We encountered a case requiring anesthetic management for a 2-year-old girl with Wolf-Hirschhorn syndrome. The selection of an appropriately sized tracheal tube and maintaining intraoperatively stable hemodynamics might be critical problems for anesthetic management. In patients with short stature, the tracheal tube size may differ from what may be predicted based on age. The appropriate size ( internal diameter ) of tracheal tubes for children has been investigated. Congenital heart disease is frequently associated with Wolf-Hirschhorn syndrome. Depending on the degree and type of heart disease, careful monitoring of hemodynamics is important.

Pharmacologic Considerations for Pediatric Sedation and Anesthesia Outside the Operating Room: A Review for Anesthesia and Non-Anesthesia Providers.

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Khurmi, Narjeet; Patel, Perene; Kraus, Molly; Trentman, Terrence

2017-10-01

Understanding the pharmacologic options for pediatric sedation outside the operating room will allow practitioners to formulate an ideal anesthetic plan, allaying anxiety and achieving optimal immobilization while ensuring rapid and efficient recovery. The authors identified relevant medical literature by searching PubMed, MEDLINE, Embase, Scopus, Web of Science, and Google Scholar databases for English language publications covering a period from 1984 to 2017. Search terms included pediatric anesthesia, pediatric sedation, non-operating room sedation, sedation safety, and pharmacology. As a narrative review of common sedation/anesthesia options, the authors elected to focus on studies, reviews, and case reports that show clinical relevance to modern day sedation/anesthesia practice. A variety of pharmacologic agents are available for sedation/anesthesia in pediatrics, including midazolam, fentanyl, ketamine, dexmedetomidine, etomidate, and propofol. Dosing ranges reported are a combination of what is discussed in the reviewed literature and text books along with personal recommendations based on our own practice. Several reports reveal that ketofol (a combination of ketamine and propofol) is quite popular for short, painful procedures. Fospropofol is a newer-generation propofol that may confer advantages over regular propofol. Remimazolam combines the pharmacologic effects of remifentanil and midazolam. A variety of etomidate derivatives such as methoxycarbonyl-etomidate, carboetomidate, methoxycarbonyl-carboetomidate, and cyclopropyl-methoxycarbonyl metomidate are in development stages. The use of nitrous oxide as a mild sedative, analgesic, and amnestic agent is gaining popularity, especially in the ambulatory setting. Utilizing a dedicated and experienced team to provide sedation enhances safety. Furthermore, limiting sedation plans to single-agent pharmacy appears to be safer than using multi-agent plans.

Measurement of consumption of sevoflurane for short pediatric anesthetic procedures: Comparison between dion′s method and dragger algorithm

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Preet Mohinder Singh

2013-01-01

Methodology: One hundred pediatric patients scheduled for ophthalmological examination under anesthesia were included in the study. Anesthesia was induced and maintained using sevoflurane with oxygen and nitrous oxide (1:1 on Primus workstation (Drager Inc., Germany. Total sevoflurane consumed for each procedure was calculated using Dion′s equation and the values obtained from Drager Primus were noted and compared. Results: Both methods showed a very strong correlation (0.895 [P < 0.001]. Dion′s method underestimated consumption by 2.59 ml with limits of agreement between 5.188 ml and −0.008 ml. Both test results showed a strong correlation, but poor concordance. Conclusions: Dion′s method strongly correlates with Drager protocol although concordance between the two methods for measuring anesthetic gas consumption is poor. Dion′s method underestimates the consumption and with slight modification addressing this underestimation, it can be electronically incorporated in other workstations to overcome limitations of real-time measurement of inhalation agent consumption.

Behavioral response and pain perception to computer controlled local anesthetic delivery system and cartridge syringe

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T D Yogesh Kumar

2015-01-01

Full Text Available Aim: The present study evaluated and compared the pain perception, behavioral response, physiological parameters, and the role of topical anesthetic administration during local anesthetic administration with cartridge syringe and computer controlled local anesthetic delivery system (CCLAD. Design: A randomized controlled crossover study was carried out with 120 children aged 7-11 years. They were randomly divided into Group A: Receiving injection with CCLAD during first visit; Group B: Receiving injection with cartridge syringe during first visit. They were further subdivided into three subgroups based on the topical application used: (a 20% benzocaine; (b pressure with cotton applicator; (c no topical application. Pulse rate and blood pressure were recorded before and during injection procedure. Objective evaluation of disruptive behavior and subjective evaluation of pain were done using face legs activity cry consolability scale and modified facial image scale, respectively. The washout period between the two visits was 1-week. Results: Injections with CCLAD produced significantly lesser pain response, disruptive behavior (P < 0.001, and pulse rate (P < 0.05 when compared to cartridge syringe injections. Application of benzocaine produced lesser pain response and disruptive behavior when compared to the other two subgroups, although the result was not significant. Conclusion: Usage of techniques which enhance behavioral response in children like injections with CCLAD can be considered as a possible step toward achieving a pain-free pediatric dental practice.

Anesthesia and the Developing Brain: Relevance to the Pediatric Cardiac Surgery

OpenAIRE

Wise-Faberowski, Lisa; Quinonez, Zoel A.; Hammer, Gregory B.

2014-01-01

Anesthetic neurotoxicity has been a hot topic in anesthesia for the past decade. It is of special interest to pediatric anesthesiologists. A subgroup of children potentially at greater risk for anesthetic neurotoxicity, based on a prolonged anesthetic exposure early in development, are those children receiving anesthesia for surgical repair of congenital heart disease. These children have a known risk of neurologic deficit after cardiopulmonary bypass for surgical repair of congenital heart d...

Scoring system for differentiating perforated and non-perforated pediatric appendicitis.

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Blumfield, Einat; Yang, Daniel; Grossman, Joshua

2017-10-01

Appendicitis is the most common indication for emergency pediatric surgery and its most significant complication is perforation. Perforated appendicitis (PA) may be managed conservatively, whereas non-perforated appendicitis (NP) is managed surgically. Recent studies have shown that ultrasound (US) is effective for differentiating between PA and NP, and does not expose pediatric patients to ionizing radiation. The purpose of this study is to enhance the accuracy of differentiation with a novel scoring system based on clinical, laboratory, and US findings. This retrospective study included 243 patients aged 2-17 years who presented between 2006 and 2013 with surgically proven appendicitis, of whom 60 had perforation. Clinical and laboratory data were collected and US images evaluated by a pediatric radiologist. To create the scoring system, point values were assigned to each parameter. A randomly selected training sample of 137 subjects was used to create a scoring prediction model. The model was tested on the remaining 106 patients. Scores of ≥6, ≥11, and ≥15 yielded specificities of 64, 91, and 99%, and sensitivities of 96, 61, and 29%, respectively (p < 0.001). We have designed a scoring system incorporating clinical, laboratory, and sonographic findings which can differentiate PA from NP with high specificity.

Pediatric anesthesia in developing countries.

Science.gov (United States)

Bösenberg, Adrian T

2007-06-01

To highlight the problems faced in developing countries where healthcare resources are limited, with particular emphasis on pediatric anesthesia. The fact that very few publications address pediatric anesthesia in the developing world is not surprising given that most anesthetics are provided by nonphysicians, nurses or unqualified personnel. In compiling this article information is drawn from pediatric surgical, anesthetic and related texts. In a recent survey more than 80% of anesthesia providers in a poor country acknowledged that with the limited resources available they could not provide basic anesthesia for children less than 5 years. Although many publications could be regarded as anecdotal, the similarities to this survey suggest that the lack of facilities is more generalized than we would like to believe. The real risk of anesthesia in comparison to other major health risks such as human immunodeficiency virus, malaria, tuberculosis and trauma remains undetermined. The critical shortage of manpower remains a barrier to progress. Despite erratic electrical supplies, inconsistent oxygen delivery, paucity of drugs or equipment and on occasion even lack of running water, many provide life-saving anesthesia. Perioperative morbidity and mortality is, however, understandably high by developed world standards.

75 FR 81618 - Anesthetic and Life Support Drugs Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-12-28

... anesthesia as well as the communication of the risk of sedative/anesthetic agents to prescribers and parents... anesthesia in children (information related to studies of patterns and causes of disease); (2) discuss the relevance of these findings to pediatric patients and provide guidance for future preclinical and clinical...

Consent for pediatric anesthesia: an observational study.

Science.gov (United States)

Lagana, Zoe; Foster, Andrew; Bibbo, Adriana; Dowling, Kate; Cyna, Allan M

2012-08-01

Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery. A convenience sample of anesthetists had their pre-anesthesia consultations voice recorded, prior to elective surgery, during a 4-month period at the largest tertiary referral centre for pediatric care in South Australia. A data collection form was used to note baseline demographic data, and voice recording transcripts were independently documented by two researchers and subsequently compared for accuracy regarding the number and nature of risks discussed. Of the 96 voice recordings, 91 (92%) were suitable for the analysis. The five most commonly discussed risks were as follows: nausea and vomiting (36%); sore throat (35%); allergy (29%); hypoxia (25%); and emergence delirium (19%). Twenty-seven pre-anesthetic consultations (30%) were found to have had no discussion of anesthetic risk at all while a further 23 consultations (26%) incorporated general statements inferring that anesthesia carried risks, but with no elaboration about their nature, ramifications or incidence. The median number of risks (IQR) specifically mentioned per consultation was higher, 3 (1) vs 1 (1), P anesthesia experience odds ratio 0.34, 95% CI [0.13, 0.87], P = 0.025. The pediatric anesthesia risk discussion is very variable. Trainees tend to discuss more specific risks than consultants and a patient's previous experience of anesthesia was associated with a more limited discussion of anesthesia risk. © 2011 Blackwell Publishing Ltd.

Developmental Neurotoxicity of Alcohol and Anesthetic Drugs Is Augmented by Co-Exposure to Caffeine

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Catherine E. Creeley

2013-07-01

Full Text Available Anesthetic and anti-epileptic drugs used in pediatric and obstetric medicine and several drugs, including alcohol, that are abused by pregnant women, trigger widespread neuroapoptosis in the developing brain of several animal species, including non-human primates. Caffeine (CAF is often administered to premature infants to stimulate respiration, and these infants are also exposed simultaneously to anesthetic drugs for procedural sedation and/or surgical procedures. Pregnant women who abuse alcohol or other apoptogenic drugs also may heavily consume CAF. We administered CAF to infant mice alone or in combination with alcohol, phencyclidine, diazepam, midazolam, ketamine, or isoflurane, which are drugs of abuse and/or drugs frequently used in pediatric medicine, and found that CAF weakly triggers neuroapoptosis by itself and markedly potentiates the neuroapoptogenic action of each of these other drugs. Exposure of infant mice to CAF + phencyclidine resulted in long-term impairment in behavioral domains relevant to attention deficit/hyperactivity disorder, whereas exposure to CAF + diazepam resulted in long-term learning/memory impairment. At doses used in these experiments, these behavioral impairments either did not occur or were substantially less pronounced in mice exposed to CAF alone or to phencyclidine or diazepam alone. CAF currently enjoys the reputation of being highly beneficial and safe for use in neonatal medicine. Our data suggest the need to consider whether CAF may have harmful as well as beneficial effects on the developing brain, and the need for research aimed at understanding the full advantage of its beneficial effects while avoiding its potentially harmful effects.

Risks of propofol sedation/anesthesia for imaging studies in pediatric research: eight years of experience in a clinical research center.

Science.gov (United States)

Kiringoda, Ruwan; Thurm, Audrey E; Hirschtritt, Matthew E; Koziol, Deloris; Wesley, Robert; Swedo, Susan E; O'Grady, Naomi P; Quezado, Zenaide M N

2010-06-01

To quantify the incidence of adverse events associated with anesthesia given for research-driven imaging studies and to identify risk factors for those events in pediatric research subjects. Retrospective cohort study. National Institutes of Health Clinical Center. Children and adolescents enrolled in clinical research protocols who required anesthesia for research-related imaging studies from January 2000 to September 2008. Propofol sedation/anesthesia. The occurrence of respiratory, cardiovascular, and all anesthesia-related adverse events that required intervention while receiving anesthetics for research-driven imaging studies and other noninvasive procedures. We identified 607 children who received 1480 propofol anesthetic procedures for imaging studies. Seventy percent of anesthetics were given to subjects with severe diseases and significant disabilities (American Society of Anesthesiologists Physical Status [ASA] III). Anesthesia had a mean (SD) duration of 115 (55) minutes, and in 12.5% of procedures, an airway device was necessary. There were 98 notable respiratory, cardiovascular, and other events in 79 anesthetic procedures, a rate of 534 per 10 000 anesthetic procedures with 1 or more adverse events. There was no long-lasting morbidity or mortality. The ASA classification (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.24-6.88), anesthetic effect duration (OR, 1.46; 95% CI, 1.25-1.70), and presence of airway abnormalities (OR, 4.41; 95% CI, 1.60-12.12) were independently associated with adverse events during anesthetic use. In our clinical research sample of high-risk children who received sedation/anesthesia by an anesthesiologist, we observed a low incidence of adverse events and no long-term complications. Risk factors for adverse events included higher ASA classification, increasing anesthetic duration, and presence of airway abnormalities.

A Time-Out Checklist for Pediatric Regional Anesthetics

Science.gov (United States)

Clebone, Anna; Burian, Barbara K.; Polaner, David M.

2017-01-01

Although pediatric regional anesthesia has a demonstrated record of safety, adverse events, especially those related to block performance issues, still may occur. To reduce the frequency of those events, we developed a Regional Anesthesia Time-Out Checklist using expert opinion and the Delphi method.

[Enterobiasis in pediatric subjects in north-western Italy: a study of home remedies].

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Dutto, M; Montù, D; Raineri, G

2012-01-01

The present study examines the most common home remedies in the Piedmont region of northwest Italy currently used in the treatment of pediatric enterobiasis, commonly known as pinworm infection. The remedies in question, typically based on popular beliefs and as such are nearly useless, were noted through interviews with subjects who had come to the local Hygiene and Public Health Services offices for information about pinworm prevention and treatment. Analysis of replies by the subjects clearly indicates that local families are ill-prepared to recognize the symptoms this parasitic infection; often it is confused with pediatric ketosis, therefore leading to inappropriate treatment which at times may be potentially harmful to the patient.

Nocebo-induced hyperalgesia during local anesthetic injection.

Science.gov (United States)

Varelmann, Dirk; Pancaro, Carlo; Cappiello, Eric C; Camann, William R

2010-03-01

Common practice during local anesthetic injection is to warn the patient using words such as: "You will feel a big bee sting; this is the worst part." Our hypothesis was that using gentler words for administration of the local anesthetic improves pain perception and patient comfort. One hundred forty healthy women at term gestation requesting neuraxial analgesia were randomized to either a "placebo" ("We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure") or "nocebo" ("You are going to feel a big bee sting; this is the worst part of the procedure") group. Pain was assessed immediately after the local anesthetic skin injection using verbal analog scale scores of 0 to 10. Median verbal analog scale pain scores were lower when reassuring words were used compared with the harsher nocebo words (3 [2-4] vs 5 [3-6]; P words improves the subjective experience during invasive procedures.

[Complications in pediatric anesthesia].

Science.gov (United States)

Becke, K

2014-07-01

As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia.

Newly postulated neurodevelopmental risks of pediatric anesthesia.

Science.gov (United States)

Hays, Stephen R; Deshpande, Jayant K

2011-04-01

Recent animal and human studies have raised concern that exposure to anesthetic agents in children may cause neuronal damage and be associated with adverse neurodevelopmental outcomes. Exposure of young animals to anesthetic agents above threshold doses and durations during a critical neurodevelopmental window in the absence of concomitant painful stimuli causes widespread neuronal apoptosis and subsequent abnormal behaviors. The relevance of such animal data to humans is unknown. Untreated neonatal pain and stress also are associated with enhanced neuronal death and subsequent maladaptive behaviors, which can be prevented by exposure to these same anesthetic agents. Retrospective observational human studies have suggested a dose-dependent association between multiple anesthetic exposures in early childhood and subsequent learning disability, the causality of which is unknown. Ongoing prospective investigations are underway, the results of which may clarify if and what neurodevelopmental risks are associated with pediatric anesthesia. No change in current practice is yet indicated.

Anesthetic action of volatile anesthetics by using Paramecium as a model.

Science.gov (United States)

Zhou, Miaomiao; Xia, Huimin; Xu, Younian; Xin, Naixing; Liu, Jiao; Zhang, Shihai

2012-06-01

Although empirically well understood in their clinical administration, volatile anesthetics are not yet well comprehended in their mechanism studies. A major conundrum emerging from these studies is that there is no validated model to assess the presumed candidate sites of the anesthetics. We undertook this study to test the hypothesis that the single-celled Paramecium could be anesthetized and served as a model organism in the study of anesthetics. We assessed the motion of Paramecium cells with Expert Vision system and the chemoresponse of Paramecium cells with T-maze assays in the presence of four different volatile anesthetics, including isoflurane, sevoflurane, enflurane and ether. Each of those volatiles was dissolved in buffers to give drug concentrations equal to 0.8, 1.0, and 1.2 EC50, respectively, in clinical practice. We could see that after application of volatile anesthetics, the swimming of the Paramecium cells was accelerated and then suppressed, or even stopped eventually, and the index of the chemoresponse of the Paramecium cells (denoted as I ( che )) was decreased. All of the above impacts were found in a concentration-dependent fashion. The biphasic effects of the clinical concentrations of volatile anesthetics on Paramecium simulated the situation of high species in anesthesia, and the inhibition of the chemoresponse also indicated anesthetized. In conclusion, the findings in our studies suggested that the single-celled Paramecium could be anesthetized with clinical concentrations of volatile anesthetics and therefore be utilized as a model organism to study the mechanisms of volatile anesthetics.

Anesthetizing the obese child

DEFF Research Database (Denmark)

Mortensen, Anette; Lenz, Katja; Abildstrøm, Hanne

2011-01-01

drugs. This has important implications on how to estimate the optimal drug dose. This article offers a review of the literature on definition, prevalence and the pathophysiology of childhood obesity and provides suggestions on preanesthetic evaluation, airway management and dosage of the anesthetic...... drugs in these patients. The authors highlight the need of supplemental studies on various areas of the subject....

An update on local anesthesia for pediatric dental patients

Science.gov (United States)

Peedikayil, Faizal C.; Vijayan, Ajoy

2013-01-01

Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients. PMID:25885712

An update on local anesthesia for pediatric dental patients

OpenAIRE

Peedikayil, Faizal C.; Vijayan, Ajoy

2013-01-01

Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients.

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

OpenAIRE

Robinson H; Engelhardt T

2017-01-01

Hal Robinson, Thomas Engelhardt Department of Anaesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK Purpose: Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findings: This review summarizes recently published studies about the long-term effects of g...

Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration

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A. Ramírez-Carrasco

2017-01-01

Full Text Available Background and Objective. Anxiety/pain are experiences that make dental treatment difficult for children, especially during the time of anesthesia. Hypnosis is used in pediatric clinical situations to modify thinking, behavior, and perception as well as, recently, in dentistry; therefore the aim of this study was to evaluate the effectiveness of hypnosis combined with conventional behavior management techniques during infiltration anesthetic. Methods. Anxiety/pain were assessed with the FLACC scale during the anesthetic moment, as well as heart rate variability and skin conductance before and during the anesthetic moment, between the control and experimental group. Results. A marginal statistical difference (p=0.05 was found in the heart rate between baseline and anesthetic moment, being lower in the hypnosis group. No statistically significant differences were found with the FLACC scale or in the skin conductance (p>0.05. Conclusion. Hypnosis combined with conventional behavior management techniques decreases heart rate during anesthetic infiltration showing that there may be an improvement in anxiety/pain control through hypnotic therapy.

Day-surgery patients anesthetized with propofol have less postoperative pain than those anesthetized with sevoflurane.

LENUS (Irish Health Repository)

Tan, Terry

2012-02-01

BACKGROUND: There have been recent studies suggesting that patients anesthetized with propofol have less postoperative pain compared with patients anesthetized with volatile anesthetics. METHODS: In this randomized, double-blind study, 80 patients undergoing day-case diagnostic laparoscopic gynecological surgery were either anesthetized with IV propofol or sevoflurane. The primary outcome measured was pain on a visual analog scale. RESULTS: Patients anesthetized with propofol had less pain compared with patients anesthetized with sevoflurane (P = 0.01). There was no difference in any of the other measured clinical outcomes. CONCLUSIONS: The patients anesthetized with propofol appeared to have less pain than patients anesthetized with sevoflurane.

Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis.

Science.gov (United States)

Mudumbai, Seshadri C; Honkanen, Anita; Chan, Jia; Schmitt, Susan; Saynina, Olga; Hackel, Alvin; Gregory, George; Phibbs, Ciaran S; Wise, Paul H

2014-12-01

Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems. To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care. We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume. We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers. Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California. © 2014 John Wiley & Sons Ltd.

Titration calorimetry of anesthetic-protein interaction: negative enthalpy of binding and anesthetic potency.

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Ueda, I; Yamanaka, M

1997-04-01

Anesthetic potency increases at lower temperatures. In contrast, the transfer enthalpy of volatile anesthetics from water to macromolecules is usually positive. The transfer decreases at lower temperature. It was proposed that a few selective proteins bind volatile anesthetics with negative delta H, and these proteins are involved in signal transduction. There has been no report on direct estimation of binding delta H of anesthetics to proteins. This study used isothermal titration calorimetry to analyze chloroform binding to bovine serum albumin. The calorimetrically measured delta H cal was -10.37 kJ.mol-1. Thus the negative delta H of anesthetic binding is not limited to signal transduction proteins. The binding was saturable following Fermi-Dirac statistics and is characterized by the Langmuir adsorption isotherms, which is interfacial. The high-affinity association constant, K, was 2150 +/- 132 M-1 (KD = 0.47 mM) with the maximum binding number, Bmax = 3.7 +/- 0.2. The low-affinity K was 189 +/- 3.8 M-1 (KD = 5.29 mM), with a Bmax of 13.2 +/- 0.3. Anesthetic potency is a function of the activity of anesthetic molecules, not the concentration. Because the sign of delta H determines the temperature dependence of distribution of anesthetic molecules, it is irrelevant to the temperature dependence of anesthetic potency.

Pain Perception: Computerized versus Traditional Local Anesthesia in Pediatric Patients.

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Mittal, M; Kumar, A; Srivastava, D; Sharma, P; Sharma, S

2015-01-01

Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups.

Protein and calorie intakes in adult and pediatric subjects with urea cycle disorders participating in clinical trials of glycerol phenylbutyrate☆

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Hook, Debra; Diaz, George A.; Lee, Brendan; Bartley, James; Longo, Nicola; Berquist, William; Le Mons, Cynthia; Rudolph-Angelich, Ingrid; Porter, Marty; Scharschmidt, Bruce F.; Mokhtarani, Masoud

2016-01-01

Background Little prospectively collected data are available comparing the dietary intake of urea cycle disorder (UCD) patients to UCD treatment guidelines or to healthy individuals. Objective To examine the protein and calorie intakes of UCD subjects who participated in clinical trials of glycerol phenylbutyrate (GPB) and compare these data to published UCD dietary guidelines and nutritional surveys. Design Dietary data were recorded for 45 adult and 49 pediatric UCD subjects in metabolic control during participation in clinical trials of GPB. Protein and calorie intakes were compared to UCD treatment guidelines, average nutrient intakes of a healthy US population based on the National Health and Nutrition Examination Survey (NHANES) and Recommended Daily Allowances (RDA). Results In adults, mean protein intake was higher than UCD recommendations but lower than RDA and NHANES values, while calorie intake was lower than UCD recommendations, RDA and NHANES. In pediatric subjects, prescribed protein intake was higher than UCD guidelines, similar to RDA, and lower than NHANES data for all age groups, while calorie intake was at the lower end of the recommended UCD range and close to RDA and NHANES data. In pediatric subjects height, weight, and body mass index (BMI) Z-scores were within normal range (− 2 to 2). Conclusions Pediatric patients treated with phenylbutyrate derivatives exhibited normal height and weight. Protein and calorie intakes in adult and pediatric UCD subjects differed from UCD dietary guidelines, suggesting that these guidelines may need to be reconsidered. PMID:27014577

Protein and calorie intakes in adult and pediatric subjects with urea cycle disorders participating in clinical trials of glycerol phenylbutyrate.

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Hook, Debra; Diaz, George A; Lee, Brendan; Bartley, James; Longo, Nicola; Berquist, William; Le Mons, Cynthia; Rudolph-Angelich, Ingrid; Porter, Marty; Scharschmidt, Bruce F; Mokhtarani, Masoud

2016-03-01

Little prospectively collected data are available comparing the dietary intake of urea cycle disorder (UCD) patients to UCD treatment guidelines or to healthy individuals. To examine the protein and calorie intakes of UCD subjects who participated in clinical trials of glycerol phenylbutyrate (GPB) and compare these data to published UCD dietary guidelines and nutritional surveys. Dietary data were recorded for 45 adult and 49 pediatric UCD subjects in metabolic control during participation in clinical trials of GPB. Protein and calorie intakes were compared to UCD treatment guidelines, average nutrient intakes of a healthy US population based on the National Health and Nutrition Examination Survey (NHANES) and Recommended Daily Allowances (RDA). In adults, mean protein intake was higher than UCD recommendations but lower than RDA and NHANES values, while calorie intake was lower than UCD recommendations, RDA and NHANES. In pediatric subjects, prescribed protein intake was higher than UCD guidelines, similar to RDA, and lower than NHANES data for all age groups, while calorie intake was at the lower end of the recommended UCD range and close to RDA and NHANES data. In pediatric subjects height, weight, and body mass index (BMI) Z-scores were within normal range (- 2 to 2). Pediatric patients treated with phenylbutyrate derivatives exhibited normal height and weight. Protein and calorie intakes in adult and pediatric UCD subjects differed from UCD dietary guidelines, suggesting that these guidelines may need to be reconsidered.

Pediatric intensive care treatment of uncontrolled status epilepticus.

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Wilkes, Ryan; Tasker, Robert C

2013-04-01

The critically ill mechanically ventilated child with ongoing seizures that are refractory to any treatment presents a distinct challenge in pediatric neurocritical care. The evidence base from randomized controlled trials on which anti-epileptic drug (AED) strategy should be used is inadequate. This review of refractory and super-refractory status epilepticus summarizes recent pediatric case series regarding definitions, the second-tier AED therapies once initial anticonvulsants have failed, and the experience of high-dose midazolam, barbiturate anesthesia, and volatile anesthetics for uncontrolled status epilepticus. Copyright © 2013 Elsevier Inc. All rights reserved.

Ambulatory anesthetic care in pediatric tonsillectomy: challenges and risks

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Collins C

2015-11-01

Full Text Available Corey Collins Massachusetts Eye and Ear Infirmary, Department of Anesthesiology, Harvard Medical School, Boston, MA, USA Abstract: Pediatric tonsillectomy is a common surgery around the world. Surgical indications are obstructive sleep apnea and recurrent tonsillitis. Despite the frequency of tonsillectomy in children, most aspects of perioperative care are supported by scant evidence. Recent guidelines provide important recommendations although clinician adherence or awareness of published guidance is variable and inconsistent. Current guidelines establish criteria for screening children for post-tonsillectomy observation, though most are based on low-grade evidence or consensus. Current recommendations for admission are: age <3 years; significant obstructive sleep apnea; obesity; and significant comorbid medical conditions. Recent reports have challenged each criterion and recommend admission criteria that are based on clinically relevant risks or observed clinical events such as adverse respiratory events in the immediate recovery period. Morbidity and mortality are low though serious complications occur regularly and may be amenable to improvements in postoperative monitoring, improved analgesic regimens, and parental education. Careful consideration of risks attributable to individual patients is vital to determine overall suitability for ambulatory discharge. Keywords: adverse airway events, complications, guidelines, mortality, OSA, pediatric anesthesia

Anesthetic management of a patient with Bartter’s syndrome: A case report

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Harun Aydoğan

2012-09-01

Full Text Available Bartter’s syndrome is a rare disorder characterized bysevere hypochloremic metabolic alkalosis, hypokalemia,hyponatremia, hyperaldosteronism, elevation in plasmarenin activity and insensitivity to angiotensin II. Electrolyteimbalances such as hypomagnesemia, hyponatremiamight make anesthetic management difficult in Barttersyndrome. A 4 years old patient underwent surgery foringuinal hernia with caudal anesthesia using bupivacaine0.25%. In this case report, it was aimed to discuss the anestheticmanagement of a patient with Bartter syndrome.Key words: Regional anesthesia, Bartter syndrome, inguinalhernia surgery, pediatric anesthesia

Warmed local anesthetic reduces pain of infiltration.

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Fialkov, J A; McDougall, E P

1996-01-01

The effect of warming local anesthetic on the amount of pain experienced during local infiltration was tested by comparing equal volumes of 40 degrees C- and 21 degrees C-infiltrates in each of 26 subjects. Six subjects were patients undergoing excision of two benign asymptomatic nevi in separate locations, and 20 subjects were healthy adult volunteers who were injected in bilateral antebrachial sites. The warmed and room temperature solutions were randomized to each side, so that each subject received both temperature injections in random order. All subjects and the injector were blinded. The rate of injection was time-controlled (0.05 ml/sec). Following both injections, subjects were asked to rate the pain experienced at each site. In addition, the subject was asked if there was no difference, a slight difference, or a substantial difference between the two sites. A two-tailed paired t-test was used to analyze the mean difference in pain scores for all subjects. Paired analysis of the pain scores for each subject eliminated intersubject variance of pain tolerance. The mean difference in pain score between the room temperature and warmed solutions was +1.5 (p < 0.0001). Of the 21 subjects (81%) who found the warmed solution less painful, 11 (52%) found the difference to be significant, while 10 (48%) found the difference to be slight. Two subjects (8%) found no difference between the two, while 3 subjects (11%) found the colder solution slightly less painful. We conclude that warming local anesthetic to 40 degrees C prior to subcutaneous injection is a simple, inexpensive means of reducing the pain of local infiltration.

Efficacy of tramadol as a preincisional infiltration anesthetic in children undergoing inguinal hernia repair: a prospective randomized study

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Numanoğlu KV

2014-09-01

Full Text Available Kemal Varim Numanoğlu,1 Hilal Ayoğlu,2 Duygu Tatli,1 Ebubekir Er11Department of Pediatric Surgery, 2Department of Anesthesiology, Faculty of Medicine, Bülent Ecevit University, Kozlu, Zonguldak, TurkeyBackground: Preincisional local anesthetic infiltration at the surgical site is a therapeutic option for postoperative pain relief for pediatric inguinal hernia. Additionally, tramadol has been used as an analgesic for postoperative pain in children. Recently, the local anesthetic effects of tramadol have been reported. The aim of this study was to determine both the systemic analgesic and the local anesthetic effects of tramadol and to determine how it differs from bupivacaine when administered preincisionally.Methods: Fifty-two healthy children, aged 2–7 years, who were scheduled for elective herniorrhaphy were randomly allocated to receive either preincisional infiltration at the surgical site with 2 mg/kg tramadol (Group T, n=26 or 0.25 mL/kg 0.5% bupivacaine (Group B, n=26. At the time of anesthetic administration, perioperative hemodynamic parameters were recorded. The pain assessments were performed 10 minutes after the end of anesthesia and during the first 6-hour period, using pain scores. The time of first dose of analgesia and need for additional analgesia were recorded.Results: Between T and B groups, the anesthesia time, perioperative hemodynamic changes, and pain scores were not statistically different. However, in group B, the postoperative analgesic requirement was higher than in group T.Conclusion: Tramadol shows equal analgesic effect to bupivacaine and decreases additional analgesic requirement, when used for preincisional infiltration anesthesia in children undergoing inguinal herniorrhaphy.Keywords: bupivacaine, postoperative analgesia, pain scores

Effect of Oral Midazolam Premedication on Children's Co-operation Before General Anesthesia in Pediatric Dentistry.

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Kaviani, Nasser; Shahtusi, Mina; Haj Norousali Tehrani, Maryam; Nazari, Sara

2014-09-01

Premedication is expedient in reducing the psychological trauma from recalling the unpleasant pre-anesthetic phases, hence, inducing a trouble-free anesthesia. This study aimed to determine the effectiveness of oral midazolam in co-operation of the subjects before general anesthesia and in recalling the pre-anesthetic phases, performed on children candidate for dental treatment under general anesthesia. In this prospective clinical trial study, 62 healthy non-cooperative children, candidate for dental treatment under general anesthesia, were randomly divided into study and control groups. The children received 20ml orange juice, 20 minutes before starting the anesthesia. The juice of the test group contained 0.5mg/kg of midazolam and that of the control group included no medication. The induction and the maintenance process of anesthesia were similar in both groups. The manner of subjects when separated from parents, their cooperation during intravenous catheterization, and recalling the pre-anesthetic events were recorded. Data were analyzed by adopting chi-square and Mann-Whitney tests. Most of the children in the test group had a comfortable separation from parents, restful IV catheterization and 90% of the subjects did not recall the pre-anesthetic events. Under the circumstances of this study, it could be concluded that 0.5mg/kg oral midazolam premedication is effective for comfortable separation of children from parents and restful IV catheterization and also forgetting the pre-anesthetic events.

Clinical Effectiveness and Dose Titration in Pediatric Practice

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Yu.V. Marushko

2016-02-01

Full Text Available The paper is devoted to the questions of usage of one of the popular antipyretic and anesthetic drug in pediatric practice — ibuprofen. In the article there are generalized literature data and own experience in ibuprofen dose titration in single dose 5 and 10 mg/kg depending on clinical situation.

Newly postulated neurodevelopmental risks of pediatric anesthesia: theories that could rock our world.

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Hays, Stephen Robert; Deshpande, Jayant K

2013-04-01

General anesthetics can induce apoptotic neurodegeneration and subsequent maladaptive behaviors in animals. Retrospective human studies suggest associations between early anesthetic exposure and subsequent adverse neurodevelopmental outcomes. The relevance of animal data to clinical practice is unclear and to our knowledge the causality underlying observed associations in humans is unknown. We reviewed newly postulated neurodevelopmental risks of pediatric anesthesia and discuss implications for the surgical care of children. We queried the MEDLINE®/PubMed® and EMBASE® databases for citations in English on pediatric anesthetic neurotoxicity with the focus on references from the last decade. Animal studies in rodents and primates demonstrate apoptotic neuropathology and subsequent maladaptive behaviors after exposure to all currently available general anesthetics with the possible exception of α2-adrenergic agonists. Similar adverse pathological and clinical effects occur after untreated pain. Anesthetic neurotoxicity in animals develops only after exposure above threshold doses and durations during a critical neurodevelopmental window of maximal synaptogenesis in the absence of concomitant painful stimuli. Anesthetic exposure outside this window or below threshold doses and durations shows no apparent neurotoxicity, while exposure in the context of concomitant painful stimuli is neuroprotective. Retrospective human studies suggest associations between early anesthetic exposure and subsequent adverse neurodevelopmental outcomes, particularly after multiple exposures. The causality underlying the associations is unknown. Ongoing investigations may clarify the risks associated with current practice. Surgical care of all patients mandates appropriate anesthesia. Neurotoxic doses and the duration of anesthetic exposure in animals may have little relevance to clinical practice, particularly surgical anesthesia for perioperative pain. The causality underlying the

[Management of pediatric status epilepticus].

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Vargas L, Carmen Paz; Varela E, Ximena; Kleinsteuber S, Karin; Cortés Z, Rocío; Avaria B, María de Los Ángeles

2016-01-01

Pediatric Status Epilepticus (SE) is an emergency situation with high morbidity and mortality that requires early and aggressive management. The minimum time criterion to define SE was reduced from 30 to 5 minutes, defined as continuous seizure activity or rapidly recurrent seizures without resumption of consciousness for more than 5 minutes. This definition considers that seizures that persist for > 5 minutes are likely to do so for more than 30 min. Those that persist for more than 30 minutes are more difficult to treat. Refractory SE is the condition that extends beyond 60-120 minutes and requires anesthetic management. Super-refractory SE is the state of no response to anesthetic management or relapse during withdrawal of these drugs. The aim of this review is to provide and update on convulsive SE concepts, pathophysiology, etiology, available antiepileptic treatment and propose a rational management scheme. A literature search of articles published between January 1993 and January 2013, focused on pediatric population was performed. The evidence about management in children is limited, mostly corresponds to case series of patients grouped by diagnosis, mainly adults. These publications show treatment alternatives such as immunotherapy, ketogenic diet, surgery and hypothermia. A 35% mortality, 26% of neurological sequelae and 35% of recovery to baseline condition is described on patient’s evolution.

Peripheral nerve blocks in pediatric anesthesia

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Novaković Dejan

2009-01-01

Full Text Available Introduction Most children undergoing surgery can benefit from regional anesthetic techniques, either as the sole anesthetic regimen or, as usual in pediatric practice, in combination with general anesthesia. The use of peripheral nerve blocks (PNBs in pediatric anesthesia is an effective way to decrease the side-effects and complications associated with central blocks. In spite of their many advantages, including easy performance end efficacy, peripheral nerve blocks are still underused. Objective This article discusses a general approach to PNBs in children and provides data concerning the practice of this regional technique in different age groups. Methods Data from 1,650 procedures were prospectively collected during the period from March 1, 2007 to February 29, 2008. The type of PNB, if any, as well as the patient age were noted. Our patients were divided into four groups: 0-3 years, 4-7 years, 8-12 years and 13-18 years. Results During the investigated period, PNBs as a sole technique or in anesthetized children were performed in 7.45% of cases. Ilioingunal/iliohypogastric nerve block and penile block were the most common (70% of all PNBs distributed mainly among the children between 4-7 years of age (p<0.05. In older children, extremity PNBs predominate in regard to other types of blocks. PNBs are most frequently performed under general anesthesia (85%, so the perineural approach requires a safe technique to avoid nerve damage. Conclusion The observed differences in PNB usage seem to be related to patient age and correlate with common pathology and also with technical availability of PNB performance.

Anesthesia Practice in Pediatric Radiation Oncology: Mayo Clinic Arizona's Experience 2014-2016.

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Khurmi, Narjeet; Patel, Perene; Koushik, Sarang; Daniels, Thomas; Kraus, Molly

2018-02-01

Understanding the goals of targeted radiation therapy in pediatrics is critical to developing high quality and safe anesthetic plans in this patient population. An ideal anesthetic plan includes allaying anxiety and achieving optimal immobilization, while ensuring rapid and efficient recovery. We conducted a retrospective chart review of children receiving anesthesia for radiation oncology procedures from 1/1/2014 to 7/31/2016. No anesthetics were excluded from the analysis. The electronic anesthesia records were analyzed for perianesthetic complications along with efficiency data. To compare our results to past and current data, we identified relevant medical literature covering a period from 1984-2017. A total of 997 anesthetic procedures were delivered in 58 unique patients. The vast majority of anesthetics were single-agent anesthesia with propofol. The average duration of radiation treatment was 13.24 min. The average duration of anesthesia was 37.81 min, and the average duration to meet discharge criteria in the recovery room was 29.50 min. There were seven instances of perianesthetic complications (0.7%) and no complications noted for the 80 CT simulations. Two of the seven complications occurred in patients receiving total body irradiation. The 5-year survival rate for pediatric cancers has improved greatly in part due to more effective and targeted radiation therapy. Providing an anesthetic with minimal complications is critical for successful daily radiation treatment. The results of our data analysis corroborate other contemporary studies showing minimal risk to patients undergoing radiation therapy under general anesthesia with propofol. Our data reveal that single-agent anesthesia with propofol administered by a dedicated anesthesia team is safe and efficient and should be considered for patients requiring multiple radiation treatments under anesthesia.

Protein and calorie intakes in adult and pediatric subjects with urea cycle disorders participating in clinical trials of glycerol phenylbutyrate

Directory of Open Access Journals (Sweden)

Debra Hook

2016-03-01

Conclusions: Pediatric patients treated with phenylbutyrate derivatives exhibited normal height and weight. Protein and calorie intakes in adult and pediatric UCD subjects differed from UCD dietary guidelines, suggesting that these guidelines may need to be reconsidered.

Management of mediastinal syndromes in pediatrics: a new challenge of ultrasound guidance to avoid high-risk general anesthesia.

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Sola, Chrystelle; Choquet, Olivier; Prodhomme, Olivier; Capdevila, Xavier; Dadure, Christophe

2014-05-01

Adverse events associated with anesthetic management of anterior mediastinal masses in pediatrics are common. To avoid an extremely hazardous general anesthesia, the use of real-time ultrasonography offers an effective alternative in high-risk cases. We report the anesthetic management including a light sedation and ultrasound guidance for regional anesthesia, surgical node biopsy, and placement of a central venous line in two children with an anterior symptomatic mediastinal mass. For pediatric patients with clinical and/or radiologic signs of airway compression, ultrasound guidance provides safety technical assistance to avoid general anesthesia and should be performed for the initial diagnostic and therapeutic procedures. © 2013 John Wiley & Sons Ltd.

Something new about ketamine for pediatric anesthesia?

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Lois, Fernande; De Kock, Marc

2008-06-01

This review discusses the place of the old anesthetic ketamine in pediatric anesthesia. Despite the availability of modern alternatives, ketamine remains a frequently used drug particularly for anesthesia in high-risk children and for procedures outside the operating room. In adult patients undergoing surgery, a renewed interest in this drug is noted. It is the consequence of recent demonstrations of the following effects. First, ketamine is highly effective against surgery and opiate-induced hyperalgesia. Second, it has original antiproinflammatory properties. In other words, it promotes self-limitation of the inflammatory response that follows surgery. In the pediatric population, these benefits wait to be confirmed. Finally, questions arise about the safety of ketamine anesthesia. Ketamine is a potent proapoptotic drug. In rodents treated during the critical period for central nervous system development, long-term behavioral deficits were noted after an anesthetic dose of ketamine. The exact consequences of these proapoptotic properties on human brain tissue development have to be exactly determined and are still debatable. Ketamine has not yet revealed all its interactions in humans. Recent discoveries indicate interesting properties on the one hand and potentially deleterious effects on the other.

The Association of Pediatric Obesity With Nocturnal Non-Dipping on 24-Hour Ambulatory Blood Pressure Monitoring.

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Macumber, Ian R; Weiss, Noel S; Halbach, Susan M; Hanevold, Coral D; Flynn, Joseph T

2016-05-01

Obesity has been linked with abnormal nocturnal dipping of blood pressure (BP) in adults, which in turn is associated with poor cardiovascular outcomes. There are few data regarding abnormal dipping status in the obese pediatric population. The goal of this study was to further describe the relationship between obesity and non-dipping status on ambulatory blood pressure monitor (ABPM) in children. We conducted a cross-sectional study using a database of patients aged 5-21 years who had undergone 24-hour ABPM at Seattle Children's Hospital from January 2008 through May 2014. Subjects were grouped by body mass index (BMI) into lean (BMI 15th-85th percentile) and obese (BMI >95th percentile) groups. Compared to lean subjects (n = 161), obese subjects (n = 247) had a prevalence ratio (PR) for non-dipping of 2.15, adjusted for race (95% confidence interval (CI) = 1.25-3.42). Increasing severity of obesity was not further associated with nocturnal non-dipping. Nocturnal non-dipping was not associated with left ventricular hypertrophy (PR = 1.01, 95% CI = 0.71-1.44). These results suggest that in children, just as in adults, obesity is related to a relatively decreased dipping in nocturnal BP. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Perception of pediatric neurology among non-neurologists.

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Jan, Mohammed M S

2004-01-01

Pediatric neurology is considered a relatively new and evolving subspecialty. In Saudi Arabia, neurologic disorders in children are common, and the demand for trained pediatric neurologists is strong. The aim was to study the perception of the pediatric neurology specialty among practicing generalists and their referral practices. Attendees of a symposium on pediatric epilepsy comprehensive review for the generalist were included. A structured 25-item questionnaire was designed to examine their demographics, training, practice, and referral patterns. One hundred nineteen participants attended the symposium, and 90 (76%) questionnaires were returned. Attendees' ages were 22 to 70 years (mean 32 years), with 65.5% female physicians. There were 32% consultants, 51% trainees, and 17% students. Most physicians (67%) were practicing general pediatrics. Only 36% received a structured pediatric neurology rotation during training. Children with neurologic complaints constituted 28.5% of those seen in their practice, and they referred 32.5% of them to pediatric neurology. Only 32% were moderately or highly confident in making the diagnosis or providing the appropriate treatment. Those who received a structured pediatric neurology rotation felt more comfortable in their management (P = .03). Many physicians (38.5%) had no direct access to a pediatric neurologist for referrals. To conclude, pediatric neurologic disorders are common in daily practice. Most generalists did not receive a structured neurology rotation during their training and were not highly confident in diagnosing and treating these children. Given the limited number of pediatric neurologists, I highly recommend that generalists receive appropriate neurologic training.

Anesthetic neuroprotection: antecedents and an appraisal of preclinical and clinical data quality.

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Ishida, Kazuyoshi; Berger, Miles; Nadler, Jacob; Warner, David S

2014-01-01

Anesthetics have been studied for nearly fifty years as potential neuroprotective compounds in both perioperative and resuscitation medicine. Although anesthetics present pharmacologic properties consistent with preservation of brain viability in the context of an ischemic insult, no anesthetic has been proven efficacious for neuroprotection in humans. After such effort, it could be concluded that anesthetics are simply not neuroprotective in humans. Moreover, pharmacologic neuroprotection with non-anesthetic drugs has also repeatedly failed to be demonstrated in human acute brain injury. Recent focus has been on rectification of promising preclinical neuroprotection data and subsequent failed clinical trials. This has led to consensus guidelines for the process of transferring purported therapeutics from bench to bedside. In this review we first examined the history of anesthetic neuroprotection research. Then, a systematic review was performed to identify major clinical trials of anesthetic neuroprotection. Both the preclinical neuroprotection portfolio cited to justify a clinical trial and the design and conduct of that clinical trial were evaluated using modern standards that include the Stroke Therapy Academic Industry Roundtable (STAIR) and Consolidated Standards of Reporting Trials (CONSORT) guidelines. In publications intended to define anesthetic neuroprotection, we found overall poor quality of both preclinical efficacy analysis portfolios and clinical trial designs and conduct. Hence, using current translational research standards, it was not possible to conclude from existing data whether anesthetics ameliorate perioperative ischemic brain injury. Incorporation of advances in translational neuroprotection research conduct may provide a basis for more definitive and potentially successful clinical trials of anesthetics as neuroprotectants.

Targets Involved in Cardioprotection by the Non-Anesthetic Noble Gas Helium

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Weber, Nina C.; Smit, Kirsten F.; Hollmann, Markus W.; Preckel, Benedikt

2015-01-01

Research data from the past decade indicate that noble gases like xenon and helium exert profound cardioprotection when applied before, during or after organ ischemia. Of all noble gases, especially helium, has gained interest in the past years because it does not have an anesthetic "side effect"

Can we use lower volume of local anesthetic for infraclavicular brachial plexus nerve block under ultrasound guidance in children?

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Ince, Ilker; Aksoy, Mehmet; Dostbil, Aysenur; Tuncer, Kutsi

2017-09-01

To determine if the infraclavicular brachial plexus block can be applied with lower volume of local anesthetic. Randomised, double-blinded clinical trial. 60 patients aged 5-15years with ASA I-II who underwent emergent or elective arm, forearm or hand operations were included in the study. Patients were divided into two groups randomly; standard volume local anesthetic administered group (Group S, n=30) and low volume anesthetic administered group (Group L, n=30). Postoperative pain scores, sensory and motor block durations were noted. Pain scores (Wong-Baker Face Scale) were evaluated and the results were detected to be similar at all times (30min, 1, 2, 4, 8, 12, 24h). Durations of motor block were 168(±16) minutes and 268(±15) minutes in Group L and Group S respectively and the difference was statistically significant (pblock were 385(±26) and 402(±39) in Group L and Group S respectively and no statistically significant difference was detected (p=0.064). Similar block success, postoperative sensory block durations and pain scores could be obtained during infraclavicular brachial plexus in pediatric patients with lower local anesthetic volumes. Copyright © 2016 Elsevier Inc. All rights reserved.

Anesthetic technique for inferior alveolar nerve block: a new approach

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PALTI, Dafna Geller; de ALMEIDA, Cristiane Machado; RODRIGUES, Antonio de Castro; ANDREO, Jesus Carlos; LIMA, José Eduardo Oliveira

2011-01-01

Background Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 1329% of cases. Objective Objective: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. Materials and Methods A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the oclusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen. Results The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. Conclusion This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry. PMID:21437463

Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial.

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Allegretti, Carlos E; Sampaio, Roberta M; Horliana, Anna C R T; Armonia, Paschoal L; Rocha, Rodney G; Tortamano, Isabel Peixoto

2016-01-01

Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

Pediatric surgeons and anesthesiologists expand the dialogue on the neurotoxicity question, rationale for early and delayed surgeries, and practice changes while awaiting definitive evidence.

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Byrne, Mary W; Casale, Pasquale; Garzon, Maria; Hyman, Joshua E; Lin, Albert Y; Lynch, Lisa R; Schleien, Charles L; Stylianos, Steven

2014-10-01

The Pediatric Anesthesia NeuroDevelopment Assessment team at Columbia University Medical Center Department of Anesthesiology convened its fourth biennial Symposium to address unresolved issues concerning potential neurotoxic effects of anesthetic agents and sedatives on young children and to assess study findings to date. Dialogue initiated at the third Symposium was continued between anesthesiologists, researchers, and a panel of expert pediatric surgeons representing general surgery and dermatology, orthopedic, and urology specialties. The panel explored the need to balance benefits of early surgery using improved technologies against potential anesthetic risks, practice changes while awaiting definitive answers, and importance of continued interprofessional dialogue.

Changes after voice therapy in objective and subjective voice measurements of pediatric patients with vocal nodules.

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Tezcaner, Ciler Zahide; Karatayli Ozgursoy, Selmin; Ozgursoy, Selmin Karatayli; Sati, Isil; Dursun, Gursel

2009-12-01

The aim of this study was to analyze the efficiency of the voice therapy in children with vocal nodules by using the acoustic analysis and subjective assessment. Thirty-nine patients with vocal fold nodules, aged between 7 and 14, were included in the study. Each subject had voice therapy led by an experienced voice therapist once a week. All diagnostic and follow-up workouts were performed before the voice therapy and after the third or the sixth month. Transoral and/or transnasal videostroboscopic examination and acoustic analysis were achieved using multi-dimensional voice program (MDVP) and subjective analysis with GRBAS scale. As for the perceptual assessment, the difference was significant for four parameters out of five. A significant improvement was found in the acoustic analysis parameters of jitter, shimmer, and noise-to-harmonic ratio. The voice therapy which was planned according to patients' needs, age, compliance and response to therapy had positive effects on pediatric patients with vocal nodules. Acoustic analysis and GRBAS may be used successfully in the follow-up of pediatric vocal nodule treatment.

Release Pattern of Salivary Chromogranin A in Pediatric Subjects with Obstructive Sleep Apnea

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Heung-Ku Lee

2014-12-01

Full Text Available Background and Objective Sleep-disordered breathing (SDB is associated with activation of the stress response, including the autonomic nervous system. Salivary chromogranin A (sCgA is considered a valuable indicator of sympathoadrenal activity. We examined the relationship between sCgA and polysomnography (PSG parameters. Methods In this prospective study, we enrolled 103 children who underwent a physical examination and fully attended in-lab PSG. Saliva was collected at night before PSG and in the early morning after PSG. Results The subjects (n = 103 were divided into control [n = 41, apnea-hypopnea index (AHI ≤ 1] and obstructive sleep apnea syndrome (OSAS; n = 62, AHI > 1 groups. The OSAS group was subdivided into mild (1 < AHI ≤ 5, moderate (5 < AHI ≤ 10, and severe (10 < AHI groups. There was no significant difference in the sCgA parameters between the control and OSAS groups. No significant difference was observed in sCgA parameters between the control group and OSAS subgroups (mild, moderate, and severe. No circadian rhythm was detected in sCgA secretion, and no difference in sCgA concentrations was measured at the two time points. Conclusions Our findings suggest that sCgA secretion was not influenced by OSAS severity and no definitive circadian rhythm was detected in pediatric subjects. Further study is needed to establish whether there is a circadian rhythm in pediatric subjects.

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

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Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; de Oliveira, Gildasio S; de Leon Casasola, Oscar; de Andrés, José; Ivani, Giorgio

2018-02-01

Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

Local Anesthetic-Induced Neurotoxicity

NARCIS (Netherlands)

Verlinde, Mark; Hollmann, Markus W.; Stevens, Markus F.; Hermanns, Henning; Werdehausen, Robert; Lirk, Philipp

2016-01-01

This review summarizes current knowledge concerning incidence, risk factors, and mechanisms of perioperative nerve injury, with focus on local anesthetic-induced neurotoxicity. Perioperative nerve injury is a complex phenomenon and can be caused by a number of clinical factors. Anesthetic risk

The application of a non-linear analysis technique to the monitoring of anesthetic effects in the rat

NARCIS (Netherlands)

Broek, P.L.C. van den; Egmond, J. van; Rijn, C.M. van; Dirksen, R.; Coenen, A.M.L.; Booij, L.H.D.J.; Lehnertz, K.; Elger, C.E.; Arnhold, J.; Grassberger, P.

2000-01-01

To find a new measure from the EEG that quantifies the effects of anesthetics during surgery, the correlation dimension (CD) of the EEG of eight rats was estimated. To get informed about the anesthetic state, the noxious induced withdrawal reflex (NIWR) was measured, i.e. the force elicited by

Pediatric ambulatory anesthesia.

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August, David A; Everett, Lucinda L

2014-06-01

Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

The effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with orthodontic elastomeric separator placement

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M. Abu Al-Melh

2017-01-01

Full Text Available Abstract Background The initial placement of orthodontic elastomeric separators can be uncomfortable and painful. Therefore, it is important to relieve this disturbing sensation to create a discomfort or pain-free orthodontic visit. The purpose of this study was to investigate the effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with the placement of orthodontic elastomeric separators. Methods Fifty subjects aging between 20–35 years were included in this study. In the maxillary arch, a lidocaine/prilocaine topical anesthetic was placed around the ginigval margins of the premolar and molar on side. On the other side, a placebo agent was placed around the ginigval margins of the premolar and molar. After two minutes, an elastomeric separator was placed between the premolar and molar on both sides. The subjects were then asked to report their findings on a Verbal Scale and a Visual Analogue Scale every second minute for a period of 10 min. The subjects were also given a questionnaire to evaluate the overall impression on the topical anesthetic use. Results The overall mean discomfort/pain score was found to be significantly lower (p < 0.001 with the topical anesthetic than with the placebo. Repeated measures ANOVA with a Greenhouse-Geisser correction determined that mean pain scores were statistically significantly low with the 10-min time duration (F (1.54,42.2 = 40.7, p = 0.001, with an estimated grand mean (8.37, 95% CI 6.75–9.98. The questionnaire responses revealed that 87% of the subjects reported an overall satisfaction and agreement with the topical anesthetic than with the placebo or no difference (13% after the initial separator placement. Conclusions The discomfort and pain resulting from the initial placement of orthodontic elastomeric separators can be significantly reduced with the lidocaine/prilocaine topical anesthetic.

Pediatric emergence delirium: Canadian Pediatric Anesthesiologists' experience.

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Rosen, H David; Mervitz, Deborah; Cravero, Joseph P

2016-02-01

Pediatric emergence agitation/delirium (ED) is a cluster of behaviors seen in the early postanesthetic period with negative emotional consequences for families and increased utilization of healthcare resources. Many studies have looked at identifying risk factors for ED and at pharmacologic regimens to prevent ED. There are few published reports on treatment options and efficacy for established ED episodes, and essentially no data concerning current practice in the treatment of ED. We sought to elicit the experience and opinions of Canadian Pediatric Anesthesiologists on the incidence of ED in their practice, definitions and diagnostic criteria, preventative strategies, treatments, and their perceived efficacy. A web-based survey was sent to pediatric anesthesiologists working at academic health science centers across Canada. The participants were selected based on being members of the Canadian Pediatric Anesthesia Society (CPAS), which represents the subspecialty in Canada. All members of CPAS who had e-mail contact information available in the membership database were invited to participate. A total of 209 members out of the total of 211 fulfilled these criteria and were included in the study population. The response rate was 51% (106/209). Of respondents, 42% felt that ED was a significant problem at their institutions, with 45% giving medication before or during anesthesia to prevent the development of ED. Propofol was the most common medication given to prevent ED (68%) and to treat ED (42%). Total intravenous anesthesia (TIVA) was considered by 38% of respondents as a technique used to prevent ED. Medications used for treatment included propofol (42%), midazolam (31%), fentanyl (10%), morphine (7%), and dexmedetomidine (5%), with 87% of respondents rating effectiveness of treatment as 'usually works quickly with one dose'. We present information on current practice patterns with respect to prophylaxis and treatment of ED among a specialized group of pediatric

Comparison between a pediatric health promotion center and a pediatric obesity clinic in detecting metabolic syndrome and non-alcoholic fatty liver disease in children.

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Yang, Hye Ran; Yi, Dae Yong; Choi, Hyoung Soo

2014-12-01

This study was done to evaluate the efficacy of health check-ups in children in detecting metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) by comparing the pediatric health promotion center with the pediatric obesity clinic. Children who visited a pediatric health promotion center (n=218) or a pediatric obesity clinic (n=178) were included. Anthropometric data, blood pressure, laboratory tests, and abdominal ultrasonography were evaluated. Two different criteria were applied to diagnose metabolic syndrome. The prevalence of metabolic syndrome in the 2 units was 3.2%-3.7% in a pediatric health promotion center and 23%-33.2% in a pediatric obesity clinic. Significant differences were observed in the prevalence of each component of metabolic syndrome between the 2 units including abdominal adiposity, blood pressure, serum triglycerides, and fasting blood glucose (Pobesity clinic targeting obese children than that among patients visiting the health promotion center offering routine check-ups. An obesity-oriented approach is required to prevent obesity-related health problems in children.

Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients.

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Landry, Elizabeth K; Gabriel, Rodney A; Beutler, Sascha; Dutton, Richard P; Urman, Richard D

2017-03-01

Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age anesthesia were also associated with unplanned ICU admissions. This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.

Anesthetic technique for inferior alveolar nerve block: a new approach

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Dafna Geller Palti

2011-02-01

Full Text Available BACKGROUND: Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 13-29% of cases. OBJECTIVE: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. MATERIAL AND METHODS: A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side, and the second following the oclusal plane (left side, a line can be achieved whose projection coincides with the left mandibular foramen. RESULTS: The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. CONCLUSION: This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry.

Dexmedetomidine-related polyuria in a pediatric patient.

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Adams, Phillip S; Cassara, Antonio

2016-04-01

Polyuria related to pharmacologic α2-adrenoreceptor agonism has been well described in vitro and in animal models and is thought to be the result of functional antagonism of arginine vasopressin. Despite its widespread use as a sedative and anesthetic adjunct, very few reports of dexmedetomidine-related polyuria in humans exist in the literature. We present the first description of a pediatric patient manifesting polyuria and hypernatremia in association with dexmedetomidine infusion for posterior spinal fusion.

A prospective study on the characteristics and subjects of pediatric palliative care case management provided by a hospital based palliative care team

NARCIS (Netherlands)

Jagt-van Kampen, Charissa T.; Kars, Marijke C.; Colenbrander, Derk A.; Bosman, Diederik K.; Grootenhuis, Martha A.; Caron, Huib N.; Schouten-van Meeteren, Antoinette Y. N.

2017-01-01

Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the content of this type of case management are lacking. We aim to describe the contents of care provided, utilization of different disciplines, and times of usage of a pediatric palliative care case

Reexpansion pulmonary edema: review of pediatric cases.

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Kira, Shinichiro

2014-03-01

Reexpansion pulmonary edema (RPE) is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. This condition is recognized to occur more frequently in patients under the age of 40 years, but there has been no detailed analysis of reported pediatric cases of RPE to date. For this review, PubMed literature searches were performed using the following terms: 're(-)expansion pulmonary (o)edema' AND ('child' OR 'children' OR 'infant' OR 'boy' OR 'girl' OR 'adolescent'). The 22 pediatric cases of RPE identified were included in this review. RPE was reported in almost the entire pediatric age range, and as in adult cases, the severity ranged from subclinical to lethal. No specific treatment for RPE was identified, and treatment was administered according to the clinical features of each patient. Of the 22 reported cases, 10 occurred during the perioperative period, but were not related to any specific surgical procedures or anesthetic techniques, or to the duration of lung collapse. Pediatric anesthesiologists should be aware that pediatric RPE can occur after reexpansion of any collapsed lung and that some invasive therapies can be useful in severe cases. © 2013 John Wiley & Sons Ltd.

Epidermolysis bullosa, dental and anesthetic management: a case report.

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Esfahanizade, Katayoun; Mahdavi, Ali Reza; Ansari, Ghassem; Fallahinejad Ghajari, Masoud; Esfahanizadeh, Abdolreza

2014-09-01

Epidermolysis bullosa (EB) is a group of rare inherited skin and mucous membrane disorders in which blister formation may arise spontaneously or following a minor friction. Various patterns of inheritance are explicated for the disease. The disease has a profound effect on oral mucosa and may result in high prevalence of dental caries. General anesthesia is sometimes the only choice for dental treatments in patients with EB. The following case report describes the dental and anesthetic management of an 12.5 -year-old girl with dystrophic type of EB. The patient was followed up every 6 months. New carious lesions were detected one year after the treatment, on the last visit. Presenting a perfect dental care to children with this disorder can be challenging for the in charge specialist, both pediatric dentist and anesthesiologist.

A comparison of two intraosseous anesthetic techniques in mandibular posterior teeth.

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Gallatin, Juliane; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel

2003-11-01

A number of studies have evaluated the Stabident (Fairfax Dental, Miami) intraosseous anesthesia technique. A second intraosseous technique--the X-tip system (X-tip Technologies, Lakewood, N.J.)--has been introduced, but no scientific studies have yet compared its effectiveness to that of the Stabident system. The authors undertook a study to compare the two systems' anesthetic outcomes in primary intraosseous injections in mandibular posterior teeth. The authors, using a crossover design, randomly administered a primary Stabident intraosseous injection and a primary X-tip intraosseous injection, at two separate appointments, to 41 subjects. Subjects were asked if they perceived an increase in heart rate with the intraosseous injections. The research team blind-tested each subject's first molar, second molar and second premolar with a pulp tester at two-minute cycles for 60 minutes after the injection. Anesthesia was considered successful when two consecutive pulp tester readings of 80 were obtained. Anesthetic success rates for the Stabident technique and the X-tip technique, respectively, were 93 percent and 93 percent for the first molar; 95 percent and 95 percent for the second molar; and 81 percent and 83 percent for the second premolar, with no significant differences (P > .05) between the two techniques. For both intraosseous techniques, onset of pulpal anesthesia occurred within the first two minutes, but the duration of anesthesia declined steadily over the 60 minutes. Eighty-five percent of the subjects had a perceived increase in heart rate with the Stabident injection and 93 percent with the X-tip injection, with no significant differences (P > .05) between the techniques. The two primary intraosseous injection techniques were similar regarding anesthetic success, onset, duration and perceived heart rate increases.

Comparative evaluation of the effectiveness of electronic dental anesthesia with 2% lignocaine in various minor pediatric dental procedures: A clinical study

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Abhishek Dhindsa

2011-01-01

Full Text Available One of the most distressing aspects of dentistry for pediatric patients is the fear and anxiety caused by the dental environment, particularly the dental injection. The application and induction of local anesthetics has always been a difficult task, and this demands an alternative method that is convenient and effective. Electronic dental anesthesia, based on the principal of transcutaneous electric nerve stimulation (TENS, promises to be a viable mode of pain control during various pediatric clinical procedures. Therefore, the aim of the present study was to evaluate the effectiveness of TENS and to compare its efficacy with 2% lignocaine during various minor pediatric dental procedures. Pain, comfort and effectiveness of both the anesthetics were evaluated using various scales and no significant difference was observed between 2% lignocaine and TENS in the various pain scales, while TENS was perceived to be significantly effective in comfort and efficacy as judged by the operator and quite comfortable as judged by the patient himself/herself.

Basiliximab induced non-cardiogenic pulmonary edema in two pediatric renal transplant recipients.

LENUS (Irish Health Repository)

Dolan, Niamh

2009-11-01

We report two cases of non-cardiogenic pulmonary edema as a complication of basiliximab induction therapy in young pediatric renal transplant patients identified following a retrospective review of all pediatric renal transplant cases performed in the National Paediatric Transplant Centre, Childrens University Hospital, Temple Street, Dublin, Ireland. Twenty-eight renal transplantations, of which five were living-related (LRD) and 23 were from deceased donors (DD), were performed in 28 children between 2003 and 2006. In six cases, transplantations were pre-emptive. Immunosuppression was induced pre-operatively using a combination of basiliximab, tacrolimus and methylprednisolone in all patients. Basiliximab induction was initiated 2 h prior to surgery in all cases and, in 26 patients, basiliximab was re-administered on post-operative day 4. Two patients, one LRD and one DD, aged 6 and 11 years, respectively, developed acute non-cardiogenic pulmonary edema within 36 h of surgery. Renal dysplasia was identified as the primary etiological factor for renal failure in both cases. Both children required assisted ventilation for between 4 and 6 days. While both grafts had primary function, the DD transplant patient subsequently developed acute tubular necrosis and was eventually lost within 3 weeks due to thrombotic microangiopathy and severe acute antibody-mediated rejection despite adequate immunosuppression. Non-cardiogenic pulmonary edema is a potentially devastating post-operative complication of basiliximab induction therapy in young pediatric patients following renal transplantation. Early recognition and appropriate supportive therapy is vital for patient and, where possible, graft survival.

Drug interactions: volatile anesthetics and opioids.

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Glass, P S; Gan, T J; Howell, S; Ginsberg, B

1997-09-01

Multiple drugs are used to provide anesthesia. Volatile anesthetics are commonly combined with opioids. Several studies have demonstrated that small doses of opioid (i.e., within the analgesic range) result in a marked reduction in minimum alveolar concentration (MAC) of the volatile anesthetic that will prevent purposeful movement in 50% of patients at skin incision). Further increases in opioid dose provide only a further small reduction in MAC. Thus, a ceiling effect of the opioid is observed at a MAC value of the volatile anesthetic equal to its MAC awake. Recovery from anesthesia when an opioid is combined with a volatile anesthetic is dependent on the rate of decrease of both drugs to their respective concentrations that are associated with adequate spontaneous ventilation and awakening. Through an understanding of the pharmacodynamic interaction of volatile anesthetics with opioids and the pharmacokinetic processes responsible for the recovery from drug effect, optimal dosing schemes can thus be developed. A review of these pharmacodynamic and pharmacokinetic principles that will allow clinicians to administer drugs to provide a more optimal anesthetic is provided.

Low Hepatic Tissue Copper in Pediatric Nonalcoholic Fatty Liver Disease.

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Mendoza, Michael; Caltharp, Shelley; Song, Ming; Collin, Lindsay; Konomi, Juna V; McClain, Craig J; Vos, Miriam B

2017-07-01

Animal models and studies in adults have demonstrated that copper restriction increases severity of liver injury in nonalcoholic fatty liver disease (NAFLD). This has not been studied in children. We aimed to determine if lower tissue copper is associated with increased NAFLD severity in children. This was a retrospective study of pediatric patients who had a liver biopsy including a hepatic copper quantitation. The primary outcome compared hepatic copper concentration in NAFLD versus non-NAFLD. Secondary outcomes compared hepatic copper levels against steatosis, fibrosis, lobular inflammation, balloon degeneration, and NAFLD activity score (NAS). The study analysis included 150 pediatric subjects (102 with NAFLD and 48 non-NAFLD). After adjusting for age, body mass index z score, gamma glutamyl transferase, alanine aminotransferase, and total bilirubin, NAFLD subjects had lower levels of hepatic copper than non-NAFLD (P = 0.005). In addition, tissue copper concentration decreased as steatosis severity increased (P steatosis alone. Further studies are needed to explore the relationship between copper levels and NAFLD progression.

Sodium channels as targets for volatile anesthetics

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Karl F. Herold

2012-03-01

Full Text Available The molecular mechanisms of modern inhaled anesthetics although widely used in clinical settings are still poorly understood. Considerable evidence supports effects on membrane proteins such as ligand- and voltage-gated ion channels of excitable cells. Na+ channels are crucial to action potential initiation and propagation, and represent potential targets for volatile anesthetics. Inhibition of presynaptic Na+ channels leads to reduced neurotransmitter release at the synapse and could therefore contribute to the mechanisms by which volatile anesthetics produce their characteristic effects: amnesia, unconsciousness, and immobility. Early studies on crayfish and squid giant axon showed inhibition of Na+ currents by volatile anesthetics. Subsequent studies using native neuronal preparations and heterologous expression systems with various mammalian Na+ channel isoforms implicated inhibition of presynaptic Na+ channels in anesthetic actions. Volatile anesthetics reduce peak Na+ current and shift the voltage of half-maximal steady-state inactivation towards more negative potentials, thus stabilizing the fast-inactivated state. Furthermore recovery from fast-inactivation is slowed together with an enhanced use-dependent block during pulse train protocols. These effects can reduce neurotransmitter release by depressing presynaptic excitability, depolarization and Ca entry, and ultimately transmitter release. This reduction in transmitter release is more portent for glutamatergic vs. GABAergic terminals. Involvement of Na+ channel inhibition in mediating the immobility caused by volatile anesthetics has been demonstrated in animal studies, in which intrathecal infusion of the Na+ channel blocker tetrodotoxin increases volatile anesthetic potency, whereas infusion of the Na+ channels agonist veratridine reduces anesthetic potency. These studies indicate that inhibition of presynaptic Na+ channels by volatile anesthetics is involved in mediating some of

Early exposure to volatile anesthetics impairs long-term associative learning and recognition memory.

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Bradley H Lee

Full Text Available Anesthetic exposure early in life affects neural development and long-term cognitive function, but our understanding of the types of memory that are altered is incomplete. Specific cognitive tests in rodents that isolate different memory processes provide a useful approach for gaining insight into this issue.Postnatal day 7 (P7 rats were exposed to either desflurane or isoflurane at 1 Minimum Alveolar Concentration for 4 h. Acute neuronal death was assessed 12 h later in the thalamus, CA1-3 regions of hippocampus, and dentate gyrus. In separate behavioral experiments, beginning at P48, subjects were evaluated in a series of object recognition tests relying on associative learning, as well as social recognition.Exposure to either anesthetic led to a significant increase in neuroapoptosis in each brain region. The extent of neuronal death did not differ between groups. Subjects were unaffected in simple tasks of novel object and object-location recognition. However, anesthetized animals from both groups were impaired in allocentric object-location memory and a more complex task requiring subjects to associate an object with its location and contextual setting. Isoflurane exposure led to additional impairment in object-context association and social memory.Isoflurane and desflurane exposure during development result in deficits in tasks relying on associative learning and recognition memory. Isoflurane may potentially cause worse impairment than desflurane.

Herbert Rackow and Ernest Salanitre: the emergence of pediatric anesthesia as a specialty in the United States.

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Friesen, Robert H

2015-07-01

Herbert Rackow and Ernest Salanitre were pediatric anesthesiologists at Babies Hospital at the Columbia-Presbyterian Medical Center in New York whose work spanned three decades beginning in the early 1950s. Their pioneering research included studies of the uptake and elimination of inhalational anesthetics and of the risk of cardiac arrest in infants and children. They were actively involved in the development of pediatric anesthesia as a specialty, and their efforts contributed to inter-disciplinary collaboration and to the formation of the Section on Anesthesiology of the American Academy of Pediatrics. Their 1969 review article, 'Modern Concepts in Pediatric Anesthesiology', provides a fascinating view of pediatric anesthesia 50 years ago. In 1990, they were jointly awarded the Robert M. Smith award by the Section on Anesthesiology of the American Academy of Pediatrics. © 2015 John Wiley & Sons Ltd.

Anesthetic management of minimally invasive intervention in children's oncohematology: preoperative patient management protocol

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V. V. Shchukin

2013-01-01

Full Text Available Preoperative patient management protocol in the complex anesthetic support of minimally invasive interventions in pediatric oncology is described. Choice of general anesthesia method was determined by the specific clinical situation by analyzing all of the following factors: airway management, necessity and anticipated duration of unconsciousness, the need for analgesia, necessity and duration of immobilization, prevention of hypothermia, the presence and severity of disturbances in the hemostatic system, comfort for the child and his representatives (parents. Basic techniques of child preoperative examination, as well as the methodology for predicting the risk of perioperative adverse events are described.

Anesthetic management of minimally invasive intervention in children's oncohematology: preoperative patient management protocol

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V. V. Shchukin

2014-07-01

Full Text Available Preoperative patient management protocol in the complex anesthetic support of minimally invasive interventions in pediatric oncology is described. Choice of general anesthesia method was determined by the specific clinical situation by analyzing all of the following factors: airway management, necessity and anticipated duration of unconsciousness, the need for analgesia, necessity and duration of immobilization, prevention of hypothermia, the presence and severity of disturbances in the hemostatic system, comfort for the child and his representatives (parents. Basic techniques of child preoperative examination, as well as the methodology for predicting the risk of perioperative adverse events are described.

The State of Anesthetic Services in Korea: A National Survey of the Status of Anesthesia Provider in the 2011-2013 Period

Science.gov (United States)

2016-01-01

Active involvement of anesthesiologists in perioperative management is important to ensure the patients' safety. This study aimed to investigate the state of anesthetic services in Korea by identifying anesthetic service providers. From the insurance claims data of National Health Insurance for 3 yr, the Korean state of anesthetic services was analyzed. The claims for anesthesia from the medical institutions which hire their own anesthesiologist or with an anesthesiologist invitation fee are assumed to be the anesthesia performed by anesthesiologists. The annual anesthetic data were similar during the study period. In 2013, total counts of 2,129,871 were composed with general anesthesia (55%), regional anesthesia (36%) and procedural sedation with intravenous anesthetics (9%). About 80% of total cases of general anesthesia were performed in general hospitals, while more than 60% of the regional anesthesia and sedation were performed in the clinics and hospitals under 100 beds. Non-anesthesiologists performed 273,006 cases of anesthesia (13% of total) including 36,008 of general anesthesia, 143,134 of regional anesthesia, and 93,864 of sedation, mainly in the clinics and hospitals under 100 beds. All procedural sedations in the institutions without direct employed anesthesiologist were performed by non-anesthesiologists. Significant numbers of anesthesia are performed by non-anesthesiologist in Korea. To promote anesthetic services that prioritize the safety of patients, the standard to qualify anesthetic service is required. Surgeons and patients need to enhance their perception of anesthesia, and the payment system should be revised in a way that advocates anesthesiologist-performed anesthetic services. PMID:26770049

Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf) examination: a retrospective cohort study.

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Kimbrough, Tiffany N; Heh, Victor; Wijesooriya, N Romesh; Ryan, Michael S

2016-01-01

To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam. A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from 'traditional' rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE). Eight hundred and sixteen participants were included in the analysis. Student performance on the PSE could not be statistically differentiated from performance on the MSE for any year except 2011 (z-score=-0.17, p=0.02). Average scores on PSE for years 2009, 2010, 2013, and 2014 were significantly higher than for SSE, but not significantly different for all other years. The PSE was highly correlated with USMLE Step 1 and Step 2 examinations (correlation range 0.56-0.77) for all years. Our results showed no difference in PSE performance during a time in which our institution transitioned to FCR. These findings should be reassuring for students, attending physicians, and medical educators.

Asleep versus awake: does it matter?: Pediatric regional block complications by patient state: a report from the Pediatric Regional Anesthesia Network.

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Taenzer, Andreas H; Walker, Benjamin J; Bosenberg, Adrian T; Martin, Lynn; Suresh, Santhanam; Polaner, David M; Wolf, Christie; Krane, Elliot J

2014-01-01

The impact of the patient state at time of placement of regional blocks on the risk of complications is unknown. Current opinion is based almost entirely on case reports, despite considerable interest in the question. Analyzing more than 50,000 pediatric regional anesthesia blocks from an observational prospective database, we determined the rate of adverse events in relation to the patient's state at the time of block placement. Primary outcomes considered were postoperative neurologic symptoms (PONSs) and local anesthetic systemic toxicity (LAST). Secondary outcome was extended hospital stay due to a block complication. The Pediatric Regional Anesthesia Network is a multi-institutional research consortium that was created with an emphasis on rigorous, prospective, and complete data collection including a data validation and audit process. For the purpose of the analysis, blocks were divided in major groups by single injection versus continuous and by block location. Rates were determined in aggregate for these groups and classified further based on the patient's state (general anesthesia [GA] without neuromuscular blockade [NMB], GA with NMB, sedated, and awake) at the time of block placement. Postoperative neurological symptoms occurred at a rate of 0.93/1000 (confidence interval [CI], 0.7-1.2) under GA and 6.82/1000 (CI, 4.2-10.5) in sedated and awake patients. The only occurrence of PONSs lasting longer than 6 months (PONSs-L) was a small sensory deficit in a sedated patient (0.019/1000 [CI, 0-0.1] for all, 0.48/1000 [CI, 0.1-2.7] for sedated patients). There were no cases of paralysis. There were 5 cases of LAST or 0.09/1000 (CI, 0.03-0.21). The incidence of LAST in patients under GA (both with and without NMB) was 0.08/1000 (CI, 0.02-0.2) and 0.34/1000 (CI, 0-1.9) in awake/sedated patients. Extended hospital stays were described 18 times (0.33/1000 [CI, 0.2-0.53]). The rate for patients under GA without NMB was 0.29/1000 (CI, 0.13-0.48); GA with NMB, 0

Lessons for pediatric anesthesia from audit and incident reporting.

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Bell, Graham

2011-07-01

This review will attempt to put the various systems that allow clinicians to assess errors, omissions, or avoidable incidents into context and where possible, look for areas that deserve more or less attention and resource specifically for those of us who practice pediatric anesthesia. Different approaches will be contrasted with respect to their outputs in terms of positive impact on the practice of anesthesia. These approaches include audits by governmental organizations, national representative bodies, specialist societies, commissioned boards of inquiry, medicolegal sources, and police force investigations. Implementation strategies are considered alongside the reports as the reports cannot be considered end points themselves. Specific areas where pediatric anesthetics has failed to address recurring risk through any currently available tools will be highlighted. © 2011 Blackwell Publishing Ltd.

Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration

International Nuclear Information System (INIS)

Hwang, Jae-Yeon; Choo, Ki Seok; Choi, Yoon Young; Kim, Jin Hyeok; Ryu, Hwaseong; Kim, Yong-Woo; Jeon, Ung Bae; Nam, Kyung Jin; Han, Junhee

2017-01-01

Several recent studies showed the optimal contrast enhancement with a low-concentration and iso-osmolar contrast media in both adult and pediatric patients. However, low contrast media concentrations are not routinely used due to concerns of suboptimal enhancement of cardiac structures and small vessels. To evaluate the feasibility of using iso-osmolar contrast media containing a low iodine dose for CT cardiac angiography at 80 kilovolts (kVp) in neonates and infants. The iodixanol 270 group consisted of 79 CT scans and the iopromide 370 group of 62 CT scans in patients ≤1 year old. Objective measurement of the contrast enhancement was analyzed and contrast-to-noise ratios of the ascending aorta and left ventricle were calculated. Regarding subjective measurement, a four-point scale system was devised to evaluate degrees of contrast enhancement, image noise, motion artifact and overall image quality of each image set. Reader performance for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment was evaluated. Group objective and subjective measurements were nonsignificantly different. Overall sensitivity, specificity and diagnostic accuracy for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment were 42.8%, 59%, and 50%, respectively. The application of iodixanol 270 achieved optimal enhancement for performing pediatric cardiac CT angiography at 80 kVp in neonates and infants. Objective measurements of contrast enhancement and subjective image quality assessments were not statistically different in the iodixanol 270 and iopromide 370 groups. (orig.)

Subjective and objective image differences in pediatric computed tomography cardiac angiography using lower iodine concentration

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Hwang, Jae-Yeon [Pusan National University Yangsan Hospital, Department of Radiology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of); Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of); Choo, Ki Seok; Choi, Yoon Young; Kim, Jin Hyeok; Ryu, Hwaseong; Kim, Yong-Woo; Jeon, Ung Bae; Nam, Kyung Jin [Pusan National University Yangsan Hospital, Department of Radiology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of); Han, Junhee [Pusan National University Yangsan Hospital, Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Yangsan-si, Gyeongsangnam-do (Korea, Republic of)

2017-05-15

Several recent studies showed the optimal contrast enhancement with a low-concentration and iso-osmolar contrast media in both adult and pediatric patients. However, low contrast media concentrations are not routinely used due to concerns of suboptimal enhancement of cardiac structures and small vessels. To evaluate the feasibility of using iso-osmolar contrast media containing a low iodine dose for CT cardiac angiography at 80 kilovolts (kVp) in neonates and infants. The iodixanol 270 group consisted of 79 CT scans and the iopromide 370 group of 62 CT scans in patients ≤1 year old. Objective measurement of the contrast enhancement was analyzed and contrast-to-noise ratios of the ascending aorta and left ventricle were calculated. Regarding subjective measurement, a four-point scale system was devised to evaluate degrees of contrast enhancement, image noise, motion artifact and overall image quality of each image set. Reader performance for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment was evaluated. Group objective and subjective measurements were nonsignificantly different. Overall sensitivity, specificity and diagnostic accuracy for correctly differentiating iodixanol 270 and iopromide 370 by visual assessment were 42.8%, 59%, and 50%, respectively. The application of iodixanol 270 achieved optimal enhancement for performing pediatric cardiac CT angiography at 80 kVp in neonates and infants. Objective measurements of contrast enhancement and subjective image quality assessments were not statistically different in the iodixanol 270 and iopromide 370 groups. (orig.)

Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures.

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Aguiar, Arthur Almeida; Lima, Luciana Cavalvanti; Araújo, Cláudia Corrêa de; Gallindo, Rodrigo Melo

2017-12-29

To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56). The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001). Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease. Copyright © 2017. Published by Elsevier Editora Ltda.

Anesthetic services in Serbia

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Majstorović Branislava M.

2016-01-01

Full Text Available Explanation the topic: Due to the development of knowledge and technology our world is becoming a global city where rapidly occur changes in political and economic milieu, such as the introduction of corporate capitalism in the economic crisis, contemporary migrations etc. Health care as a public good on one hand and as the highest individual value of each individual on the other hand, changes and suffers changes. Health care system policy insists on partnership relation of the individual with medical service providers. This refers to the a secure and accessible modern treatment of each individual and to the state as to rationalize and reduce medical costs with effective methods of treatment. Topic position in scientific/professional public: Anesthesiology is evolving along with the surgical disciplines. Highly sophisticated with organized service, anesthesiology is equally important because of the multiplicity of anesthetic services in the surgical treatment of the disease in terms of teamwork and multidisciplinary treatment of the disease. The intention is to provide a description of work, education and our results in the economic, geopolitical and cultural context of the Serbian health system policy as well as to improve safe performance, availability and cost rationalization in anesthesia. The health care system is territorially organized in Serbia. In hospitals, Serbia employs 940 anesthesiologists (1:7,575 inhabitants. According to data from the Regional Medical Chamber of Belgrade,382 anesthesiologists were registered in Belgrade out of total. Anesthesia department network is well organized in all surgical hospitals. Anesthesia services are available depending on the place of residence, type of surgical illness or injury, and the distance to the nearest clinic. Sub-specializations in the field of anesthesiology have not been introduced although pediatric, neurosurgery and cardiosurgical anesthesia have spontaniously singled, as well as

Perceived core competency achievements of fellowship and non-fellowship-trained early career pediatric hospitalists.

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Librizzi, Jamie; Winer, Jeffrey C; Banach, Laurie; Davis, Aisha

2015-06-01

The pediatric hospital medicine (PHM) core competencies were established in 2010 to identify the specific knowledge base and skill set needed to provide the highest quality of care for hospitalized children. The objectives of this study were to examine the perceived core competency achievements of fellowship-trained and non-fellowship-trained early career pediatric hospitalists and identify perceived gaps in our current training models. An anonymous Web-based survey was distributed in November 2013. Hospitalists within 5 years of their residency graduation reported their perceived competency in select PHM core competencies. χ(2) and multiprobit regression analyses were utilized. One hundred ninety-seven hospitalists completed the survey and were included; 147 were non-fellowship-trained and 50 were PHM fellowship graduates or current PHM fellows. Both groups reported feeling less than competent in sedation and aspects of business practice. Non-fellowship-trained hospitalists also reported mean scores in the less than competent range in intravenous access/phlebotomy, technology-dependent emergencies, performing Plan-Do-Study-Act process and root cause analysis, defining basic statistical terms, and identifying research resources. Non-fellowship-trained hospitalists reported mean competency scores greater than fellowship-trained hospitalists in pain management, newborn care, and transitions in care. Early career pediatric hospitalists report deficits in several of the PHM core competencies, which should be considered when designing PHM-specific training in the future. Fellowship-trained hospitalists report higher levels of perceived competency in many core areas. © 2015 Society of Hospital Medicine.

Estimating pediatric general anesthesia exposure: Quantifying duration and risk.

Science.gov (United States)

Bartels, Devan Darby; McCann, Mary Ellen; Davidson, Andrew J; Polaner, David M; Whitlock, Elizabeth L; Bateman, Brian T

2018-05-02

Understanding the duration of pediatric general anesthesia exposure in contemporary practice is important for identifying groups at risk for long general anesthesia exposures and designing trials examining associations between general anesthesia exposure and neurodevelopmental outcomes. We performed a retrospective cohort analysis to estimate pediatric general anesthesia exposure duration during 2010-2015 using the National Anesthesia Clinical Outcomes Registry. A total of 1 548 021 pediatric general anesthetics were included. Median general anesthesia duration was 57 minutes (IQR: 28-86) with 90th percentile 145 minutes. Children aged 3 hours. High ASA physical status and care at a university hospital were associated with longer exposure times. While the vast majority (94%) of children undergoing general anesthesia are exposed for risk for longer exposures. These findings may help guide the design of future trials aimed at understanding neurodevelopmental impact of prolonged exposure in these high-risk groups. © 2018 John Wiley & Sons Ltd.

21 CFR 868.5550 - Anesthetic gas mask.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthetic gas mask. 868.5550 Section 868.5550...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5550 Anesthetic gas mask. (a) Identification. An anesthetic gas mask is a device, usually made of conductive rubber, that is positioned over a...

Anesthetic management of minimally invasive intervention in pediatric oncohematology: possibilities and limitations of inhalation and intravenous anesthesia

Directory of Open Access Journals (Sweden)

V. V. Shchukin

2013-01-01

Full Text Available In contrast to the "adult" medicine, pediatric oncology and hematology requires considerably more anesthesiologist participation in diagnosticsand treatment. According to data of Federal Research Center of Pediatric Hematology, Oncology and Immunology more than 70 % of indications for general anesthesia are minimally invasive interventions. The purpose of general anesthesia for small interventions is to provide patient safety and comfort during painful and fear-inducing manipulations. Protocols of inhalation and intravenous anesthesia recommended for widespread use in pediatric patients are presented.

Anesthetic management of minimally invasive intervention in pediatric oncohematology: possibilities and limitations of inhalation and intravenous anesthesia

Directory of Open Access Journals (Sweden)

V. V. Shchukin

2014-07-01

Full Text Available In contrast to the "adult" medicine, pediatric oncology and hematology requires considerably more anesthesiologist participation in diagnosticsand treatment. According to data of Federal Research Center of Pediatric Hematology, Oncology and Immunology more than 70 % of indications for general anesthesia are minimally invasive interventions. The purpose of general anesthesia for small interventions is to provide patient safety and comfort during painful and fear-inducing manipulations. Protocols of inhalation and intravenous anesthesia recommended for widespread use in pediatric patients are presented.

Preventing Emergence Agitation Using Ancillary Drugs with Sevoflurane for Pediatric Anesthesia: A Network Meta-Analysis.

Science.gov (United States)

Wang, Xin; Deng, Qi; Liu, Bin; Yu, Xiangdi

2017-11-01

Using sevoflurane for pediatric anesthesia plays a pivotal role in surgeries. Emergence agitation (EA) is a major adverse event accompanied with pediatric anesthesia. Other anesthetic adjuvants can be combined with sevoflurane in clinical practices for different purposes. However, it is uncertain that such a practice may have substantial influence on the risk of EA. We conducted a literature search in online databases, including PubMed, Embase, Cochrane Library, and Clinical Trials. Key data were extracted from eligible randomized control trials (RCTs). Both pairwise and network meta-analysis (NMA) were conducted for synthesizing data from eligible studies. The relative risk of EA was assessed using the odds ratios (ORs) and their corresponding 95 % confidence intervals (CI) or credible intervals (CrI). Ranking scheme based on the surface under the cumulative ranking curve (SUCRA) values was produced. Several key assumptions of NMA such as heterogeneity, degree of consistence, and publication bias were validated by different statistical or graphical approaches. Evidence from 67 randomized control trials was synthesized. The relative risk of EA associated with eight anesthetic adjuvants was analyzed, including ketamine, propofol, dexmedetomidine, clonidine, midazolam, fentanyl, remifentanil, and sufentanil. Patients with the following anesthetic adjuvants appeared to have significantly reduced risk of EA in relation to those with placebo: dexmedetomidine (OR = 0.18, 95 % CrI 0.12-0.25), fentanyl (OR = 0.19, 95 % CrI 0.12-0.30), sufentanil (OR = 0.20, 95 % CrI 0.08-0.50), ketamine (OR = 0.21, 95 % CrI 0.13-0.34), clonidine (OR = 0.25, 95 % CrI 0.14-0.46), propofol (OR = 0.32, 95 % CrI 0.18-0.56), midazolam (OR = 0.46, 95 % CrI 0.27-0.77), and remifentanil (OR = 0.29, 95 % CrI 0.13-0.68). The SUCRA values for each anesthetic adjuvant were: dexmedetomidine (73.65 %), fentanyl (68.04 %), sufentanil (60.81 %), ketamine (59.99 %), clonidine

The Risk of Intraocular Pressure Elevation in Pediatric Non-infectious Uveitis

Science.gov (United States)

Kothari, Srishti; Foster, C. Stephen; Pistilli, Maxwell; Liesegang, Teresa L.; Daniel, Ebenezer; Sen, H. Nida; Suhler, Eric B.; Thorne, Jennifer E.; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Lawrence, Scott D.; Kempen, John H.

2015-01-01

Purpose To characterize the risk and risk factors for intraocular pressure (IOP) elevation in pediatric non-infectious uveitis. Design Multi-center retrospective cohort study. Participants Nine hundred sixteen children (1593 eyes) uveitis followed between January 1978 through December 2007 at five academic uveitis centers in United States. Methods Medical records review by trained, certified experts. Main outcome measures Prevalence and incidence of IOP≥21 and ≥30mmHg and incidence of a rise in IOP by ≥10mmHg. To avoid under ascertainment, outcomes were counted as present when IOP-lowering therapies were in use. Results Initially 251 (15.8%) and 46 eyes (2.9%) had IOP≥21 and ≥30mmHg, respectively. Factors associated with presenting IOP elevation included age 6–12 years (versus other pediatric ages), prior cataract surgery (adjusted odds ratio≥21mmHg [aOR21]=2.42, P=0.01), pars plana vitrectomy (adjusted odds ratio≥30mmHg[aOR30]=11.1, P=0.03), duration of uveitis ≥6 months (aORs30 up to 11.8, Puveitis. Statistically significant risk factors include IOP elevation or use of IOP-lowering treatment in the contralateral eye and local corticosteroid use – that demonstrated a dose-and route of administration-dependent relationship. In contrast, use of immunosuppressive drug therapy did not increase such risk. Pediatric eyes with non-infectious uveitis should be followed closely for IOP elevation when strong risk factors such as the use of local corticosteroids and contralateral IOP elevation are present. PMID:26233626

Pediatric neuroimaging using magnetic resonance imaging during non-sedated sleep

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Dean, Douglas C.; Dirks, Holly; Walker, Lindsay; Lehman, Katie; Han, Michelle; Waskiewicz, Nicole; Deoni, Sean C.L. [Brown University, Advanced Baby Imaging Lab, School of Engineering, Providence, RI (United States); O' Muircheartaigh, Jonathan [Brown University, Advanced Baby Imaging Lab, School of Engineering, Providence, RI (United States); King' s College London, Institute of Psychiatry, Department of NeuroImaging Sciences, London (United Kingdom); Jerskey, Beth A. [Brown University, Department of Human Behaviour and Psychiatry, Warren Alpert Medical School, Providence, RI (United States)

2014-01-15

Etiological studies of many neurological and psychiatric disorders are increasingly turning toward longitudinal investigations of infant brain development in order to discern predisposing structural and/or functional differences prior to the onset of overt clinical symptoms. While MRI provides a noninvasive window into the developing brain, MRI of infants and toddlers is challenging due to the modality's extreme motion sensitivity and children's difficulty in remaining still during image acquisition. Here, we outline a broad research protocol for successful MRI of children under 4 years of age during natural, non-sedated sleep. All children were imaged during natural, non-sedated sleep. Active and passive measures to reduce acoustic noise were implemented to reduce the likelihood of the children waking up during acquisition. Foam cushions and vacuum immobilizers were used to limit intra-scan motion artifacts. More than 380 MRI datasets have been successfully acquired from 220 children younger than 4 years of age within the past 39 months. Implemented measures permitted children to remain asleep for the duration of the scan and allowed the data to be acquired with an overall 97% success rate. The proposed method greatly advances current pediatric imaging techniques and may be readily implemented in other research and clinical settings to facilitate and further improve pediatric neuroimaging. (orig.)

Pediatric neuroimaging using magnetic resonance imaging during non-sedated sleep

International Nuclear Information System (INIS)

Dean, Douglas C.; Dirks, Holly; Walker, Lindsay; Lehman, Katie; Han, Michelle; Waskiewicz, Nicole; Deoni, Sean C.L.; O'Muircheartaigh, Jonathan; Jerskey, Beth A.

2014-01-01

Etiological studies of many neurological and psychiatric disorders are increasingly turning toward longitudinal investigations of infant brain development in order to discern predisposing structural and/or functional differences prior to the onset of overt clinical symptoms. While MRI provides a noninvasive window into the developing brain, MRI of infants and toddlers is challenging due to the modality's extreme motion sensitivity and children's difficulty in remaining still during image acquisition. Here, we outline a broad research protocol for successful MRI of children under 4 years of age during natural, non-sedated sleep. All children were imaged during natural, non-sedated sleep. Active and passive measures to reduce acoustic noise were implemented to reduce the likelihood of the children waking up during acquisition. Foam cushions and vacuum immobilizers were used to limit intra-scan motion artifacts. More than 380 MRI datasets have been successfully acquired from 220 children younger than 4 years of age within the past 39 months. Implemented measures permitted children to remain asleep for the duration of the scan and allowed the data to be acquired with an overall 97% success rate. The proposed method greatly advances current pediatric imaging techniques and may be readily implemented in other research and clinical settings to facilitate and further improve pediatric neuroimaging. (orig.)

Methods to produce calibration mixtures for anesthetic gas monitors and how to perform volumetric calculations on anesthetic gases.

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Christensen, P L; Nielsen, J; Kann, T

1992-10-01

A simple procedure for making calibration mixtures of oxygen and the anesthetic gases isoflurane, enflurane, and halothane is described. One to ten grams of the anesthetic substance is evaporated in a closed, 11,361-cc glass bottle filled with oxygen gas at atmospheric pressure. The carefully mixed gas is used to calibrate anesthetic gas monitors. By comparison of calculated and measured volumetric results it is shown that at atmospheric conditions the volumetric behavior of anesthetic gas mixtures can be described with reasonable accuracy using the ideal gas law. A procedure is described for calculating the deviation from ideal gas behavior in cases in which this is needed.

Anesthetic complications in dogs undergoing hepatic surgery: cholecystectomy versus non-cholecystectomy.

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Burns, Brigid R; Hofmeister, Erik H; Brainard, Benjamin M

2014-03-01

To determine if dogs that undergo laparotomy for cholecystectomy suffer from a greater number or magnitude of perianesthetic complications, including hypotension, hypothermia, longer recovery time, and lower survival rate, than dogs that undergo laparotomy for hepatic surgery without cholecystectomy. Retrospective cohort study. One hundred and three dogs, anesthetised between January 2007 and October 2011. The variables collected from the medical record included age, weight, gender, surgical procedure, pre-operative bloodwork, American Society of Anesthesiologists (ASA) status, emergency status, total bilirubin concentration, anesthetic agents administered, body temperature nadir, final body temperature, hypotension, duration of hypotension, blood pressure nadir, intraoperative drugs, anesthesia duration, surgery duration, time to extubation, final diagnosis, days spent in the intensive care unit (ICU), total bill, survival to discharge, and survival to follow-up. No significant difference in body temperature nadir, final temperature, presence of hypotension, duration of hypotension, blood pressure nadir, the use of inotropes, or final outcome was found between dogs undergoing cholecystectomy and dogs undergoing exploratory laparotomy for other hepatic disease. Dogs that had cholecystectomy had longer anesthesia durations and longer surgery durations than dogs that did not have cholecystectomy. No significant differences existed for temperature nadir (34.8 versus 35.3°C; non-cholecystectomy versus cholecystectomy), final temperature (35.6 versus 35.9°C), time to extubation (30 versus 49 minutes), duration of hypotension (27 versus 21 minutes), or MAP nadir (56 versus 55 mmHg). Hypotension occurred in 66% and 74% and inotropes were used in 64% and 53%, for non-cholecystectomy and cholecystectomy patients, respectively. Dogs that underwent cholecystectomies did not suffer a greater number of anesthesia complications than did dogs undergoing hepatic surgery without

Development of lidocaine gels for enhanced local anesthetic action.

Science.gov (United States)

Shin, Sang-Chul; Cho, Cheong-Weon; Yang, Kyu-Ho

2004-12-09

In relieving local pains, lidocaine, one of ester type local anesthetics, has been used. To develop the lidocaine gels of enhanced local anesthetic effects, hydroxypropyl methylcellulose (HPMC) based bioadhesive polymer gel containing an enhancer was formulated. As the drug concentration in the gels increased up to 3%, the permeation rate of drug linearly increased, thereafter reaching a plateau. As the temperature of surrounding solutions increased, the permeation of drug increased. The activation energy of drug permeation was 3.29 kcal/mol for lidocaine. The permeation rate of drug through skin was studied using various enhancers, such as glycols, non-ionic surfactants, and bile salts. Among the enhancers studied, diethylene glycol showed the greatest enhancing effects on drug permeation through skin. The analgesic activity was examined using a tail-flick analgesimeter. In the area under the efficacy curve (AUEC) of the rat-tail flick tests, lidocaine gel containing diethylene glycol showed about 3.89-fold increase in analgesic activity compared with the control. The addition of vasoconstrictor in the gels prolonged the analgesic effects. The result of this study supports that the bioadhesive gel with efficient anesthetic effect could be developed using HPMC with combination of enhancer and vasoconstrictor.

Hemodynamic response after injection of local anesthetics with or without adrenaline in adult Nigerian subjects undergoing simple tooth extraction

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Olutayo James

2015-01-01

Full Text Available Objective: This study was conducted to determine the changes in the blood pressure (BP and the pulse rate (PR of normotensive patients having dental extraction under the administration of 2% lignocaine local anesthetic with or without adrenaline. Materials and Methods: This prospective study was carried out on 325 consecutive normotensive patients who presented at the exodontia clinic of the Lagos University Teaching Hospital (LUTH, Lagos, Yoruba State, Nigeria from December 2004 to August 2005 for simple tooth extraction. The patients were randomly allocated into two groups according to the type of anesthetic solution employed. Group A had tooth extraction done under the administration of 2% lignocaine with adrenaline (1:80,000 while group B had tooth extraction done under the administration of 2% lignocaine local anesthetic without vasoconstrictor (plain lignocaine. Each patient had single tooth extracted. The following parameters were monitored in each of the surgical interventions: systolic blood pressure (SBP, diastolic blood pressure (DBP, and PR. Measurements were taken in the waiting room before surgery, during the surgery after local anesthesia, during tooth extraction, and 15 min after tooth extraction. Results: The sample consisted of 176 females and 149 males. Age range of the patients was 18-89 years with the mean age of 35.08 ± 15.60 years. The hemodynamic responses to lignocaine with adrenaline (1:80,000 and plain lignocaine essentially follow the same pattern in the study. There was no statistically significant difference between the measured parameters in the two groups after the administration of local anesthetics. Conclusion: This study, therefore, shows that there was no difference in the hemodynamic changes observed with the use of lignocaine with adrenaline or plain lignocaine during a simple tooth extraction in healthy adults.

Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

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Elif Oral Ahiskalioglu

2015-11-01

Full Text Available Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

Directory of Open Access Journals (Sweden)

Elif Oral Ahiskalioglu

2015-12-01

Full Text Available ABSTRACT Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

Williams Syndrome and Anesthesia for Non-cardiac Surgery: High Risk Can Be Mitigated with Appropriate Planning.

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Brown, Morgan L; Nasr, Viviane G; Toohey, Rebecca; DiNardo, James A

2018-03-23

Patients with Williams syndrome are considered at high risk for anesthesia-related adverse events. At our institution, all William syndrome patients undergoing cardiac surgical, cardiac catheterization/interventional procedures, and cardiac imaging studies are cared for by cardiac anesthesiologists. All William syndrome patients undergoing non-cardiac surgical, interventional, or imaging studies are cared for by main operating room pediatric anesthesiologists with consultative input from a cardiac anesthesiologist. We reviewed our experience with 75 patients undergoing 202 separate anesthetics for 95 non-cardiac procedures and 107 cardiac procedures from 2012 to 2016. The mean age was 7.5 ± 7.0 years and the mean weight was 22.3 ± 17.0 kg. One hundred and eighty-seven patients had a general anesthetic (92.6%). Medications used included etomidate in 26.2%, propofol in 37.6%, isoflurane in 47.5%, and sevoflurane in 68.3%. Vasopressors and inotropes were required including calcium (22.8%), dopamine (10.4%), norepinephrine (17.3%), phenylephrine (35.1%), vasopressin (0.5%), and ephedrine (5.4%). The median length of stay after anesthesia was 2.8 days (range 0-32). No adverse events occurred in 89.6% of anesthetics. There were two cases of cardiac arrest, one of which required extracorporeal life support for resuscitation. Of the non-cardiac surgical procedures, 95.7% did not have a cardiovascular adverse event. Patients with Williams syndrome are at high risk for anesthesia, especially when undergoing cardiac procedures. The risk can be mitigated with appropriate planning and adherence to the hemodynamic goals for non-cardiac surgical procedures.

[Louis Ombrédanne (1871-1956) pediatric and plastic surgeon].

Science.gov (United States)

Glicenstein, J

2015-04-01

One of the fathers of pediatric surgery in France, Louis Ombrédanne (1871-1956) was a great plastic surgeon. During his residency he was initiated to plastic surgery by Charles Nélaton (1851-1911). Both wrote two books: "La rhinoplastie" and "Les autoplasties", taking stock of these techniques in the early 20th century. In 1906, he was the first to describe the pectoral muscle flap for immediate breast reconstruction after mastectomy. He used this flap in conjunction with an axillo thoracic flap. From 1908 to 1941, Louis Ombrédanne practised pediatric surgery, most of which was devoted in reconstruction of congenital and acquire anomalies. From 1924 to 1941, he was Professor of pediatric surgery at the hospital Enfants-Malades in Paris. In 1907, Louis Ombrédanne created a prototype of an ether inhaler as a safe anesthetic device. The device was successfully used for fifty years in Europe. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

[Comparative effectiveness of surgical and non-surgical treatment for pediatric mandibular condylar fractures].

Science.gov (United States)

Hu, Min; Wang, Yanyi; Zhang, Lihai; Yao, Jun

2010-12-01

To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of clinical therapy. The clinical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) with non-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbling in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospitalization; and 5 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 3 cases as bilateral condylar fractures complicated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by falling from height in 4 cases, by tumbling in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospitalization; and 12 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 5 cases as bilateral condylar fractures (1 complicated by mental fracture). Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or limited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P > 0.05). During centric occlusion, mental point located at the midline with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had slight snap when opening their mouths. Mandible

Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

International Nuclear Information System (INIS)

Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y.; Hibbard, Roberta A.; Hicks, Ralph A.

2017-01-01

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

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Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Hibbard, Roberta A.; Hicks, Ralph A. [Indiana University School of Medicine, Department of Pediatrics, Section of Child Protection Programs, Indianapolis, IN (United States)

2017-07-15

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

Interaction of Local Anesthetics with Biomembranes Consisting of Phospholipids and Cholesterol: Mechanistic and Clinical Implications for Anesthetic and Cardiotoxic Effects

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Hironori Tsuchiya

2013-01-01

Full Text Available Despite a long history in medical and dental application, the molecular mechanism and precise site of action are still arguable for local anesthetics. Their effects are considered to be induced by acting on functional proteins, on membrane lipids, or on both. Local anesthetics primarily interact with sodium channels embedded in cell membranes to reduce the excitability of nerve cells and cardiomyocytes or produce a malfunction of the cardiovascular system. However, the membrane protein-interacting theory cannot explain all of the pharmacological and toxicological features of local anesthetics. The administered drug molecules must diffuse through the lipid barriers of nerve sheaths and penetrate into or across the lipid bilayers of cell membranes to reach the acting site on transmembrane proteins. Amphiphilic local anesthetics interact hydrophobically and electrostatically with lipid bilayers and modify their physicochemical property, with the direct inhibition of membrane functions, and with the resultant alteration of the membrane lipid environments surrounding transmembrane proteins and the subsequent protein conformational change, leading to the inhibition of channel functions. We review recent studies on the interaction of local anesthetics with biomembranes consisting of phospholipids and cholesterol. Understanding the membrane interactivity of local anesthetics would provide novel insights into their anesthetic and cardiotoxic effects.

Comparison of the anesthetic efficacy of articaine infiltration versus lidocaine inferior alveolar nerve block in pulp therapy of lower primary molars

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Maryam Sharifi

2017-12-01

Full Text Available Introduction: Pain control is essential to the behavioral management of children in pediatric dentistry. Effective anesthesia plays a key role in this regard, especially in pulp therapy. In order to achieve successful anesthesia, the type of analgesics and injection techniques should be considered. The present study aimed to compare the anesthetic efficacy of articaine infiltration and lidocaine inferior alveolar nerve block in the pulp therapy of lower primary molars. Materials and Methods: This randomized, crossover, triple-blind clinical trial was conducted on 64 children aged 4-10 years, who required the bilateral pulp therapy of the lower primary molars. Subjects were randomly divided into two groups. Treatment was performed for two sessions, and one lower primary molar was treated in each session. In the first treatment session, subjects in group A were injected with lidocaine inferior alveolar nerve block, and in the second session, they were injected with articaine infiltration. In group B, all the procedures were similar to group A. In the first treatment session, subjects in group B were injected with articaine infiltration, and in the second session, they were injected with lidocaine inferior alveolar nerve block. Pain intensity was measured upon the initiation of the pulp exposure using the visual analogue scale (VAS. Data analysis was performed by crossover analysis, paired t-test, and independent two-sample t-test. Results: During the study period, mean pain intensity in the children treated by lidocaine inferior alveolar nerve block was significantly lower compared to those treated by articaine infiltration. However, the two techniques had no statistically significant difference in the children aged 4-6 years and the treatment of the first primary molars. Conclusion: According to the results, lidocaine inferior alveolar nerve block has higher anesthetic efficacy in the pulp therapy of the lower primary molars compared to articaine

Anesthetic management of hypertensive crisis in a three-year-old patient with undiagnosed severe renal artery stenosis: a case report.

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Park, Sang-Hee; Lee, Yoon-Sook; Min, Too Jae; Kim, Woon Young; Kim, Jae Hwan; Park, Young Cheol

2014-10-01

Pediatric hypertensive crisis is a potentially life threatening medical emergency, usually secondary to an underlying disease. Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists. However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients. We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis.

Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery.

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Ahiskalioglu, Elif Oral; Ahiskalioglu, Ali; Firinci, Binali; Dostbil, Aysenur; Aksoy, Mehmet

2015-01-01

Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Evaluation of the Aesthetics of Physical Methods of Euthanasia of Anesthetized Rats

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Hickman, Debra L; Johnson, Steven W

2011-01-01

Dissection of living brain tissue for in vitro experiments requires the use of a rapid euthanasia method. However, the method must not subject animals to unnecessary pain and must be aesthetically acceptable to experimenters. The purposes of the current study were to assess the aesthetics of 6 euthanasia methods, measure the procedure duration, and evaluate brain for pathology after each procedure. We digitally recorded euthanasia of isoflurane-anesthetized rats by 6 physical methods: anesthetic overdose, cardiac exsanguination, decapitation, closed intrathoracic transection of the great vessels and heart, thoracic percussion, and thoracotomy with rupture of great vessels. Volunteer researchers and animal caretakers watched the video and completed an associated questionnaire. Anesthetic overdose and cardiac exsanguinations were rated most aesthetically pleasing, although these procedures took the longest to complete. In contrast, decapitation and thoracic percussion were the least aesthetically pleasing, but these methods were the quickest. No demographic factor was identified that could predict whether a given euthanasia procedure would be favored for aesthetic reasons, and participants provided a wide variety of rationales for the aesthetic ratings they assigned. Although all of these euthanasia methods meet the criteria of approved methods of euthanasia of anesthetized rats as defined by the AVMA, aesthetic features and the scientific need for rapid euthanasia are both considerations in selecting a method. PMID:22330717

The Common Inhalational Anesthetic Sevoflurane Induces Apoptosis and Increases β-Amyloid Protein Levels

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Dong, Yuanlin; Zhang, Guohua; Zhang, Bin; Moir, Robert D.; Xia, Weiming; Marcantonio, Edward R.; Culley, Deborah J.; Crosby, Gregory; Tanzi, Rudolph E.; Xie, Zhongcong

2009-01-01

Objective: To assess the effects of sevoflurane, the most commonly used inhalation anesthetic, on apoptosis and β-amyloid protein (Aβ) levels in vitro and in vivo. Subjects: Naive mice, H4 human neuroglioma cells, and H4 human neuroglioma cells stably transfected to express full-length amyloid precursor protein. Interventions: Human H4 neuroglioma cells stably transfected to express full-length amyloid precursor protein were exposed to 4.1% sevoflurane for 6 hours. Mice received 2.5% sevoflurane for 2 hours. Caspase-3 activation, apoptosis, and Aβ levels were assessed. Results: Sevoflurane induced apoptosis and elevated levels of β-site amyloid precursor protein-cleaving enzyme and Aβ in vitro and in vivo. The caspase inhibitor Z-VAD decreased the effects of sevoflurane on apoptosis and Aβ. Sevoflurane-induced caspase-3 activation was attenuated by the γ-secretase inhibitor L-685,458 and was potentiated by Aβ. These results suggest that sevoflurane induces caspase activation which, in turn, enhances β-site amyloid precursor protein–cleaving enzyme and Aβ levels. Increased Aβ levels then induce further rounds of apoptosis. Conclusions: These results suggest that inhalational anesthetic sevoflurane may promote Alzheimer disease neuropathogenesis. If confirmed in human subjects, it may be prudent to caution against the use of sevoflurane as an anesthetic, especially in those suspected of possessing excessive levels of cerebral Aβ. PMID:19433662

Fat, demented and stupid: An unrecognized legacy of pediatric urology?

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Cooper, Christopher S

2017-08-01

The human body is an unfathomably intricate structure consisting of many connected and intertwined systems. This makes it impossible for therapeutic interventions to selectively target only one physiologic system without some impact or side effects on all the other systems. The resiliency of the human body modifies and disguises side effects, some of which may be undetectable for years and not apparent without scientific investigation. Pediatric urologists employ relatively few medications for the common conditions they treat and in general these consist of antibiotics, anticholinergics, and anesthetics. Although harm from early side effects is well recognized, recent medical literature suggests there may be other side effects of these common interventions that aren't as well recognized. Antibiotics have been added to livestock feed as growth promoters for three-quarters of a century. Antibiotics alter the microbiota of the intestinal tract and these alterations have been demonstrated to impact growth, metabolism, and the risk of obesity in animals and humans. To date, the long-term impact of daily antibiotic prophylaxis in children with such pediatric urology conditions as vesicoureteral reflux or prenatal hydronephrosis have not been published. Similarly, there are no studies assessing long-term effects of anticholinergic use on cognition in children despite research demonstrating an increased risk of dementia in adults using anticholinergics. Research in animals and children recently led the FDA to issue a warning regarding the risk of lengthy use of general anesthesia on cognitive development in children. This review raises the possibility that antibiotics in children may alter growth, anticholinergics may increase their risk of dementia later in life, and anesthetics may impair their cognitive development. The possibility of such an unrecognized legacy from current therapeutic interventions should give all physicians, including pediatric urologists, pause for

Prediction of medication non-adherence and associated outcomes in pediatric kidney transplant recipients.

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Connelly, James; Pilch, N; Oliver, M; Jordan, C; Fleming, J; Meadows, H; Baliga, P; Nadig, S; Twombley, K; Shatat, I; Taber, D

2015-08-01

Studies have continued to evaluate risk factors associated with post-transplant non-adherence in pediatric patients. However, many of these studies fail to evaluate how risk factors can be utilized to predict MNA. The aims of this study were to (i) determine salient risk factors associated with MNA to develop an adequate predictive risk model and (ii) assess transplant outcomes based on the presence of MNA in a large, diverse cohort of pediatric KTX recipients. One hundred and seventy-five solitary pediatric KTX recipients transplanted from 1999 to 2013 were included. AA, males, older patients, those who lived in urban environments, had legal issues, and lived shorter distances from the transplant center were more likely to have MNA. Using logistic regression, a parsimonious model applying nine risk factors together was developed for predicting MNA, demonstrating a PPV of 69% and a NPV of 81%. Patients with MNA had more than twice the risk of biopsy proven acute rejection, 1.6 times the risk of hospitalization, and 1.8 times the risk of graft loss. Utilization of a predictive model to determine risk of MNA after pediatric KTX may offer clinicians the ability to efficiently and effectively monitor MNA following transplant. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pediatric neurocritical care.

Science.gov (United States)

Murphy, Sarah

2012-01-01

Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

Pain management in the pediatric oncological patient and factors influencing its perception

International Nuclear Information System (INIS)

Gallego Muñoz, Cristóbal; Martínez Bautista, María José; Romero Hernández, Irene; García Martín, Fátima; Manzano Martín, María Victoria; Guerrero Navarro, Nieves

2015-01-01

Pain is a subjective characteristic found in many patients during their hospital stay. Pediatric population presents physiological and psychological characteristics different from those of the adults. Added to this, if a cancer process is present, for which they are subjected to numerous painful experiences during their diagnosis and treatment, adequate pain management is vital. The objective of this paper was to review the main factors that influence the perception of cancer pain in the pediatric patient and both non-pharmacological and pharmacological measures that are necessary to take into account for proper pain management. To this end, a literature review was made in MEDLINE database, which covered the scientific publications of the last 25 years. It can be concluded that oncological pain perception has a multifactoral component. Furthermore, in addition to appropriate use of pharmacologic measures, non-pharmacological actions are very important for a comprehensive approach to pain. (author)

Anesthetic management of an 8-month-old infant with osteogenesis imperfecta undergoing liver transplantation: a case report.

Science.gov (United States)

Lee, Jiwon; Ryu, Ho-Geol; Kim, Anna; Yoo, Seokha; Shin, Seung-Yeon; Kang, Sun-Hye; Jeong, Jinyoung; Yoo, Yongjae

2014-06-01

Anesthetic management of pediatric liver transplantation in a patient with osteogenesis imperfecta (OI) requires tough decisions and comprehensive considerations of the cascade of effects that may arise and the required monitoring. Total intravenous anesthesia (TIVA) with propofol and remifentanil was chosen as the main anesthetic strategy. Malignant hyperthermia (MH), skeletal fragility, anhepatic phase during liver transplantation, uncertainties of TIVA in children, and propofol infusion syndrome were considered and monitored. There were no adverse events during the operation. Despite meticulous precautions with regard to the risk of MH, there was an episode of high fever (40℃) in the ICU a few hours after the operation, which was initially feared as MH. Fortunately, MH was ruled out as the fever subsided soon after hydration and antipyretics were given. Although the delivery of supportive care and the administration of dantrolene are the core principles in the management of MH, perioperative fever does not always mean a MH in patients at risk for MH, and other common causes of fever should also be considered.

Anesthetic management of comprehensive dental restoration in a child with glutaric aciduria type 1 using volatile sevoflurane

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Wei-Nung Teng

2014-10-01

Full Text Available Glutaric aciduria type 1 (GA1 is a rare, inherited mitochondrial disorder that results from deficiency of mitochondrial glutaryl-CoA dehydrogenase. Most patients develop neurological dysfunction early in life, which leads to severe disabilities. We present a 37-month-old girl with GA1 manifested as macrocephaly and hypotonia who received comprehensive dental restoration surgery under general anesthesia with sevoflurane. She was placed on specialized fluid management during a preoperative fasting period and anesthesia was administered without complications. All the physiological parameters, including glucose and lactate blood levels and arterial blood gas were carefully monitored and maintained within normal range perioperatively. Strategies for anesthetic management should include prevention of pulmonary aspiration, dehydration, hyperthermia and catabolic state, adequate analgesia to minimize surgical stress, and avoidance of prolonged neuromuscular blockade. We administered general anesthesia with sevoflurane uneventfully, which was well tolerated by our patient with GA1. Additionally, communication with a pediatric geneticist and surgeons should be undertaken to formulate a comprehensive anesthetic strategy in these patients.

Role of FDG-PET scan in the management of pediatric mature B cell non-Hodgkin’s lymphoma. CCHE experience

OpenAIRE

Abdel Rahman, Hany; Sedky, Mohamed; Hamoda, Asmaa; Raafat, Tarek; Youssef, Ayda; Omar, Walid; Hassanein, Omneya; Moussa, Emad

2016-01-01

Aim of work: To evaluate the sensitivity (Se), specificity (Sp), and predictive values (PV) of PET scan during management of pediatric mature B cell non-Hodgkin’s lymphoma (NHL) in comparison with conventional computed tomography (CT) scan. Patients and methods: A retrospective study enrolled on pediatric NHL patients at Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to the end of June 2013. Results: For 115 pediatric patients diagnosed with mature B cell NHL, 15...

Anesthetic management in a pediatric patient with Noonan syndrome, hypopituitarism and hypothyroidism: A case report

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Abdulkadir Yektaş

2013-06-01

Full Text Available Noonan syndrome is a genetically transmitted autosomaldominant disorder characterized by various anatomicanomalies and pathophysiologic derangements. Associatedanomalies include hyperthelorism, ptosis, micrognathia,downward sloping palpebral fissures, low-set ears,abnormal helix of ear, deeply grooved philtrum, short and/or webbed neck, low hairline and cervical vertebral anomalies.Patients with Noonan syndrome are known to presentwith challenging airways. Tracheal intubation can bedifficult because of airway and cervical vertebral anomaliesand bag mask ventilation may be difficult because ofasymmetrical face. We present a case of anesthetic managementfor Noonan syndrome. J Clin Exp Invest 2013;4 (2: 238-241Key words: Anesthesia, general, noonan syndrome, airwaymanagement

Anesthesia and the pediatric cardiac catheterization suite: a review.

Science.gov (United States)

Lam, Jennifer E; Lin, Erica P; Alexy, Ryan; Aronson, Lori A

2015-02-01

Advances in technology over the last couple of decades have caused a shift in pediatric cardiac catheterization from a primary focus on diagnostics to innovative therapeutic interventions. These improvements allow patients a wider range of nonsurgical options for treatment of congenital heart disease. However, these therapeutic modalities can entail higher risk in an already complex patient population, compounded by the added challenges inherent to the environment of the cardiac catheterization suite. Anesthesiologists caring for children with congenital heart disease must understand not only the pathophysiology of the disease but also the effects the anesthetics and interventions have on the patient in order to provide a safe perioperative course. It is the aim of this article to review the latest catheterization modalities offered to patients with congenital heart disease, describe the unique challenges presented in the cardiac catheterization suite, list the most common complications encountered during catheterization and finally, to review the literature regarding different anesthetic drugs used in the catheterization lab. © 2014 John Wiley & Sons Ltd.

Update on complications in pediatric anesthesia

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Giovanni de Francisci

2013-02-01

Full Text Available Complications in pediatric anesthesia can happen, even in our modern hospitals with the most advanced equipment and skilled anesthesiologists. It is important, albeit in a tranquil and reassuring way, to inform parents of the possibility of complications and, in general, of the anesthetic risks. This is especially imperative when speaking to the parents of children who will be operated on for minor procedures: in our experience, they tend to think that the anesthesia will be a light anesthesia without risks. Often the surgeons tell them that the operation is very simple without stressing the fact that it will be done under general anesthesia which is identical to the one we give for major operations. Different is the scenario for the parents of children who are affected by malignant neoplasms: in these cases they already know that the illness is serious. They have this tremendous burden and we choose not to add another one by discussing anesthetic risks, so we usually go along with the examination of the child without bringing up the possibility of complications, unless there is some specific problem such as a mediastinal mass.

New frontiers in pediatric Allo-SCT.

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Talano, J M; Pulsipher, M A; Symons, H J; Militano, O; Shereck, E B; Giller, R H; Hancock, L; Morris, E; Cairo, M S

2014-09-01

The inaugural meeting of 'New Frontiers in Pediatric Allogeneic Stem Cell Transplantation' organized by the Pediatric Blood and Transplant Consortium (PBMTC) was held at the American Society of Pediatric Hematology and Oncology Annual Meeting. This meeting provided an international platform for physicians and investigators active in the research and utilization of pediatric Allo-SCT in children and adolescents with malignant and non-malignant disease (NMD), to share information and develop future collaborative strategies. The primary objectives of the conference included: (1) to present advances in Allo-SCT in pediatric ALL and novel pre and post-transplant immunotherapy; (2) to highlight new strategies in alternative allogeneic stem cell donor sources for children and adolescents with non-malignant hematological disorders; (3) to discuss timing of immune reconstitution after Allo-SCT and methods of facilitating more rapid recovery of immunity; (4) to identify strategies of utilizing Allo-SCT in pediatric myeloproliferative disorders; (5) to develop diagnostic and therapeutic approaches to hematological complications post pediatric Allo-SCT; (6) to enhance the understanding of new novel cellular therapeutic approaches to pediatric malignant and non-malignant hematological disorders; and (7) to discuss optimizing drug therapy in pediatric recipients of Allo-SCT. This paper will provide a brief overview of the conference.

Pharmacokinetics of inhaled anesthetics in green iguanas (Iguana iguana).

Science.gov (United States)

Brosnan, Robert J; Pypendop, Bruno H; Barter, Linda S; Hawkins, Michelle G

2006-10-01

To test the hypothesis that differences in anesthetic uptake and elimination in iguanas would counter the pharmacokinetic effects of blood:gas solubility and thus serve to minimize kinetic differences among inhaled agents. 6 green iguanas (Iguana iguana). Iguanas were anesthetized with isoflurane, sevoflurane, or desflurane in a Latin-square design. Intervals from initial administration of an anesthetic agent to specific induction events and from cessation of administration of an anesthetic agent to specific recovery events were recorded. End-expired gas concentrations were measured during anesthetic washout. Significant differences were not detected for any induction or recovery events for any inhalation agent in iguanas. Washout curves best fit a 2-compartment model, but slopes for both compartments did not differ significantly among the 3 anesthetics. Differences in blood:gas solubility for isoflurane, sevoflurane, and desflurane did not significantly influence differences in pharmacokinetics for the inhalation agents in iguanas.

An evaluation of the safety and efficacy of bimatoprost for eyelash growth in pediatric subjects

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Borchert M

2016-03-01

Full Text Available Mark Borchert,1 Suzanne Bruce,2 David Wirta,3 Steven G Yoelin,4 Sungwook Lee,5 Cheri Mao,5 Amanda VanDenburgh5 1Children’s Hospital Los Angeles, Los Angeles, CA, USA; 2Suzanne Bruce and Associates, PA, Houston, TX, USA; 3David Wirta and Associates, Newport Beach, CA, USA; 4Medical Associates Inc., Newport Beach, CA, USA; 5Allergan plc, Irvine, CA, USA Purpose: Evaluate the safety and effectiveness of bimatoprost 0.03% for treatment of eyelash hypotrichosis in a pediatric population. Patients and methods: This multicenter, randomized, double-masked, parallel-group study was conducted at seven sites in the US and Brazil. Subjects with eyelash hypotrichosis caused by chemotherapy or alopecia areata (aged 5–17 years or healthy adolescents aged 15–17 years were enrolled (N=71. Subjects applied bimatoprost 0.03% or vehicle to upper eyelid margins once nightly for 4 months and were followed for 1 month post-treatment. Eyelash prominence was assessed using the validated 4-grade Global Eyelash Assessment scale with photonumeric guide. Changes in eyelash length, thickness, and darkness were measured by digital image analysis. Safety was assessed by adverse events and ophthalmic observations. Results: Eyelash prominence improved in a significantly greater proportion of subjects treated with bimatoprost compared with vehicle at month 4 (70.8% versus 26.1%; P<0.001. This benefit was sustained at month 5 post-treatment assessment. Digital image analysis measures were significantly improved with bimatoprost. Significant treatment benefits with bimatoprost versus vehicle were evident among the healthy adolescents but not in the postchemotherapy or alopecia areata subgroups. The safety profile of bimatoprost was consistent with previous studies in adults. Conclusion: Bimatoprost was safe and well tolerated in pediatric subjects with eyelash hypotrichosis. In this study with limited sample size, subgroup analyses showed that treatment was effective in

Pharmacoeconomics of inhaled anesthetic agents: considerations for the pharmacist.

Science.gov (United States)

Chernin, Eric L

2004-10-15

Types of economic analyses used for inhaled anesthetic agents, factors to consider in calculating the cost of inhaled anesthetics, limitations of pharmacoeconomic studies of these agents, and strategies for controlling inhaled anesthetic costs are discussed. Inhaled anesthetic agents comprise a substantial component of drug budgets. Calculation of the cost of administering an inhaled anesthetic should take into consideration the cost per mL, potency, waste, concentration and duration of gas delivery, fresh gas flow rate, molecular weight, and density. The use of newer inhaled anesthetic agents with low solubility in blood and tissue provides a more rapid recovery from anesthesia than older, more soluble agents, and also provides the same level of control of depth of anesthesia at a lower fresh gas flow rate and possibly a lower cost than older agents at a higher fresh gas flow rate. A more rapid recovery may facilitate fast-track recovery and yield cost savings if it allows the completion of additional surgical cases or allows a reduction in personnel overtime expenses. Interpretation of pharmacoeconomic studies of inhaled anesthetics requires an appreciation of the limitations in methodology and ability to extrapolate results from one setting to another. Pharmacists' efforts to reduce anesthetic waste and collaborate with anesthesiologists to improve the use of these agents can help contain costs, but improving scheduling and efficiency in the operating room has a greater potential to reduce operating room costs. Much can be done to control costs of anesthetic agents without compromising availability of these agents and patient care.

ONC201 induces cell death in pediatric non-Hodgkin's lymphoma cells.

Science.gov (United States)

Talekar, Mala K; Allen, Joshua E; Dicker, David T; El-Deiry, Wafik S

2015-08-03

ONC201/TIC10 is a small molecule initially discovered by its ability to coordinately induce and activate the TRAIL pathway selectively in tumor cells and has recently entered clinical trials in adult advanced cancers. The anti-tumor activity of ONC201 has previously been demonstrated in several preclinical models of cancer, including refractory solid tumors and a transgenic lymphoma mouse model. Based on the need for new safe and effective therapies in pediatric non-Hodgkin's lymphoma (NHL) and the non-toxic preclinical profile of ONC201, we investigated the in vitro efficacy of ONC201 in non-Hodgkin's lymphoma (NHL) cell lines to evaluate its therapeutic potential for this disease. ONC201 caused a dose-dependent reduction in the cell viability of NHL cell lines that resulted from induction of apoptosis. As expected from prior observations, induction of TRAIL and its receptor DR5 was also observed in these cell lines. Furthermore, dual induction of TRAIL and DR5 appeared to drive the observed apoptosis and TRAIL expression was correlated linearly with sub-G1 DNA content, suggesting its potential role as a biomarker of tumor response to ONC201-treated lymphoma cells. We further investigated combinations of ONC201 with approved chemotherapeutic agents used to treat lymphoma. ONC201 exhibited synergy in combination with the anti-metabolic agent cytarabine in vitro, in addition to cooperating with other therapies. Together these findings indicate that ONC201 is an effective TRAIL pathway-inducer as a monoagent that can be combined with chemotherapy to enhance therapeutic responses in pediatric NHL.

LOCAL ANESTHETICS IN PATIENTS WITH CARDIOVASCULAR DISEASES.

Directory of Open Access Journals (Sweden)

risto Daskalov

2015-03-01

Full Text Available A significant problem in the dental medicine is pain alleviation. Many studies in the dental anesthesiology result in the production of new agents for locoregional anesthesia. Objective: This article aim to present the results of the last studies on the effect of the local anesthetics used in the oral surgery on patients with cardiovascular diseases. Material: A general review of the existing literature on the effect of the adrenaline, included as vasoconstrictor in the local anesthetics, used in patients with cardiovascular diseases is made. The benefits of vasoconstrictors for the quality of the anesthetic effect are proven. Conclusion: A small amount of adrenaline in the anesthetic solution does not result in complications development in patients with controlled cardiovascular diseases. Articaine is recommended agent of first choice for local anesthesia in the oral surgery.

Heart rate effects of intraosseous injections using slow and fast rates of anesthetic solution deposition.

Science.gov (United States)

Susi, Louis; Reader, Al; Nusstein, John; Beck, Mike; Weaver, Joel; Drum, Melissa

2008-01-01

The authors, using a crossover design, randomly administered, in a single-blind manner, 3 primary intraosseous injections to 61 subjects using: the Wand local anesthetic system at a deposition rate of 45 seconds (fast injection); the Wand local anesthetic system at a deposition rate of 4 minutes and 45 seconds (slow injection); a conventional syringe injection at a deposition rate of 4 minutes and 45 seconds (slow injection), in 3 separate appointments spaced at least 3 weeks apart. A pulse oximeter measured heart rate (pulse). The results demonstrated the mean maximum heart rate was statistically higher with the fast intraosseous injection (average 21 to 28 beats/min increase) than either of the 2 slow intraosseous injections (average 10 to 12 beats/min increase). There was no statistically significant difference between the 2 slow injections. We concluded that an intraosseous injection of 1.4 mL of 2% lidocaine with 1 : 100,000 epinephrine with the Wand at a 45-second rate of anesthetic deposition resulted in a significantly higher heart rate when compared with a 4-minute and 45-second anesthetic solution deposition using either the Wand or traditional syringe.

ONC201 induces cell death in pediatric non-Hodgkin's lymphoma cells

OpenAIRE

Talekar, Mala K; Allen, Joshua E; Dicker, David T; El-Deiry, Wafik S

2015-01-01

ONC201/TIC10 is a small molecule initially discovered by its ability to coordinately induce and activate the TRAIL pathway selectively in tumor cells and has recently entered clinical trials in adult advanced cancers. The anti-tumor activity of ONC201 has previously been demonstrated in several preclinical models of cancer, including refractory solid tumors and a transgenic lymphoma mouse model. Based on the need for new safe and effective therapies in pediatric non-Hodgkin's lymphoma (NHL) a...

Can anesthetic treatment worsen outcome in status epilepticus?

Science.gov (United States)

Sutter, Raoul; Kaplan, Peter W

2015-08-01

Status epilepticus refractory to first-line and second-line antiepileptic treatments challenges neurologists and intensivists as mortality increases with treatment refractoriness and seizure duration. International guidelines advocate anesthetic drugs, such as continuously administered high-dose midazolam, propofol, and barbiturates, for the induction of therapeutic coma in patients with treatment-refractory status epilepticus. The seizure-suppressing effect of anesthetic drugs is believed to be so strong that some experts recommend using them after benzodiazepines have failed. Although the rationale for the use of anesthetic drugs in patients with treatment-refractory status epilepticus seems clear, the recommendation of their use in treating status epilepticus is based on expert opinions rather than on strong evidence. Randomized trials in this context are lacking, and recent studies provide disturbing results, as the administration of anesthetics was associated with poor outcome independent of possible confounders. This calls for caution in the straightforward use of anesthetics in treating status epilepticus. However, there are still more questions than answers, and current evidence for the adverse effects of anesthetic drugs in patients with status epilepticus remains too limited to advocate a change of treatment algorithms. In this overview, the rationale and the conflicting clinical implications of anesthetic drugs in patients with treatment-refractory status epilepticus are discussed, and remaining questions are elaborated. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015 Elsevier Inc. All rights reserved.

The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units.

Science.gov (United States)

Cobo, Nicole H; Sankar, Raman; Murata, Kristina K; Sewak, Sarika L; Kezele, Michele A; Matsumoto, Joyce H

2015-02-01

Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients. © The Author(s) 2014.

Pediatric Electrocardiographic Imaging (ECGI) Applications

Science.gov (United States)

Silva, Jennifer N. A.

2014-01-01

Summary Noninvasive electrocardiographic imaging (ECGI) has been used in pediatric and congenital heart patients to better understand their electrophysiologic substrates. In this article we focus on the 4 subjects related to pediatric ECGI: 1) ECGI in patients with congenital heart disease and Wolff-Parkinson-White syndrome, 2) ECGI in patients with hypertrophic cardiomyopathy and pre-excitation, 3) ECGI in pediatric patients with Wolff-Parkinson-White syndrome, and 4) ECGI for pediatric cardiac resynchronization therapy. PMID:25722754

Preparation and evaluation of bioadhesive benzocaine gels for enhanced local anesthetic effects.

Science.gov (United States)

Shin, Sang-Chul; Lee, Jin-Woo; Yang, Kyu-Ho; Lee, Chi H

2003-07-09

This study was performed to develop new enhanced anesthetic benzocaine gels with a suitable bioadhesive property for local anesthetic effects. As the concentration of benzocaine in the HPMC gels increased up to 15%, the permeation of drug increased, thereafter slightly increased. The activation energy of drug permeation was 11.29 kcal/mol. Bioadhesive forces were also measured. The permeation rate of drug through the skin was studied using various enhancers, such as glycols, non-ionic surfactants or fatty acids. Among the enhancers used, diethylene glycol showed the most enhancing effects. Analgesic activity was examined using a tail-flick analgesimeter. According to the rat tail-flick test, the value of AUEC (0 - 360min) of 15% benzocaine gels containing diethylene glycol was 4662 +/- 200 s min, while that of gels without diethylene glycol was 3353 +/- 132 s min, showing about 1.39-fold increase in analgesic activity. Fifteen percentage of benzocaine gels containing diethylene glycol showed the most enhanced, prolonged analgesic effects, showing the maximum anesthetic effects at 240 min, while the gels without diethylene glycol showed maximum effect at 180 min.

The use of compound topical anesthetics: a review.

Science.gov (United States)

Kravitz, Neal D

2007-10-01

The author reviewed the history of, federal regulations regarding, risks of and adverse drug reactions of five compound topical anesthetics: tetracaine, adrenaline/epinephrine and cocaine (TAC); lidocaine, adrenaline/epinephrine and tetracaine (LET); lidocaine, tetracaine and phenylephrine (TAC 20 percent Alternate); lidocaine, prilocaine and tetracaine (Profound); and lidocaine, prilocaine, tetracaine and phenylephrine with thickeners (Profound PET). The author reviewed clinical trials, case reports, descriptive articles, and U.S. Food and Drug Administration (FDA) regulations and recent public advisory warnings regarding the federal approval of and risks associated with the use of compound topical anesthetics. Compound topical anesthetics are neither FDA-regulated nor -unregulated. Some compounding pharmacies bypass the new FDA drug approval process, which is based on reliable scientific data and ensures that a marketed drug is safe, effective, properly manufactured and accurately labeled. Two deaths have been attributed to the lay use of compound topical anesthetics. In response, the FDA has announced the strengthening of its efforts against unapproved drug products. Compound topical anesthetics may be an effective alternative to local infiltration for some minimally invasive dental procedures; however, legitimate concerns exist in regard to their safety. Until they become federally regulated, compound topical anesthetics remain unapproved drug products whose benefits may not outweigh their risks for dental patients.

Parent perspectives on privacy and governance for a pediatric repository of non-biological, research data.

Science.gov (United States)

Manhas, Kiran P; Page, Stacey; Dodd, Shawn X; Letourneau, Nicole; Ambrose, Aleta; Cui, Xinjie; Tough, Suzanne C

2015-02-01

Research data repositories (RDRs) are data storage entities where data can be submitted, stored, and subsequently accessed for purposes beyond the original intent. There is little information relating to non-biological RDRs, nor considerations regarding pediatric data storage and re-use. We examined parent perspectives on pediatric, non-biological RDRs. Qualitative, descriptive methods including both interviews and focus groups were used. Purposive sampling of adult participants in two provincial birth cohorts yielded 19 interviewees and 18 focus group participants (4 groups). Transcripts were analyzed by thematic content analysis. Parent research participants strongly supported the sharing of their own, and their child's, non-biological research data. Four themes emerged: that altruism has limits, that participants have ongoing privacy concerns, that some participants need the assurance of congruent values between themselves and researchers/research questions, and that opinions diverge for some governance issues. The establishment of RDRs is important and maximizes participants', researchers', and funders' investments. Participants as data donors have concerns relating to privacy, relationships, and governance that must be considered in RDR development. © The Author(s) 2014.

Occupational exposure to anesthetics leads to genomic instability, cytotoxicity and proliferative changes

International Nuclear Information System (INIS)

Souza, Kátina M.; Braz, Leandro G.; Nogueira, Flávia R.; Souza, Marajane B.; Bincoleto, Lahis F.; Aun, Aline G.; Corrente, José E.; Carvalho, Lídia R.; Braz, José Reinaldo C.; Braz, Mariana G.

2016-01-01

Highlights: • Anesthesiologists exposed to the most commonly used anesthetic gases were evaluated. • No alterations were detected for lymphocyte DNA damage detected by the comet assay. • Decreased frequencies of basal cells were detected in exfoliated buccal cells (BMCyt). • Increased frequencies of micronucleus and cytotoxicity were observed in BMCyt assay. • Anesthesiologists have genomic instability due to occupational exposure. - Abstract: Data on the genotoxic and mutagenic effects of occupational exposure to the most frequently used volatile anesthetics are limited and controversial. The current study is the first to evaluate genomic instability, cell death and proliferative index in exfoliated buccal cells (EBC) from anesthesiologists. We also evaluated DNA damage and determined the concentrations of the anesthetic gases most commonly used in operating rooms. This study was conducted on physicians who were allocated into two groups: the exposed group, which consisted of anesthesiologists who had been exposed to waste anesthetic gases (isoflurane, sevoflurane, desflurane and nitrous oxide − N 2 O) for at least two years; and the control group, which consisted of non-exposed physicians matched for age, sex and lifestyle with the exposed group. Venous blood and EBC samples were collected from all participants. Basal DNA damage was evaluated in lymphocytes by the comet assay, whereas the buccal micronucleus (MN) cytome (BMCyt) assay was applied to evaluate genotoxic and cytotoxic effects. The concentrations of N 2 O and anesthetics were measured via a portable infrared spectrophotometer. The average concentration of waste gases was greater than 5 parts per million (ppm) for all of the halogenated anesthetics and was more than 170 ppm for N 2 O, expressed as a time-weighted average. There was no significant difference between the groups in relation to lymphocyte DNA damage. The exposed group had higher frequencies of MN, karyorrhexis and pyknosis, and

Occupational exposure to anesthetics leads to genomic instability, cytotoxicity and proliferative changes

Energy Technology Data Exchange (ETDEWEB)

Souza, Kátina M.; Braz, Leandro G.; Nogueira, Flávia R.; Souza, Marajane B.; Bincoleto, Lahis F.; Aun, Aline G. [Faculdade de Medicina de Botucatu, UNESP − Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu (Brazil); Corrente, José E.; Carvalho, Lídia R. [Instituto de Biociências de Botucatu, UNESP − Univ Estadual Paulista, Departamento de Bioestatística, Botucatu (Brazil); Braz, José Reinaldo C. [Faculdade de Medicina de Botucatu, UNESP − Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu (Brazil); Braz, Mariana G., E-mail: mgbraz@hotmail.com [Faculdade de Medicina de Botucatu, UNESP − Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu (Brazil)

2016-09-15

Highlights: • Anesthesiologists exposed to the most commonly used anesthetic gases were evaluated. • No alterations were detected for lymphocyte DNA damage detected by the comet assay. • Decreased frequencies of basal cells were detected in exfoliated buccal cells (BMCyt). • Increased frequencies of micronucleus and cytotoxicity were observed in BMCyt assay. • Anesthesiologists have genomic instability due to occupational exposure. - Abstract: Data on the genotoxic and mutagenic effects of occupational exposure to the most frequently used volatile anesthetics are limited and controversial. The current study is the first to evaluate genomic instability, cell death and proliferative index in exfoliated buccal cells (EBC) from anesthesiologists. We also evaluated DNA damage and determined the concentrations of the anesthetic gases most commonly used in operating rooms. This study was conducted on physicians who were allocated into two groups: the exposed group, which consisted of anesthesiologists who had been exposed to waste anesthetic gases (isoflurane, sevoflurane, desflurane and nitrous oxide − N{sub 2}O) for at least two years; and the control group, which consisted of non-exposed physicians matched for age, sex and lifestyle with the exposed group. Venous blood and EBC samples were collected from all participants. Basal DNA damage was evaluated in lymphocytes by the comet assay, whereas the buccal micronucleus (MN) cytome (BMCyt) assay was applied to evaluate genotoxic and cytotoxic effects. The concentrations of N{sub 2}O and anesthetics were measured via a portable infrared spectrophotometer. The average concentration of waste gases was greater than 5 parts per million (ppm) for all of the halogenated anesthetics and was more than 170 ppm for N{sub 2}O, expressed as a time-weighted average. There was no significant difference between the groups in relation to lymphocyte DNA damage. The exposed group had higher frequencies of MN, karyorrhexis and

Novopen Echo® for the delivery of insulin: a comparison of usability, functionality and preference among pediatric subjects, their parents, and health care professionals

DEFF Research Database (Denmark)

Olsen, Birthe S; Lilleøre, Søren Kruse; Korsholm, Conny Nøhr

2010-01-01

Despite advances in insulin pen design and functionality, the selection of pens available for children with diabetes is limited. This study assessed the usability, functionality and attitudes towards NovoPen Echo®, a new durable insulin pen designed for pediatric patients that combines a simple...... memory function with half-increment dosing, versus NovoPen® Junior and HumaPen® Luxura™ HD in pediatric subjects, their parents, and health care professionals (HCPs)....

Vasoconstriction Potency Induced by Aminoamide Local Anesthetics Correlates with Lipid Solubility

Directory of Open Access Journals (Sweden)

Hui-Jin Sung

2012-01-01

Full Text Available Aminoamide local anesthetics induce vasoconstriction in vivo and in vitro. The goals of this in vitro study were to investigate the potency of local anesthetic-induced vasoconstriction and to identify the physicochemical property (octanol/buffer partition coefficient, pKa, molecular weight, or potency of local anesthetics that determines their potency in inducing isolated rat aortic ring contraction. Cumulative concentration-response curves to local anesthetics (levobupivacaine, ropivacaine, lidocaine, and mepivacaine were obtained from isolated rat aorta. Regression analyses were performed to determine the relationship between the reported physicochemical properties of local anesthetics and the local anesthetic concentration that produced 50% (ED50 of the local anesthetic-induced maximum vasoconstriction. We determined the order of potency (ED50 of vasoconstriction among local anesthetics to be levobupivacaine > ropivacaine > lidocaine > mepivacaine. The relative importance of the independent variables that affect the vasoconstriction potency is octanol/buffer partition coefficient > potency > pKa > molecular weight. The ED50 in endothelium-denuded aorta negatively correlated with the octanol/buffer partition coefficient of local anesthetics (r2=0.9563; P<0.001. The potency of the vasoconstriction in the endothelium-denuded aorta induced by local anesthetics is determined primarily by lipid solubility and, in part, by other physicochemical properties including potency and pKa.

Functional and Topological Conditions for Explosive Synchronization Develop in Human Brain Networks with the Onset of Anesthetic-Induced Unconsciousness.

Science.gov (United States)

Kim, Minkyung; Mashour, George A; Moraes, Stefanie-Blain; Vanini, Giancarlo; Tarnal, Vijay; Janke, Ellen; Hudetz, Anthony G; Lee, Uncheol

2016-01-01

Sleep, anesthesia, and coma share a number of neural features but the recovery profiles are radically different. To understand the mechanisms of reversibility of unconsciousness at the network level, we studied the conditions for gradual and abrupt transitions in conscious and anesthetized states. We hypothesized that the conditions for explosive synchronization (ES) in human brain networks would be present in the anesthetized brain just over the threshold of unconsciousness. To test this hypothesis, functional brain networks were constructed from multi-channel electroencephalogram (EEG) recordings in seven healthy subjects across conscious, unconscious, and recovery states. We analyzed four variables that are involved in facilitating ES in generic, non-biological networks: (1) correlation between node degree and frequency, (2) disassortativity (i.e., the tendency of highly-connected nodes to link with less-connected nodes, or vice versa), (3) frequency difference of coupled nodes, and (4) an inequality relationship between local and global network properties, which is referred to as the suppressive rule. We observed that the four network conditions for ES were satisfied in the unconscious state. Conditions for ES in the human brain suggest a potential mechanism for rapid recovery from the lightly-anesthetized state. This study demonstrates for the first time that the network conditions for ES, formerly shown in generic networks only, are present in empirically-derived functional brain networks. Further investigations with deep anesthesia, sleep, and coma could provide insight into the underlying causes of variability in recovery profiles of these unconscious states.

Management of exposure to waste anesthetic gases.

Science.gov (United States)

Smith, Francis Duval

2010-04-01

Anesthetic agents were developed in the 1700s, and nitrous oxide was first used in 1884. Research on the effects of waste anesthetic gas exposure started appearing in the literature in 1967. Short-term exposure causes lethargy and fatigue, and long-term exposure may be linked to spontaneous abortion, congenital abnormalities, infertility, premature births, cancer, and renal and hepatic disease. Today, perioperative staff members are exposed to trace amounts of waste anesthetic gas, and although this exposure cannot be eliminated, it can be controlled. Health care facilities are required to develop, implement, measure, and control practices to reduce anesthetic gas exposure to the lowest practical level. Exposure levels must be measured every six months and maintained at less than 25 parts per million for nitrous oxide and 2 parts per million for halogenated agents to be compliant with Occupational Safety and Health Administration standards. Copyright 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Anesthetic salts used in dentistry: a literature review

Directory of Open Access Journals (Sweden)

Guilherme Klein Parise

2017-08-01

Full Text Available Local anesthetics allow a better and suitable control of pain in patients that submit to dental treatments. The pharmacology of local anesthetics is too complex, therefore it is important to know how to select the correct drug to each procedure to be accomplished. Thus, it is concluded that the production of a literary review material is of great relevance in order to gather current and important information about the local anesthetics most used in dentistry.

Usage of lidocaine-prilocaine cream in the treatment of postburn pain in pediatric patients.

Science.gov (United States)

Kargi, Eksal; Tekerekoğlu, Bülent

2010-05-01

Facial burns are quite common among children. Many different wound-covers can be used for dressing burn wounds, which is usually painful for the patients. These covers can also be combined with local anesthetic creams. Lidocaine-prilocaine cream 5% (LPC) is commonly used as a topical anesthetic by physicians performing plastic surgery. In the present study, we investigated the effects of topical LPC on pain cessation in pediatric patients with face burn and compared results with a control group in which LPC was not used in the wound dressing. Thirty pediatric patients (average age 11.3, range 8-15) among those who admitted to our emergency service and plastic surgery outpatient clinic between 2003 and 2006 were included in this study. The patient's burned areas ranged between 1 and 5% percent of their total body surface. The need for analgesic medicine was recorded in the first, second and third 8-hour periods postburn in both groups, and pain level was evaluated at these time points using a verbal rating scale. There was a significant difference between the two groups with respect to values of the first and second 8-hour periods, while in the third 8-hour period, no significant difference was observed. We conclude that topical local anesthetics administered for 16 hours postburn significantly reduce the duration of pain after injury, which suggests a potential use in clinical practice in the treatment of children with face burn. While LPC was found to have an ameliorating effect in the first 16 hours, we recommend oral analgesic co-therapy support since it loses its efficacy in the last 8-hour period.

Anesthetic Efficacy of a Combination of 4% Prilocaine/2% Lidocaine with Epinephrine for the Inferior Alveolar Nerve Block: A Prospective, Randomized, Double-blind Study.

Science.gov (United States)

Cook, Olivia; Nusstein, John; Drum, Melissa; Fowler, Sara; Reader, Al; Draper, John

2018-05-01

Prilocaine plain has a high pH and concentration (4%), which could decrease the pain of injection and increase success. The purpose of this study was to compare pain associated with anesthetic solution deposition and the degree of pulpal anesthesia obtained with the combination of prilocaine and lidocaine versus a lidocaine and lidocaine combination when used for inferior alveolar nerve blocks (IANBs). One hundred eighteen asymptomatic subjects were randomly given a combination of 1 cartridge of 4% prilocaine plain plus 1 cartridge of 2% lidocaine with 1:100,000 epinephrine or a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine for the IANB at 2 separate appointments. Subjects rated the pain associated with anesthetic solution deposition of injection. Mandibular teeth were tested with an electric pulp tester every 4 minutes for 57 minutes. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 17 minutes and the 80 reading was continuously sustained for 57 minutes. Comparisons for anesthetic success were analyzed using the exact McNemar test, and pain ratings associated with anesthetic solution deposition were analyzed using multiple Wilcoxon matched pairs signed rank tests; both were adjusted using the step-down Bonferroni method of Holm. Four percent prilocaine plain was significantly less painful upon anesthetic solution deposition. Pulpal anesthetic success was not significantly different between the 2 combinations. The combination of 4% prilocaine plain plus 2% lidocaine with 1:100,000 epinephrine did not increase pulpal anesthetic success for IANBs compared with a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine. Pain associated with anesthetic solution deposition from the first cartridge of 4% prilocaine plain was significantly less when compared with the first cartridge of 2% lidocaine with 1:100,000 epinephrine. Copyright © 2018 American Association of Endodontists. Published

Comparison of anesthetic agents in the sea otter

Energy Technology Data Exchange (ETDEWEB)

Williams, T.D.; Kocher, F.H.

1978-01-01

Five anesthetic agents (CI744, etorphine, fentanyl, ketamine hydrochloride, and halothane) were tested to establish the dosage of a safe, effective, short-acting anesthetic for use in the sea otter. Etorphine, at a dosage of 0.75 mg per adult otter and used in conjunction with diazepam, at a dosage of 1.25 mg per adult otter, met most of the requirements for use under field conditions. Halothane, administered through an anesthetic machine, proved to be effective for use in a veterinary hospital.

Anesthesia for Pediatric Lung Transplantation: Case Presentation and Review of the Literature

Directory of Open Access Journals (Sweden)

Premal M Trivedi

2017-08-01

Full Text Available The first pediatric lung transplant was performed in 1987 at the University of Toronto in a 15-year-old with familial pulmonary fibrosis. Since that time, over 2000 children have received lung transplants worldwide, with an annual number ranging between 99 and 137 over the past decade. For the anesthesiologist charged with managing these rare patients, an understanding of the indications that lead to transplantation, their pathophysiology, and the physiology of the transplanted lungs are critical. To provide a context for the anesthetic management of the child undergoing lung transplantation, we discuss the case of a 2-month-old who underwent bilateral lung transplantation for intractable respiratory failure. Both the unique aspects of this case and pediatric lung transplantation, in general, are presented. Then a review of the literature is discussed.

[Case report : usefulness of the airwayscope for difficult intubations in a pediatric patients with Coffin-Siris syndrome].

Science.gov (United States)

Sakugawa, Yoko; Kamizato, Kota; Miyata, Yuji; Kakinohana, Manabu; Sugahara, Kazuhiro

2013-05-01

We experienced management of general anesthesia in a patients with Coffin-Siris syndrome (CS syndrome) which is an autosomal dominant disorder characterized by mental retardation, growth failure, hypoplasia of the fifth finger's distal phalanx and limb, and syndrome-specific facial appearance. Anesthesia was induced by sevoflurane by mask. After obtaining muscle relaxation by rocuronium, laryngoscopy by Machintosh #2 failed to reveal the vocal cord. However, the vocal cord was revealed by AirwayScope (AWS) for the pediatrics and then tracheal intubation was successful. Surgical procedures and anes-thetic management were performed uneventfully. This case demonstrates usefulness of AWS in pediatric patients with difficult intubation.

Challenges Encountered Using Ophthalmic Anesthetics in Space Medicine

Science.gov (United States)

Bayuse, T.; Law, J.; Alexander, D.; Moynihan, S.; LeBlanc, C.; Langford, K.; Magalhaes, L.

2015-01-01

On orbit, ophthalmic anesthetics are used for tonometry and off-nominal corneal examinations. Proparacaine has been flown traditionally. However, the manufacturers recently changed its storage requirements from room temperature storage to refrigerated storage to preserve stability and prolong the shelf-life. Since refrigeration on orbit is not readily available and there were stability concerns about flying proparacaine unrefrigerated, tetracaine was selected as an alternative ophthalmic anesthetic in 2013. We will discuss the challenges encountered flying and using these anesthetics on the International Space Station.

Local Anesthetics: Review of Pharmacological Considerations

Science.gov (United States)

Becker, Daniel E; Reed, Kenneth L

2012-01-01

Local anesthetics have an impressive history of efficacy and safety in medical and dental practice. Their use is so routine, and adverse effects are so infrequent, that providers may understandably overlook many of their pharmacotherapeutic principles. The purpose of this continuing education article is to provide a review and update of essential pharmacology for the various local anesthetic formulations in current use. Technical considerations will be addressed in a subsequent article. PMID:22822998

Addition of lacal anesthetics to contrast media. Pt. 2

International Nuclear Information System (INIS)

Nilsson, P.; Almen, T.; Golman, K.; Jonsson, K.; Nyman, U.; Malmoe Allmaenna Sjukhus

1988-01-01

The acute intravenous toxicity (i.v. LD 50 ) of solutions of the ratio 1.5 contrast media metrizoate or diatrizoate and the ratio 3.0 contrast medium metrizamide was determined in mice with and without the addition of local anesthetics to the solutions. The two local anesthetics mepivacaine or lidocaine were added to final concentrations up to 2.0 mg/ml of the contrast medium solutions. This corresponds to clinically used concentrations. All additions of local anesthetics to the solutions increased the mortalities caused by the contrast medium solutions. Addition of local anesthetics to a final concentration of 2 mg/ml approximately doubled the acute intravenous toxicity of the contrast media. The ratio 3 contrast media produce less hypertonic solutions than the ratio 1.5 contrast media and should be preferred for angiography because they cause less pain and do not require the addition of local anesthetics which increase the acute toxicity of the solutions. (orig.)

[Intra-anesthetic arterial hypotension in elderly patients during emergency surgery: what are the risk factors?

Science.gov (United States)

Boubacar Ba, El Hadji; Leye, Papa Alassane; Traoré, Mamadou Mour; Ndiaye, Pape Ibrahima; Gaye, Ibrahima; Bah, Mamadou Diawo; Fall, Mamadou Lamine; Diouf, Elisabeth

2017-01-01

Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.

Factors associated with non-reimbursable activity on an inpatient pediatric consultation-liaison service.

Science.gov (United States)

Bierenbaum, Melanie L; Katsikas, Steven; Furr, Allen; Carter, Bryan D

2013-12-01

The aim of this study was to identify factors contributing to clinician time spent in non-reimbursable activity on an inpatient pediatric consultation-liaison (C-L) service. A retrospective study was conducted using inpatient C-L service data on 1,246 consecutive referrals. For this patient population, the strongest predictor of level of non-reimbursable clinical activity was illness chronicity and the number of contacts with C-L service clinicians during their hospital stay. Patients with acute life-threatening illnesses required the highest mean amount of non-reimbursable service activity. On average, 28 % of total clinician time in completing a hospital consultation was spent in non-reimbursable activity. Effective C-L services require a proportion of time spent in non-reimbursable clinical activity, such as liaison and coordinating care with other providers. Identifying referral and systemic factors contributing to non-reimbursable activity can provide insight into budgeting/negotiating for institutional support for essential clinical and non-clinical functions in providing competent quality patient care.

Life cycle greenhouse gas emissions of anesthetic drugs.

Science.gov (United States)

Sherman, Jodi; Le, Cathy; Lamers, Vanessa; Eckelman, Matthew

2012-05-01

Anesthesiologists must consider the entire life cycle of drugs in order to include environmental impacts into clinical decisions. In the present study we used life cycle assessment to examine the climate change impacts of 5 anesthetic drugs: sevoflurane, desflurane, isoflurane, nitrous oxide, and propofol. A full cradle-to-grave approach was used, encompassing resource extraction, drug manufacturing, transport to health care facilities, drug delivery to the patient, and disposal or emission to the environment. At each stage of the life cycle, energy, material inputs, and emissions were considered, as well as use-specific impacts of each drug. The 4 inhalation anesthetics are greenhouse gases (GHGs), and so life cycle GHG emissions include waste anesthetic gases vented to the atmosphere and emissions (largely carbon dioxide) that arise from other life cycle stages. Desflurane accounts for the largest life cycle GHG impact among the anesthetic drugs considered here: 15 times that of isoflurane and 20 times that of sevoflurane on a per MAC-hour basis when administered in an O(2)/air admixture. GHG emissions increase significantly for all drugs when administered in an N(2)O/O(2) admixture. For all of the inhalation anesthetics, GHG impacts are dominated by uncontrolled emissions of waste anesthetic gases. GHG impacts of propofol are comparatively quite small, nearly 4 orders of magnitude lower than those of desflurane or nitrous oxide. Unlike the inhaled drugs, the GHG impacts of propofol primarily stem from the electricity required for the syringe pump and not from drug production or direct release to the environment. Our results reiterate previous published data on the GHG effects of these inhaled drugs, while providing a life cycle context. There are several practical environmental impact mitigation strategies. Desflurane and nitrous oxide should be restricted to cases where they may reduce morbidity and mortality over alternative drugs. Clinicians should avoid

Detomidine reduces isoflurane anesthetic requirement (MAC) in horses.

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Steffey, Eugene P; Pascoe, Peter J

2002-10-01

To quantitate the dose- and time-related magnitude of the anesthetic sparing effect of, and selected physiological responses to detomidine during isoflurane anesthesia in horses. Randomized cross-over study. Three, healthy, young adult horses weighing 485 ± 14 kg. Horses were anesthetized on two occasions to determine the minimum alveolar concentration (MAC) of isoflurane in O 2 and then to measure the anesthetic sparing effect (time-related MAC reduction) following IV detomidine (0.03 and 0.06 mg kg -1 ). Selected common measures of cardiopulmonary function, blood glucose and urinary output were also recorded. Isoflurane MAC was 1.44 ± 0.07% (mean ± SEM). This was reduced by 42.8 ± 5.4% and 44.8 ± 3.0% at 83 ± 23 and 125 ± 36 minutes, respectively, following 0.03 and 0.06 mg kg -1 , detomidine. The MAC reduction was detomidine dose- and time-dependent. There was a tendency for mild cardiovascular and respiratory depression, especially following the higher detomidine dose. Detomidine increased both blood glucose and urine flow; the magnitude of these changes was time- and dose-dependent CONCLUSIONS: Detomidine reduces anesthetic requirement for isoflurane and increases blood glucose concentration and urine flow in horses. These changes were dose- and time-related. The results imply potent anesthetic sparing actions by detomidine. The detomidine-related increased urine flow should be considered in designing anesthetic protocols for individual horses. Copyright © 2002 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Introduction-Pediatric epilepsy surgery techniques.

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Rydenhag, Bertil; Cukiert, Arthur

2017-04-01

This supplement includes the proceedings from the Pediatric Epilepsy Surgery Techniques Meeting held in Gothenburg (July 4-5, 2014), which focused on presentations and discussions regarding specific surgical technical issues in pediatric epilepsy surgery. Pediatric epilepsy neurosurgeons from all over the world were present and active in very fruitful and live presentations and discussions. These articles represent a synopsis of the areas and subjects dealt with there. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

Validation of the bispectral index as an indicator of anesthetic depth in Thoroughbred horses anesthetized with sevoflurane.

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Tokushige, Hirotaka; Kakizaki, Masashi; Ode, Hirotaka; Okano, Atsushi; Okada, Jun; Kuroda, Taisuke; Wakuno, Ai; Ohta, Minoru

2016-01-01

To evaluate the bispectral index (BIS) as an indicator of anesthetic depth in Thoroughbred horses, BIS values were measured at multiple stages of sevoflurane anesthesia in five horses anesthetized with guaifenesin and thiopental following premedication with xylazine. There was no significant difference between the BIS values recorded at end-tidal sevoflurane concentrations of 2.8% (median 60 ranging from 47 to 68) and 3.5% (median 71 ranging from 49 to 82) in anesthetized horses. These BIS values during anesthesia were significantly lower (Phorses (median 98 ranging from 98 to 98) or sedated horses (median 92 ranging from 80 to 93). During the recovery phase, the BIS values gradually increased over time but did not significantly increase until the horses showed movement. In conclusion, the BIS value could be useful as an indicator of awakening during the recovery period in horses, as previous reported.

The pharmacological effects of the anesthetic alfaxalone after intramuscular administration to dogs.

Science.gov (United States)

Tamura, Jun; Ishizuka, Tomohito; Fukui, Sho; Oyama, Norihiko; Kawase, Kodai; Miyoshi, Kenjiro; Sano, Tadashi; Pasloske, Kirby; Yamashita, Kazuto

2015-03-01

The pharmacological effects of the anesthetic alfaxalone were evaluated after intramuscular (IM) administration to 6 healthy beagle dogs. The dogs received three IM doses each of alfaxalone at increasing dose rates of 5 mg/kg (IM5), 7.5 mg/kg (IM7.5) and 10 mg/kg (IM10) every other day. Anesthetic effect was subjectively evaluated by using an ordinal scoring system to determine the degree of neuro-depression and the quality of anesthetic induction and recovery from anesthesia. Cardiorespiratory variables were measured using noninvasive methods. Alfaxalone administered IM produced dose-dependent neuro-depression and lateral recumbency (i.e., 36 ± 28 min, 87 ± 26 min and 115 ± 29 min after the IM5, IM7.5 and IM10 treatments, respectively). The endotracheal tube was tolerated in all dogs for 46 ± 20 and 58 ± 21 min after the IM7.5 and IM10 treatments, respectively. It was not possible to place endotracheal tubes in 5 of the 6 dogs after the IM5 treatment. Most cardiorespiratory variables remained within clinically acceptable ranges, but hypoxemia was observed by pulse oximetry for 5 to 10 min in 2 dogs receiving the IM10 treatment. Dose-dependent decreases in rectal temperature, respiratory rate and arterial blood pressure also occurred. The quality of recovery was considered satisfactory in all dogs receiving each treatment; all the dog exhibited transient muscular tremors and staggering gait. In conclusion, IM alfaxalone produced a dose-dependent anesthetic effect with relatively mild cardiorespiratory depression in dogs. However, hypoxemia may occur at higher IM doses of alfaxalone.

Intravenous sub-anesthetic ketamine for perioperative analgesia

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Andrew W Gorlin

2016-01-01

Full Text Available Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine′s metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

Integrative Literature Review: Ascertaining Discharge Readiness for Pediatrics After Anesthesia.

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Whitley, Deborah R

2016-02-01

Unplanned hospital readmissions after the administration of general anesthesia for ambulatory procedures may contribute to loss of reimbursement and assessment of financial penalties. Pediatric patients represent a unique anesthetic risk. The purpose of this integrative literature review was to ascertain specific criteria used to evaluate discharge readiness for pediatric patients after anesthesia. This study is an integrative review of literature. An integrative literature search was conducted and included literature sources dated January 2008 to November 2013. Key words included pediatric, anesthesia, discharge, criteria, standards, assessment, recovery, postoperative, postanesthesia, scale, score, outpatient, and ambulatory. Eleven literature sources that contributed significantly to the research question were identified. Levels of evidence included three systematic reviews, one randomized controlled trial, three cohort studies, two case series, and two expert opinions. This integrative literature review revealed evidence-based discharge criteria endorsing home readiness for postanesthesia pediatric patients should incorporate consideration for physiological baselines, professional judgment with regard to infant consciousness, and professional practice standards/guidelines. Additionally, identifying and ensuring discharge to a competent adult was considered imperative. Nurses should be aware that frequently used anesthesia scoring systems originated in the 1970s, and this review was unable to locate current literature examining the reliability and validity of their use in conjunction with modern anesthesia-related health care practices. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions

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Vajro Pietro

2012-10-01

Full Text Available Abstract The epidemics of overweight and obesity has resulted in a significant increase of non alcoholic fatty liver disease (NAFLD, a potentially progressive condition. Currently, obesity related hepatopathy represents therefore the main cause of pediatric chronic liver disease. The first choice treatment at all ages is weight loss and/or lifestyle changes, however compliance is very poor and a pharmacological approach has become necessary. In the present article we present a systematic literature review focusing on established pediatric NALFD drugs (ursodeoxycholic acid, insulin sensitizers, and antioxidants and on innovative therapeutic options as well. Regarding the former ones, a pediatric pilot study highlighted that ursodeoxycholic acid is not efficient on transaminases levels and bright liver. Similarly, a recent large scale, multicenter randomized clinical trial (TONIC study showed that also insulin sensitizers and antioxidant vitamin E have scarce effects on serum transaminase levels. Among a large series of novel therapeutic approaches acting on recently proposed different pathomechanisms, probiotics seem hitherto the most interesting and reasonable option for their safety and tolerability. Toll-like receptors modifiers, Pentoxifylline, and Farnesoid X receptors agonists have been still poorly investigated, and will need further studies before becoming possible promising innovative therapeutic strategies.

[Anesthetic management of four patients with Fournier syndrome].

Science.gov (United States)

Sato, Rui; Tomioka, Toshiya; Orii, Ryo; Yamada, Yoshitsugu

2008-03-01

We experienced anesthetic managements of four patients with Fournier syndrome. In the anesthetic management of the patients with Fournier syndrome the following three points should be kept in mind; (a) the necessity of careful preoperative examination, (b) the better anesthesia, and (c) the careful postoperative care.

THE EFFECT OF LOCAL ANESTHETICS ON TEAR PRODUCTION

African Journals Online (AJOL)

that local anesthetics measure only basic secretion thus reducing normal tear production/secretion, which is both reflex and basic. This could be attributed to the fact that local anesthetics have an adrenergic potentiating effects and because lacrimal fluid receive a preganglionic parasympathetic supply from lacrimal muscles ...

Management of pediatric tonsillectomy pain: a review of the literature

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Hansen J

2016-05-01

Full Text Available Jennifer Hansen, Ravi D Shah, Hubert A Benzon Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: Tonsillectomy is associated with significant pain and postoperative pain control is often unsatisfactory. We discuss the various strategies that have been investigated to control pain following tonsillectomy. Codeine is a weak analgesic frequently used in children for the treatment of mild-to-moderate pain, however, due to adverse events related to its metabolism, it has been contraindicated for postoperative pain in children since 2013. Intravenous morphine is frequently used for moderate-to-severe pain in children, however, its active metabolite can lead to respiratory depressant and other undesirable side effects. Hydromorphone is a commonly used alternative that has been studied infrequently. Alternatives to narcotic pain strategies have also been studied. Nonsteroidal anti-inflammatory drugs (NSAIDs are effective as analgesics, yet many practitioners avoid their use given the concern for postoperative bleeding. Intraoperative acetaminophen has been shown to improve postoperative pain and decrease recovery room time. Dexamethasone has been shown to improve postoperative pain, vomiting, and decrease airway swelling, and seems to be effective for use during tonsillectomy surgery. Ketamine has been shown to decrease analgesic requirements without adverse affects of hallucinations. Direct injection of local anesthetic into the tonsillar bed has been shown to be effective in improving pain control, however, there is concern that local anesthetic could be erroneously injected into the carotid artery and lead to devastating consequences. Optimal pain control regimens following pediatric tonsillectomy continue to be a challenge for both anesthesiologists and otorhinolaryngologists. Opioids are the most commonly used but are

E-learning in pediatric basic life support: a randomized controlled non-inferiority study.

Science.gov (United States)

Krogh, Lise Qvirin; Bjørnshave, Katrine; Vestergaard, Lone Due; Sharma, Maja Bendtsen; Rasmussen, Stinne Eika; Nielsen, Henrik Vendelbo; Thim, Troels; Løfgren, Bo

2015-05-01

Dissemination of pediatric basic life support (PBLS) skills is recommended. E-learning is accessible and cost-effective, but it is currently unknown whether laypersons can learn PBLS through e-learning. The hypothesis of this study was to investigate whether e-learning PBLS is non-inferior to instructor-led training. Participants were recruited among child-minders and parents of children aged 0-6 years. Participants were randomized to either 2-h instructor-led training or e-learning using an e-learning program (duration 17 min) including an inflatable manikin. After training, participants were assessed in a simulated pediatric cardiac arrest scenario. Tests were video recorded and PBLS skills were assessed independently by two assessors blinded to training method. Primary outcome was the pass rate of the PBLS test (≥8 of 15 skills adequately performed) with a pre-specified non-inferiority margin of 20%. In total 160 participants were randomized 1:1. E-learning was non-inferior to instructor-led training (difference in pass rate -4%; 95% CI -9:0.5). Pass rates were 100% among instructor-led trained (n=67) and 96% among e-learned (n=71). E-learners median time spent on the e-learning program was 30 min (range: 15-120 min) and the median number of log-ons was 2 (range: 1-5). After the study, all participants felt that their skills had improved. E-learning PBLS is non-inferior to instructor-led training among child-minders and parents with children aged 0-6 years, although the pass rate was 4% (95% CI -9:0.5) lower with e-learning. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Blood profiles in unanesthetized and anesthetized guinea pigs (Cavia porcellus).

Science.gov (United States)

Williams, Wendy R; Johnston, Matthew S; Higgins, Sarah; Izzo, Angelo A; Kendall, Lon V

2016-01-01

The guinea pig is a common animal model that is used in biomedical research to study a variety of systems, including hormonal and immunological responses, pulmonary physiology, corticosteroid response and others. However, because guinea pigs are evolutionarily a prey species, they do not readily show behavioral signs of disease, which can make it difficult to detect illness in a laboratory setting. Minimally invasive blood tests, such as complete blood counts and plasma biochemistry assays, are useful in both human and veterinary medicine as an initial diagnostic technique to rule in or rule out systemic illness. In guinea pigs, phlebotomy for such tests often requires that the animals be anesthetized first. The authors evaluated hematological and plasma biochemical effects of two anesthetic agents that are commonly used with guinea pigs in a research setting: isoflurane and a combination of ketamine and xylazine. Hematological and plasma biochemical parameters were significantly different when guinea pigs were under either anesthetic, compared to when they were unanesthetized. Plasma proteins, liver enzymes, white blood cells and red blood cells appeared to be significantly altered by both anesthetics, and hematological and plasma biochemical differences were greater when guinea pigs were anesthetized with the combination of ketamine and xylazine than when they were anesthetized with isoflurane. Overall these results indicate that both anesthetics can significantly influence hematological and plasma biochemical parameters in guinea pigs.

Memory-impairing effects of local anesthetics in an elevated plus-maze test in mice

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S.L. Blatt

1998-04-01

Full Text Available Post-training intracerebroventricular administration of procaine (20 µg/µl and dimethocaine (10 or 20 µg/µl, local anesthetics of the ester class, prolonged the latency (s in the retention test of male and female 3-month-old Swiss albino mice (25-35 g body weight; N = 140 in the elevated plus-maze (mean ± SEM for 10 male mice: control = 41.2 ± 8.1; procaine = 78.5 ± 10.3; 10 µg/µl dimethocaine = 58.7 ± 12.3; 20 µg/µl dimethocaine = 109.6 ± 5.73; for 10 female mice: control = 34.8 ± 5.8; procaine = 55.3 ± 13.4; 10 µg/µl dimethocaine = 59.9 ± 12.3 and 20 µg/µl dimethocaine = 61.3 ± 11.1. However, lidocaine (10 or 20 µg/µl, an amide class type of local anesthetic, failed to influence this parameter. Local anesthetics at the dose range used did not affect the motor coordination of mice exposed to the rota-rod test. These results suggest that procaine and dimethocaine impair some memory process(es in the plus-maze test. These findings are interpreted in terms of non-anesthetic mechanisms of action of these drugs on memory impairment and also confirm the validity of the elevated plus-maze for the evaluation of drugs affecting learning and memory in mice

Relationship between potency and boiling point of general anesthetics: a thermodynamic consideration.

Science.gov (United States)

Dastmalchi, S; Barzegar-Jalali, M

2000-07-20

The most important group of nonspecific drugs is that of the general anesthetics. These nonspecific compounds vary greatly in structure, from noble gases such as Ar or Xe to complex steroids. Since the development of clinical anesthesia over a century ago, there has been a vast amount of research and speculation concerning the mechanism of action of general anesthetics. Despite these efforts, the exact mechanism remains unknown. Many theories of narcosis do not explain how unconsciousness is produced at a molecular level, but instead relate some physicochemical property of anesthetic agents to their anesthetic potencies. In this paper, we address some of those physicochemical properties, with more emphasis on correlating the anesthetic potency of volatile anesthetics to their boiling points based on thermodynamic principles.

ANESTHETIC INDUCTION AND RECOVERY PARAMETERS IN BEARDED DRAGONS (POGONA VITTICEPS): COMPARISON OF ISOFLURANE DELIVERED IN 100% OXYGEN VERSUS 21% OXYGEN.

Science.gov (United States)

O, Odette; Churgin, Sarah M; Sladky, Kurt K; Smith, Lesley J

2015-09-01

Inland bearded dragons (Pogona vitticeps, n=6) were anesthetized for 1 hr using isoflurane in either 100% oxygen or 21% oxygen (FI 21; medical-grade room air). Parameters of anesthetic depth were recorded throughout both induction and recovery by an observer blinded to the fraction of inspired oxygen (FiO2), including the loss and return of withdrawal and righting reflexes, muscle tone, ability to intubate or extubate, and return to spontaneous respiration. Physiologic data were recorded every 5 min throughout the anesthetic procedures, including heart rate, body temperature, end-tidal CO2, hemoglobin oxygen saturation (SpO2), and percent expired isoflurane. Lizards were subjected to application of a noxious stimulus (needle stick) at 0, 30, and 60 min, and responses recorded. Following a minimum 7-day washout period, the experiment was repeated with each lizard subjected to the other protocol in a randomized, complete crossover design. The only statistically significant difference was a lower mean SpO2 in the group inspiring 21% oxygen (P<0.0020). No statistically significant differences were detected in any parameters during induction or recovery; however, all values were uniformly shorter for the FI 21 group, indicating a possible clinically significant difference. A larger sample size may have detected statistically significant differences. Further studies are needed to evaluate these effects in other reptile species and with the concurrent use of injectable anesthetic and analgesic drugs.

Dose-Dependent Protective Effect of Inhalational Anesthetics Against Postoperative Respiratory Complications

DEFF Research Database (Denmark)

Grabitz, Stephanie D; Farhan, Hassan N; Ruscic, Katarina J

2017-01-01

OBJECTIVES: Inhalational anesthetics are bronchodilators with immunomodulatory effects. We sought to determine the effect of inhalational anesthetic dose on risk of severe postoperative respiratory complications. DESIGN: Prospective analysis of data on file in surgical cases between January 2007...... with endotracheal intubation. INTERVENTIONS: Median effective dose equivalent of inhalational anesthetics during surgery (derived from mean end-tidal inhalational anesthetic concentrations). MEASUREMENTS AND MAIN RESULTS: Postoperative respiratory complications occurred in 6,979 of 124,497 cases (5.61%). High...... inhalational anesthetic dose of 1.20 (1.13-1.30) (median [interquartile range])-fold median effective dose equivalent versus 0.57 (0.45-0.64)-fold median effective dose equivalent was associated with lower odds of postoperative respiratory complications (odds ratio, 0.59; 95% CI, 0.53-0.65; p

Cell shape changes induced by cationic anesthetics

Science.gov (United States)

1976-01-01

The effects of local anesthetics on cultivated macrophages were studied in living preparations and recorded in still pictures and time-lapse cine-micrographs. Exposure to 12mM lidocaine or 1.5 mM tetracaine resulted in rounding in 10-15 min. Rounding was characterized by cell contraction, marked increase in retraction fibrils, withdrawal of cell processes, and, in late stages, pulsation-like activity and zeiosis. Cells showed appreciable membrane activity as they rounded. Respreading was complete within 15 min of perfusion in drug-free medium and entailed a marked increase in surface motility over control periods. As many as eight successive cycles of rounding and spreading were obtained with lidocaine without evidence of cell damage. The effects of anesthetics were similar to those observed with EDTA, but ethylene- glycol-bis(beta-aminoethylether)-N, N'-tetraacetic acid-Mg was ineffective. Rounding was also induced by benzocaine, an anesthetic nearly uncharged at pH 7.0. Quaternary (nondischargeable) compounds were of low activity, presumably because they are slow permeants. Lidocaine induced rounding at 10 degrees C and above but was less effective at 5 degrees C and ineffective at 0 degrees C. Rounding by the anesthetic was also obtained in media depleted or Na or enriched with 10 mM Ca or Mg. The latter finding, together with the failure of tetrodotoxin to induce rounding, suggests that the anesthetic effect is unrelated to inhibition of sodium conductance. It is possible that the drugs influence divalent ion fluxes or some component of the contractile cells' machinery, but a metabolic target of action cannot yet be excluded. PMID:814194

ANESTHETIC MANAGEMENT FOR A PATIENT WITH ACUTE INTERMITTENT PORPHYRIA

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Nenad Savić

2010-09-01

Full Text Available Acute intermittent porphyria is a rare metabolic disorder resulting from a partial deficiency of porphobilinogen deaminase, enzyme in the heme biosynthetic pathway. Its inheritance is autosomal dominant. A deficiency of porphobilinogen deaminase is not sufficient by its self to produce acute intermittent porphyria, and other activating factors must also be present. These include some drugs, hormones, infection, injury and alcohol. Besides others, anesthetics have been implicated in the triggering of a number of severe porphyric reactions. Although there is no clinical evidence, the fear of hypothesized porphyrinogenicity of repetitive anesthetics exposures still remains. Despite these doubts, we report here the case of uneventful repeated exposure to anesthetics in a patient suffering from acute intermittent porphyria, within a fifteen- month period. On both occasions, the patient was safely exposed to certain anesthetics included: propofol, sevoflurane, rocuronium, midazolam and fentanyl.

Pediatric awake craniotomy for seizure focus resection with dexmedetomidine sedation-a case report.

Science.gov (United States)

Sheshadri, Veena; Chandramouli, B A

2016-08-01

Resection of lesions near the eloquent cortex of brain necessitates awake craniotomy to reduce the risk of permanent neurologic deficits during surgery. There are limited reports of anesthetic management of awake craniotomy in pediatric patients. This report is on use of dexmedetomidine sedation for awake craniotomy in a 11-year-old child, without any airway adjuncts throughout the procedure. Dexmedetomidine infusion administered at a dosage of 0.2 to 0.7μg kg(-1) h(-1) provided adequate sedation for the entire procedure. There were no untoward incidents or any interference with electrocorticography, intraoperative stimulation, and functional mapping. Adequate preoperative visits and counseling of patient and parents regarding course and nature of events along with well-planned intraoperative management are of utmost importance in a pediatric age group for successful intraoperative awake craniotomy. Copyright © 2016 Elsevier Inc. All rights reserved.

Tolerance to acute isovolemic hemodilution. Effect of anesthetic depth

NARCIS (Netherlands)

van der Linden, Philippe; de Hert, Stefan; Mathieu, Nathalie; Degroote, Françoise; Schmartz, Denis; Zhang, Haibo; Vincent, Jean-Louis

2003-01-01

BACKGROUND: Acceptance of a lower transfusion trigger in the perioperative period requires study of the effects of anesthetic depth on the tolerance to acute isovolemic anemia. Anesthetic agents with negative effects on the cardiovascular system may exert proportionately greater depressant effects

Comparative audit of clinical research in pediatric neurology.

Science.gov (United States)

Al-Futaisi, Amna; Shevell, Michael

2004-11-01

Clinical research involves direct observation or data collection on human subjects. This study was conducted to evaluate the profile of pediatric neurology clinical research over a decade. Trends in pediatric neurology clinical research were documented through a systematic comparative review of articles published in selected journals. Eleven journals (five pediatric neurology, three general neurology, three general pediatrics) were systematically reviewed for articles involving a majority of human subjects less than 18 years of age for the years 1990 and 2000. Three hundred thirty-five clinical research articles in pediatric neurology were identified in the 11 journals for 1990 and 398 for 2000, a 19% increase. A statistically significant increase in analytic design (21.8% vs 39.5%; P = .01), statistical support (6% vs 16.6%; P neurology over a decade. Trends apparently suggest a more rigorous approach to study design and investigation in this field.

Anesthetic and Perioperative Management of Patients With Brugada Syndrome.

Science.gov (United States)

Dendramis, Gregory; Paleologo, Claudia; Sgarito, Giuseppe; Giordano, Umberto; Verlato, Roberto; Baranchuk, Adrian; Brugada, Pedro

2017-09-15

Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit. For this reason, in the anesthesia management of patients with BrS, the decision of using each drug must be made after careful consideration and always in controlled conditions, avoiding other factors that are known to have the potential to induce arrhythmias and with a close cooperation between anesthetists and cardiologists, which is essential before and after surgery. In conclusion, given the absence of large studies in literature, we want to focus on some general rules, which resulted from case series and clinical practice, to be followed during the perioperative and anesthetic management of patients with BrS. Copyright © 2017 Elsevier Inc. All rights reserved.

Toxic keratopathy due to abuse of topical anesthetic drugs.

Science.gov (United States)

Yeniad, Baris; Canturk, Serife; Esin Ozdemir, Fatma; Alparslan, Nilufer; Akarcay, Koray

2010-06-01

To describe 8 cases of toxic keratopathy due to abuse of topical anesthetic drugs. Clinical findings from patients with toxic keratopathy were investigated retrospectively. Two patients had toxic keratopathy bilaterally. Five of 8 patients had an ocular history of a corneal foreign body, 1 had basal membrane dystrophy, 1 had ultraviolet radiation, and 1 had chemical burn. All patients had undergone psychiatric consultation. Four patients had anxiety disorder and 1 had bipolar disease. Clinical signs were improved in all patients with discontinuation of topical anesthetic drug use along with adjunctive psychiatric treatment. Penetrating keratoplasty was performed in 2 patients. Toxic keratopathy due to topical anesthetic abuse is a curable disease. Early diagnosis and prevention of topical anesthetic drug use are the most important steps in the treatment of this condition. As these patients commonly exhibit psychiatric disorders, adjunctive psychiatric treatment may help to break the chemical addiction.

Pediatric medical device development by surgeons via capstone engineering design programs.

Science.gov (United States)

Sack, Bryan S; Elizondo, Rodolfo A; Huang, Gene O; Janzen, Nicolette; Espinoza, Jimmy; Sanz-Cortes, Magdalena; Dietrich, Jennifer E; Hakim, Julie; Richardson, Eric S; Oden, Maria; Hanks, John; Haridas, Balakrishna; Hury, James F; Koh, Chester J

2018-03-01

There is a need for pediatric medical devices that accommodate the unique physiology and anatomy of pediatric patients that is increasingly receiving more attention. However, there is limited literature on the programs within children's hospitals and academia that can support pediatric device development. We describe our experience with pediatric device design utilizing collaborations between a children's hospital and two engineering schools. Utilizing the academic year as a timeline, unmet pediatric device needs were identified by surgical faculty and matched with an engineering mentor and a team of students within the Capstone Engineering Design programs at two universities. The final prototypes were showcased at the end of the academic year and if appropriate, provisional patent applications were filed. All twelve teams successfully developed device prototypes, and five teams obtained provisional patents. The prototypes that obtained provisional patents included a non-operative ureteral stent removal system, an evacuation device for small kidney stone fragments, a mechanical leech, an anchoring system of the chorio-amniotic membranes during fetal surgery, and a fetal oxygenation monitor during fetoscopic procedures. Capstone Engineering Design programs in partnership with surgical faculty at children's hospitals can play an effective role in the prototype development of novel pediatric medical devices. N/A - No clinical subjects or human testing was performed. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of use of an infrared anesthetic gas monitor and refractometry for measurement of anesthetic agent concentrations.

Science.gov (United States)

Ambrisko, Tamas D; Klide, Alan M

2011-10-01

To assess agreement between anesthetic agent concentrations measured by use of an infrared anesthetic gas monitor (IAGM) and refractometry. SAMPLE-4 IAGMs of the same type and 1 refractometer. Mixtures of oxygen and isoflurane, sevoflurane, desflurane, or N(2)O were used. Agent volume percent was measured simultaneously with 4 IAGMs and a refractometer at the common gas outlet. Measurements obtained with each of the 4 IAGMs were compared with the corresponding refractometer measurements via the Bland-Altman method. Similarly, Bland-Altman plots were also created with either IAGM or refractometer measurements and desflurane vaporizer dial settings. Bias ± 2 SD for comparisons of IAGM and refractometer measurements was as follows: isoflurane, -0.03 ± 0.18 volume percent; sevoflurane, -0.19 ± 0.23 volume percent; desflurane, 0.43 ± 1.22 volume percent; and N(2)O, -0.21 ± 1.88 volume percent. Bland-Altman plots comparing IAGM and refractometer measurements revealed nonlinear relationships for sevoflurane, desflurane, and N(2)O. Desflurane measurements were notably affected; bias ± limits of agreement (2 SD) were small (0.1 ± 0.22 volume percent) at < 12 volume percent, but both bias and limits of agreement increased at higher concentrations. Because IAGM measurements did not but refractometer measurements did agree with the desflurane vaporizer dial settings, infrared measurement technology was a suspected cause of the nonlinear relationships. Given that the assumption of linearity is a cornerstone of anesthetic monitor calibration, this assumption should be confirmed before anesthetic monitors are used in experiments.

Pediatric renal transplant practices in India.

Science.gov (United States)

Sethi, Sidharth Kumar; Sinha, Rajiv; Rohatgi, Smriti; Kher, Vijay; Iyengar, Arpana; Bagga, Arvind

2017-05-01

Limited access to tertiary-level health care, limited trained pediatric nephrologists and transplant physicians, lack of facilities for dialysis, lack of an effective deceased donor program, non-affordability, and non-adherence to immunosuppressant drugs poses a major challenge to universal availability of pediatric transplantation in developing countries. We present the results of a survey which, to the best of our knowledge, is the first such published attempt at understanding the current state of pediatric renal transplantation in India. A designed questionnaire formulated by a group of pediatric nephrologists with the aim of understanding the current practice of pediatric renal transplantation was circulated to all adult and pediatric nephrologists of the country. Of 26 adult nephrologists who responded, 16 (61.5%) were involved in pediatric transplantation, and 10 of 15 (66.6%) pediatric nephrologists were involved in pediatric transplantation. Most of the centers doing transplants were private/trust institution with only three government institutions undertaking it. Induction therapy was varied among pediatric and adult nephrologists. There were only a few centers (n=5) in the country routinely doing >5 transplants per year. Preemptive transplants and protocol biopsies were a rarity. The results demonstrate lower incidence of undertaking pediatric transplants in children below 6 years, paucity of active cadaveric programs and lack of availability of trained pediatric nephrologists and staff. In contrast to these dissimilarities, the immunosuppressant use seems to be quite similar to Western registry data with majority favoring induction agent and triple immunosuppressant (steroid, mycophenolate mofetil and tacrolimus) for maintenance. The survey also identifies major concerns in availability of this service to all regions of India as well as to all economic segments. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pediatric Reference Intervals for Free Thyroxine and Free Triiodothyronine by Equilibrium Dialysis-Liquid Chromatography-Tandem Mass Spectrometry.

Science.gov (United States)

La'ulu, Sonia L; Rasmussen, Kyle J; Straseski, Joely A

2016-03-05

Thyroid hormone concentrations fluctuate during growth and development. To accurately diagnose thyroid disease in pediatric patients, reference intervals (RIs) should be established with appropriate age groups from an adequate number of healthy subjects using the most exact methods possible. Obtaining statistically useful numbers of healthy patients is particularly challenging for pediatric populations. The objective of this study was to determine non-parametric RIs for free thyroxine (fT4) and free triiodothyronine (fT3) using equilibrium dialysis-high performance liquid chromatography-tandem mass spectrometry with over 2200 healthy children 6 months-17 years of age. Subjects were negative for both thyroglobulin and thyroid peroxidase autoantibodies and had normal thyrotropin concentrations. The study included 2213 children (1129 boys and 1084 girls), with at least 120 subjects (average of 125) from each year of life, except for the 6 month to 1 year age group (n=96). Non-parametric RIs (95th percentile) for fT4 were: 18.0-34.7 pmol/L (boys and girls, 6 months-6 years) and 14.2-25.7 pmol/L (boys and girls, 7-17 years). RIs for fT3 were: 5.8-13.1 pmol/L (girls, 6 months-6 years); 5.7-11.8 pmol/L (boys, 6 months-6 years); 5.7-10.0 pmol/L (boys and girls, 7-12 years); 4.5-8.6 pmol/L (girls, 13-17 years); and 5.2-9.4 pmol/L (boys, 13-17 years). Numerous significant differences were observed between pediatric age groups and previously established adult ranges. This emphasizes the need for well-characterized RIs for thyroid hormones in the pediatric population.

Scientometrics of anesthetic drugs and their techniques of administration, 1984–2013

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Vlassakov KV

2014-12-01

Full Text Available Kamen V Vlassakov, Igor Kissin Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Abstract: The aim of this study was to assess progress in the field of anesthetic drugs over the past 30 years using scientometric indices: popularity indices (general and specific, representing the proportion of articles on a drug relative to all articles in the field of anesthetics (general index or the subfield of a specific class of anesthetics (specific index; index of change, representing the degree of growth in publications on a topic from one period to the next; index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000 biomedical journals covered by PubMed; and index of ultimate success, representing a publication outcome when a new drug takes the place of a common drug previously used for the same purpose. Publications on 58 topics were assessed during six 5-year periods from 1984 to 2013. Our analysis showed that during 2009–2013, out of seven anesthetics with a high general popularity index (≥2.0, only two were introduced after 1980, ie, the inhaled anesthetic sevoflurane and the local anesthetic ropivacaine; however, only sevoflurane had a high index of expectations (12.1. Among anesthetic adjuncts, in 2009–2013, only one agent, sugammadex, had both an extremely high index of change (>100 and a high index of expectations (25.0, reflecting the novelty of its mechanism of action. The index of ultimate success was positive with three anesthetics, ie, lidocaine, isoflurane, and propofol, all of which were introduced much longer than 30 years ago. For the past 30 years, there were no new anesthetics that have produced changes in scientometric indices indicating real progress. Keywords: anesthetics, anesthetic adjuvants, mortality, safety margins, therapeutic indices

A COMPARATIVE STUDY OF PEDIATRIC CARDIAC CATHETERIZATION PROCEDURE UNDER GENERAL ANESTHESIA WITH OR WITHOUT FEMORAL NERVE BLOCK

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Jigisha

2016-02-01

Full Text Available OBJECTIVE Anesthetic management for interventional cardiac procedures/cardiac catheterization in pediatric patients is challenging. Cardiac anomalies vary from simple to complex congenital cardiac anomalies, shunts may be present at multiple levels and patients may be profoundly cyanotic, may be with ventricular dysfunction. They usually require sedation and analgesia to maintain steady stable state. In adults, such type of procedures can be well managed with local anesthesia. METHODS Fifty patients were included in the study. They were randomly divided into two groups- Group A (n=25 patients received femoral N. block along with IV sedation and analgesia while group B (n=25 patients received only IV sedation and analgesia. Both groups were compared for hemodynamics, pain score and requirement of IV anesthetic agents and any complications if come up. RESULTS Group A patients required IV ketamine 3.24mg/kg (±0.31SD as compared to 5.58mg/kg (±1.6SD in group B, which suggests significantly reduced requirement of IV anesthetic agents in group where femoral nerve block has been given. Hemodynamic parameters remained stable and comparable (no statistically significant variation Pain score was less in group A patients than group B. CONCLUSION It has been observed that Group A patients required less dosages of IV anesthetic agents, with stable hemodynamics and less pain score and sedation score as compared to group B patients.

Evaluation of local anesthetic and antipyretic activities of Cinchona ...

African Journals Online (AJOL)

Purpose: To evaluate the local anesthetic and antipyretic activities of an aqueous extract of Cinchona officinalis (C. officinalis) in experimental animal models. Methods: Various doses of the aqueous extract was tested for its local anesthetic activity in guinea pigs and frogs using intracutaneous and plexus anesthesia, ...

TH-B-207B-00: Pediatric Image Quality Optimization

International Nuclear Information System (INIS)

2016-01-01

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children

TH-B-207B-00: Pediatric Image Quality Optimization

Energy Technology Data Exchange (ETDEWEB)

NONE

2016-06-15

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children.

Anesthetic gases and global warming: Potentials, prevention and future of anesthesia.

Science.gov (United States)

Gadani, Hina; Vyas, Arun

2011-01-01

Global warming refers to an average increase in the earth's temperature, which in turn causes changes in climate. A warmer earth may lead to changes in rainfall patterns, a rise in sea level, and a wide range of impacts on plants, wildlife, and humans. Greenhouse gases make the earth warmer by trapping energy inside the atmosphere. Greenhouse gases are any gas that absorbs infrared radiation in the atmosphere and include: water vapor, carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), halogenated fluorocarbons (HCFCs), ozone (O3), perfluorinated carbons (PFCs), and hydrofluorocarbons (HFCs). Hazardous chemicals enter the air we breathe as a result of dozens of activities carried out during a typical day at a healthcare facility like processing lab samples, burning fossil fuels etc. We sometimes forget that anesthetic agents are also greenhouse gases (GHGs). Anesthetic agents used today are volatile halogenated ethers and the common carrier gas nitrous oxide known to be aggressive GHGs. With less than 5% of the total delivered halogenated anesthetic being metabolized by the patient, the vast majority of the anesthetic is routinely vented to the atmosphere through the operating room scavenging system. The global warming potential (GWP) of a halogenated anesthetic is up to 2,000 times greater than CO2. Global warming potentials are used to compare the strength of different GHGs to trap heat in the atmosphere relative to that of CO2. Here we discuss about the GWP of anesthetic gases, preventive measures to decrease the global warming effects of anesthetic gases and Xenon, a newer anesthetic gas for the future of anesthesia.

Effectiveness of various formulations of local anesthetics and additives for topical anesthesia – a prospective, randomized, double-blind, placebo-controlled study

Directory of Open Access Journals (Sweden)

Weilbach C

2017-05-01

Full Text Available Christian Weilbach,1 Christian Hoppe,2 Matthias Karst,3 Michael Winterhalter,4 Konstantinos Raymondos,3 Arthur Schultz,3 Niels Rahe-Meyer2 1Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, St. Josefs-Hospital Cloppenburg, Cloppenburg, 2Clinic for Anesthesiology and Operational Intensive Care, Franziskus Hospital Bielefeld, Bielefeld, 3Clinic for Anesthesiology and Intensive Care, Medizinische Hochschule Hannover, Hannover, 4Clinic for Anesthesiology and Pain Therapy, Klinikum Bremen-Mitte, Bremen, Germany Background: Topical anesthesia is used to control pain associated with many procedures in medicine. Today, the product most commonly applied for topical anesthesia in Germany is EMLA® (lidocaine/prilocaine. However, since prilocaine is a methemoglobin-inducing agent, there are limitations to its use, especially in neonates and infants. The aim of this study was to evaluate the effect of prilocaine and lidocaine as well as propylene glycol, a penetration enhancer, and trometamol, a buffer substance, in anesthetic creams.Patients and methods: Twenty-nine healthy adults participated in this study. Standardized creams with eight different compositions were applied and left for 20, 40 or 60 min. After exposure to standardized painful stimuli (blunt/sharp with pressures of 0.2, 0.4 or 0.8 N, subjects rated the experimental pain using a visual analog scale.Results: Significant results were only found with an exposure time of 60 min and a stamp pressure of 0.8 N. At a concentration of 20%, lidocaine was more effective compared to placebo and equally effective compared to lidocaine/prilocaine in controlling pain. The analgesic effect of the cream containing lidocaine 10% and additional trometamol was significantly superior to that of placebo and non-inferior to that of lidocaine/prilocaine. In this study, the penetration enhancer propylene glycol did not accelerate the onset of the analgesic effect. In contrast

Ultrasound-guided peripheral and truncal blocks in pediatric patients

Directory of Open Access Journals (Sweden)

Mohamed Bilal Delvi

2011-01-01

Full Text Available Ultrasound has added a feather in the cap of the anesthesiologists as real-time nerve localization and drug deposition around the nerve structure under real-time guidance is now a reality, as the saying "seeing is believing" has been proven true with the advent of ultrasound in anesthesia. Pediatric patients are a unique group regarding their anatomical and physiological features in comparison with adults; regional blocks in adults with the anatomical landmark and surface marking are almost uniform across the adult population. The landmark technique in pediatric patients is not reliable in all patients due to the variability in the age and size; the advent of ultrasound in assisting nerve localization has changed the way regional blocks are achieved in children and the range of blocks performed on adults can now be performed on pediatric patients; with advances in the technology and dexterity of ultrasound equipment, the chances of success of blocks has increased with a smaller dose of the local anesthetic in comparison to the traditional methods. Anesthesiologists are now able to perform blocks with more accuracy and avoid complications like intravascular injection and injury to the pleura and peritoneum during routine practice with the assistance of high-frequency transducers and top of the range portable ultrasound machines; catheters can be inserted to provide a continuous analgesia in the postoperative period. This review article describes the common peripheral blocks in pediatric patients; the readers are encouraged to gain experience by attending workshops, hands-on practice under supervision, and conduct random controlled trials pertaining to ultrasound-guided blocks in the pediatric age group. The recent literature is encouraging and further research is promising; a wide range of blocks being described in detail by many prominent experts from all over the world.

Trapping of Syntaxin1a in Presynaptic Nanoclusters by a Clinically Relevant General Anesthetic

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Adekunle T. Bademosi

2018-01-01

Full Text Available Summary: Propofol is the most commonly used general anesthetic in humans. Our understanding of its mechanism of action has focused on its capacity to potentiate inhibitory systems in the brain. However, it is unknown whether other neural mechanisms are involved in general anesthesia. Here, we demonstrate that the synaptic release machinery is also a target. Using single-particle tracking photoactivation localization microscopy, we show that clinically relevant concentrations of propofol and etomidate restrict syntaxin1A mobility on the plasma membrane, whereas non-anesthetic analogs produce the opposite effect and increase syntaxin1A mobility. Removing the interaction with the t-SNARE partner SNAP-25 abolishes propofol-induced syntaxin1A confinement, indicating that syntaxin1A and SNAP-25 together form an emergent drug target. Impaired syntaxin1A mobility and exocytosis under propofol are both rescued by co-expressing a truncated syntaxin1A construct that interacts with SNAP-25. Our results suggest that propofol interferes with a step in SNARE complex formation, resulting in non-functional syntaxin1A nanoclusters. : Bademosi et al. use single-molecule imaging microscopy to understand how general anesthetics might affect presynaptic release mechanisms. They find that a clinically relevant concentration of propofol targets the presynaptic release machinery by specifically restricting syntaxin1A mobility on the plasma membrane. This suggests an alternate target process for these drugs. Keywords: super-resolution microscopy, sptPALM, propofol, etomidate, SNARE, Drosophila melanogaster, PC12, syntaxin1A, SNAP-25, neurotransmission

Analgesic, Anxiolytic and Anaesthetic Effects of Melatonin: New Potential Uses in Pediatrics

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Lucia Marseglia

2015-01-01

Full Text Available Exogenous melatonin is used in a number of situations, first and foremost in the treatment of sleep disorders and jet leg. However, the hypnotic, antinociceptive, and anticonvulsant properties of melatonin endow this neurohormone with the profile of a drug that modulates effects of anesthetic agents, supporting its potential use at different stages during anesthetic procedures, in both adults and children. In light of these properties, melatonin has been administered to children undergoing diagnostic procedures requiring sedation or general anesthesia, such as magnetic resonance imaging, auditory brainstem response tests and electroencephalogram. Controversial data support the use of melatonin as anxiolytic and antinociceptive agents in pediatric patients undergoing surgery. The aim of this review was to evaluate available evidence relating to efficacy and safety of melatonin as an analgesic and as a sedative agent in children. Melatonin and its analogs may have a role in antinociceptive therapies and as an alternative to midazolam in premedication of adults and children, although its effectiveness is still controversial and available data are clearly incomplete.

Pediatric Melanoma and Drug Development

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Klaus Rose

2018-03-01

Full Text Available Importance—Pediatric melanoma occurs, albeit rarely. Should patients be treated by today’s medical standards, or be subjected to medically unnecessary clinical studies? Observations—We identified international, industry-sponsored pediatric melanoma studies triggered by regulatory demands in www.clinicaltrials.gov and further pediatric melanoma studies demanded by European Union pediatric investigation plans. We retrieved related regulatory documents from the internet. We analyzed these studies for rationale and medical beneficence on the basis of physiology, pediatric clinical pharmacology and rationale. Regulatory authorities define children by chronological age, not physiologically. Newborns’ organs are immature but they develop and mature rapidly. Separate proof of efficacy in underage patients is justified formally/regulatorily but lacks medical sense. Children—especially post-puberty—and adults vis-a-vis medications are physiologically very similar. Two adolescent melanoma studies were terminated in 2016 because of waning recruitment, while five studies in pediatric melanoma and other solid tumors, triggered by European Union pediatric investigation plans, continue recruiting worldwide. Conclusions and Relevance—Regulatory-demanded pediatric melanoma studies are medically superfluous. Melanoma patients of all ages should be treated with effective combination treatment. Babies need special attention. Children need dose-finding and pharmacokinetic studies but adolescents metabolize and respond to drugs similarly to adults. Institutional Review Boards/ethics committees should suspend ongoing questionable pediatric melanoma studies and reject newly submitted questionable studies.

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

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Robinson H

2017-04-01

Full Text Available Hal Robinson, Thomas Engelhardt Department of Anaesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK Purpose: Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findings: This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED and emergence agitation (EA. New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.Summary: Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up. Keywords: myringotomy, ventilation tubes, anesthesia, pediatrics, ambulatory, day case

Topical anesthetic versus lidocaine infiltration in arteriovenous fistula cannulation

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Anisha George

2014-01-01

Full Text Available Background: End stage renal disease (ESRD patients on maintenance hemodialysis undergo arterio-venous fistula (AVF cannulation prior to each hemodialysis session for blood access. Prior to cannulation lidocaine infiltration is done, which is often perceived as painful. Eutectic mixture of local anesthetic (EMLA has been found to significantly reduce pain associated with radial artery cannulation compared with lidocaine infiltration. Aims: To evaluate the efficacy of EMLA compared to infiltration of lidocaine in hemodialysis patients for AVF cannulation. Materials and Methods: A single-centre, crossover study of patients with an AVF on regular maintenance hemodialysis was performed in the dialysis unit of a tertiary care teaching hospital. The site of AVF, number of attempts for AVF cannulation and cannula insertion time were recorded. The patients were asked about the acceptability of application of the anesthetic, delay between anesthetic and cannulation and to score the pain on cannulation. Results: Fifty patients were included in the study. With the visual analog scale, pain score on infiltration was 4.8. Pain score on cannulation after topical application was 2.9 and after infiltration, 2.0. The number of attempts for cannulation and the cannula insertion time were similar. Anesthesia was more stressful in the injectable group rather than the topical group (P < 0.001. Delay between anesthetic and cannulation was unacceptable in the topical group (P < 0.001. Patient compliance was better during infiltration compared to topical (P < 0.005. Mean pain score during infiltration of anesthetic was significantly higher than cannulation pain after either anesthetic, although pain on cannulation was higher in the topical group (P < 0.001. Conclusions: EMLA offers a suitable alternative to lidocaine infiltration for patients using AVF for blood access.

Paradigms and mechanisms of inhalational anesthetics mediated neuroprotection against cerebral ischemic stroke.

Science.gov (United States)

Wang, Hailian; Li, Peiying; Xu, Na; Zhu, Ling; Cai, Mengfei; Yu, Weifeng; Gao, Yanqin

2016-01-01

Cerebral ischemic stroke is a leading cause of serious long-term disability and cognitive dysfunction. The high mortality and disability of cerebral ischemic stroke is urging the health providers, including anesthesiologists and other perioperative professioners, to seek effective protective strategies, which are extremely limited, especially for those perioperative patients. Intriguingly, several commonly used inhalational anesthetics are recently suggested to possess neuroprotective effects against cerebral ischemia. This review introduces multiple paradigms of inhalational anesthetic treatments that have been investigated in the setting of cerebral ischemia, such as preconditioning, proconditioning and postconditioning with a variety of inhalational anesthetics. The pleiotropic mechanisms underlying these inhalational anesthetics-afforded neuroprotection against stroke are also discussed in detail, including the common pathways shared by most of the inhalational anesthetic paradigms, such as anti-excitotoxicity, anti-apoptosis and anti-inflammation. There are also distinct mechanisms involved in specific paradigms, such as preserving blood brain barrier integrity, regulating cerebral blood flow and catecholamine release. The ready availability of these inhalational anesthetics bedside and renders them a potentially translatable stroke therapy attracting great efforts for understanding of the underlying mechanisms.

RISK OF OBESITY FOR HYPERTENSION DIFFERS BETWEEN DIABETIC AND NON-DIABETIC SUBJECTS

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MA Sayeed

2007-01-01

Full Text Available In recent years, non-communicable diseases (NCD like obesity, hypertension (HTN and Type2 diabetes (T2DM are on the increase, specially in the developing nations. Body mass index (BMI, waist-to-hip ratio (WHR and Waist-to-height ratio (WHtR are used as indices of obesity to relate T2DM, HTN and coronary artery disease (CAD. This study addresses whether the risk of obesity for HTN differs between T2DM and non-DM subjects. We investigated 693 diabetic patients from BIRDEM and 2384 from communities. We measured height, weight, waist-girth, hip-girth and blood pressure. All subjects underwent oral glucose tolerance test (OGTT. BMI, WHR and WHtR were calculated. Systolic and diastolic hypertension (sHTN and dHTN were defined as SBP >=140 and DBP >= 90 mmHg, respectively. The prevalence of both sHTN and dHTN in T2DM was higher than the non-DM subjects (sHTN: 49.1 vs 14.3%, dHTN 19.6 vs. 9.5%. The comparison of characteristics between subjects with and without hypertension showed that the differences were significant for age, weight, waist-girth, BMI, WHR and WHtR for both T2DM and non-DM subjects (for all p<0.001. The increasing trend of hypertension with increasing obesity was observed more in the non-DM than in the T2DM subjects. The risk (OR of obesity for hypertension increased with increasing WHR and WHtR in the non-DM than the T2DM subjects. Compared with the non-DM the T2DM participants had two to three folds higher prevalence of HTN. In either group, BMI, WHR and WHtR were significantly higher in the hypertensive than the non-hypertensive subjects. The prevalence of hypertension increased with the increasing BMI, WHR and WHtR but significant only in the non-DM. Further studies may confirm these findings and determine whether there was any altered association between blood pressure and obesity in diabetes possibily, with or without autonomic neuropathy. Ibrahim Med. Coll. J. 2007; 1(1: 1-6

Exploring engagement in a virtual community of practice in pediatric rehabilitation: who are non-users, lurkers, and posters?

Science.gov (United States)

Hurtubise, Karen; Pratte, Gabrielle; Rivard, Lisa; Berbari, Jade; Héguy, Léa; Camden, Chantal

2017-12-20

Communities of practice are increasingly recognized in rehabilitation as useful knowledge transfer tools; however, little is known about their users. This exploratory study describes the characteristics of participants and non-participants invited to engage in a pediatric rehabilitation virtual community of practice. In addition, we explored virtual community of practice utilization behaviors, engagement predictors, and the impact of strategies designed to foster engagement. Participants' demographics including information-seeking style and organization e-readiness, as well as online platform frequency of use data were collected and analyzed using descriptive, comparative, and predictive statistics. Seventy-four percent of those invited used the virtual community of practice. Users had less years of experience in pediatric rehabilitation than non-users. Among the users, 71% were classified as "lurkers," who engaged through reading content only; while 29% were classified as "posters," editing online content. Predictive factors were not uncovered, however an increased number of forum visits correlated with being a poster, a non-information seeker, an employee of an organization demonstrating e-readiness, and regularly working with children with the virtual community of practice specific condition. User-engagement strategies increased visits to the forum. These findings will assist rehabilitation leaders in leveraging rehabilitation-specific virtual community of practice to improve knowledge transfer and practice in pediatric rehabilitation and disability management. Implications for Rehabilitation Communities of practice are increasingly recognized as useful knowledge transfer tools for rehabilitation professionals and are made more accessible thanks to virtual technologies. Our virtual community of practice was found to be optimized in health care organizations with an electronic culture, when the topic area had daily relevance to its target audience, and was

Noninvasive in vivo optical coherence tomography tracking of chronic otitis media in pediatric subjects after surgical intervention

Science.gov (United States)

Monroy, Guillermo L.; Pande, Paritosh; Nolan, Ryan M.; Shelton, Ryan L.; Porter, Ryan G.; Novak, Michael A.; Spillman, Darold R.; Chaney, Eric J.; McCormick, Daniel T.; Boppart, Stephen A.

2017-12-01

In an institutional review board-approved study, 25 pediatric subjects diagnosed with chronic or recurrent otitis media were observed over a period of six months with optical coherence tomography (OCT). Subjects were followed throughout their treatment at the initial patient evaluation and preoperative consultation, surgery (intraoperative imaging), and postoperative follow-up, followed by an additional six months of records-based observation. At each time point, the tympanic membrane (at the light reflex region) and directly adjacent middle-ear cavity were observed in vivo with a handheld OCT probe and portable system. Imaging results were compared with clinical outcomes to correlate the clearance of symptoms in relation to changes in the image-based features of infection. OCT images of most all participants showed the presence of additional infection-related biofilm structures during their initial consultation visit and similarly for subjects imaged intraoperatively before myringotomy. Subjects with successful treatment (no recurrence of infectious symptoms) had no additional structures visible in OCT images during the postoperative visit. OCT image findings suggest surgical intervention consisting of myringotomy and tympanostomy tube placement provides a means to clear the middle ear of infection-related components, including middle-ear fluid and biofilms. Furthermore, OCT was demonstrated as a rapid diagnostic tool to prospectively monitor patients in both outpatient and surgical settings.

An innovative technique to improve safety of volatile anesthetics suction from the cardiopulmonary bypass circuit

Directory of Open Access Journals (Sweden)

Francesco De Simone

2017-01-01

Full Text Available Context: Myocardial injury during cardiac surgery on cardiopulmonary bypass (CPB is a major determinant of morbidity and mortality. Preclinical and clinical evidence of dose- and time-related cardioprotective effects of volatile anesthetic drugs exist and their use during the whole surgery duration could improve perioperative cardiac protection. Even if administering volatile agents during CPB are relatively easy, technical problems, such as waste gas scavenging, may prevent safe and manageable administration of halogenated vapors during CPB. Aims: The aim of this study is to improve the safe administration of volatile anesthesia during CPB. Settings and Design: Tertiary teaching hospital. Subjects and Methods: We describe an original device that collects and disposes of any volatile anesthetic vapors present in the exit stream of the oxygenator, hence preventing its dispersal into the operating theatre environment and adaptively regulates pressure of oxygenator chamber in the CPB circuit. Results: We have so far applied a prototype of this device in more than 1300 adult cardiac surgery patients who received volatile anesthetics during the CPB phase. Conclusions: Widespread implementation of scavenging system like the one we designed may facilitate the perfusionist and the anesthesiologist in delivering these cardioprotective drugs with beneficial impact on patients' outcome without compromising on safety.

Mycophenolate mofetil in pediatric renal transplantation: A single center experience.

LENUS (Irish Health Repository)

Raheem, Omer A

2011-05-01

Raheem OA, Kamel MH, Daly PJ, Mohan P, Little DM, Awan A, Hickey DP. Mycophenolate mofetil in pediatric renal transplantation: A single center experience. Pediatr Transplantation 2011: 15:240-244. © 2009 John Wiley & Sons A\\/S. Abstract:  We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

Low-tube-voltage selection for non-contrast-enhanced CT: Comparison of the radiation dose in pediatric and adult phantoms.

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Shimonobo, Toshiaki; Funama, Yoshinori; Utsunomiya, Daisuke; Nakaura, Takeshi; Oda, Seitaro; Kiguchi, Masao; Masuda, Takanori; Sakabe, Daisuke; Yamashita, Yasuyuki; Awai, Kazuo

2016-01-01

We used pediatric and adult anthropomorphic phantoms to compare the radiation dose of low- and standard tube voltage chest and abdominal non-contrast-enhanced computed tomography (CT) scans. We also discuss the optimal low tube voltage for non-contrast-enhanced CT. Using a female adult- and three differently-sized pediatric anthropomorphic phantoms we acquired chest and abdominal non-contrast-enhanced scans on a 320-multidetector CT volume scanner. The tube voltage was set at 80-, 100-, and 120 kVp. The tube current was automatically assigned on the CT scanner in response to the set image noise level. On each phantom and at each tube voltage we measured the surface and center dose using high-sensitivity metal-oxide-semiconductor field-effect transistor detectors. The mean surface dose of chest and abdominal CT scans in 5-year olds was 4.4 and 5.3 mGy at 80 kVp, 4.5 and 5.4 mGy at 100 kV, and 4.0 and 5.0 mGy at 120 kVp, respectively. These values were similar in our 3-pediatric phantoms (p > 0.05). The mean surface dose in the adult phantom increased from 14.7 to 19.4 mGy for chest- and from 18.7 to 24.8 mGy for abdominal CT as the tube voltage decreased from 120 to 80 kVp (p voltage and the low tube voltage technique can be used for non-contrast-enhanced chest- and abdominal scanning. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Multivariable analysis of anesthetic factors associated with time to extubation in dogs.

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Kleine, Stephanie; Hofmeister, Erik; Egan, Katrina

2014-12-01

The purpose of this study was to identify factors that prolong the time to extubation in dogs. Anesthetic records of 900 dogs at a university teaching hospital were searched. Multiple linear regression was used to compare independent predictors (patient demographics, anesthetic and intraoperative variables) with the dependent variable (time to extubation). Induction with propofol (P temperature (P = 0.0000), and by 0.096 minutes for every 1 minute increase in anesthetic duration (P = 0.000). Anesthetic variables, which can be manipulated by the anesthetist, include choice of premedication and induction drugs, hypothermia, and duration of anesthesia. Published by Elsevier Ltd.

Serum Neuropeptide Y and Leptin Levels compared between Non-pregnant and Pregnant Women in Overall, Non-obese, and Obese Subjects

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Chantacha Sitticharoon, M.D., Ph.D.

2018-05-01

Full Text Available Objective: The primary objective of this study was to compare serum NPY and leptin levels between non-pregnant and pregnant women in overall, non-obese, and obese subjects. The secondary objective was to compare these peptides between non-obese and obese pregnant women. Methods: Fasting venous blood was collected from non-pregnant women before open abdominal surgery and from pregnant women when admitted to the delivery room during the latent phase of labor. Results: There were 12 non-obese and 14 obese subjects in the non-pregnant group and 9 non-obese and 30 obese subjects in the pregnant group. Systolic blood pressure (SBP was comparable, but heart rate (HR was higher in pregnant compared to non-pregnant women. Mean±S.E.M serum NPY levels were lower in the pregnant than in the non-pregnant group in overall (0.54±0.02 and 1.34±0.08, respectively, non-obese (0.53±0.05 and 1.23±0.14, respectively, and obese (0.54±0.03 and 1.43±0.09, respectively subjects (p<0.01 for all, but these were comparable between obese and non- obese pregnant subjects. Serum NPY was positively correlated with SBP (R=0.281, p<0.05, but negatively correlated with HR (R=-0.324, p<0.01. Serum leptin levels were not different between pregnant and non-pregnant groups, but were significantly higher in obese than non-obese pregnant subjects (p<0.001. Serum leptin levels were positively correlated with body weight, BMI, waist and hip circumferences in overall and pregnant subjects (p<0.001 all. Conclusion: In pregnancy, decreased NPY levels might be associated with inhibition of SBP rising as well as increased HR. Leptin levels might not be associated with pregnancy, but associated mainly with obesity.

Pediatric evaluation of disability inventory : the Dutch adaption

NARCIS (Netherlands)

Custers, J.W.H.

2001-01-01

In Chapter 1 the theoretical concept of childhood disablement is explained. In addition, a brief introduction is presented, regarding pediatric functional status measurement, and more specifically the subject of this thesis: the Pediatric Evaluation of Disability Inventory. The aims and outline of

Latanoprost systemic exposure in pediatric and adult patients with glaucoma

DEFF Research Database (Denmark)

Raber, Susan; Courtney, Rachel; Maeda-Chubachi, Tomoko

2011-01-01

To evaluate short-term safety and steady-state systemic pharmacokinetics (PK) of latanoprost acid in pediatric subjects with glaucoma or ocular hypertension who received the adult latanoprost dose.......To evaluate short-term safety and steady-state systemic pharmacokinetics (PK) of latanoprost acid in pediatric subjects with glaucoma or ocular hypertension who received the adult latanoprost dose....

An Update on Treatment of Pediatric Chronic Non-Infectious Uveitis.

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Sood, Arjun B; Angeles-Han, Sheila T

2017-03-01

There are no standardized treatment protocols for pediatric non-infectious uveitis. Topical corticosteroids are the typical first-line agent, although systemic corticosteroids are used in intermediate, posterior and panuveitic uveitis. Corticosteroids are not considered to be long-term therapy due to potential ocular and systemic side effects. In children with severe and/or refractory uveitis, timely management with higher dose disease-modifying antirheumatic drugs (DMARDs) and biologic agents is important. Increased doses earlier in the disease course may lead to improved disease control and better visual outcomes. In general, methotrexate is the usual first-line steroid-sparing agent and given as a subcutaneous weekly injection at >0.5 mg/kg/dose or 10-15 mg/m2 due to better bioavailability. Other DMARDs, for instance mycophenolate, azathioprine, and cyclosporine are less common treatments for pediatric uveitis. Anti-tumor necrosis factor-alpha agents, primarily infliximab and adalimumab are used as second line agents in children refractory to methotrexate, or as first-line treatment in those with severe complicated disease at presentation. Infliximab may be given at a minimum of 7.5 mg/kg/dose every 4 weeks after loading doses, up to 20 mg/kg/dose. Adalimumab may be given up to 20 or 40 mg weekly. In children who fail anti-tumor necrosis factor-alpha agents, develop anti-tumor necrosis factor-alpha antibodies, experience adverse effects, or have difficulty with tolerance, there is less data available regarding subsequent treatment. Promising results have been noted with tocilizumab infusions every 2-4 weeks, abatacept monthly infusions and rituximab.

The development of the PARENTS: a tool for parents to assess residents' non-technical skills in pediatric emergency departments.

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Moreau, Katherine A; Eady, Kaylee; Tang, Kenneth; Jabbour, Mona; Frank, Jason R; Campbell, Meaghan; Hamstra, Stanley J

2017-11-14

Parents can assess residents' non-technical skills (NTS) in pediatric emergency departments (EDs). There are no assessment tools, with validity evidence, for parental use in pediatric EDs. The purpose of this study was to develop the Parents' Assessment of Residents Enacting Non-Technical Skills (PARENTS) educational assessment tool and collect three sources of validity evidence (i.e., content, response process, internal structure) for it. We established content evidence for the PARENTS through interviews with physician-educators and residents, focus groups with parents, a literature review, and a modified nominal group technique with experts. We collected response process evidence through cognitive interviews with parents. To examine the internal structure evidence, we administered the PARENTS and performed exploratory factor analysis. Initially, a 20-item PARENTS was developed. Cognitive interviews led to the removal of one closed-ended item, the addition of resident photographs, and wording/formatting changes. Thirty-seven residents and 434 parents participated in the administration of the resulting 19-item PARENTS. Following factor analysis, a one-factor model prevailed. The study presents initial validity evidence for the PARENTS. It also highlights strategies for potentially: (a) involving parents in the assessment of residents, (b) improving the assessment of NTS in pediatric EDs, and (c) capturing parents' perspectives to improve the preparation of future physicians.

Liver enzymes in diabetic and non diabetic subjects with clinically diagnosed hepatitis

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Bidhan Chandra Sarkar

2011-07-01

Full Text Available The occurrence of liver disease and raised liver enzymes is common in diabetic patients and the increasing level of enzymes indicates the severity of hepatic injury. Very few studies have addressed this issue in Bangladesh though Bangladeshi population is very much susceptible to diabetes. This study investigated a total of 1400 diabetic patients and 100 non diabetic individuals to compare the level of liver enzymes between diabetic and non-diabetic subjects. The comparisons were made among subjects who were referred to the department of Gastro-hepato-pancreatic diseases (GHPD of BIRDEM with the clinical diagnosis of chronic hepatitis and other gastro-intestinal disorders. The investigations included alanine aminotransferase (ALT, aspartate aminotransferase (AST, alkaline phosphatase (ALP and bilirubin levels. The subjects were categorized with and without hepatitis based on these investigations. The biochemical markers (ALT, AST, ALP, bilirubin did not differ significantly between non-diabetic male and female subjects. Neither the differences were significant between diabetic males and females though the diabetic patients had higher level of markers. In contrast, when compared between diabetic and non-diabetic subjects there were striking differences in either sex. Compared with the non-diabetic the diabetic subjects had significantly higher level of ALT (48.3 vs. 277.0, AST (42.0 vs. 213.0 and ALP (148 vs. 302 in males (p<0.005 for all. Similarly, these values were found significantly higher in diabetic females than their non-diabetic counterparts (p<0.01. For bilirubin, it was also found significant in males (p<0.001. The study revealed that the liver enzymes were found elevated in both diabetic and non-diabetic subjects who were referred with clinically diagnosed hepatitis. The enzymes were found markedly elevated among the diabetic than non diabetic patients, which indicate hepatic injury was more marked among the diabetic patients. Further

Anesthetic Approach to a Child with Noonan's Syndrome

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Zehra Hatipoglu

2015-03-01

Full Text Available Noonan syndrome is characterized by fascial and physical features along with congenital heart disease. In these patients, fascial features include short webbed neck, micrognathia, limited mouth opening and high arched palate. Pulmonary stenosis and hypertrophic obstructive cardiomyopathy are highly prevalent in Noonan's syndrome. The anesthetic management is important because of difficult airway and severe cardiac abnormalities. We reported that anesthetic management of a child with Noonan's syndrome. [Cukurova Med J 2015; 40(Suppl 1: 47-50

Paradigms and mechanisms of inhalational anesthetics mediated neuroprotection against cerebral ischemic stroke

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Hailian Wang

2016-01-01

Full Text Available Cerebral ischemic stroke is a leading cause of serious long-term disability and cognitive dysfunction. The high mortality and disability of cerebral ischemic stroke is urging the health providers, including anesthesiologists and other perioperative professioners, to seek effective protective strategies, which are extremely limited, especially for those perioperative patients. Intriguingly, several commonly used inhalational anesthetics are recently suggested to possess neuroprotective effects against cerebral ischemia. This review introduces multiple paradigms of inhalational anesthetic treatments that have been investigated in the setting of cerebral ischemia, such as preconditioning, proconditioning and postconditioning with a variety of inhalational anesthetics. The pleiotropic mechanisms underlying these inhalational anesthetics-afforded neuroprotection against stroke are also discussed in detail, including the common pathways shared by most of the inhalational anesthetic paradigms, such as anti-excitotoxicity, anti-apoptosis and anti-inflammation. There are also distinct mechanisms involved in specific paradigms, such as preserving blood brain barrier integrity, regulating cerebral blood flow and catecholamine release. The ready availability of these inhalational anesthetics bedside and renders them a potentially translatable stroke therapy attracting great efforts for understanding of the underlying mechanisms.

Phantom Limb Pain in Pediatric Oncology

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Patrick DeMoss

2018-04-01

Full Text Available Phantom limb pain (PLP is a prevalent problem for children and adolescents undergoing amputation due to cancer treatment. The symptoms are wide ranging from sharp to tingling. PLP in children typically lasts for a few minutes but can be almost constant and can be highly distressing. This focused review describes the characteristics, epidemiology, mechanisms, and evidence-based treatment of PLP in pediatric populations, focusing on pediatric cancer. In pediatric oncology, the administration of chemotherapy is a risk factor that potentially sensitizes the nervous system and predisposes pediatric cancer patients to develop PLP after amputation. Gabapentin, tricyclic antidepressants, opiates, nerve blocks, and epidural catheters have shown mixed success in adults and case reports document potential utility in pediatric patients. Non-pharmacologic treatments, such as mirror therapy, psychotherapy, and acupuncture have also been used in pediatric PLP with success. Prospective controlled trials are necessary to advance care for pediatric patients with PLP.

Pediatric radiology

International Nuclear Information System (INIS)

Benz-Bohm, G.

1997-01-01

Pediatric radiology is an important subsection of diagnostic radiology involving specific difficulties, but unfortunately is quite too often neglected as a subject of further education and training. The book therefore is not intended for specialists in the field, but for radiologists wishing to plunge deeper into the matter of pediatric radiology and to acquire a sound, basic knowledge and information about well-proven modalities, the resulting diagnostic images, and interpretation of results. The book is a compact guide and a helpful source of reference and information required for every-day work, or in special cases. With patients who are babies or children, the challenges are different. The book offers all the information needed, including important experience from pediatric hospital units that may be helpful in diagnostic evaluation, information about specific dissimilarities in anatomy and physiology which affect the imaging results, hints for radiology planning and performance, as well as information about the various techniques and their indication and achievements. The book presents a wide spectrum of informative and annotated images. (orig./CB) [de

Similar incretin secretion in obese and non-obese Japanese subjects with type 2 diabetes

DEFF Research Database (Denmark)

Kozawa, Junji; Okita, Kohei; Imagawa, Akihisa

2010-01-01

Incretin secretion and effect on insulin secretion are not fully understood in patients with type 2 diabetes. We investigated incretin and insulin secretion after meal intake in obese and non-obese Japanese patients with type 2 diabetes compared to non-diabetic subjects. Nine patients with type 2......, incretin secretion does not differ between Japanese obese and non-obese patients with type 2 diabetes and non-diabetic subjects....... diabetes and 5 non-diabetic subjects were recruited for this study. Five diabetic patients were obese (BMI > or = 25) and 4 patients were non-obese (BMI

Applying a Lifespan Developmental Perspective to Chronic Pain: Pediatrics to Geriatrics.

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Walco, Gary A; Krane, Elliot J; Schmader, Kenneth E; Weiner, Debra K

2016-09-01

An ideal taxonomy of chronic pain would be applicable to people of all ages. Developmental sciences focus on lifespan developmental approaches, and view the trajectory of processes in the life course from birth to death. In this article we provide a review of lifespan developmental models, describe normal developmental processes that affect pain processing, and identify deviations from those processes that lead to stable individual differences of clinical interest, specifically the development of chronic pain syndromes. The goals of this review were 1) to unify what are currently separate purviews of "pediatric pain," "adult pain," and "geriatric pain," and 2) to generate models so that specific elements of the chronic pain taxonomy might include important developmental considerations. A lifespan developmental model is applied to the forthcoming Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society Pain Taxonomy to ascertain the degree to which general "adult" descriptions apply to pediatric and geriatric populations, or if age- or development-related considerations need to be invoked. Copyright © 2016. Published by Elsevier Inc.

Economic considerations in the use of inhaled anesthetic agents.

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Golembiewski, Julie

2010-04-15

To describe the components of and factors contributing to the costs of inhaled anesthesia, basis for quantifying and comparing these costs, and practical strategies for performing pharmacoeconomic analyses and reducing the costs of inhaled anesthetic agents. Inhaled anesthesia can be costly, and some of the variable costs, including fresh gas flow rates and vaporizer settings, are potential targets for cost savings. The use of a low fresh gas flow rate maximizes rebreathing of exhaled anesthetic gas and is less costly than a high flow rate, but it provides less control of the level of anesthesia. The minimum alveolar concentration (MAC) hour is a measure that can be used to compare the cost of inhaled anesthetic agents at various fresh gas flow rates. Anesthesia records provide a sense of patterns of inhaled anesthetic agent use, but the amount of detail can be limited. Cost savings have resulted from efforts to reduce the direct costs of inhaled anesthetic agents, but reductions in indirect costs through shortened times to patient recovery and discharge following the judicious use of these agents are more difficult to demonstrate. The patient case mix, fresh gas flow rates typically used during inhaled anesthesia, availability and location of vaporizers, and anesthesia care provider preferences and practices should be taken into consideration in pharmacoeconomic evaluations and recommendations for controlling the costs of inhaled anesthesia. Understanding factors that contribute to the costs of inhaled anesthesia and considering those factors in pharmacoeconomic analyses and recommendations for use of these agents can result in cost savings.

Comparison of endotracheal aspirate and non-bronchoscopic bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia in a pediatric intensive care unit.

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Yıldız-Atıkan, Başak; Karapınar, Bülent; Aydemir, Şöhret; Vardar, Fadıl

2015-01-01

Ventilator-associated pneumonia (VAP) is defined as pneumonia occuring in any period of mechanical ventilation. There is no optimal diagnostic method in current use and in this study we aimed to compare two non-invasive diagnostic methods used in diagnosis of VAP in children. This prospective study was conducted in 8 bedded Pediatric Intensive Care Unit at Ege University Children´s Hospital. Endotracheal aspiration (ETA) and non-bronchoscopic bronchoalveolar lavage (BAL) were performed in case of developing VIP after 48 hours of ventilation. Quantitative cultures were examined in Ege University Department of Diagnostic Microbiology, Bacteriology Laboratory. Fourty-one patients were enrolled in the study. The mean age of study subjects was 47.2±53.6 months. A total of 28 in 82 specimens taken with both methods were negative/negative; 28 had positive result with ETA and a negative result with non-bronchoscopic BAL and both results were negative in 26 specimens. There were no patients whose respiratory specimen culture was negative with ETA and positive with non-bronchoscopic BAL. These results imply that there is a significant difference between two diagnostic methods (p VAP; therefore, ETA results were compared with this method. ETA's sensitivity, specificity, negative and positive predictive values were 100%, 50%, 100% and 48% respectively. The study revealed the ease of usability and the sensitivity of non-bronchoscopic BAL, in comparison with ETA.

Deficits in social cognition and response flexibility in pediatric bipolar disorder.

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McClure, Erin B; Treland, Julia E; Snow, Joseph; Schmajuk, Mariana; Dickstein, Daniel P; Towbin, Kenneth E; Charney, Dennis S; Pine, Daniel S; Leibenluft, Ellen

2005-09-01

Little is known about neuropsychological and social-cognitive function in patients with pediatric bipolar disorder. Identification of specific deficits and strengths that characterize pediatric bipolar disorder would facilitate advances in diagnosis, treatment, and research on pathophysiology. The purpose of this study was to test the hypothesis that youths with bipolar disorder would perform more poorly than matched healthy comparison subjects on measures of social cognition, motor inhibition, and response flexibility. Forty outpatients with pediatric bipolar disorder and 22 comparison subjects (no differences in age, gender, and IQ) completed measures of social cognition (the pragmatic judgment subtest of the Comprehensive Assessment of Spoken Language, facial expression recognition subtests of the Diagnostic Analysis of Nonverbal Accuracy Scale, the oral expression subtest of the Test of Language Competence), inhibition and response flexibility (stop and stop-change tasks), and motor inhibition (continuous performance tasks). Pediatric bipolar disorder patients performed more poorly than comparison subjects on social-cognitive measures (pragmatic judgment of language, facial expression recognition) and on a task requiring response flexibility. These deficits were present in euthymic patients. Differences between patients and comparison subjects could not be attributed to comorbid attention deficit hyperactivity disorder. Findings of impaired social cognition and response flexibility in youths with pediatric bipolar disorder suggest continuity between pediatric bipolar disorder and adult bipolar disorder. These findings provide a foundation for neurocognitive research designed to identify the neural mechanisms underlying these deficits.

A novel approach to scavenging anesthetic gases in rodent surgery.

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Nesbitt, Jeffrey C; Krageschmidt, Dale A; Blanco, Michael C

2013-01-01

Laboratory animal procedures using gas anesthetics may amass elevated waste gas concentrations in operating rooms if controls are not implemented for capturing and removing the vapors. Area sampling using an infrared analyzer indicated isoflurane concentrations likely to exceed occupational exposure guidelines. Our study showed environmental concentrations of oxygen as high as 40% and isoflurane concentrations >100 ppm when no controls or merely passive controls were utilized. These extraneous isoflurane emissions were determined to be originating from the pre-procedural induction process as well as the gas delivery nose cone. A novel waste gas collection cylinder was designed to enclose the gas delivery nose cone and animal head during the administration of anesthetic gases. The vented cylinder utilized a house vacuum to remove the waste anesthetic gases from the surgical field. A commercially available induction chamber designed to be actively and externally exhausted was used to lower concentrations during the induction process. With implementation of local exhaust ventilation controls, waste anesthetic gas concentrations decreased to below recommended occupational exposure levels. In vitro (sham) testing compared favorably to in vivo measurements validating the reduction capability of active ventilation during rodent anesthetic administration. In vivo isoflurane reductions for the induction chamber emissions, the operating room, and the surgeon's breathing zone were 95%, 60%, and 53%, respectively. The same measurements for an in vitro procedure were 98%, 84%, and 87%, respectively.

Anesthetic activity of Brazilian native plants in silver catfish (Rhamdia quelen

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Lenise de Lima Silva

Full Text Available There is an increasing demand for inexpensive and safe anesthetics that can reduce fish stress caused by some procedures such as capture and handling. In this context, the present study evaluated the potential of essential oils (EO of three Brazilian native plants (Hesperozygis ringens, Lippia sidoides and Ocotea acutifolia as anesthetics for the silver catfish - Rhamdia quelen. Moreover, an analysis was made of the chemical composition of these oils and their influence on stress parameter. EO of H. ringens and O. acutifolia were effective as anesthetics, without behavioral side effects. EO of O. acutifolia (150 µL L-1 promoted an increase in blood glucose level. Regarding to the composition, pulegone accounts for 96.63% of the EO of H. ringens, and caryophyllene oxide amounts to 56.90% of the EO of O. acutifolia. Two chemotypes, thymol and carvacrol (68.40% and 67.89%, respectively were verified for EO of L. sidoides. Both samples of EO of L. sidoides showed anesthetic activity in silver catfish, but exposure also caused loss of mucus and mortality. Thus, only the EO of H. ringens and O. acutifolia are advised for anesthetic use

Cardiovascular responses to microinjections of GABA or anesthetics into the rostral ventrolateral medulla of conscious and anesthetized rats

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Lacerda J.E.C.

2003-01-01

Full Text Available The rostral ventrolateral medulla (RVLM contains neurons involved in tonic and reflex control of arterial pressure. We describe the effects of gamma-aminobutyric acid (GABA and anesthetics injected into the RVLM of conscious and urethane (1.2 g/kg, iv anesthetized Wistar rats (300-350 g. In conscious rats, bilateral microinjection of GABA (50 nmol/200 nl induced a small but significant decrease in blood pressure (from 130 ± 3.6 to 110 ± 5.6 mmHg, N = 7. A similar response was observed with sodium pentobarbital microinjection (24 nmol/200 nl. However, in the same animals, the fall in blood pressure induced by GABA (from 121 ± 8.9 to 76 ± 8.8 mmHg, N = 7 or pentobarbital (from 118 ± 4.5 to 57 ± 11.3 mmHg, N = 6 was significantly increased after urethane anesthesia. In contrast, there was no difference between conscious (from 117 ± 4.1 to 92 ± 5.9 mmHg, N = 7 and anesthetized rats (from 123 ± 6.9 to 87 ± 8.7 mmHg, N = 7 when lidocaine (34 nmol/200 nl was microinjected into the RVLM. The heart rate variations were not consistent and only eventually reached significance in conscious or anesthetized rats. The right position of pipettes was confirmed by histology and glutamate microinjection into the RVLM. These findings suggest that in conscious animals the RVLM, in association with the other sympathetic premotor neurons, is responsible for the maintenance of sympathetic vasomotor tone during bilateral RVLM inhibition. Activity of one or more of these premotor neurons outside the RVLM can compensate for the effects of RVLM inhibition. In addition, the effects of lidocaine suggest that fibers passing through the RVLM are involved in the maintenance of blood pressure in conscious animals during RVLM inhibition.

Pre-anesthetic Anxiety Level in Children with Congenital Heart Disease: Comparison between Maternal Presence during Anesthetic Induction and Midazolam Premedication

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Ratna F Soenarto

2016-09-01

Full Text Available General anesthesia was needed by children with congenital heart disease (CHD who underwent cardiaccatheterization procedure and surgery. Pre-anesthetic anxiety in children with CHD can cause significantproblems during induction of anesthesia which leads to negative postoperative outcomes. This studycompared the role of maternal presence during anesthesia induction with midazolam premedication onpre-anesthetic anxiety level in children with CHD. Dr. Cipto Mangunkusumo National Hospital on April toSeptember 2014. Forty-five CHD patients aged 2-5 years old who underwent cardiac invasive procedurewere divided into P group (received midazolam premedication and M group (had maternal presence duringanesthesia induction. Modified Yale Pre-anxiety Scale (MYPAS was used for measuring anxiety level ineach patient during preoperative visit, on the time patient entered the procedure room and during induction ofanesthesia. There was no significant difference of MYPAS scores between the two groups in all measurementtimes. The MYPAS score results were non-anxious (median score 23.4 and the highest was at induction ofanesthesia. Inter-rater agreement test between 2 observers was good (k>0.5. In conclusion, there was nosignificant difference between the effect of maternal presence during induction of anesthesia and midazolampremedication on pre-anesthetic anxiety level in children with CHD. Keywords: pre-anesthetic anxiety, congenital heart disease, maternal presence, midazolam.   Peran Kehadiran Ibu selama Induksi Anestesia dengan PremedikasiMidazolam terhadap Tingkat Kecemasan Pra-anestesia Anak denganPenyakit Jantung Bawan Abstrak Pembiusan umum diperlukan oleh pasien dengan penyakit jantung bawaan (PJB pada saat kateterisasiatau pembedahan jantung. Kecemasan pra-anestesia dapat menimbulkan masalah saat induksi anestesiayang berdampak negatif pascapembedahan. Penelitian ini bertujuan untuk membandingkan efek premedikasimidazolam dan kehadiran ibu selama

Occurrence of paresthesia after dental local anesthetic administration in the United States.

Science.gov (United States)

Garisto, Gabriella A; Gaffen, Andrew S; Lawrence, Herenia P; Tenenbaum, Howard C; Haas, Daniel A

2010-07-01

Several studies have suggested that the likelihood of paresthesia may depend on the local anesthetic used. The purpose of this study was to determine if the type of local anesthetic administered had any effect on reports of paresthesia in dentistry in the United States. The authors obtained reports of paresthesia involving dental local anesthetics during the period from November 1997 through August 2008 from the U.S. Food and Drug Administration Adverse Event Reporting System. They used chi(2) analysis to compare expected frequencies, on the basis of U.S. local anesthetic sales data, with observed reports of oral paresthesia. During the study period, 248 cases of paresthesia occurring after dental procedures were reported. Most cases (94.5 percent) involved mandibular nerve block. The lingual nerve was affected in 89.0 percent of cases. Reports involving 4 percent prilocaine and 4 percent articaine were 7.3 and 3.6 times, respectively, greater than expected (chi(2), P paresthesia occurs more commonly after use of 4 percent local anesthetic formulations. These findings are consistent with those reported in a number of studies from other countries. Until further research indicates otherwise, dentists should consider these results when assessing the risks and benefits of using 4 percent local anesthetics for mandibular block anesthesia.

Influence of Ventilation Strategies and Anesthetic Techniques on Regional Cerebral Oximetry in the Beach Chair Position: A Prospective Interventional Study with a Randomized Comparison of Two Anesthetics.

Science.gov (United States)

Picton, Paul; Dering, Andrew; Alexander, Amir; Neff, Mary; Miller, Bruce S; Shanks, Amy; Housey, Michelle; Mashour, George A

2015-10-01

Beach chair positioning during general anesthesia is associated with cerebral oxygen desaturation. Changes in cerebral oxygenation resulting from the interaction of inspired oxygen fraction (FIO2), end-tidal carbon dioxide (PETCO2), and anesthetic choice have not been fully evaluated in anesthetized patients in the beach chair position. This is a prospective interventional within-group study of patients undergoing shoulder surgery in the beach chair position that incorporated a randomized comparison between two anesthetics. Fifty-six patients were randomized to receive desflurane or total intravenous anesthesia with propofol. Following induction of anesthesia and positioning, FIO2 and minute ventilation were sequentially adjusted for all patients. Regional cerebral oxygenation (rSO2) was the primary outcome and was recorded at each of five set points. While maintaining FIO2 at 0.3 and PETCO2 at 30 mmHg, there was a decrease in rSO2 from 68% (SD, 12) to 61% (SD, 12) (P positioning. The combined interventions of increasing FIO2 to 1.0 and increasing PETCO2 to 45 mmHg resulted in a 14% point improvement in rSO2 to 75% (SD, 12) (P position. There was no significant interaction effect of the anesthetic at the study intervention points. Increasing FIO2 and PETCO2 resulted in a significant increase in rSO2 that overcomes desaturation in patients anesthetized in the beach chair position and that appears independent of anesthetic choice.

Team-based learning on a third-year pediatric clerkship improves NBME subject exam blood disorder scores

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Kris Saudek

2015-10-01

Full Text Available Purpose: At our institution, speculation amongst medical students and faculty exists as to whether team-based learning (TBL can improve scores on high-stakes examinations over traditional didactic lectures. Faculty with experience using TBL developed and piloted a required TBL blood disorders (BD module for third-year medical students on their pediatric clerkship. The purpose of this study is to analyze the BD scores from the NBME subject exams before and after the introduction of the module. Methods: We analyzed institutional and national item difficulties for BD items from the NBME pediatrics content area item analysis reports from 2011 to 2014 before (pre and after (post the pilot (October 2012. Total scores of 590 NBME subject examination students from examinee performance profiles were analyzed pre/post. t-Tests and Cohen's d effect sizes were used to analyze item difficulties for institutional versus national scores and pre/post comparisons of item difficulties and total scores. Results: BD scores for our institution were 0.65 (±0.19 compared to 0.62 (±0.15 nationally (P=0.346; Cohen's d=0.15. The average of post-consecutive BD scores for our students was 0.70(±0.21 compared to examinees nationally [0.64 (±0.15] with a significant mean difference (P=0.031; Cohen's d=0.43. The difference in our institutions pre [0.65 (±0.19] and post [0.70 (±0.21] BD scores trended higher (P=0.391; Cohen's d=0.27. Institutional BD scores were higher than national BD scores for both pre and post, with an effect size that tripled from pre to post scores. Institutional BD scores increased after the use of the TBL module, while overall exam scores remained steadily above national norms. Conclusions: Institutional BD scores were higher than national BD scores for both pre and post, with an effect size that tripled from pre to post scores. Institutional BD scores increased after the use of the TBL module, while overall exam scores remained steadily above

Dual effect of local anesthetics on the function of excitable rod outer segment disk membrane

Energy Technology Data Exchange (ETDEWEB)

Mashimo, T.; Abe, K.; Yoshiya, I.

1986-04-01

The effects of local anesthetics and a divalent cation, Ca2+, on the function of rhodopsin were estimated from the measurements of light-induced proton uptake. The light-induced proton uptake by rhodopsin in the rod outer segment disk membrane was enhanced at lower pH (4) but depressed at higher pHs (6 to 8) by the tertiary amine local anesthetics lidocaine, bupivacaine, tetracaine, and dibucaine. The order of local anesthetic-induced depression of the proton uptake followed that of their clinical anesthetic potencies. The depression of the proton uptake versus the concentration of the uncharged form of local anesthetic nearly describes the same curve for small and large dose of added anesthetic. Furthermore, a neutral local anesthetic, benzocaine, depressed the proton uptake at all pHs between 4 and 7. These results indicate that the depression of the proton uptake is due to the effect of only the uncharged form. It is hypothesized that the uncharged form of local anesthetics interacts hydrophobically with the rhodopsin in the disk membrane. The dual effect of local anesthetics on the proton uptake, on the other hand, suggests that the activation of the function of rhodopsin may be caused by the charged form. There was no significant change in the light-induced proton uptake by rhodopsin when 1 mM of Ca2+ was introduced into the disk membrane at varying pHs in the absence or presence of local anesthetics. This fact indicates that Ca2+ ion does not influence the diprotonating process of metarhodopsin; neither does it interfere with the local anesthetic-induced changes in the rhodopsin molecule.

A closed-loop anesthetic delivery system for real-time control of burst suppression

Science.gov (United States)

Liberman, Max Y.; Ching, ShiNung; Chemali, Jessica; Brown, Emery N.

2013-08-01

Objective. There is growing interest in using closed-loop anesthetic delivery (CLAD) systems to automate control of brain states (sedation, unconsciousness and antinociception) in patients receiving anesthesia care. The accuracy and reliability of these systems can be improved by using as control signals electroencephalogram (EEG) markers for which the neurophysiological links to the anesthetic-induced brain states are well established. Burst suppression, in which bursts of electrical activity alternate with periods of quiescence or suppression, is a well-known, readily discernible EEG marker of profound brain inactivation and unconsciousness. This pattern is commonly maintained when anesthetics are administered to produce a medically-induced coma for cerebral protection in patients suffering from brain injuries or to arrest brain activity in patients having uncontrollable seizures. Although the coma may be required for several hours or days, drug infusion rates are managed inefficiently by manual adjustment. Our objective is to design a CLAD system for burst suppression control to automate management of medically-induced coma. Approach. We establish a CLAD system to control burst suppression consisting of: a two-dimensional linear system model relating the anesthetic brain level to the EEG dynamics; a new control signal, the burst suppression probability (BSP) defining the instantaneous probability of suppression; the BSP filter, a state-space algorithm to estimate the BSP from EEG recordings; a proportional-integral controller; and a system identification procedure to estimate the model and controller parameters. Main results. We demonstrate reliable performance of our system in simulation studies of burst suppression control using both propofol and etomidate in rodent experiments based on Vijn and Sneyd, and in human experiments based on the Schnider pharmacokinetic model for propofol. Using propofol, we further demonstrate that our control system reliably

Anesthetic keratopathy presenting as bilateral Mooren-like ulcers

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Khakshoor H

2012-10-01

Full Text Available Hamid Khakshoor,1 Majid Moshirfar,2 Rachel G Simpson,3 Hamid Gharaee,1 Amir H Vejdani,1 Steven M Christiansen,2 Jason N Edmonds,2 Nicholas L Behunin21Mashhad University of Medical Sciences, Department of Ophthalmology, Mashad, Iran; 2John A Moran Eye Center, University of Utah, Salt Lake City, UT, 3The University of Arizona College of Medicine, Phoenix, AZ, USAAbstract: This observational case report describes the development of bilateral Mooren-like ulcers in a patient with anesthetic keratopathy. A 42-year-old man with a recent history of minor eye trauma and pain self-treated with tetracaine eye drops presented with complaints of acutely worsening vision and severe pain bilaterally. His visual acuity at presentation was limited to hand motion. Slit-lamp examination revealed bilateral epithelial defects at the center of the cornea, and an area of stromal infiltration and thinning with an undermining leading edge resembling a Mooren's ulcer in both eyes. Corneal haze and hypopyon were visible. Anesthetic use was halted immediately and the patient was started on prednisolone and mycophenolate mofetil (Cellcept®, after which visual acuity gradually improved and pain decreased. Despite improvement of symptoms, residual epithelial defects remained, and the patient was ultimately treated with keratoplasty for recovery of vision. We suggest that anesthetic keratopathy should be included in the differential diagnosis for any patient presenting with ring-shaped stromal infiltrates or nonhealing epithelial defects.Keywords: anesthetic abuse, corneal damage, corneal ulceration

Anesthetizing a child for a large compressive mediastinal mass with distraction techniques and music therapies as the sole agents.

Science.gov (United States)

Adler, Adam C; Schwartz, Emily R; Waters, Jennifer M; Stricker, Paul A

2016-12-01

Anesthetic management of the child with an anterior mediastinal mass is challenging. The surgical/procedural goal typically is to obtain a definitive tissue diagnosis to guide treatment; the safest approach to anesthesia is often one that alters cardiorespiratory physiology the least. In severe cases, this may translate to little or no systemic sedatives/analgesics. Distraction techniques, designed to shift attention away from procedure-related pain (such as counting, listening to music, non-procedure-related talk), may be of great benefit, allowing for avoidance of pharmaceuticals. In this report, we present an approach in children where the anesthetic risk is deemed excessive. Copyright © 2016 Elsevier Inc. All rights reserved.

Spectrum of heart diseases in children: an echocardiographic study of 1,666 subjects in a pediatric hospital, Yaounde, Cameroon.

Science.gov (United States)

Chelo, David; Nguefack, Félicitée; Menanga, Alain P; Ngo Um, Suzanne; Gody, Jean C; Tatah, Sandra A; Koki Ndombo, Paul O

2016-02-01

Children's health programs in Sub-Saharan Africa have always been oriented primarily to infectious diseases and malnutrition. We are witnessing in the early 21(st) century an epidemiological transition marked by the decline of old diseases and the identification of new diseases including heart disease. Therefore, it is necessary to describe the spectrum of these diseases in order to better prepare health workers to these new challenges. We conducted a cross-sectional study focused on heart disease diagnosed by echocardiography in children seen from January 2006 to December 2014 in a pediatric hospital of Yaounde. We collected socio-demographic data and the types of heart disease from registers, patients files as well as the electronic database of echocardiographic records. A total of 2,235 patients underwent echocardiographic examination during the study period including 1,666 subjects with heart disease. Congenital cardiopathies were found in 1,230 (73.8%) patients and acquired abnormalities in 429 (25.8%). Seven children (0.4%) had a combination of both types. Congenital heart defects (CHD) were dominated by ventricular septal defect (VSD). Acquired heart disease was mostly rheumatic valvulopathies. Dyspnea on exertion was the most frequent presenting complaint (87.6%). Discovery of a heart murmur was the principal clinical finding on physical examination (81.4%). The median age was 9 months for congenital heart disease and 132 months for acquired heart disease. As infectious diseases recede and the diagnostic facilities are improving, pediatric heart diseases occupy a more important position in the spectrum of pediatric diseases in our context. However, the ability to evoke the diagnosis remains unsatisfactory by the majority of health personnel and therefore needs to be improved. Apart from congenital heart diseases, the impact of acquired heart diseases, rheumatic valvulopathy being the highest ranking, is remarkable in pediatrics. Awareness of health

Monitoring Anesthetic Depth Modification, Evaluation and Application of the Correlation Dimension

NARCIS (Netherlands)

Broek, P.L.C. van den

2003-01-01

Anesthesia is administered to patients to facilitate surgical and diagnostic procedures. The anesthesiologist generally determines the amount of anesthetics needed on the basis of body weight. However, the inter-individual variation in sensitivity to anesthetics is wide and the needed level of

Radiographic assessment of laryngeal reflexes in ketamine-anesthetized cats

International Nuclear Information System (INIS)

Robinson, E.P.; Johnston, G.R.

1986-01-01

The competence of the laryngeal closure reflexes of cats anesthetized with ketamine was assessed. Radiographic evaluations of the respiratory and digestive tracts were made after colloidal barium suspension was instilled into the pharynges of conscious and ketamine-anesthetized cats. There was a significant ketamine dose-related response of spread of contrast medium into the supraglottic laryngeal area and into the stomach 2 minutes after contrast medium was instilled into the pharynx (P less than 0.05). Cats did not aspirate contrast medium into the lower respiratory tract. Three ketamine-anesthetized cats aspirated contrast medium into the subglottic area of the larynx, and 2 of these cats also aspirated the material into the cranial part of the trachea. This material was coughed up and swallowed within 5 minutes. Transit time of contrast medium into the stomach seemed to be increased in 11 of the 15 cats given the larger dosages of ketamine (24, 36, 48 mg/kg of body weight), compared with that in conscious cats and those given ketamine at 12 mg/kg. Competent laryngeal protective reflexes in cats can be maintained with ketamine anesthesia. Contrast radiography could be used as a diagnostic aid in ketamine-anesthetized cats suspected of laryngeal reflex abnormalities

Feasibility, tolerability and safety of pediatric hyperpolarized {sup 129}Xe magnetic resonance imaging in healthy volunteers and children with cystic fibrosis

Energy Technology Data Exchange (ETDEWEB)

Walkup, Laura L.; Watters, Erin; Ruppert, Kai [Cincinnati Children' s Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH (United States); Thomen, Robert P.; Woods, Jason C. [Cincinnati Children' s Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH (United States); Washington University in St. Louis, Department of Physics, St. Louis, MO (United States); Akinyi, Teckla G.; Cleveland, Zackary I. [Cincinnati Children' s Hospital Medical Center, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati, OH (United States); University of Cincinnati, Biomedical Engineering Program, Cincinnati, OH (United States); Clancy, John P. [Cincinnati Children' s Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, OH (United States)

2016-11-15

Hyperpolarized {sup 129}Xe is a promising contrast agent for MRI of pediatric lung function, but its safety and tolerability in children have not been rigorously assessed. To assess the feasibility, safety and tolerability of hyperpolarized {sup 129}Xe gas as an inhaled contrast agent for pediatric pulmonary MRI in healthy control subjects and in children with cystic fibrosis. Seventeen healthy control subjects (ages 6-15 years, 11 boys) and 11 children with cystic fibrosis (ages 8-16 years, 4 boys) underwent {sup 129}Xe MRI, receiving up to three doses of {sup 129}Xe gas prepared by either a commercially available or a homebuilt {sup 129}Xe polarizer. Subject heart rate and SpO{sub 2} were monitored for 2 min post inhalation and compared to resting baseline values. Adverse events were reported via follow-up phone call at days 1 and 30 (range ±7 days) post-MRI. All children tolerated multiple doses of {sup 129}Xe, and no children withdrew from the study. Relative to baseline, most children who received a full dose of gas for imaging (10 of 12 controls and 8 of 11 children with cystic fibrosis) experienced a nadir in SpO{sub 2} (mean -6.0 ± standard deviation 7.2%, P≤0.001); however within 2 min post inhalation SpO{sub 2} values showed no significant difference from baseline (P=0.11). There was a slight elevation in heart rate (mean +6.6 ± 13.9 beats per minute [bpm], P=0.021), which returned from baseline within 2 min post inhalation (P=0.35). Brief side effects related to the anesthetic properties of xenon were mild and quickly resolved without intervention. No serious or severe adverse events were observed; in total, four minor adverse events (14.3%) were reported following {sup 129}Xe MRI, but all were deemed unrelated to the study. The feasibility, safety and tolerability of {sup 129}Xe MRI has been assessed in a small group of children as young as 6 years. SpO{sub 2} changes were consistent with the expected physiological effects of a short anoxic breath

Repetitive Pediatric Anesthesia in a Non-Hospital Setting

International Nuclear Information System (INIS)

Buchsbaum, Jeffrey C.; McMullen, Kevin P.; Douglas, James G.; Jackson, Jeffrey L.; Simoneaux, R. Victor; Hines, Matthew; Bratton, Jennifer; Kerstiens, John; Johnstone, Peter A.S.

2013-01-01

Purpose: Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia. Methods and Materials: The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008, and April 12, 2012. Results: A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy. Conclusions: This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers

Eugenol as an anesthetic for juvenile common snook

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Jurandir Joaquim Bernardes Júnior

2013-08-01

Full Text Available The objective of this work was to evaluate the efficacy of eugenol as an anesthetic for juvenile common snook, and to determine the minimum effective concentration for use in handling procedures. In the first trial, juvenile common snook were subjected to immersion baths at 25, 50, 75, 100, 125, and 150 mg L-1 eugenol concentrations, after which induction and recovery times were evaluated. In the second experiment, the lethal exposure time (LT50 at 75 mg L-1 was estimated. Minimum effective eugenol concentration was 50 mg L-1, andthe stage of deep anesthesia and recovery were, respectively, reached at 126.3 and 208.8 s. At 75 mg L-1, LT50 was 1,314 s, and induction time and recovery were also satisfactory; however, fish cannot tolerate over 229 s exposure.

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians.

Science.gov (United States)

Skedros, John G; Hunt, Kenneth J; Pitts, Todd C

2007-07-06

Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1) fluorinated vs. non-fluorinated corticosteroids, 2) acetate vs. phosphate types, 3) patient age, and 4) adjustments for special considerations including young athletes and diabetics. 169 (64% response rate, RR) surveys were returned: 105/163 orthopaedic surgeons (64%RR), 44/77 PCSMs/PMRs (57%RR), 20/24 rheumatologists (83%RR). Although corticosteroid doses do not differ significantly between specialties (p > 0.3), anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol(R) (methylprednisolone acetate) and Kenalog(R) (triamcinolone acetonide) are most commonly used. More rheumatologists (80%) were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76%) and orthopaedists (60%). However, relatively fewer rheumatologists (25%) than PCSMs/PMRs (32%) or orthopaedists (32%) knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37% orthopaedists. Nearly 85% use the same

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

Directory of Open Access Journals (Sweden)

Skedros John G

2007-07-01

Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

Mycophenolate mofetil in pediatric renal transplantation: a single center experience.

LENUS (Irish Health Repository)

Raheem, Omer A

2012-02-01

We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

A Comparison of Anesthetic and Cardiorespiratory Effects of Tiletamine-Zolazepam/Xylazine and Tiletamine-Zolazepam/Xylazine/Tramadol in Dogs

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De-Zhang Lu, Sheng Jiang1, Shi-Ming Yu and Hong-Gang Fan1*

2014-01-01

Full Text Available This study compared the anesthetic and cardiorespiratory effects of 3 intramuscular anesthetic combinations in 8 dogs. Tiletamine-zolazepam (8 mg kg-1 and xylazine (0.5 mg kg-1 (TZX; Tiletamine-zolazepam (8 mg kg-1, xylazine (0.5 mg kg-1 and tramadol (2 mg kg-1 (TZXT; or the TZXT protocol plus atipamezole (0.05 mg kg-1 given 30 min later to reverse xylazine, were administered. Immobilization and analgesia scores of the dogs and baseline physiological parameters (heart rate, respiratory rate, non-invasive systolic, diastolic and mean arterial blood pressures, arterial hemoglobin oxygen saturation, and rectal temperature were determined. All 3 combinations effectively induced anesthesia, and dogs became laterally recumbent within 5 min. The changes in physiological parameters after administration of the drug combinations remained within biologically acceptable limits. While both TZX and TZXT appeared to be effective injectable anesthetic combinations, TZXT provided significantly better analgesia with a longer duration than did TZX. Atipamezole administration provided effective antagonism and no adverse effects were observed in this study.

Non union of an epiphyseal fibular fracture in a pediatric patient.

Science.gov (United States)

Mirmiran, Roya; Schuberth, John M

2006-01-01

There are few reports on delayed or nonunion in the pediatric ankle fracture. The authors present a case of a nonunion of a mid-epiphyseal fracture of the distal fibula, described as a type 7 pediatric fracture. Both the occurrence of this injury pattern and a nonunion has not been reported in the same patient. Operative reduction of the nonunion resulted in a satisfactory outcome.

Anesthetic activity of plant essential oils on Cyprinus carpio (koi carp).

Science.gov (United States)

Khumpirapang, Nattakanwadee; Pikulkaew, Surachai; Anuchapreeda, Songyot; Okonogi, Siriporn

2018-03-19

The aims of this study were to investigate the anesthetic and cytotoxic effects of essential oils (EOs) of Ocimum basilicum (OBO), O. canum (OCO), and O. sanctum (OSO) on Cyprinus carpio (koi carp). For anesthetic effect, induction time to surgical anesthesia and recovery time were determined. For cytotoxicity effect, viability of fish peripheral blood nuclear cells (PBMCs) was investigated. Results indicated that increasing oil concentration caused significant (p OSO at 100, 200, and 300 mg/L gave the induction time of 169.5 ± 10.2, 62.8 ± 2.3, 45.3 ± 2.2 sec, respectively, significantly shorter than OCO, and OBO. The recovery time of anesthetized fish was dose dependent (p OSO and OBO, respectively. Within 10 min contact time of the EOs and fish PBMCs, the fish PBMC viability was higher than 80%. Increase contact time and EO concentration caused an increase in cytotoxicity to fish PBMC. OBO showed less toxic than OSO and OCO. Based on the desired induction and recovery times for anesthetizing koi carp, OBO, OCO, and OSO at 300, 200, and 100 mg/L, respectively were suggested to be the most suitable. It was concluded that OBO, OCO, and OSO can be used as natural anesthetics for fish.

Ring Keratitis Associated With Topical Abuse of a Dilute Anesthetic After Refractive Surgery

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Yu-Chih Hou

2009-12-01

Full Text Available Anesthetic toxic keratitis is rare and presents as a ring keratitis, which is often misdiagnosed as Acanthamoeba keratitis. Here, we report an unusual case of toxic keratitis caused by topical abuse of a dilute anesthetic. A 26-year-old woman presented with bilateral corneal edema, ring infiltrates, pigmented keratic precipitate, Descemet's membrane folding, and strong anterior chamber reactions 2 weeks after laser subepithelial keratomileusis surgery. Tracing back her medical history, topical dilute 0.1% proparacaine was prescribed and frequently used for 1 month. Toxic keratitis was suspected. After discontinuation of the topical anesthetic and initiation of treatment with topical 20% autologous serum, complete corneal epithelialization was achieved within 1 week. Corneal infiltrates and anterior chamber reaction gradually subsided. Vision improved from finger counting to 20/20 in the right eye and 20/25 in the left eye, but confocal microscopy showed decreased corneal endothelial cells. Topical abuse of a dilute topical anesthetic can cause severe toxic keratitis and endothelial cell loss. The physician must be aware of the signs of topical anesthetic abuse and should not prescribe even a dilute anesthetic for long-term use. Autologous serum can help in the recovery of toxic keratitis.

Increased inspiratory pressure for reduction of atelectasis in children anesthetized for CT scan

International Nuclear Information System (INIS)

Sargent, Michael A.; Jamieson, Douglas H.; McEachern, Anita M.; Blackstock, Derek

2002-01-01

Background: Atelectasis is more frequent and more severe in children anesthetized for CT scan than it is in children sedated for CT scan.Objective: To determine the effect of increased inspiratory pressure on atelectasis during chest CT in anesthetized children. Materials and methods: Atelectasis on chest CT was assessed by two observers in three groups of patients. Group A comprised 13 children (26 lungs) anesthetized at inspiratory pressures up to and including 25 cm H 2 O. Group B included 11 children anesthetized at inspiratory pressures ≥30 cm H 2 O. Group C included 8 children under deep sedation. Results: Atelectasis was significantly more severe in group A than in groups B and C. There was no significant difference between groups B and C. Conclusion: An inspiratory pressure of 30 cm H 2 O is recommended for children anesthetized for CT scan of the chest. (orig.)

Cardiac evaluation of anesthetized Grevy's zebras (Equus grevyi).

Science.gov (United States)

Adin, Darcy B; Maisenbacher, Herbert W; Ojeda, Nyurka; Fiorello, Christine V; Estrada, Amara H; Prosek, Robert; Citino, Scott B

2007-02-01

To determine ECG and echocardiographic measurements in healthy anesthetized Grevy's zebras (Equus grevyi). 20 healthy zebras. Auscultation, base-apex ECG, and echocardiography were performed on anesthetized zebras. Low-grade systolic murmurs were detected in the left basilar region in 4 of 20 zebras. Evaluation of ECGs from 19 zebras revealed sinus rhythm with a predominantly negative QRS complex and a mean +/- SD heart rate of 67 +/- 10 beats/min. Echocardiograms of sufficient image quality were obtained for 16 zebras. Interventricular septal thickness in diastole, left ventricular chamber in diastole and systole, left atrial diameter, and left ventricular mass were significantly and moderately correlated with estimated body weight (r values ranged from 0.650 to 0.884). Detectable swirling of blood in the right and sometimes the left ventricles was detected in 9 of 16 zebras, whereas physiologic regurgitation of blood was detected for the aortic valve in 3 zebras, pulmonary valve in 2 zebras, mitral valve in 2 zebras, and tricuspid valve in 1 zebra. Results of this study provide reference information for use in the cardiac evaluation of anesthetized Grevy's zebras.

Local anesthetics disrupt energetic coupling between the voltage-sensing segments of a sodium channel.

Science.gov (United States)

Muroi, Yukiko; Chanda, Baron

2009-01-01

Local anesthetics block sodium channels in a state-dependent fashion, binding with higher affinity to open and/or inactivated states. Gating current measurements show that local anesthetics immobilize a fraction of the gating charge, suggesting that the movement of voltage sensors is modified when a local anesthetic binds to the pore of the sodium channel. Here, using voltage clamp fluorescence measurements, we provide a quantitative description of the effect of local anesthetics on the steady-state behavior of the voltage-sensing segments of a sodium channel. Lidocaine and QX-314 shifted the midpoints of the fluorescence-voltage (F-V) curves of S4 domain III in the hyperpolarizing direction by 57 and 65 mV, respectively. A single mutation in the S6 of domain IV (F1579A), a site critical for local anesthetic block, abolished the effect of QX-314 on the voltage sensor of domain III. Both local anesthetics modestly shifted the F-V relationships of S4 domain IV toward hyperpolarized potentials. In contrast, the F-V curve of the S4 domain I was shifted by 11 mV in the depolarizing direction upon QX-314 binding. These antagonistic effects of the local anesthetic indicate that the drug modifies the coupling between the voltage-sensing domains of the sodium channel. Our findings suggest a novel role of local anesthetics in modulating the gating apparatus of the sodium channel.

Anesthetic success of 1.8ml lidocaine 2% for mandibular tooth extraction. A pilot study

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Pedro Aravena

2013-04-01

Full Text Available Aim: To determine the anesthetic effect of a 1.8ml cartridge of anesthetic lidocaine 2% with epinephrine 1:100,000 in inferior alveolar nerve block (NAI for the extraction in mandibular teeth. Material and methods: A pilot study with analitic design. Participating patients of Dental Emergency Service volunteers from Valdivia-Chile for mandibular teeth extractions attending between May and July of 2010. The anesthetic technique was performed by a dentist using only one cartridge of anesthetic to the NAI. After 15 minutes, the effect was considered effective when anesthetic not require reinforcement with additional anesthesia during extraction of teeth. We analyzed the relationship between success anesthetic effect with sex, age, diagnosis of tooth and type and level of pain observed (chi-square and logistic regression, p<0.05. Results: 62 patients were selected, of which only 47(75.8% was achieved anesthetic success. There was no statistical association with sex, age, type or dental diagnosis and perceived pain. Conclusion: Using a 1.8ml cartridge of anesthesia was effective in three of four patients treated by extraction of mandibular teeth. It suggests further research in relation to the clinical effectiveness of other anesthetics with the same dose in NAI.

Anesthetic-Induced Oxidative Stress and Potential Protection

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Cheng Wang

2010-01-01

Full Text Available Prolonged exposure of developing mammals to general anesthetics affects the N-methyl-D-aspartate (NMDA–type glutamate or γ-aminobutyric acid (GABA receptor systems and enhances neuronal toxicity. Stimulation of immature neurons by NMDA antagonists or GABA agonists is thought to increase overall nervous system excitability and may contribute to abnormal neuronal cell death during development. Although the precise mechanisms by which NMDA antagonists or GABA agonists cause neuronal cell death are still not completely understood, up-regulation of the NMDA receptor subunit NR1 may be an initiative factor in neuronal cell death. It is increasingly apparent that mitochondria lie at the center of the cell death regulation process. Evidence for the role of oxidative stress in anesthetic-induced neurotoxicity has been generated in studies that apply oxidative stress blockers. Prevention of neuronal death by catalase and superoxide dismutase in vitro, or by M40403 (superoxide dismutase mimetic in vivo, supports the contention that the involvement of reactive oxygen species (ROS and the nature of neuronal cell death in rodents is mainly apoptotic. However, more evidence is necessary to in order verify the role of the NMDA receptor subunit NR1 and ROS in anesthetic-induced neurodegeneration.

Increasing topical anesthetic efficacy with microneedle application.

Science.gov (United States)

Buhsem, Ömer; Aksoy, Alper; Kececi, Yavuz; Sir, Emin; Güngör, Melike

2016-10-01

Since topical anesthetics alone seldom provide adequate analgesia for laser resurfacing procedures, injectable forms of anesthesia are often required. However, their application is uncomfortable for the patient. In this study, it is investigated whether microneedle application would enhance the efficacy of topical anesthetics. Forty-seven patients participated in the study. Topical anesthetic agent EMLA was applied to the whole face of the patients. Microneedle treatment was applied to one side of the face with a roller-type device. Whole-face carbon dioxide laser resurfacing therapy was carried out then. The pain that patients experienced was assessed by using visual analog scale (VAS) method. VAS scores of two sides of the face were compared by using Wilcoxon signed-rank test. The mean of VAS score of the microneedle treated side was 2.1 ± 1.1 while that of the untreated side was 5.9 ± 0.9 and this difference was statistically significant (Wilcoxon signed-rank test, the Z-value is - 5.9683 and the p-value is < 0.001). This study revealed that microneedle application, with a roller-type device, is a safe and easy procedure in providing sufficient anesthesia for facial laser resurfacing without the need for supplementary nerve blocks or injections.

Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study.

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Falster, Kathleen; Banks, Emily; Lujic, Sanja; Falster, Michael; Lynch, John; Zwi, Karen; Eades, Sandra; Leyland, Alastair H; Jorm, Louisa

2016-10-21

Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9-91.4) in Aboriginal children and 44.9/1000 person-years (44.8-45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7-1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged primary care, have potential to narrow this gap.

Feasibility, tolerability and safety of pediatric hyperpolarized "1"2"9Xe magnetic resonance imaging in healthy volunteers and children with cystic fibrosis

International Nuclear Information System (INIS)

Walkup, Laura L.; Watters, Erin; Ruppert, Kai; Thomen, Robert P.; Woods, Jason C.; Akinyi, Teckla G.; Cleveland, Zackary I.; Clancy, John P.

2016-01-01

Hyperpolarized "1"2"9Xe is a promising contrast agent for MRI of pediatric lung function, but its safety and tolerability in children have not been rigorously assessed. To assess the feasibility, safety and tolerability of hyperpolarized "1"2"9Xe gas as an inhaled contrast agent for pediatric pulmonary MRI in healthy control subjects and in children with cystic fibrosis. Seventeen healthy control subjects (ages 6-15 years, 11 boys) and 11 children with cystic fibrosis (ages 8-16 years, 4 boys) underwent "1"2"9Xe MRI, receiving up to three doses of "1"2"9Xe gas prepared by either a commercially available or a homebuilt "1"2"9Xe polarizer. Subject heart rate and SpO_2 were monitored for 2 min post inhalation and compared to resting baseline values. Adverse events were reported via follow-up phone call at days 1 and 30 (range ±7 days) post-MRI. All children tolerated multiple doses of "1"2"9Xe, and no children withdrew from the study. Relative to baseline, most children who received a full dose of gas for imaging (10 of 12 controls and 8 of 11 children with cystic fibrosis) experienced a nadir in SpO_2 (mean -6.0 ± standard deviation 7.2%, P≤0.001); however within 2 min post inhalation SpO_2 values showed no significant difference from baseline (P=0.11). There was a slight elevation in heart rate (mean +6.6 ± 13.9 beats per minute [bpm], P=0.021), which returned from baseline within 2 min post inhalation (P=0.35). Brief side effects related to the anesthetic properties of xenon were mild and quickly resolved without intervention. No serious or severe adverse events were observed; in total, four minor adverse events (14.3%) were reported following "1"2"9Xe MRI, but all were deemed unrelated to the study. The feasibility, safety and tolerability of "1"2"9Xe MRI has been assessed in a small group of children as young as 6 years. SpO_2 changes were consistent with the expected physiological effects of a short anoxic breath-hold, and other mild side effects were

Differences in Motor Evoked Potentials Induced in Rats by Transcranial Magnetic Stimulation under Two Separate Anesthetics: Implications for Plasticity Studies.

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Sykes, Matthew; Matheson, Natalie A; Brownjohn, Philip W; Tang, Alexander D; Rodger, Jennifer; Shemmell, Jonathan B H; Reynolds, John N J

2016-01-01

Repetitive transcranial magnetic stimulation (rTMS) is primarily used in humans to change the state of corticospinal excitability. To assess the efficacy of different rTMS stimulation protocols, motor evoked potentials (MEPs) are used as a readout due to their non-invasive nature. Stimulation of the motor cortex produces a response in a targeted muscle, and the amplitude of this twitch provides an indirect measure of the current state of the cortex. When applied to the motor cortex, rTMS can alter MEP amplitude, however, results are variable between participants and across studies. In addition, the mechanisms underlying any change and its locus are poorly understood. In order to better understand these effects, MEPs have been investigated in vivo in animal models, primarily in rats. One major difference in protocols between rats and humans is the use of general anesthesia in animal experiments. Anesthetics are known to affect plasticity-like mechanisms and so may contaminate the effects of an rTMS protocol. In the present study, we explored the effect of anesthetic on MEP amplitude, recorded before and after intermittent theta burst stimulation (iTBS), a patterned rTMS protocol with reported facilitatory effects. MEPs were assessed in the brachioradialis muscle of the upper forelimb under two anesthetics: a xylazine/zoletil combination and urethane. We found MEPs could be induced under both anesthetics, with no differences in the resting motor threshold or the average baseline amplitudes. However, MEPs were highly variable between animals under both anesthetics, with the xylazine/zoletil combination showing higher variability and most prominently a rise in amplitude across the baseline recording period. Interestingly, application of iTBS did not facilitate MEP amplitude under either anesthetic condition. Although it is important to underpin human application of TMS with mechanistic examination of effects in animals, caution must be taken when selecting an

Hydrogen-1 NMR relaxation time studies in membrane: anesthetic systems

International Nuclear Information System (INIS)

Pinto, L.M.A.; Fraceto, L.; Paula, E. de; Franzoni, L.; Spisni, A.

1997-01-01

The study of local anesthetics'(LA) interaction with model phospholipid membranes is justified by the direct correlation between anesthetic's hydrophobicity and its potency/toxicity. By the same reason, uncharged LA species seems to play a crucial role in anesthesia. Most clinically used LA are small amphiphilics with a protonated amine group (pKa around 8). Although both charged (protonated) and uncharged forms can coexist at physiological pH, it has been shown (Lee, Biochim. Biophys. Acta 514:95, 1978; Screier et al. Biochim. Biophys. Acta 769:231, 1984) that the real anesthetic pka can be down-shifted, due to differential partition into membranes, increasing the ratio of uncharged species at pH 7.4. We have measured 1 H-NMR longitudinal relaxation times (T 1 ) for phospholipid and three local anesthetics (tetracaine, lidocaine, benzocaine), in sonicated vesicles at a 3:1 molar ratio. All the LA protons have shown smaller T 1 in this system than in isotropic phases, reflecting LA immobilization caused by insertion in the membrane. T 1 values for the lipid protons in the presence of LA were analyzed, in an attempt to identify specific LA:lipid contact regions. (author)

TH-B-207B-01: Optimizing Pediatric CT in the Emergency Department

International Nuclear Information System (INIS)

Dodge, C.

2016-01-01

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children

TH-B-207B-01: Optimizing Pediatric CT in the Emergency Department

Energy Technology Data Exchange (ETDEWEB)

Dodge, C. [Texas Children’s Hospital (United States)

2016-06-15

This imaging educational program will focus on solutions to common pediatric image quality optimization challenges. The speakers will present collective knowledge on best practices in pediatric imaging from their experience at dedicated children’s hospitals. One of the most commonly encountered pediatric imaging requirements for the non-specialist hospital is pediatric CT in the emergency room setting. Thus, this educational program will begin with optimization of pediatric CT in the emergency department. Though pediatric cardiovascular MRI may be less common in the non-specialist hospitals, low pediatric volumes and unique cardiovascular anatomy make optimization of these techniques difficult. Therefore, our second speaker will review best practices in pediatric cardiovascular MRI based on experiences from a children’s hospital with a large volume of cardiac patients. Learning Objectives: To learn techniques for optimizing radiation dose and image quality for CT of children in the emergency room setting. To learn solutions for consistently high quality cardiovascular MRI of children.

Vitamin D status in pediatric irritable bowel syndrome.

Directory of Open Access Journals (Sweden)

Benjamin Udoka Nwosu

Full Text Available Irritable bowel syndrome (IBS is associated with significant morbidity in children and adolescents, and the therapeutic efficacy of available treatment options is limited. The role of vitamin D supplementation in pediatric IBS is unclear as the vitamin D status of pediatric patients with IBS is unknown. Equally, the relationship of vitamin D status with psychosomatic symptoms in children and adolescents is unclear.To characterize the vitamin D status of pediatric patients with IBS using a case-control study design.Serum 25-hydroxyvitamin D [25(OHD] concentration will be similar between patients with IBS and controls.A retrospective case-controlled study of 116 controls (age 14.6 ± 4.3 y, female (n = 67; 58% and 55 subjects with IBS (age 16.5 ± 3.1y, female (n = 44; 80%. Overweight was defined as BMI of ≥85th but 90% of IBS subjects had vitamin D deficiency at a cut-off point of 50% of the subjects with IBS had vitamin D deficiency. This is a much higher prevalence of vitamin D deficiency compared to IBD and other malabsorption syndromes. Monitoring for vitamin D deficiency should be part of the routine care for patients with IBS. Randomized control trials are warranted to determine the role of adjunctive vitamin D therapy in pediatric IBS.

Anesthesia and the developing brain.

Science.gov (United States)

Aker, John; Block, Robert I; Biddle, Chuck

2015-04-01

Despite the profound evolution in the safety and efficacy of neonatal and pediatric anesthesia, questions remain concerning the long-term neurotoxic and neurocognitive effects of the drugs used in anesthetic care. A variety of prospective animal models and retrospective human studies exist that inconsistently demonstrate a detrimental effect of early life exposure to anesthetic drugs and subsequent learning performance. Limitations associated with both non-human and human observational studies are critiqued. Research currently underway is briefly described. A framework for discussing the relevant issues with concerned parents is presented.

Exploring microsolvation of the anesthetic propofol

NARCIS (Netherlands)

Leon, I.; Cocinero, E. J.; Millan, J.; Jaeqx, S.; Rijs, A. M.; Lesarri, A.; Castano, F.; Fernandez, J. A.

2012-01-01

Propofol (2,6-diisopropylphenol) is a broadly used general anesthetic. By combining spectroscopic techniques such as 1- and 2-color REMPI, UV/UV hole burning, infrared ion-dip spectroscopy (IRIDS) obtained under cooled and isolated conditions with high-level ab initio calculations, detailed

Trends in death associated with pediatric dental sedation and general anesthesia.

Science.gov (United States)

Lee, Helen H; Milgrom, Peter; Starks, Helene; Burke, Wylie

2013-08-01

Inadequate access to oral health care places children at risk of caries. Disease severity and inability to cooperate often result in treatment with general anesthesia (GA). Sedation is increasingly popular and viewed as lower risk than GA in community settings. Currently, few data are available to quantify pediatric morbidity and mortality related to dental anesthesia. Summarize dental anesthesia-related pediatric deaths described in media reports. Review of media reports in the Lexis-Nexis Academic database and a private foundation website. Dental offices, ambulatory surgery centers, and hospitals. Patients :US-based children (≤21 years old) who died subsequently receiving anesthesia for a dental procedure between 1980-2011. Most deaths occurred among 2-5 year-olds (n = 21/44), in an office setting (n = 21/44), and with a general/pediatric dentist (n = 25/44) as the anesthesia provider. In this latter group, 17 of 25 deaths were linked with a sedation anesthetic. This series of media reports likely represent only a fraction of the overall morbidity and mortality related to dental anesthesia. These data may indicate an association between mortality and pediatric dental procedures under sedation, particularly in office settings. However, these relationships are difficult to test in the absence of a database that could provide an estimate of incidence and prevalence of morbidity and mortality. With growing numbers of children receiving anesthesia for dental procedures from providers with variable training, it is imperative to be able to track anesthesia-related adverse outcomes. Creating a national database of adverse outcomes will enable future research to advance patient safety and quality. © 2013 John Wiley & Sons Ltd.

The legal ethics of pediatric research.

Science.gov (United States)

Coleman, Doriane Lambelet

2007-12-01

Since the mid- to late 1990s, the scientific and medical research community has sought to increase its access to healthy children for research protocols that involve harm or a risk of harm. This move reverses longstanding policy within that community generally to exclude healthy children from such protocols on the grounds that the research as to them is non-therapeutic, that they are particularly vulnerable to research-related abuses, and that they are unable themselves to give informed consent to their participation. The research community's new posture has been supported by prominent pediatric bioethicists who have argued that unless healthy children are included as research subjects in harmful or risky research, the pediatric population will continue to suffer relative to the adult population in the extent to which it benefits from modern advances in science and medicine. In their view, it is possible for the research community to self-administer a rule that strikes a balance between protecting healthy children from research-related abuses and allowing their inclusion in cutting-edge pediatric research. In this scheme, parental consent is central to the research community's claims about child protection. This Article explores the flaws inherent in this ethics of pediatric research. Specifically, it challenges the view from ethics that the law permits parents to consent to their children's inclusion in harmful or risky research to the extent that related invasions would meet legal maltreatment standards. More broadly, it challenges the movement to increase access to healthy children for harmful and risky research on the ground that it risks two important regressions: First, in its willingness to risk harm to individual children in the interests of the group, it threatens the progress the law has made in its development of the concept of the child as an individual worthy of respect in his or her own right, a concept that imagines parents as fiduciaries and that

Pediatric interventional radiology: vascular interventions

International Nuclear Information System (INIS)

Kandasamy, Devasenathipathy; Gamanagatti, Shivanand; Gupta, Arun Kumar

2016-01-01

Pediatric interventional radiology (PIR) comprises a range of minimally invasive diagnostic and therapeutic procedures that are performed using image guidance. PIR has emerged as an essential adjunct to various surgical and medical conditions. Over the years, technology has undergone dramatic and continuous evolution, making this speciality grow. In this review, the authors will discuss various vascular interventional procedures undertaken in pediatric patients. It is challenging for the interventional radiologist to accomplish a successful interventional procedure. There are many vascular interventional radiology procedures which are being performed and have changed the way the diseases are managed. Some of the procedures are life saving and have become the treatment of choice in those patients. The future is indeed bright for the practice and practitioners of pediatric vascular and non-vascular interventions. As more and more of the procedures that are currently being performed in adults get gradually adapted for use in the pediatric population, it may be possible to perform safe and successful interventions in many of the pediatric vascular lesions that are otherwise being referred for surgery. (author)

Non-surgical management of a pediatric "intoed" gait pattern - a systematic review of the current best evidence.

Science.gov (United States)

Uden, Hayley; Kumar, Saravana

2012-01-01

An intoed gait pattern is one of the most common referrals for children to an orthopedic consultation. Parental concern as to the aesthetics of the child's gait pattern and/or its symptomatic nature will primarily drive these referrals during a child's early developmental years. Whilst some of these referrals prove to be the result of a normal growth variant, some children will present with a symptomatic intoed gait pattern. Various treatments, both conservative and surgical, have been proposed including: braces, wedges, stretches and exercises, shoe modifications, and surgical procedures. However, which treatments are effective and justified in the management of this condition is not clear within the literature. The aim of this systematic review was to therefore identify and critique the best available evidence for the non-surgical management of an intoed gait pattern in a pediatric population. A systematic review was conducted of which only experimental studies investigating a management option for an intoeing gait pattern were included. Studies needed to be written in English, pertaining to a human pediatric population, and published within a peer reviewed journal. Electronic databases were searched: Ovid (Medline), EMBASE, AMED, PubMed, SportDiscus, CINAHL, and Cochrane Library. The National Health and Medical Research Council's designation of levels of hierarchy and the Critical Appraisal Skills Programme cohort studies critical appraisal tool were used. Five level IV studies were found. The studies were of varied quality and with mixed results. Gait plates, physiologic/standardized shoes, and orthotic devices (with gate plate extension) were shown to produce a statistically significant improvement to an intoed gait pattern. Shoe wedges, torqheels, and a leather counter splint were not able to reduce an intoed gait pattern. There is limited evidence to inform the non-surgical management of a pediatric intoed gait pattern. The body of evidence that does exist

QT-RR relationships and suitable QT correction formulas for halothane-anesthetized dogs.

Science.gov (United States)

Tabo, Mitsuyasu; Nakamura, Mikiko; Kimura, Kazuya; Ito, Shigeo

2006-10-01

Several QT correction (QTc) formulas have been used for assessing the QT liability of drugs. However, they are known to under- and over-correct the QT interval and tend to be specific to species and experimental conditions. The purpose of this study was to determine a suitable formula for halothane-anesthetized dogs highly sensitive to drug-induced QT interval prolongation. Twenty dogs were anesthetized with 1.5% halothane and the relationship between the QT and RR intervals were obtained by changing the heart rate under atrial pacing conditions. The QT interval was corrected for the RR interval by applying 4 published formulas (Bazett, Fridericia, Van de Water, and Matsunaga); Fridericia's formula (QTcF = QT/RR(0.33)) showed the least slope and lowest R(2) value for the linear regression of QTc intervals against RR intervals, indicating that it dissociated changes in heart rate most effectively. An optimized formula (QTcX = QT/RR(0.3879)) is defined by analysis of covariance and represents a correction algorithm superior to Fridericia's formula. For both Fridericia's and the optimized formula, QT-prolonging drugs (d,l-sotalol, astemizole) showed QTc interval prolongation. A non-QT-prolonging drug (d,l-propranolol) failed to prolong the QTc interval. In addition, drug-induced changes in QTcF and QTcX intervals were highly correlated with those of the QT interval paced at a cycle length of 500 msec. These findings suggest that Fridericia's and the optimized formula, although the optimized is a little bit better, are suitable for correcting the QT interval in halothane-anesthetized dogs and help to evaluate the potential QT prolongation of drugs with high accuracy.

What is a pediatric tumor?

Directory of Open Access Journals (Sweden)

Mora J

2012-11-01

Full Text Available Jaume Mora1,21Department of Oncology, 2Developmental Tumor Biology Laboratory, Hospital Sant Joan de Deu, Fundacio Sant Joan de Deu, Barcelona, SpainAbstract: Working together with medical oncologists, the question of whether a Ewing sarcoma in a 25-year-old is a pediatric tumor comes up repeatedly. Like Ewing's, some tumors present characteristically at ages that cross over what has been set as the definition of pediatrics (15 years, 18 years, or 21 years?. Pediatric oncology textbooks, surprisingly, do not address the subject of defining a pediatric tumor. They all begin with an epidemiology chapter defining the types of tumors appearing at distinct stages of childhood, adolescence, and young adulthood. Describing the epidemiology of tumors in relation to age, it becomes clear that the disease is related to the phenomenon of aging. The question, however, remains: is there a biological definition of what pediatric age is? And if so, will tumors occurring during this period of life have anything to do with such biological definition? With the aim of finding an objective definition, the fundamental concepts of what defines "pediatrics" was reviewed and then the major features of tumors arising during development were analyzed. The tumors were explored from the perspective of a host immersed in the normal process of growth and development. This physiological process, from pluripotential and undifferentiated cells, makes possible the differentiation, maturation, organization, and function of tissues, organs, and apparatus. A biological definition of pediatric tumors and the infancy–childhood–puberty classification of developmental tumors according to the infancy–childhood–puberty model of normal human development are proposed.Keywords: growth and development, pediatric tumor, infant, childhood and adolescence, pubertal tumors

Administration and monitoring of intravenous anesthetics

NARCIS (Netherlands)

Sahinovic, Marko M.; Absalom, Anthony R.; Struys, Michel M. R. F.

2010-01-01

Purpose of review The importance of accuracy in controlling the dose-response relation for intravenous anesthetics is directly related to the importance of optimizing the efficacy and quality of anesthesia while minimizing adverse drug effects. Therefore, it is important to measure and control all

Methylparaben concentration in commercial Brazilian local anesthetics solutions

Directory of Open Access Journals (Sweden)

Gustavo Henrique Rodriguez da Silva

2012-08-01

Full Text Available OBJECTIVE: To detect the presence and concentration of methylparaben in cartridges of commercial Brazilian local anesthetics. MATERIAL AND METHODS: Twelve commercial brands (4 in glass and 8 in plastic cartridges of local anesthetic solutions for use in dentistry were purchased from the Brazilian market and analyzed. Different lots of the commercial brands were obtained in different Brazilian cities (Piracicaba, Campinas and São Paulo. Separation was performed using high performance liquid chromatography (HPLC with UV-Vis detector. The mobile phase used was acetonitrile:water (75:25 - v/v, pH 4.5, adjusted with acetic acid at a flow rate of 1.0 ml.min-1. RESULTS: When detected in the solutions, the methylparaben concentration ranged from 0.01% (m/v to 0.16% (m/v. One glass and all plastic cartridges presented methylparaben. CONCLUSION: 1. Methylparaben concentration varied among solutions from different manufacturers, and it was not indicated in the drug package inserts; 2. Since the presence of methylparaben in dental anesthetics is not regulated by the Brazilian National Health Surveillance Agency (ANVISA and this substance could cause allergic reactions, it is important to alert dentists about its possible presence.

Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System.

Science.gov (United States)

Vohra, Rais; Huntington, Serena; Koike, Jennifer; Le, Kevin; Geller, Richard J

2017-08-01

Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia. This is a retrospective study of exposures reported to a statewide poison control system. The electronic health records were queried for pediatric exposures to topical benzocaine treated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewed for demographic and clinical information, and descriptive statistical analysis was performed. The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscoding of non-benzocaine exposures. Children four years of age and younger represented the majority of cases (93%) with a median age of 1 year. There were 88 cases of accidental/ exploratory exposure, while 6 cases resulted from therapeutic application or error, 4 cases from adverse reactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5% of cases, but major clinical effects were observed in 5 patients. Those with serious effects were exposed to a range of benzocaine concentrations (7.5-20%), with 4 cases reporting methemoglobin levels between 20.2%-55%. Methylene blue was administered in 4 of the cases exhibiting major effects. The majority of exposures were accidental ingestions by young children. Most exposures resulted in minor to no effects. However, some patients required treatment with methylene blue and admission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverse effects from these commonly available products.

Salivary flow and composition in diabetic and non-diabetic subjects.

Science.gov (United States)

Lasisi, T J; Fasanmade, A A

2012-06-07

The study investigated the effects of type 2 diabetes mellitus on salivary flow and composition in humans compared to healthy sex and age matched controls. Forty adult human subjects divided into 20 diabetic and 20 non-diabetic healthy subjects were included. Saliva samples were collected and analysed for glucose, total protein, calcium, sodium, potassium, chloride and bicarbonate. Salivary flow rate was also determined. The results showed that salivary glucose and potassium levels were significantly higher (p = 0.01 and 0.002 respectively) in diabetic patients compared with non-diabetic participants. It was also found that the diabetic patients had significant reduction in salivary flow rate when compared with non-diabetic individuals. In contrast, there was no significant difference in levels of total protein, Na+, Ca++, Cl- and HCO3- between the two groups. These results suggest that some oral diseases associated with diabetes mellitus may be due to altered levels of salivary glucose, potassium and flow.

A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children.

Science.gov (United States)

Eichenfield, Lawrence F; Funk, Ann; Fallon-Friedlander, Sheila; Cunningham, Bari B

2002-06-01

A double-randomized, blinded crossover trial was performed to assess the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics (EMLA) for pain relief during pediatric venipuncture procedures. Safety was assessed by evaluation for topical or systemic effects and measurement of serum lidocaine concentrations. A total of 120 children who were scheduled for repeat venipuncture for non-study-related reasons at 2 sites participated in the study. Patients were doubly randomized to treatment regimen (study medication application time of either 30 or 60 minutes) and to the order of application of the topical anesthetics for each venipuncture. The primary outcome measures were the child's rating of pain immediately after the venipuncture procedures using a 100-mm visual analog scale (VAS) tool and the parent's and blinded research observer's Observed Behavioral Distress scores. Both ELA-Max and EMLA seemed to alleviate venipuncture pain. There was no clinically or statistically significant difference in the patient VAS scores within the 30-minute or 60-minute treatment groups, and there was no clinical or statistical difference in VAS scores between the 30-minute ELA-Max treatment without occlusion and the 60-minute EMLA treatment with occlusion. There were no clinically or statistically significant differences between treatment with ELA-Max and EMLA in parental or blinded researcher Observed Behavioral Distress scores, the most frequent response at any observation time being "no distress." This study demonstrates that a 30-minute application of ELA-Max without occlusion is as safe and as effective for ameliorating pain associated with venipuncture as a 60-minute application of the prescription product EMLA requiring occlusion.

Anesthesia and Duchenne or Becker muscular dystrophy: review of 117 anesthetic exposures.

Science.gov (United States)

Segura, Leal G; Lorenz, Jessica D; Weingarten, Toby N; Scavonetto, Federica; Bojanić, Katarina; Selcen, Duygu; Sprung, Juraj

2013-09-01

Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are associated with life-threatening perioperative complications, including rhabdomyolysis, hyperkalemia, and hyperthermia. Current recommendations contraindicate use of succinylcholine and volatile anesthetics; however, the latter recommendation remains controversial. To review the perioperative outcomes of patients with DMD and BMD. We reviewed records of patients with DMD or BMD who underwent anesthetic management at our institution from January 1990 through December 2011. We identified 47 patients (DMD, 37; BMD, 10) who underwent 117 anesthetic exposures (DMD, 101; BMD, 16). Volatile anesthetic agents were used 66 times (DMD, 59; BMD, 7). One patient with undiagnosed BMD received succinylcholine and developed acute rhabdomyolysis and hyperkalemic cardiac arrest. All other major complications were attributed to the procedure (i.e., large bleeding), to preexisting comorbidities (i.e., respiratory failure, cardiac disease), or to both. Use of succinylcholine in children with dystrophinopathy is contraindicated. These patients have significant comorbidities and are frequently undergoing extensive operations; complications related to these factors can develop, as evidenced by our series. These complications may occur with use of volatile and nonvolatile anesthetics. However, because most of our patients were older than 8 years at the time of surgery, our observation cannot be generalized to younger dystrophin-deficient children. © 2013 John Wiley & Sons Ltd.

Utility of hand-held echocardiography in outpatient pediatric cardiology management.

Science.gov (United States)

Riley, Alan; Sable, Craig; Prasad, Aparna; Spurney, Christopher; Harahsheh, Ashraf; Clauss, Sarah; Colyer, Jessica; Gierdalski, Marcin; Johnson, Ashley; Pearson, Gail D; Rosenthal, Joanna

2014-12-01

Adult patient series have shown hand-held echocardiography (echo) units (HHE) to be accurate for rapid diagnosis and triage. This is the first study to evaluate the ability of HHE to inform decision making in outpatient pediatric cardiology. New pediatric cardiology patients in outpatient clinics staffed by six pediatric cardiologists (experience 1-17 years) were prospectively enrolled if an echocardiogram (echo) was ordered during their initial visit. After history and physical examination and before a standard echo, the cardiologists performed a bedside HHE examination (GE Vscan 1.7-3.8 MHz), documented findings, and made a clinical decision. Diagnoses and decisions based on HHE were compared with final management after the standard echo. The study enrolled 101 subjects (ages 9 days to 19 years). The cardiologists considered HHE imaging adequate for decision making for 80 of the 101 subjects. For 77 of the 80 subjects with acceptable HHE imaging (68/68 normal and 9/12 abnormal standard echoes), the HHE-based primary diagnoses and decisions agreed with the final management. The sensitivity of HHE was 75 % (95 % confidence interval [CI] 43-94 %) and the positive predictive value 100 % (95 % CI 66-100 %) for pediatric heart disease. The agreement between standard echocardiography and HHE imaging was substantial (κ = 0.82). Excluding one of the least experienced cardiologists, HHE provided the basis for correct cardiac diagnoses and management for all the subjects with acceptable HHE imaging (58/58 normal and 9/9 abnormal echoes). In outpatient pediatric cardiology, HHE has potential as a tool to complement physical examination. Further investigation is needed to evaluate how value improves with clinical experience.

The risk of shorter fasting time for pediatric deep sedation.

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Clark, Mathew; Birisci, Esma; Anderson, Jordan E; Anliker, Christina M; Bryant, Micheal A; Downs, Craig; Dalabih, Abdallah

2016-01-01

Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications. This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4-6 h and >6 h). Complication rates were calculated and compared between the three groups. In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4-6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups. This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation.

Pediatric MS

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... Pediatric MS Share this page Facebook Twitter Email Pediatric MS Pediatric MS Pediatric MS Support Pediatric Providers ... system through the Pediatric MS Support Group . Treating pediatric MS In 2018 the U.S. Food and Drug ...

Discordant Impact of HLA on Viral Replicative Capacity and Disease Progression in Pediatric and Adult HIV Infection.

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Emily Adland

2015-06-01

Full Text Available HLA class I polymorphism has a major influence on adult HIV disease progression. An important mechanism mediating this effect is the impact on viral replicative capacity (VRC of the escape mutations selected in response to HLA-restricted CD8+ T-cell responses. Factors that contribute to slow progression in pediatric HIV infection are less well understood. We here investigate the relationship between VRC and disease progression in pediatric infection, and the effect of HLA on VRC and on disease outcome in adult and pediatric infection. Studying a South African cohort of >350 ART-naïve, HIV-infected children and their mothers, we first observed that pediatric disease progression is significantly correlated with VRC. As expected, VRCs in mother-child pairs were strongly correlated (p = 0.004. The impact of the protective HLA alleles, HLA-B*57, HLA-B*58:01 and HLA-B*81:01, resulted in significantly lower VRCs in adults (p<0.0001, but not in children. Similarly, in adults, but not in children, VRCs were significantly higher in subjects expressing the disease-susceptible alleles HLA-B*18:01/45:01/58:02 (p = 0.007. Irrespective of the subject, VRCs were strongly correlated with the number of Gag CD8+ T-cell escape mutants driven by HLA-B*57/58:01/81:01 present in each virus (p = 0.0002. In contrast to the impact of VRC common to progression in adults and children, the HLA effects on disease outcome, that are substantial in adults, are small and statistically insignificant in infected children. These data further highlight the important role that VRC plays both in adult and pediatric progression, and demonstrate that HLA-independent factors, yet to be fully defined, are predominantly responsible for pediatric non-progression.

Prediction of pediatric unipolar depression using multiple neuromorphometric measurements: a pattern classification approach.

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Wu, Mon-Ju; Wu, Hanjing Emily; Mwangi, Benson; Sanches, Marsal; Selvaraj, Sudhakar; Zunta-Soares, Giovana B; Soares, Jair C

2015-03-01

Diagnosis of pediatric neuropsychiatric disorders such as unipolar depression is largely based on clinical judgment - without objective biomarkers to guide diagnostic process and subsequent therapeutic interventions. Neuroimaging studies have previously reported average group-level neuroanatomical differences between patients with pediatric unipolar depression and healthy controls. In the present study, we investigated the utility of multiple neuromorphometric indices in distinguishing pediatric unipolar depression patients from healthy controls at an individual subject level. We acquired structural T1-weighted scans from 25 pediatric unipolar depression patients and 26 demographically matched healthy controls. Multiple neuromorphometric indices such as cortical thickness, volume, and cortical folding patterns were obtained. A support vector machine pattern classification model was 'trained' to distinguish individual subjects with pediatric unipolar depression from healthy controls based on multiple neuromorphometric indices and model predictive validity (sensitivity and specificity) calculated. The model correctly identified 40 out of 51 subjects translating to 78.4% accuracy, 76.0% sensitivity and 80.8% specificity, chi-square p-value = 0.000049. Volumetric and cortical folding abnormalities in the right thalamus and right temporal pole respectively were most central in distinguishing individual patients with pediatric unipolar depression from healthy controls. These findings provide evidence that a support vector machine pattern classification model using multiple neuromorphometric indices may qualify as diagnostic marker for pediatric unipolar depression. In addition, our results identified the most relevant neuromorphometric features in distinguishing PUD patients from healthy controls. Copyright © 2015 Elsevier Ltd. All rights reserved.

Local anesthetic wound infiltration for pain management after periacetabular osteotomy. A randomized, placebo-controlled, double-blind clinical trial with 53 patients

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Bech, Rune D; Ovesen, Ole; Lindholm, Peter

2014-01-01

BACKGROUND AND PURPOSE: To our knowledge, there is no evidence to support the use of local infiltration analgesia (LIA) for postoperative pain relief after periacetabular osteotomy (PAO). We investigated the effect of wound infiltration with a long-acting local anesthetic (ropivacaine) for postop......BACKGROUND AND PURPOSE: To our knowledge, there is no evidence to support the use of local infiltration analgesia (LIA) for postoperative pain relief after periacetabular osteotomy (PAO). We investigated the effect of wound infiltration with a long-acting local anesthetic (ropivacaine...... subjects received intraoperative infiltration followed by 5 postoperative injections in 10-hour intervals through a multi-holed catheter placed at the surgical site. 26 patients received ropivacaine and 27 received saline. The intervention period was 2 days and the observational period was 4 days. All...... subjects received patient-controlled opioid analgesia without any restrictions on the total daily dose. Pain was assessed at specific postoperative time points and the daily opioid usage was registered. RESULTS: Infiltration with 75 mL (150 mg) of ropivacaine did not reduce postoperative pain or opioid...

New procedure to synthesize silver nanoparticles and their interaction with local anesthetics

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Mocanu A

2013-10-01

Full Text Available Aurora Mocanu,1 Roxana Diana Pasca,1 Gheorghe Tomoaia,2 Corina Garbo,1 Petre T Frangopol,1 Ossi Horovitz,1 Maria Tomoaia-Cotisel11Chemical Engineering Department, Babes-Bolyai University, 2Orthopedic Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, RomaniaAbstract: Silver nanoparticles (AgNPs were prepared in aqueous colloid dispersions by the reduction of Ag+ with glucose in alkaline medium. Tetraethyl orthosilicate and l-asparagine were added as stabilizers of NPs. The AgNPs were characterized, and their interaction with three local anesthetics (procaine, dibucaine, or tetracaine was investigated. Optical spectra show the characteristic absorption band of AgNPs, due to surface plasmon resonance. Modifications in the position and shape of this band reflect the self-assembly of metal NPs mediated by anesthetic molecules and the progress in time of the aggregation process. Zeta-potential measuring was applied in order to characterize the electrostatic stability of the NPs. The size and shape of the AgNPs, as well as the features of the assemblies formed by their association in the presence of anesthetics, were evidenced by transmission electron microscopy images. Atomic force microscopy images showed the characteristics of the films of AgNPs deposited on glass support. The effect of the anesthetics could be described in terms of electrostatic forces between the negatively charged AgNPs and the anesthetic molecules, existing also in their cationic form at the working pH. But also hydrophobic and hydrogen bonding interactions between the coated nanoparticles and anesthetics molecular species should be considered.Keywords: self-assembled nanostructures, UV-vis spectra, TEM, AFM, zeta potential

The anesthetics influence (ethilic-eter and urethane) on renal radiopharmaceuticals

International Nuclear Information System (INIS)

Muramoto, E.; Achando, S.S.; Araujo, E.B. de; Hamada, H.S.; Silva Valente Goncalves, R. da; Pereira, N.P.S. de; Silva, C.P.G. da.

1990-01-01

A comparative study was done using anesthetics like ether ethilic and urethane, in rats (Wistar). A significative variation was observed in the results obtained when renal radiopharmaceuticals were investigated. Using urethane, the renal uptake increase progressivelly due to the inhibition of the renal filtration and it starts to recuperate when the anesthetic effect was eliminated. Using ether ethilic the radiopharmaceuticals are quickly eliminated from the kidneys (tubular or glomerular filtration), showing that the renal function was protected. (author) [pt

Spike timing rigidity is maintained in bursting neurons under pentobarbital-induced anesthetic conditions

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Risako Kato

2016-11-01

Full Text Available Pentobarbital potentiates γ-aminobutyric acid (GABA-mediated inhibitory synaptic transmission by prolonging the open time of GABAA receptors. However, it is unknown how pentobarbital regulates cortical neuronal activities via local circuits in vivo. To examine this question, we performed extracellular unit recording in rat insular cortex under awake and anesthetic conditions. Not a few studies apply time-rescaling theorem to detect the features of repetitive spike firing. Similar to these methods, we define an average spike interval locally in time using random matrix theory (RMT, which enables us to compare different activity states on a universal scale. Neurons with high spontaneous firing frequency (> 5 Hz and bursting were classified as HFB neurons (n = 10, and those with low spontaneous firing frequency (< 10 Hz and without bursting were classified as non-HFB neurons (n = 48. Pentobarbital injection (30 mg/kg reduced firing frequency in all HFB neurons and in 78% of non-HFB neurons. RMT analysis demonstrated that pentobarbital increased in the number of neurons with repulsion in both HFB and non-HFB neurons, suggesting that there is a correlation between spikes within a short interspike interval. Under awake conditions, in 50% of HFB and 40% of non-HFB neurons, the decay phase of normalized histograms of spontaneous firing were fitted to an exponential function, which indicated that the first spike had no correlation with subsequent spikes. In contrast, under pentobarbital-induced anesthesia conditions, the number of non-HFB neurons that were fitted to an exponential function increased to 80%, but almost no change in HFB neurons was observed. These results suggest that under both awake and pentobarbital-induced anesthetized conditions, spike firing in HFB neurons is more robustly regulated by preceding spikes than by non-HFB neurons, which may reflect the GABAA receptor-mediated regulation of cortical activities. Whole-cell patch

Combined use of intravenous anesthetics and hypothermia in treating refractory status epilepticus

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Guo-ping REN

2015-11-01

Full Text Available The primary choice of treating refractory status epilepticus (RSE is intravenous anesthetics, but the seizures of some patients can not get a good control. Thus, other therapies must be combined. Hypothermia not only can terminate seizures, but also play a part in brain protection. Though combined use of intravenous anesthetics and hypothermia is not a regular clinical scheme, the favorable effect has been proved by a lot of clinical research. This paper mainly focuses on the dose of intravenous anesthetics, the time, temperature and procedure of hypothermia, the indications and contraindications of combined therapy, and so on. DOI: 10.3969/j.issn.1672-6731.2015.11.006

An improved method for lifting and transporting anesthetized pigs within an animal facility

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Schumacher-Petersen, Camilla; Hammelev, Karsten Pharao; Flescher, Jens Erik

2014-01-01

Transporting anesthetized pigs in a laboratory setting often requires strenuous manual lifting, posing a hazard to the safety of animal care personnel and to the welfare of the pigs. The authors developed an improved approach to lifting and transporting anesthetized pigs weighing up to 350 kg using...... mechanical lifts. Different equipment was used to accommodate pigs of different sizes as well as the building designs of three animal facilities. Using the lifts, anesthetized pigs are carried on sheets to maintain their comfort while being transported. The approach refines previous methods for handling...

Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism.

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Lange, Elizabeth M S; Toledo, Paloma; Stariha, Jillian; Nixon, Heather C

2016-08-01

The literature on the anesthetic management of parturients with dwarfism is sparse and limited to isolated case reports. Pregnancy complications associated with dwarfism include an increased risk of respiratory compromise, an increased risk of Cesarean delivery, and an unpredictable degree of anesthesia with neuraxial techniques. Therefore, we conducted this retrospective review to evaluate the anesthetic management of parturients with a diagnosis of dwarfism. We used a query of billing data to identify short statured women who underwent a Cesarean delivery during May 1, 2008 to May 1, 2013. We then hand searched the electronic medical record for qualifying patients with heights diagnosis of dwarfism. The extracted data included patient demographics and obstetric and anesthetic information. We identified 13 women with dwarfism who had 15 Cesarean deliveries in total. Twelve of the women had disproportionate dwarfism, and ten of the 15 Cesarean deliveries were due to cephalopelvic disproportion. Neuraxial anesthesia was attempted in 93% of deliveries. The dose chosen for initiation of neuraxial anesthesia was lower than the typical doses used in parturients of normal stature. Neuraxial anesthetic complications included difficult neuraxial placement (64%), high spinal (7%), inadequate surgical level (13%), and unrecognized intrathecal catheter (7%). The data collected suggest that females with a diagnosis of dwarfism may have difficult neuraxial placement and potentially require lower dosages of local anesthetic for both spinal and epidural anesthesia to achieve adequate surgical blockade.

Anesthetic management of a child with autistic spectrum disorder and homocysteinemia

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Deepak Choudhary

2016-01-01

Full Text Available Autistic spectrum disorder (ASD is a developmental disability of the central nervous system with rapid worsening. A subset of patients also has mitochondrial dysfunction leading to increased sensitivity to various anesthetic agents. Rarely, gene mutation in these patients results in homocysteinemia which causes higher incidences of thromboembolism, hypoglycemia, and seizures. Anesthetic management of ASD with homocysteinemia and refractory seizures has not been previously reported.

Training medical staff for pediatric disaster victims: a comparison of different teaching methods.

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Behar, Solomon; Upperman, Jeffrey S; Ramirez, Marizen; Dorey, Fred; Nager, Alan

2008-01-01

The goal of this study was to assess the effectiveness of the different types of healthcare worker training in pediatric disaster medicine knowledge over time and to analyze the effects of training type on healthcare workers' attitude toward pediatric disaster medicine. Prospective randomized controlled longitudinal study. Large, urban, tertiary academic children's hospital. Physicians and nurses employed at Children's Hospital Los Angeles randomly selected from a global hospital e-mail server over a 3-week time frame were invited to participate and receive an incentive on completion. Forty-three controls and 42 intervention subjects (22 lecture + tabletop exercise, 20 lecture only) completed the study. Subjects with disaster training in the prior 6 months were excluded. Subjects underwent a didactic lecture or a combination of didactic lecture and tabletop exercise. Preintervention and postintervention testing took place using a 37-question multiple-choice test on pediatric disaster medical topics. Posttesting took place immediately after intervention and then 1, 3, and 6 months after the intervention. Subjects also were surveyed before and after intervention regarding their attitudes toward pediatric disaster medicine. (1) Scores on a 37-question knowledge test and (2) Likert scores on self-perceptions of knowledge, comfort, and interest in pediatric disaster medicine. Regardless of intervention type, participant scores on a postintervention pediatric disaster medicine tests over a 6-month period increased and remained well above pretest means for intervention and control pretest scores. There were no differences in scores comparing type of intervention. However, subjects who underwent the tabletop simulation had a better sense of knowledge and comfort with the topics compared with those who only underwent a didactic lecture. Didactic lecture and tabletop exercises both increase healthcare worker's knowledge of pediatric disaster medical topics. This knowledge

Dynamic behaviour of non-uniform Bernoulli-Euler beams subjected ...

African Journals Online (AJOL)

This paper investigates the dynamics behaviour of non-uniform Bernoulli-Euler beams subjected to concentrated loads ravelling at variable velocities. The solution technique is based on the Generalized Galerkin Method and the use of the generating function of the Bessel function type. The results show that, for all the ...

Examination of the Safety of Pediatric Vaccine Schedules in a Non-Human Primate Model: Assessments of Neurodevelopment, Learning, and Social Behavior

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Curtis, Britni; Liberato, Noelle; Rulien, Megan; Morrisroe, Kelly; Kenney, Caroline; Yutuc, Vernon; Ferrier, Clayton; Marti, C. Nathan; Mandell, Dorothy; Burbacher, Thomas M.; Sackett, Gene P.

2015-01-01

Background In the 1990s, the mercury-based preservative thimerosal was used in most pediatric vaccines. Although there are currently only two thimerosal-containing vaccines (TCVs) recommended for pediatric use, parental perceptions that vaccines pose safety concerns are affecting vaccination rates, particularly in light of the much expanded and more complex schedule in place today. Objectives The objective of this study was to examine the safety of pediatric vaccine schedules in a non-human primate model. Methods We administered vaccines to six groups of infant male rhesus macaques (n = 12–16/group) using a standardized thimerosal dose where appropriate. Study groups included the recommended 1990s Pediatric vaccine schedule, an accelerated 1990s Primate schedule with or without the measles–mumps–rubella (MMR) vaccine, the MMR vaccine only, and the expanded 2008 schedule. We administered saline injections to age-matched control animals (n = 16). Infant development was assessed from birth to 12 months of age by examining the acquisition of neonatal reflexes, the development of object concept permanence (OCP), computerized tests of discrimination learning, and infant social behavior. Data were analyzed using analysis of variance, multilevel modeling, and survival analyses, where appropriate. Results We observed no group differences in the acquisition of OCP. During discrimination learning, animals receiving TCVs had improved performance on reversal testing, although some of these same animals showed poorer performance in subsequent learning-set testing. Analysis of social and nonsocial behaviors identified few instances of negative behaviors across the entire infancy period. Although some group differences in specific behaviors were reported at 2 months of age, by 12 months all infants, irrespective of vaccination status, had developed the typical repertoire of macaque behaviors. Conclusions This comprehensive 5-year case–control study, which closely examined

Plasma cytokine profiles at diagnosis in pediatric patients with non-hodgkin lymphoma

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Mellgren, Karin; Hedegaard, Chris Juul; Schmiegelow, Kjeld

2012-01-01

Non-Hodgkin lymphoma (NHL) has been associated with elevated levels of inflammatory and immune-regulating cytokines, and polymorphisms in the genes encoding interleukin (IL)-10 and tumor necrosis factor (TNF)-α have been associated with increased incidence of certain subtypes of NHL. The aim......, between 1995 and 2008. Cytokines and growth factors were measured in serum using the Luminex platform by application of a 30-plex kit. Levels of IL-6, IL-2R, IL-10, TNF-RI, and macrophage inflammatory protein-1α were significantly higher in patients with anaplastic large-cell lymphoma compared...... with patients diagnosed with B-cell lymphomas and lymphoblastic lymphomas. High levels of IL-4, IL-13, TNF-RI, and epidermal growth factor were associated with a poorer general condition at diagnosis. The present study suggests that NHL subgrouping and the general condition of pediatric patients at diagnosis...

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives.

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Robinson, Hal; Engelhardt, Thomas

2017-01-01

Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction. This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed. Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6-4-0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

Differences in motor evoked potentials induced in rats by transcranial magnetic stimulation under two separate anesthetics: implications for plasticity studies

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Matthew Sykes

2016-10-01

Full Text Available Repetitive transcranial magnetic stimulation (rTMS is primarily used in humans to change the state of corticospinal excitability. To assess the efficacy of different rTMS stimulation protocols, motor evoked potentials (MEPs are used as a readout due to their non-invasive nature. Stimulation of the motor cortex produces a response in a targeted muscle, and the amplitude of this twitch provides an indirect measure of the current state of the cortex. When applied to the motor cortex, rTMS can alter MEP amplitude, however results are variable between participants and across studies. In addition, the mechanisms underlying any change and its locus are poorly understood. In order to better understand these effects, MEPs have been investigated in vivo in animal models, primarily in rats. One major difference in protocols between rats and humans is the use of general anesthesia in animal experiments. Anesthetics are known to affect plasticity-like mechanisms and so may contaminate the effects of an rTMS protocol. In the present study, we explored the effect of anesthetic on MEP amplitude, recorded before and after intermittent theta burst stimulation (iTBS, a patterned rTMS protocol with reported facilitatory effects. MEPs were assessed in the brachioradialis muscle of the upper forelimb under two anesthetics: a xylazine/zoletil combination and urethane. We found MEPs could be induced under both anesthetics, with no differences in the resting motor threshold or the average baseline amplitudes. However, MEPs were highly variable between animals under both anesthetics, with the xylazine/zoletil combination showing higher variability and most prominently a rise in amplitude across the baseline recording period. Interestingly, application of iTBS did not facilitate MEP amplitude under either anesthetic condition. Although it is important to underpin human application of TMS with mechanistic examination of effects in animals, caution must be taken when

Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience.

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Ali, Amany M; Sayd, Heba A; Hamza, Hesham M; Salem, Mohamed A

2011-03-29

Abdominal Non-Hodgkin lymphomas (NHL) are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI), Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15). Thirty patients (86%) presented with abdominal pain, 23 patients (66%) presented with abdominal mass and distention, 13 patients (34%) presented with weight loss, and intestinal obstruction occurred in six patients (17%). The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively). Burkitt's lymphoma was the most common histological type in 29 patients (83%). Ten (28.5%) stage II (group A) and 25 (71.5%) stage III (group B). Complete resections were performed in 10 (28.5%), debulking in 6 (17%) and imaging guided biopsy in 19 (54%). A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months). The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience

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Mohamed A. Salem

2011-03-01

Full Text Available Abdominal Non-Hodgkin lymphomas (NHL are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI, Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15. Thirty patients (86% presented with abdominal pain, 23 patients (66% presented with abdominal mass and distention, 13 patients (34% presented with weight loss, and intestinal obstruction occurred in six patients (17%. The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively. Burkitt's lymphoma was the most common histological type in 29 patients (83%. Ten (28.5% stage II (group A and 25 (71.5% stage III (group B. Complete resections were performed in 10 (28.5%, debulking in 6 (17% and imaging guided biopsy in 19 (54%. A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months. The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

Adaptive statistical iterative reconstruction use for radiation dose reduction in pediatric lower-extremity CT: impact on diagnostic image quality.

Science.gov (United States)

Shah, Amisha; Rees, Mitchell; Kar, Erica; Bolton, Kimberly; Lee, Vincent; Panigrahy, Ashok

2018-06-01

For the past several years, increased levels of imaging radiation and cumulative radiation to children has been a significant concern. Although several measures have been taken to reduce radiation dose during computed tomography (CT) scan, the newer dose reduction software adaptive statistical iterative reconstruction (ASIR) has been an effective technique in reducing radiation dose. To our knowledge, no studies are published that assess the effect of ASIR on extremity CT scans in children. To compare radiation dose, image noise, and subjective image quality in pediatric lower extremity CT scans acquired with and without ASIR. The study group consisted of 53 patients imaged on a CT scanner equipped with ASIR software. The control group consisted of 37 patients whose CT images were acquired without ASIR. Image noise, Computed Tomography Dose Index (CTDI) and dose length product (DLP) were measured. Two pediatric radiologists rated the studies in subjective categories: image sharpness, noise, diagnostic acceptability, and artifacts. The CTDI (p value = 0.0184) and DLP (p value ASIR compared with non-ASIR studies. However, the subjective ratings for sharpness (p ASIR images (p ASIR CT studies. Adaptive statistical iterative reconstruction reduces radiation dose for lower extremity CTs in children, but at the expense of diagnostic imaging quality. Further studies are warranted to determine the specific utility of ASIR for pediatric musculoskeletal CT imaging.

Validity Evidence for a Serious Game to Assess Performance on Critical Pediatric Emergency Medicine Scenarios.

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Gerard, James M; Scalzo, Anthony J; Borgman, Matthew A; Watson, Christopher M; Byrnes, Chelsie E; Chang, Todd P; Auerbach, Marc; Kessler, David O; Feldman, Brian L; Payne, Brian S; Nibras, Sohail; Chokshi, Riti K; Lopreiato, Joseph O

2018-01-26

We developed a first-person serious game, PediatricSim, to teach and assess performances on seven critical pediatric scenarios (anaphylaxis, bronchiolitis, diabetic ketoacidosis, respiratory failure, seizure, septic shock, and supraventricular tachycardia). In the game, players are placed in the role of a code leader and direct patient management by selecting from various assessment and treatment options. The objective of this study was to obtain supportive validity evidence for the PediatricSim game scores. Game content was developed by 11 subject matter experts and followed the American Heart Association's 2011 Pediatric Advanced Life Support Provider Manual and other authoritative references. Sixty subjects with three different levels of experience were enrolled to play the game. Before game play, subjects completed a 40-item written pretest of knowledge. Game scores were compared between subject groups using scoring rubrics developed for the scenarios. Validity evidence was established and interpreted according to Messick's framework. Content validity was supported by a game development process that involved expert experience, focused literature review, and pilot testing. Subjects rated the game favorably for engagement, realism, and educational value. Interrater agreement on game scoring was excellent (intraclass correlation coefficient = 0.91, 95% confidence interval = 0.89-0.9). Game scores were higher for attendings followed by residents then medical students (Pc game and written test scores (r = 0.84, P game scores to assess knowledge of pediatric emergency medicine resuscitation.

[Efficiency of teeth local anesthesia by articaine-containing formulation with adrenaline and clonidine in pediatric dentistry].

Science.gov (United States)

Mel'nikova, A V; Shugaĭlov, I A; Garus, Ia N

2014-01-01

The study evaluated duration and depth of the local infiltration anesthesia by articaine with different combinations of epinephrine and clonidine : articaine (4%) + epinephrine (1: 200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1: 400 000) + clonidine (1:100, 000) in pediatric dental practice. It was revealed that the replacement of the vasoconstrictor epinephrine on clonidine associated with reduced depth and duration of analgesia. This increased efficiency is provided by inclusion of epinephrine (1:200 000), and clonidine (1:100 000) into anesthetic solution, which provided statistically significant increase in depth and duration of anesthesia.

Effect of kinesiotaping, non-elastic taping and bracing on segmental foot kinematics during drop landing in healthy subjects and subjects with chronic ankle instability.

Science.gov (United States)

Kuni, B; Mussler, J; Kalkum, E; Schmitt, H; Wolf, S I

2016-09-01

To evaluate the effects of kinesiotape, non-elastic tape, and soft brace on segmental foot kinematics during drop landing in subjects with chronic ankle instability and healthy subjects. Controlled study with repeated measurements. Three-dimensional motion analysis laboratory. Twenty participants with chronic ankle instability and 20 healthy subjects. The subjects performed drop landings with 17 retroreflective markers on the foot and lower leg in four conditions: barefoot, with kinesiotape, with non-elastic tape and with a soft brace. Ranges of motion of foot segments using a foot measurement method. In participants with chronic ankle instability, midfoot movement in the frontal plane (inclination of the medial arch) was reduced significantly by non-elastic taping, but kinesiotaping and bracing had no effect. In healthy subjects, both non-elastic taping and bracing reduced that movement. In both groups, non-elastic taping and bracing reduced rearfoot excursion in inversion/eversion significantly, which indicates a stabilisation effect. No such effect was found with kinesiotaping. All three methods reduced maximum plantar flexion significantly. Non-elastic taping stabilised the midfoot best in patients with chronic ankle instability, while kinesiotaping did not influence foot kinematics other than to stabilise the rearfoot in the sagittal plane. ClinicalTrials.gov NCT01810471. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Radionuclide methods in pediatric cardiology

International Nuclear Information System (INIS)

Reich, O.; Ruth, C.; Samanek, M.

1990-01-01

The use of radionuclide methods in pediatric cardiology is discussed for non-invasive evaluation of myocardial function and perfusion, regional lung perfusion and ventilation, and for measuring central and peripheral hemodynamics. (H.W.). 16 refs

The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation.

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Messika, Jonathan; Stoclin, Annabelle; Bouvard, Eric; Fulgencio, Jean-Pierre; Ridel, Christophe; Muresan, Ioan-Paul; Boffa, Jean-Jacques; Bachmeyer, Claude; Denis, Michel; Gounant, Valérie; Esteso, Adoracion; Loi, Valeria; Verdet, Charlotte; Prigent, Hélène; Parrot, Antoine; Fartoukh, Muriel

2016-02-01

Early recognition and an attempt at obtaining microbiological documentation are recommended in patients with non-community-acquired pneumonia (NCAP), whether hospital-acquired (HAP) or health care-associated (HCAP). We aimed to characterize the clinical features and microbial etiologies of NCAP to assess the impact of microbiological investigation on their management. This was a prospective 1-y study in a university hospital with 141 non-mechanically ventilated subjects suspected of having HAP (n = 110) or HCAP (n = 31). Clinical criteria alone poorly identified pneumonia (misdiagnosis in 50% of cases). Microbiological confirmation was achievable in 80 subjects (57%). Among 79 microorganisms isolated, 28 were multidrug-resistant aerobic Gram-negative bacilli and group III Enterobacteriaceae and 6 were methicillin-resistant Staphylococcus aureus. Multidrug-resistant aerobic Gram-negative bacilli accounted for one third of the microorganisms in early-onset HAP and for 50% in late-onset HAP. Methicillin-resistant S. aureus was most often recovered from subjects with HCAP. Inappropriate empirical antibiotics were administered to 36% of subjects with confirmed pneumonia. Forty subjects were admitted to the ICU, 13 (33%) of whom died. Overall, 39 subjects (28%) died in the hospital. Integrating the microbiological investigation in the complex clinical diagnostic workup of patients suspected of having NCAP is mandatory. Respiratory tract specimens should be obtained whenever possible for appropriate management. Copyright © 2016 by Daedalus Enterprises.

Understanding academic clinicians' intent to treat pediatric obesity.

Science.gov (United States)

Frankfurter, Claudia; Cunningham, Charles; Morrison, Katherine M; Rimas, Heather; Bailey, Karen

2017-02-08

To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians' intent to treat pediatric obesity. A multi-disciplinary panel iteratively devised a Likert scale survey based on the constructs of the TPB applied to a set of pediatric obesity themes. A cross-sectional electronic survey was then administered to academic clinicians at tertiary care centers across Canada from January to April 2012. Descriptive statistics were used to summarize demographic and item agreement data. A hierarchical linear regression analysis controlling for demographic variables was conducted to examine the extent to which the TPB subscales predicted intent to treat pediatric obesity. A total of 198 physicians, surgeons, and allied health professionals across Canada (British Columbia, Alberta, Manitoba, Saskatchewan, Nova Scotia, Ontario and Quebec) completed the survey. On step 1, demographic factors accounted for 7.4% of the variance in intent scores. Together in step 2, demographic variables and TPB subscales predicted 56.9% of the variance in a measure of the intent to treat pediatric obesity. Perceived behavioral control, that is, confidence in one's ability to manage pediatric obesity, and subjective norms, congruent with one's context of practice, were the most significant predictors of the intent to treat pediatric obesity. Attitudes and barriers did not predict the intent to treat pediatric obesity in this context. Enhancing self-confidence in the ability to treat pediatric obesity and the existence of supportive treatment environments are important to increase clinician's intent to treat pediatric obesity.

Impact of hyaluronidase on anesthetic distribution in retrobulbar region following sub-Tenon anesthesia

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Šurbatović Maja

2008-01-01

Full Text Available Background/Aim. Sub-Tenon's block is nowadays commonly used in ophthalmic surgery because of its safety and efficacy. The aim of this study was to investigate the distribution of the anesthetic solution with different amounts of hyaluronidase in the retrobulbar space, following an injection into the Sub-Tenon's space. Methods. In this experimental study, 40 pig cadaver heads were used (80 eyeballs. The material was divided into four groups (of 20 eyeballs each. Each group was administered 4.5 ml of a mixture of 2% lignocaine, 0.5% bupivacaine, and 0.5 ml of Indian ink, with different amounts of hyaluronidase - 15 IU/ml, 75 IU/ml, 150 IU/ml, except the control one. Samples of retrobulbar tissue were analyzed using the standard histopathological procedure. After that, they were also analyzed using the Adobe Photoshop program® (Windows, USA. The retrobulbar space was divided into eight zones by four perpendicular lines, which crossed in the centre of the optic nerve. The presence of ink in fat and muscle tissues and in the sheath of the optic nerve was observed. Results. The presence of the local anesthetic solution was significantly higher in inferonasal and superonasal quadrants of the fat and muscle tissues (p < 0.01. The distribution in optic nerve sheath is similar in each quadrant. Distribution of local anesthetic in each zone of the muscle tissue (I-VIII was strongly influenced by the amount of hyaluronidase added. In the fat tissue, the distribution of local anesthetic under the influence of hyaluronidase was significantly higher (p < 0.05 in the areas which were distant from the place of injection (I-IV. The distribution in the optic nerve sheath is significantly higher (p < 0.01 in the group with 150 IU/ml of hyaluronidase. Conclusions. Following a sub-Tenon block local anesthetic was present in the retrobulbar space in a high percentage of the cases. The presence of local anesthetic solution in retrobulbar space depends on the amount of

Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System

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Rais Vohra

2017-07-01

Full Text Available Introduction: Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia. Methods: This is a retrospective study of exposures reported to a statewide poison control system. The electronic health records were queried for pediatric exposures to topical benzocaine treated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewed for demographic and clinical information, and descriptive statistical analysis was performed. Results: The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscoding of non-benzocaine exposures. Children four years of age and younger represented the majority of cases (93% with a median age of 1 year. There were 88 cases of accidental/ exploratory exposure, while 6 cases resulted from therapeutic application or error, 4 cases from adverse reactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5% of cases, but major clinical effects were observed in 5 patients. Those with serious effects were exposed to a range of benzocaine concentrations (7.5–20%, with 4 cases reporting methemoglobin levels between 20.2%–55%. Methylene blue was administered in 4 of the cases exhibiting major effects. Conclusion: The majority of exposures were accidental ingestions by young children. Most exposures resulted in minor to no effects. However, some patients required treatment with methylene blue and admission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverse effects from these commonly available products.

Aspectos éticos en pediatría Ethical features in Pediatrics

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Daisy Amparo Martínez Delgado

2011-06-01

Full Text Available Se realizó una revisión bibliográfica sobre la ética en pediatría, con el objetivo de corroborar los criterios actuales sobre el tema. Se analizaron algunos dilemas éticos y bioéticos que se deben tener en cuenta en la relación médico-paciente. Se brinda información sobre algunas particularidades del consentimiento informado y se diferencian las formas de comunicación según las edades pediátricas.A bibliographic review was conducted on the Ethics in Pediatrics to corroborate the current criteria on this subject. Some ethical and bioethical dilemmas were analyzed took into account in the physician-patient relation. Authors offer information on some peculiarities of informed consent and the ways of communication according to children ages were distinguished.

Children's (Pediatric) CT (Computed Tomography)

Medline Plus

Full Text Available ... wear during the procedure. Metal objects including jewelry, eyeglasses, hearing aids, non-permanent retainers and hairpins may ... and treatments have special pediatric considerations. The teddy bear denotes child-specific content. Related Articles and Media ...

Assessment of the densities of local anesthetics and their combination with adjuvants: an experimental study.

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Imbelloni, Luiz Eduardo; Moreira, Adriano Dias; Gaspar, Flávia Cunha; Gouveia, Marildo A; Cordeiro, José Antônio

2009-01-01

The relative density of a local anesthetic in relation to that of the cerebrospinal fluid (CSF) at 37 degrees C is one of the most important physical properties that affect the level of analgesia obtained after the subarachnoid administration of the drug. The objective of this study was to determine the density of local anesthetic solutions, with and without glucose, and the combination of the local anesthetic with adjuvants at 20 degrees C, 25 degrees C, and 37 degrees C. The density (g.mL(-1)) was determined by using a DMA 450 densimeter with a sensitivity of +/- 0.00001 g.mL(-1). The densities, and variations, according to the temperature were obtained for all local anesthetics and their combination with opioids at 20 degrees C, 25 degrees C, and 37 degrees C. The solution is hyperbaric if its density exceeds 1.00099, hypobaric when its density is lower than 1.00019, and isobaric when its density is greater than 1.00019 and lower than 1.00099. The densities of both local anesthetics and adjuvants decrease with the increase in temperature. At 37 degrees C, all glucose-containing solutions are hyperbaric. In the absence of glucose, all solutions are hypobaric. At 37 degrees C, morphine, fentanyl, sufentanil, and clonidine are hypobaric. The densities of local anesthetics and adjuvants decrease with the increase in temperature and increase when glucose is added. The knowledge of the relative density helps select the most adequate local anesthetic to be administered in the subarachnoid space.

Effectiveness of preoperative intranasal dexmedetomidine, compared with oral midazolam, for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia: a systematic review.

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FitzSimons, James; Bonanno, Laura S; Pierce, Stephanie; Badeaux, Jennifer

2017-07-01

Emergence delirium is defined as a cognitive disturbance during emergence from general anesthesia resulting in hallucinations, delusions and confusion manifested by agitation, restlessness, involuntary physical movement and extreme flailing in bed. Postoperative emergence delirium develops in 12% to 18% of all children undergoing general anesthesia for surgery. This post-anesthetic phenomenon changes cognitive and psychomotor behavior, and puts pediatric patients and health care personnel at risk of injury. A newer drug, dexmedetomidine, is a selective alpha-2 agonist, which works in the brain and spinal cord that has sedative, analgesic and anxiolytic properties. Dexmedetomidine also has the ability to lower the overall anesthetic requirements by reducing sympathetic outflow in response to painful surgical stimulation. In current literature, there is not a systematic review that compares the effectiveness of preoperative intranasal dexmedetomidine administration against oral midazolam for the prevention of emergence delirium. The objective of this review was to identify the effectiveness of preoperative intranasal dexmedetomidine compared to oral midazolam for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia. This review considered studies that included pediatric patients aged three to seven years, with an American Society of Anesthesiologists (ASA) classification of I or II, and undergoing general anesthesia for elective/ambulatory surgery. This review excluded studies that included patients who had special needs including: developmental delay, chronic pain issues, and/or any preexisting mental or physical health disorders which categorized them above an ASA II. This review considered studies that compared preoperative intranasal administration of dexmedetomidine with preoperative oral administration of midazolam for the prevention of emergence delirium. This review considered both experimental and non-experimental study

Anesthetic management of a parturient with Guillain-Barre syndrome posted for emergency caesarian section

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Abhijit Paul

2012-01-01

Full Text Available We report the anesthetic management of a case of Guillain-Barre syndrome in the 34 th week of gestation coming for an emergency Cesarean section. The perioperative anesthetic challenges have been discussed with emphasis on the medical and anesthetic management which includes the use of plasma-pheresis, intravenous gamma-globulin, and the safety of preservative free 0.75% isobaric ropivacaine, which was administered intrathecally in this difficult medical condition with excellent hemodynamic, maternal, and fetal outcome. The sensory and motor blocks achieved were well suited to the clinical risks and conditions.

Elective cesarean section in a parturient with post burn neck contracture: An anesthetic challenge!

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Kamlesh Kumari

2013-01-01

Full Text Available The incidence of failed intubation in the pregnant population is 1 in 250-300 patients, which is 8 times higher than non-pregnant patients. Regional anesthesia is the technique of choice in a parturient with recognized potentially difficult airway for cesarean section; however, it may be controversial in the presence of anticipated intraoperative hemodynamic instability. We describe anesthetic management of 23-year-old female, gravida 2, para 1 admitted in the labor ward with central placenta previa and severe post burn contracture of neck for elective cesarean delivery.

Anesthetic drugs accelerate the progression of postoperative metastases of mouse tumors.

OpenAIRE

Shapiro, J; Jersky, J; Katzav, S; Feldman, M; Segal, S

1981-01-01

Experiments were made to investigate the effect of four anesthetic drugs that are commonly used in surgical practice on the postoperative growth of mouse tumors in syngeneic recipients. These experiments revealed that some of the anesthetics when applied for surgical excision of the local tumor, strongly accelerated postoperative progression of spontaneous lung metastases produced by the 3LL Lewis lung carcinoma and by the B16 melanoma. Some of the drugs caused the appearance of metastases in...

Obesity and outcomes following burns in the pediatric population.

Science.gov (United States)

Ross, Evan; Burris, Agnes; Murphy, Joseph T

2014-03-01

While obesity is associated with increased mortality and decreased functional outcomes in adult burn patients, the ramifications of larger than average body size in the pediatric burn population are less well understood. The present study examines whether obesity was associated with poor outcomes following pediatric burn injuries. Thermal injury data for patients ≤ 18 years of age admitted to a Level III burn center over ten years (n=536) was analyzed. Obesity was defined as ≥ 95 th percentile of weight for height according to the WHO growth charts (obese (n=154) and non-obese (n=382) children. All data was collected in accordance with IRB regulations. Obese and non-obese thermally-injured children did not differ in TBSA, percentage of full thickness burn, or overall mortality. However, these groups were significantly different with respect to age (obese=7.16 ± 0.46 years, non-obese=9.38 ± 0.32 years, pobese=4.89 ± 1.3 days, non-obese=2.67 ± 0.49 days, pobese (n=46) and non-obese (n=129) did not differ significantly with respect to age, TBSA, percentage of full thickness burn or other outcome measures. However, significant differences between these groups were noted for ICU LOS (obese=18.59 ± 5.18 days, non-obese=9.51 ± 1.82 days, pobese=11.65 ± 3.91 days, non-obese=3.92 ± 0.85 days, pobese pediatric patients required longer and more intensive medical support in the form of BICU care and respiratory intervention. Counter to findings in adult populations, differences in mortality were not observed. Collectively, these findings suggest obesity as a risk factor for increased morbidity in the pediatric burn population. © 2014 Elsevier Inc. All rights reserved.

Assessment of patient satisfaction with the preoperative anesthetic evaluation

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Gebremedhn EG

2014-09-01

Full Text Available Endale Gebreegziabher Gebremedhn, Vidhya Nagaratnam Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The evaluation of patient satisfaction is a core aspect of the continuous quality improvement in anesthesia service that can be affected by the preoperative anesthetist visit. This visit enables the anesthetist to know about the patient's general health status and the nature of surgery, to choose the type of anesthesia, and to discuss perioperative complications and their management with the patient. Patients have sometimes complained about the information given during the preoperative anesthetic evaluation in the University of Gondar teaching and referral hospital. The aim of this study was to determine the level of patient satisfaction with the preoperative anesthetist visit. Methods: A cross-sectional study was conducted from February 15 to April 15, 2013. All consecutive elective patients who were operated upon under anesthesia during the study period were interviewed 24 hours after operation. A pretested questionnaire and checklists, which were developed based on the hospital's anesthetic evaluation sheet, were used for data collection. Results: A total of 116 elective patients were operated upon under anesthesia during the study period. Of these, 102 patients were included in our study, with a response rate of 87.9%. Anesthetists introduced themselves to ~24% patients; provided information about anesthesia to ~32%, postoperative complications to ~21%, postoperative analgesia to ~18, and postoperative nausea and vomiting to ~21%; and spent adequate time with ~74%. Patients' questions were answered by the anesthetist in ~65% of cases, and ~65% of patients had reduced anxiety after the anesthetist visit. The patients' overall satisfaction with the preoperative anesthetist visit was ~65%. Conclusion and recommendation: Patient satisfaction with the

Aortic Involvement in Pediatric Marfan syndrome: A Review.

Science.gov (United States)

Ekhomu, Omonigho; Naheed, Zahra J

2015-06-01

Outlining specific protocols for the management of pediatric patients with Marfan syndrome has been challenging. This is mostly due to a dearth of clinical studies performed in pediatric patients. In Marfan syndrome, the major sources of morbidity and mortality relate to the cardiovascular system. In this review, we focus on aortic involvement seen in pediatric patients with Marfan syndrome, ranging from aortic dilatation to aortic rupture and heart failure. We discuss the histological, morphological, and pathogenetic basis of the cardiac manifestations seen in pediatric Marfan syndrome and use a specific case to depict our experienced range of cardiovascular manifestations. The survival for patients with Marfan syndrome may approach the expected survival for non-affected patients, with optimal management. With this potentiality in mind, we explore possible and actual management considerations for pediatric Marfan syndrome, examining both medical and surgical therapy modalities that can make the possibility of improved survival a reality.

The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

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Rachel Gooden

2014-12-01

Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

Thermoluminescent dosimetry in pediatric patients subjected to TAC cranium multi cutting studies

International Nuclear Information System (INIS)

Tabares V, M.J.; Azorin N, J.; Azorin V, J.C.

2007-01-01

Full text: In this work the doses to critical organs in pediatric patient subjected to studies of multi cutting skull tomography were determined. The study included patient smaller than 16. The used tomograph was a Siemens Somaton 16 plus multi cutting. The dosimetry one carries out with thermoluminescent dosemeters of LiF:Mg,Cu,P +Ptfe of national production. This dosemeters type was used due to it characteristics, such as low fading, equivalence with the tissue, easy handling and reading and independence of it answer with the radiation energy. The value of the absorbed doses in organs in the simple study results half of the obtained value in the contrasted study that which indicates that the CTDI vol is proportional to the dose to organ. In the case of the skull three-dimensional reconstruction tomography the CTDI vol was practically the same one that for simple tomography was practically; however, the doses to organs differed significantly. When comparing the TDI vol value of the three-dimensional reconstruction tomography with that of the contrasted tomography the obtained reason it was 1:2; however, the doses to organ didn't show the same relationship and the absorbed dose in the case of the thyroid gland was even bigger in the study of three-dimensional reconstruction. The value of the CTDI vol is a good indicator of the exposure factors selected for the tomographic exploration and it is useful for the determination of the effective dose, but it doesn't indicate the absorbed dose to organ. (Author)

Pediatric Mania: The Controversy between Euphoria and Irritability

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Serra, Giulia; Uchida, Mai; Battaglia, Claudia; Casini, Maria Pia; De Chiara, Lavinia; Biederman, Joseph; Vicari, Stefano; Wozniak, Janet

2017-01-01

Abstract: Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders and associated with high levels of morbidity and disability and with a great risk of suicide. While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified. We reviewed the available studies on the phenomenology of pediatric mania with the aim of summarizing the prevalence, demographics, clinical correlates and course of these two types of pediatric mania. Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age. Future research should focus on the heterogeneity of irritability aiming at differentiating distinct subtypes of pediatric psychiatric disorders with distinct phenomenology, course, outcome and biomarkers. Longitudinal studies of samples attending to mood presentation, irritable versus elated, and course, chronic versus episodic, may help clarify whether these are meaningful distinctions in the course, treatment and outcome of pediatric onset bipolar disorder. PMID:28503110

Pediatric Mania: The Controversy between Euphoria and Irritability.

Science.gov (United States)

Serra, Giulia; Uchida, Mai; Battaglia, Claudia; Casini, Maria Pia; De Chiara, Lavinia; Biederman, Joseph; Vicari, Stefano; Wozniak, Janet

2017-04-01

Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders and associated with high levels of morbidity and disability and with a great risk of suicide. While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified. We reviewed the available studies on the phenomenology of pediatric mania with the aim of summarizing the prevalence, demographics, clinical correlates and course of these two types of pediatric mania. Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95-100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common. Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age. Future research should focus on the heterogeneity of irritability aiming at differentiating distinct subtypes of pediatric psychiatric disorders with distinct phenomenology, course, outcome and biomarkers. Longitudinal studies of samples attending to mood presentation, irritable versus elated, and course, chronic versus episodic, may help clarify whether these are meaningful distinctions in the course, treatment and outcome of pediatric onset bipolar disorder.

Virtual Pediatric Hospital

Science.gov (United States)

... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

[Full-text publication of abstracts presented at the 33th Argentinean pediatric meeting and non publication related factors].

Science.gov (United States)

Canosa, Daniela; Ferrero, Fernando; Melamud, Ariel; Otero, Paula D; Merech, Raúl S; Ceriani Cernadas, José M

2011-02-01

There is no information about non publication of research presented at scientific meetings in Argentina. We analyzed the full-text publication rate of abstracts presented at the 33° Argentinean Pediatric Congress (APC), time to achieve publication, and factors associated with publication or non-publication. Survey-based cross-sectional study, including authors of abstracts presented at the 33° APC. The survey included age, gender, specialty and sub-specialty, professional area and reason of publication or non-publication. We randomly selected 140/894 presented abstracts. Only 16 abstracts (11.4%) were subsequently published in full, requiring 27±15 months. There were no association between full-text publication and author's characteristics. "Oral presentations" were more likely to be subsequently published (p= 0.018). In non published abstracts, 95% were not submitted by the author, more frequently because of "lack of time" (35.9%). Only 11.4% of abstracts were subsequently published in full. Oral presentation was associated with a higher publication rate. Most frequent cause for non-publication was non submission due to lack of time.

Pediatric Specialists

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... Healthy Children > Family Life > Medical Home > Pediatric Specialists Pediatric Specialists Article Body ​Your pediatrician may refer your child to a pediatric specialist for further evaluation and treatment. Pediatric specialists ...

A novel local anesthetic system: transcriptional transactivator peptide-decorated nanocarriers for skin delivery of ropivacaine

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Chen CY

2017-06-01

Full Text Available Chuanyu Chen, Peijun You Department of Anesthesiology, Shandong Jining No 1 People’s Hospital, Jining, Shandong, People’s Republic of China Purpose: Barrier properties of the skin and physicochemical properties of drugs are the main factors for the delivery of local anesthetic molecules. The present work evaluates the anesthetic efficacy of drug-loaded nanocarrier (NC systems for the delivery of local anesthetic drug, ropivacaine (RVC. Methods: In this study, transcriptional transactivator peptide (TAT-decorated RVC-loaded NCs (TAT-RVC/NCs were successfully fabricated. Physicochemical properties of NCs were determined in terms of particle size, zeta potential, drug encapsulation efficiency, drug-loading capacity, stability, and in vitro drug release. The skin permeation of NCs was examined using a Franz diffusion cell mounted with depilated mouse skin in vitro, and in vivo anesthetic effect was evaluated in mice. Results: The results showed that TAT-RVC/NCs have a mean diameter of 133.2 nm and high drug-loading capacity of 81.7%. From the in vitro skin permeation results, it was observed that transdermal flux of TAT-RVC/NCs was higher than that of RVC-loaded NCs (RVC/NCs and RVC injection. The evaluation of in vivo anesthetic effect illustrated that TAT-RVC/NCs can enhance the transdermal delivery of RVC by reducing the pain threshold in mice. Conclusion: These results indicate that TAT-decorated NCs systems are useful for overcoming the barrier function of the skin, decreasing the dosage of RVC and enhancing the anesthetic effect. Therefore, TAT-decorated NCs can be used as an effective transdermal delivery system for local anesthesia. Keywords: local anesthetic system, ropivacaine, transcriptional transactivator peptide, nanocarriers, skin delivery

Anesthetic exposure and health of dental personnel, 1 June 1978-30 November 1980

Energy Technology Data Exchange (ETDEWEB)

Cohen, E.N.

1980-01-01

An epidemiologic survey was conducted to determine possible health hazards in the dental profession, with particular attention being given to the results of exposure to anesthetic gases. The survey contacted 30,650 dentists and 30,547 chairside assistants who were subsequently grouped according to exposure to inhalation anesthetics in the dental operatory during the course of their employment experience. An increase in liver disease 1.7 above that expected was noted in male dentists heavily exposed to anesthetics, combined with a 1.2 fold increase for kidney disease and 1.9-fold increase for neurological disease. The spontaneous abortion rate in wives of male dentists was 1.5-fold higher than expected. Occupational exposure to anesthetics, either direct or indirect, was associated with significant increases in spontaneous abortion over control levels during the first and second trimester of pregnancy. Women who smoked during pregnancy showed increased risk of spontaneous abortion, with a 27% increase occurring in dental assistants and a 21% increase in wives of dentists. A 34% increased risk of babies having congenital abnormalities was noted among smoking dental assistants.

Allyl m-Trifluoromethyldiazirine Mephobarbital: An Unusually Potent Enantioselective and Photoreactive Barbiturate General Anesthetic

Energy Technology Data Exchange (ETDEWEB)

Savechenkov, Pavel Y.; Zhang, Xi; Chiara, David C.; Stewart, Deirdre S.; Ge, Rile; Zhou, Xiaojuan; Raines, Douglas E.; Cohen, Jonathan B.; Forman, Stuart A.; Miller, Keith W.; Bruzik, Karol S. (Harvard-Med); (Mass. Gen. Hosp.); (UIC)

2012-12-10

We synthesized 5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl)barbituric acid (14), a trifluoromethyldiazirine-containing derivative of general anesthetic mephobarbital, separated the racemic mixture into enantiomers by chiral chromatography, and determined the configuration of the (+)-enantiomer as S by X-ray crystallography. Additionally, we obtained the {sup 3}H-labeled ligand with high specific radioactivity. R-(-)-14 is an order of magnitude more potent than the most potent clinically used barbiturate, thiopental, and its general anesthetic EC{sub 50} approaches those for propofol and etomidate, whereas S-(+)-14 is 10-fold less potent. Furthermore, at concentrations close to its anesthetic potency, R-(-)-14 both potentiated GABA-induced currents and increased the affinity for the agonist muscimol in human {alpha}1{beta}2/3{gamma}2L GABA{sub A} receptors. Finally, R-(-)-14 was found to be an exceptionally efficient photolabeling reagent, incorporating into both {alpha}1 and {beta}3 subunits of human {alpha}1{beta}3 GABAA receptors. These results indicate R-(-)-14 is a functional general anesthetic that is well-suited for identifying barbiturate binding sites on Cys-loop receptors.

Anesthetic Management and Complications of Percutaneous Aortic Valve Implantation

Directory of Open Access Journals (Sweden)

Tailur Alberto Grando

2013-05-01

Full Text Available Background and objective: Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia Method: Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM, electrocardiogram (ECG, pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. Results: Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe. Conclusion: The initial experience with percutaneous aortic valve implantation under general anesthesia has proven to be safe and effective, with no significant anesthetic complications during this procedure. Keywords: Aesthesia, General, Cardiac Surgical Procedures, Aortic Valve Stenosis, Aged.

Availability of anesthetic effect monitoring: utilization, intraoperative management and time to extubation in liver transplantation.

Science.gov (United States)

Schumann, R; Hudcova, J; Bonney, I; Cepeda, M S

2010-12-01

Titration of volatile anesthetics to anesthetic effect monitoring using the bispectral index (BIS) has been shown to decrease anesthetic requirements and facilitate recovery from anesthesia unrelated to liver transplantation (OLT). To determine whether availability of such monitoring influences its utilization pattern and affect anesthetic care and outcomes in OLT, we conducted a retrospective analysis in recipients with and without such monitoring. We evaluated annual BIS utilization over a period of 7 years, and compared 41 BIS-monitored patients to 42 controls. All received an isoflurane/air/oxygen and opioid-based anesthetic with planned postoperative ventilation. Data collection included age, body mass index (BMI), gender, Model for End-stage Liver Disease (MELD) score, and time to extubation (TtE). Mean preanhepatic, anhepatic, and postanhepatic end-tidal isoflurane concentrations were compared, as well as BIS values for each phase of OLT using the Kruskal-Wallis and Wilcoxon signed-rank tests, respectively. The use of anesthetic effect monitoring when available increased steadily from 15% of cases in the first year to almost 93% by year 7. There was no significant difference in age, gender, BMI, MELD, or TtE between groups. The BIS group received less inhalational anesthetic during each phase of OLT compared to the control group. However, this difference was statistically significant only during the anhepatic phase (P = .026), and was clinically not impressive. Within the BIS group, the mean BIS value was 38.74 ± 5.25 (mean ± standard deviation), and there was no difference for the BIS value between different transplant phases. Availability of anesthetic effect monitoring as an optional monitoring tool during OLT results in its increasing utilization by anesthesia care teams over time. However, unless integrated into an intraoperative algorithm and an early extubation protocol for fast tracking of OLT recipients, this utilization does not appear to provide

Vedolizumab Therapy in Severe Pediatric Inflammatory Bowel Disease.

Science.gov (United States)

Conrad, Máire A; Stein, Ronen E; Maxwell, Elizabeth C; Albenberg, Lindsey; Baldassano, Robert N; Dawany, Noor; Grossman, Andrew B; Mamula, Petar; Piccoli, David A; Kelsen, Judith R

2016-10-01

Vedolizumab is effective for inducing and maintaining remission in adults with inflammatory bowel disease (IBD); however, there is limited pediatric data. This study aimed to describe the adverse events and clinical response to vedolizumab in refractory pediatric IBD. Disease activity indices, clinical response, concomitant medication use, and adverse events were measured over 22 weeks in an observational prospective cohort study of children with refractory IBD who had failed anti-tumor necrosis factor therapy and subsequently initiated vedolizumab therapy. Twenty-one subjects, 16 with Crohn disease, received vedolizumab. Clinical response was observed in 6/19 (31.6%) of the evaluable subjects at week 6 and in 11/19 (57.9%) by week 22. Before induction, 15/21 (71.4%) participants were treated with systemic corticosteroids, as compared with 7/21 (33.3%) subjects at 22 weeks. Steroid-free remission was seen in 1/20 (5.0%) subjects at 6 weeks, 3/20 (15.0%) at 14 weeks, and 4/20 (20.0%) at 22 weeks. There was statistically significant improvement in serum albumin and hematocrit; however, C-reactive protein increased by week 22 (P < 0.05). There were no infusion reactions. Vedolizumab was discontinued in 2 patients because of severe colitis, requiring surgical intervention. There is limited experience with vedolizumab therapy in pediatric IBD. There seems to be a marked number of subjects with clinical response in the first 6 weeks that increases further by week 22 despite the severity of disease in this cohort. Adverse events may not be directly related to vedolizumab. This study is limited by small sample size, and larger prospective studies are warranted.

Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

Science.gov (United States)

Riveros-Perez, Efrain; Hermesch, Amy C; Barbour, Linda A; Hawkins, Joy L

2018-01-01

Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis. PMID:29535558

Uses and Doses of Local Anesthetics in Fish, Amphibians, and Reptiles.

Science.gov (United States)

Chatigny, Frederic; Kamunde, Collins; Creighton, Catherine M; Stevens, E Don

2017-05-01

Local anesthetics are an integral part of routine pain management in mammals, yet their use is relatively limited in fish, amphibians and reptiles. These animals frequently undergo potentially painful surgical procedures and therefore could possibly benefit from those drugs. Some recommendations are currently available in the literature concerning analgesic use in these animals. However the pharmacological properties, safety and often efficacy of local anesthetic drugs have not been investigated yet in fish, amphibians, or reptiles. This review compiled current information concerning the use of those agents in fish, reptiles and amphibians to help clinicians make an informed decision as to which dose and drug to use. The resulting literature search showed that the literature concerning use of local analgesics in fish and amphibians is very limited while the literature for reptiles is more extensive. We found few experimental studies evaluating the efficacy of local anesthetics. Further studies would provide additional information for developing guidelines to improve the welfare of fish, amphibians and reptiles.

Role of Network Science in the Study of Anesthetic State Transitions.

Science.gov (United States)

Lee, UnCheol; Mashour, George A

2018-04-23

The heterogeneity of molecular mechanisms, target neural circuits, and neurophysiologic effects of general anesthetics makes it difficult to develop a reliable and drug-invariant index of general anesthesia. No single brain region or mechanism has been identified as the neural correlate of consciousness, suggesting that consciousness might emerge through complex interactions of spatially and temporally distributed brain functions. The goal of this review article is to introduce the basic concepts of networks and explain why the application of network science to general anesthesia could be a pathway to discover a fundamental mechanism of anesthetic-induced unconsciousness. This article reviews data suggesting that reduced network efficiency, constrained network repertoires, and changes in cortical dynamics create inhospitable conditions for information processing and transfer, which lead to unconsciousness. This review proposes that network science is not just a useful tool but a necessary theoretical framework and method to uncover common principles of anesthetic-induced unconsciousness.

Photoacoustic microscopy of cerebral hemodynamic and oxygen-metabolic responses to anesthetics

Science.gov (United States)

Cao, Rui; Li, Jun; Ning, Bo; Sun, Naidi; Wang, Tianxiong; Zuo, Zhiyi; Hu, Song

2017-02-01

General anesthetics are known to have profound effects on cerebral hemodynamics and neuronal activities. However, it remains a challenge to directly assess anesthetics-induced hemodynamic and oxygen-metabolic changes from the true baseline under wakefulness at the microscopic level, due to the lack of an enabling technology for high-resolution functional imaging of the awake mouse brain. To address this challenge, we have developed head-restrained photoacoustic microscopy (PAM), which enables simultaneous imaging of the cerebrovascular anatomy, total concentration and oxygen saturation of hemoglobin (CHb and sO2), and blood flow in awake mice. From these hemodynamic measurements, two important metabolic parameters, oxygen extraction fraction (OEF) and the cerebral metabolic rate of oxygen (CMRO2), can be derived. Side-by-side comparison of the mouse brain under wakefulness and anesthesia revealed multifaceted cerebral responses to isoflurane, a volatile anesthetic widely used in preclinical research and clinical practice. Key observations include elevated cerebral blood flow (CBF) and reduced oxygen extraction and metabolism.

Hypnosis control based on the minimum concentration of anesthetic drug for maintaining appropriate hypnosis.

Science.gov (United States)

Furutani, Eiko; Nishigaki, Yuki; Kanda, Chiaki; Takeda, Toshihiro; Shirakami, Gotaro

2013-01-01

This paper proposes a novel hypnosis control method using Auditory Evoked Potential Index (aepEX) as a hypnosis index. In order to avoid side effects of an anesthetic drug, it is desirable to reduce the amount of an anesthetic drug during surgery. For this purpose many studies of hypnosis control systems have been done. Most of them use Bispectral Index (BIS), another hypnosis index, but it has problems of dependence on anesthetic drugs and nonsmooth change near some particular values. On the other hand, aepEX has an ability of clear distinction between patient consciousness and unconsciousness and independence of anesthetic drugs. The control method proposed in this paper consists of two elements: estimating the minimum effect-site concentration for maintaining appropriate hypnosis and adjusting infusion rate of an anesthetic drug, propofol, using model predictive control. The minimum effect-site concentration is estimated utilizing the property of aepEX pharmacodynamics. The infusion rate of propofol is adjusted so that effect-site concentration of propofol may be kept near and always above the minimum effect-site concentration. Simulation results of hypnosis control using the proposed method show that the minimum concentration can be estimated appropriately and that the proposed control method can maintain hypnosis adequately and reduce the total infusion amount of propofol.

A Pharmacokinetics, Efficacy, and Safety Study of Gadoterate Meglumine in Pediatric Subjects Aged Younger Than 2 Years.

Science.gov (United States)

Scala, Mario; Koob, Meriam; de Buttet, Sophie; Bourrinet, Philippe; Felices, Mathieu; Jurkiewicz, Elzbieta

2018-02-01

The primary objective of this study was to investigate the pharmacokinetic profile of gadoterate meglumine in pediatric patients younger than 2 years; the secondary objectives were to document its efficacy and safety. This was a Phase IV open-label, prospective study conducted in 9 centers (4 countries). Forty-five patients younger than 2 years with normal estimated glomerular filtration rate and scheduled to undergo routine gadolinium-enhanced magnetic resonance imaging (MRI) of any organ were included and received a single intravenous injection of gadoterate meglumine (0.1 mmol/kg). To perform the population pharmacokinetics analysis, 3 blood samples per subject were drawn during 3 time windows at time points allocated by randomization. Gadoterate meglumine concentrations were best fitted using a 2-compartmental model with linear elimination from central compartment. The median total clearance adjusted to body weight was estimated at 0.06 L/h per kg and increased with estimated glomerular filtration rate according to a power model. The median volume of distribution at steady state (Vss) adjusted to body weight was estimated at 0.047 L/kg. Estimated median terminal half-life (t1/2β) was 1.35 h, and the median systemic exposure (area under the curve) was 1591 μmol h/L. Efficacy was assessed by comparing precontrast +postcontrast images to precontrast images in a subset of 28 subjects who underwent an MRI examination of brain, spine, and associated tissues. A total of 28 lesions were identified and analyzed in 15 subjects with precontrast images versus 30 lesions in 16 subjects with precontrast + postcontrast images. Lesion visualization was improved with a mean (SD) increase in scores at subject level of 0.7 (1.0) for lesion border delineation, 0.9 (1.6) for internal morphology, and 3.1 (3.2) for contrast enhancement. Twenty-six adverse events occurred postinjection in 13 subjects (28.9%), including 3 serious reported in 1 subject (2.2%). One subject (2

Acute differential effects of dietary protein quality on postprandial lipemia in obese non-diabetic subjects

DEFF Research Database (Denmark)

Holmer-Jensen, Jens; Mortensen, Lene Sundahl; Astrup, Arne

2013-01-01

Non-fasting triglyceridemia is much closer associated to cardiovascular risk compared to fasting triglyceridemia. We hypothesized that there would be acute differential effects of four common dietary proteins (cod protein, whey isolate, gluten, and casein) on postprandial lipemia in obese non......-diabetic subjects. To test the hypothesis we conducted a randomized, acute clinical intervention study with crossover design. We supplemented a fat rich mixed meal with one of four dietary proteins i.e. cod protein, whey protein, gluten or casein. Eleven obese non-diabetic subjects (age: 40-68, body mass index: 30...... concentration in the chylomicron rich fraction (P = .0293). Thus, we have demonstrated acute differential effects on postprandial metabolism of four dietary proteins supplemented to a fat rich mixed meal in obese non-diabetic subjects. Supplementation with whey protein caused lower postprandial lipemia compared...

ACCURACY OF NONINVASIVE ANESTHETIC MONITORING IN THE ANESTHETIZED GIRAFFE (GIRAFFA CAMELOPARDALIS)

DEFF Research Database (Denmark)

Bertelsen, Mads F; Grøndahl, Carsten; Stegmann, George F

2017-01-01

This study evaluated the accuracy of pulse oximetry, capnography, and oscillometric blood pressure during general anesthesia in giraffes (Giraffa camelopardalis). Thirty-two giraffes anesthetized for physiologic experiments were instrumented with a pulse oximeter transmittance probe positioned...... on the tongue and a capnograph sampling line placed at the oral end of the endotracheal tube. A human size 10 blood pressure cuff was placed around the base of the tail, and an indwelling arterial catheter in the auricular artery continuously measured blood pressure. Giraffes were intermittently ventilated...... using a Hudson demand valve throughout the procedures. Arterial blood for blood gas analysis was collected at multiple time points. Relationships between oxygen saturation as determined by pulse oximetry and arterial oxygen saturation, between arterial carbon dioxide partial pressure and end...

Evaluation of undergraduate clinical learning experiences in the subject of pediatric dentistry using critical incident technique.

Science.gov (United States)

Vyawahare, S; Banda, N R; Choubey, S; Parvekar, P; Barodiya, A; Dutta, S

2013-01-01

In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student's perceptions should be considered in any discussion of their education, but there has been no systematic examination of India's undergraduate dental students learning experiences. This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students' viewpoint using critical incident technique (CIT). The sample group for this investigation came from all 240 3rd and 4th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1) The instructor; 2) the patient; 3) the learning process; and 4) the learning environment. The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

Social pediatrics: weaving horizontal and vertical threads through pediatric residency.

Science.gov (United States)

van den Heuvel, Meta; Martimianakis, Maria Athina Tina; Levy, Rebecca; Atkinson, Adelle; Ford-Jones, Elizabeth; Shouldice, Michelle

2017-01-13

Social pediatrics teaches pediatric residents how to understand disease within their patients' social, environmental and political contexts. It's an essential component of pediatric residency training; however there is very little literature that addresses how such a broad-ranging topic can be taught effectively. The aim of this study was to determine and characterize social pediatric education in our pediatric residency training in order to identify strengths and gaps. A social pediatrics curriculum map was developed, attending to 3 different dimensions: (1) the intended curriculum as prescribed by the Objectives of Training for Pediatrics of the Royal College of Physicians and Surgeons of Canada (RCPSC), (2) the formal curriculum defined by rotation-specific learning objectives, and (3) the informal/hidden curriculum as reflected in resident and teacher experiences and perceptions. Forty-one social pediatric learning objectives were extracted from the RCPSC Objectives of Training for Pediatrics, most were listed in the Medical Expert (51%) and Health Advocate competencies (24%). Almost all RCPSC social pediatric learning objectives were identified in more than one rotation and/or seminar. Adolescent Medicine (29.2%), Pediatric Ambulatory Medicine (26.2%) and Developmental Pediatrics (25%) listed the highest proportion of social pediatric learning objectives. Four (10%) RCPSC social pediatric objectives were not explicitly named within learning objectives of the formal curriculum. The informal curriculum revealed that both teachers and residents viewed social pediatrics as integral to all clinical encounters. Perceived barriers to teaching and learning of social pediatrics included time constraints, particularly in a tertiary care environment, and the value of social pediatrics relative to medical expert knowledge. Despite the lack of an explicit thematic presentation of social pediatric learning objectives by the Royal College and residency training program

Medication organizers (pill minders) increase the risk for unintentional pediatric ingestions.

Science.gov (United States)

Wang, George Sam; Hoppe, Jason A; Brou, Lina; Heard, Kennon J

2017-09-01

Medication organizers may help improve medication compliance; however, they may increase the risk of having an unintentional pediatric exposure. The objective of this study was to measure the association between a pediatric emergency department (ED) visit for an unintentional pharmaceutical ingestion and the use of a medication organizer in the household. This was a cross-sectional case control study at a tertiary care children's hospital ED. Cases included subjects organizer was 2.0 (95% CI, 1.3, 2.9). After adjusting for the presence of prescription medications in the home, the OR of risk for ingestion remained statistically significant at 1.8 (95% CI, 1.1, 2.7). The child obtained the exposure medication from the medication organizer in 63% of cases where a medication organizer was present in the home. Cases were more likely to have knowledge of, and previous contact with poison control centers (PCC) than non-injury controls. Overall, a large number of caregivers (36%) did not have any knowledge of PCC. There were also differences in smoking and use of seat belts between cases and controls. The use of medication organizers may be a risk factor for unintentional pediatric pharmaceutical ingestions, even when controlling for the use of prescription medications in the home. Further research is needed to evaluate the specific role of medication organizers, and subsequently, improve prevention strategies.

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with symptomatic versus asymptomatic irreversible pulpitis.

Science.gov (United States)

Argueta-Figueroa, Liliana; Arzate-Sosa, Gabriel; Mendieta-Zeron, Hugo

2012-01-01

This study sought to determine the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in patients with symptomatic and asymptomatic irreversible pulpitis in mandibular posterior teeth and if individual patient factors, pulpal disease characteristics, and previous medication are correlated to local anesthetic success. A second objective was to determine the specificity and sensibility of a cold test for prediction of anesthetic success prior to endodontic treatment. Seventy patients diagnosed with irreversible pulpitis in mandibular posterior teeth received 1.6 mL of 4% articaine with 1:100,000 epinephrine for an inferior alveolar nerve block (IANB) using a metal guide. The anesthetic solution was injected with a computer-preprogrammed delivery system for local anesthesia. Endodontic access was begun 15 minutes after solution deposition; later, patients rated their discomfort using the visual analog scale (VAS). The success rate for the IA NB using articaine was 64.2% in patients with symptomatic irreversible pulpitis and 86.9% in patients with asymptomatic irreversible pulpitis. Cold test prior to root canal treatment had a specificity and sensibility of 12.5% and 87.1%, respectively. The anesthetic efficacy of articaine in irreversible pulpitis is moderately acceptable, and anesthetic success increases when the patient has been premedicated with NSAIDs. The cold test appears to be a favorable indicator for predicting anesthetic success.

Microbial pattern of pressure ulcer in pediatric patients

Science.gov (United States)

Paramita, D. A.; Khairina; Lubis, N. Z.

2018-03-01

Pressure ulcer (PU) is a localized trauma to the skin and or tissue beneath which lies in bony prominence due to pressure or pressure that combines with a sharp surface. Several studies have found that PU is a common problem in pediatrics population. Infection at the site of a PU is the most common complication in which the PU may host a resistant microorganism and may turn into a local infection that will be the source of bacteremia in hospitalized patients. To reveal which is the most common microbial species that underlie in pressure ulcer of pediatrics patients.A cross-sectional study was conducted in July-September 2017, involving 18 PU pediatric patients in Haji Adam Malik Hospital. To each subject, swab culture from the ulcer was madein microbial laboratory in Haji Adam Malik Hospital to determine the microbial pattern. This study found that the most common microbial pattern in pressure ulcers of pediatrics patient in Haji Adam Malik Hospital is Acinetobacter baumannii (22.2%).

Pediatric echocardiograms performed at primary centers: Diagnostic errors and missing links!

International Nuclear Information System (INIS)

Saraf, Rahul P; Suresh, PV; Maheshwari, Sunita; Shah, Sejal S

2015-01-01

The present study was undertaken to assess the accuracy of pediatric echocardiograms done at non-tertiary centers and to evaluate the relationship of inaccurate interpretations with age, echocardiogram performer and complexity of congenital heart disease (CHD). The echocardiogram reports of 182 consecutive children with CHD (5 days-16 years) who were evaluated at a non-tertiary center and subsequently referred to our center were reviewed. Age of the child at echocardiogram, echocardiogram performer and complexity of CHD were noted. These reports were compared with echocardiogram done at our center. Discrepancies were noted and categorized. To assess our own error rate, we compared our echocardiogram reports with the findings obtained during surgery (n = 172), CT scan (n = 9) or cardiac catheterization reports (n = 1). Most of the children at the non-tertiary center (92%) underwent echocardiogram by personnel other than a pediatric cardiologist. Overall, diagnostic errors were found in 69/182 (38%) children. Moderate and major discrepancies affecting the final management were found in 42/182 (23%) children. Discrepancies were higher when the echocardiogram was done by personnel other than pediatric cardiologist (P < 0.01) and with moderate and high complexity lesions (P = 0.0001). There was no significant difference in proportion of these discrepancies in children ≤ 1 year vs. >1 year of age. A significant number of pediatric echocardiograms done at non-tertiary centers had discrepancies that affected the management of these children. More discrepancies were seen when the echocardiogram performer was not a pediatric cardiologist and with complex CHD

Interactions of the local anesthetic tetracaine with membranes containing phosphatidylcholine and cholesterol: a 2H NMR study

International Nuclear Information System (INIS)

Auger, M.; Jarrell, H.C.; Smith, I.C.P.

1988-01-01

The interactions of local anesthetic tetracaine with multilamellar dispersions of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) and cholesterol have been investigated by deuterium nuclear magnetic resonance of specifically deuteriated tetracaines, DMPC and cholesterol. Experiments were performed at pH 5.5, when the anesthetic is primarily charged, and at pH 9.5, when it is primarily uncharged. The partition coefficients of the anesthetic in the membrane have been measured at both pH values for phosphatidylcholine bilayers with and without cholesterol. The higher partition coefficients obtained at pH 9.5 reflect the hydrophobic interactions between the uncharged form of the anesthetic and the hydrocarbon region of the bilayer. The lower partition coefficients for the DMPC/cholesterol system at both pH values suggest that cholesterol, which increases the order of the lipid chains, decreases the solubility of tetracaine into the bilayer. For phosphatidylcholine bilayers, it has been proposed that the charged tetracaine at low pH is located mostly at the phospholipid headgroup level while the uncharged tetracaine intercalates more deeply into the bilayer. The present study suggests that the location of tetracaine in the cholesterol-containing system is different from that in pure phosphatidylcholine bilayers: the anesthetic sits higher in the membrane. An increase in temperature results in a deeper penetration of the anesthetic into the bilayer. Moreover, the incorporation of the anesthetic into DMPC bilayers with or without cholesterol results in a reduction of the lipid order parameters both in the plateau and in the tail regions of the acyl chains, this effect being greater with the charged form of the anesthetic

Local anesthetics for brain tumor resection: Current perspectives

NARCIS (Netherlands)

J.W. Potters (Jan Willem); M. Klimek (Markus)

2018-01-01

textabstractThis review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local

Technical tips and advancements in pediatric minimally invasive surgical training on porcine based simulations.

Science.gov (United States)

Narayanan, Sarath Kumar; Cohen, Ralph Clinton; Shun, Albert

2014-06-01

Minimal access techniques have transformed the way pediatric surgery is practiced. Due to various constraints, surgical residency programs have not been able to tutor adequate training skills in the routine setting. The advent of new technology and methods in minimally invasive surgery (MIS), has similarly contributed to the need for systematic skills' training in a safe, simulated environment. To enable the training of the proper technique among pediatric surgery trainees, we have advanced a porcine non-survival model for endoscopic surgery. The technical advancements over the past 3 years and a subjective validation of the porcine model from 114 participating trainees using a standard questionnaire and a 5-point Likert scale have been described here. Mean attitude scores and analysis of variance (ANOVA) were used for statistical analysis of the data. Almost all trainees agreed or strongly agreed that the animal-based model was appropriate (98.35%) and also acknowledged that such workshops provided adequate practical experience before attempting on human subjects (96.6%). Mean attitude score for respondents was 19.08 (SD 3.4, range 4-20). Attitude scores showed no statistical association with years of experience or the level of seniority, indicating a positive attitude among all groups of respondents. Structured porcine-based MIS training should be an integral part of skill acquisition for pediatric surgery trainees and the experience gained can be transferred into clinical practice. We advocate that laparoscopic training should begin in a controlled workshop setting before procedures are attempted on human patients.

Refractometry for quality control of anesthetic drug mixtures.

Science.gov (United States)

Stabenow, Jennifer M; Maske, Mindy L; Vogler, George A

2006-07-01

Injectable anesthetic drugs used in rodents are often mixed and further diluted to increase the convenience and accuracy of dosing. We evaluated clinical refractometry as a simple and rapid method of quality control and mixing error detection of rodent anesthetic or analgesic mixtures. Dilutions of ketamine, xylazine, acepromazine, and buprenorphine were prepared with reagent-grade water to produce at least 4 concentration levels. The refraction of each concentration then was measured with a clinical refractometer and plotted against the percentage of stock concentration. The resulting graphs were linear and could be used to determine the concentration of single-drug dilutions or to predict the refraction of drug mixtures. We conclude that refractometry can be used to assess the concentration of dilutions of single drugs and can verify the mixing accuracy of drug combinations when the components of the mixture are known and fall within the detection range of the instrument.

An evaluation of instruments for scoring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in pediatric mechanically ventilated patients: A systematic review.

Science.gov (United States)

Dorfman, Tamara L; Sumamo Schellenberg, Elizabeth; Rempel, Gwen R; Scott, Shannon D; Hartling, Lisa

2014-04-01

Advancing technology allows for successful treatment of children with life-threatening illnesses. Effectively assessing and optimally treating a child's distress during their stay in the Pediatric Intensive Care Unit (PICU) is paramount. Objective measures of distress in mechanically ventilated pediatric patients are increasingly available but few have been evaluated. The objectives of this systematic review were to identify available instruments appropriate for measuring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in mechanically ventilated pediatric patients, and evaluate these instruments in terms of their psychometric properties. A systematic review of original and validation reports of objective instruments to measure pain and non-pain related distress, and adequacy of analgesia and sedation in mechanically ventilated PICU patients was undertaken. A comprehensive search was conducted in 10 databases from January 1970 to June 2011. Reference lists of relevant articles were reviewed to identify additional articles. Studies were included in the review if they met pre-established eligibility criteria. Two independent reviewers reviewed studies for inclusion, assessed quality, and extracted data. Twenty-five articles were included, identifying 15 instruments. The instruments had different foci including: assessing pain, non-pain related distress, and sedation (n=2); assessing pain exclusively (n=4); assessing sedation exclusively (n=7), assessing sedation in mechanically ventilated muscle relaxed PICU patients (n=1); and assessing delirium in mechanically ventilated PICU patients (n=1). The Comfort Scale demonstrated the greatest clinical utility in the assessment of pain, non-pain related distress, and sedation in mechanically ventilated pediatric patients. Modified FLACC and the MAPS are more appropriate, however, for the assessment of procedural pain and other brief painful events. More work is

Effect of subjective economic status on psychological distress among farmers and non-farmers of rural China.

Science.gov (United States)

Feng, Danjun; Ji, Linqin; Xu, Lingzhong

2015-08-01

This study aims to compare the prevalence of psychological distress between farmers and non-farmers of rural China. Further, this examines the effect of subjective economic status on psychological distress and whether this effect varies between farmers and non-farmers. The study design is a cross-sectional survey. The study was conducted in 27 villages of Dongying City in Shandong Province. Rural employed people included 1433 farmers and 584 non-farmers. Psychological distress was assessed by the Kessler 10 questionnaire, and subjective economic status was assessed by a single question. Overall, the farmers did not report significantly higher prevalence of psychological distress than non-farmers (31.13% versus 30.01%). However, the farmers aged 51-70 years did report significantly higher psychological distress than their non-farmer counterparts (33.4% versus 24.2%, P = 0.04). Second, subjective economic status had a significant (β = -0.28, P farmers (β = 0.30, P farmers (β = 0.20, P farmers had a comparable prevalence of psychological distress when compared with non-farmers in rural China. Subjective economic status exerted a significant effect on the psychological distress of rural employed people, and this effect was stronger for the farmers than for the non-farmers. © 2015 National Rural Health Alliance Inc.

The Professional Learning Experiences of Non-Mathematics Subject Specialist Teachers: A Descriptive Study

OpenAIRE

Ho Younghusband, Alice Christine

2017-01-01

Certified teachers in British Columbia (BC) schools can be assigned to teach secondary mathematics without having a major, minor, or formal background in mathematics. This is known as out-of-field teaching. These non-mathematics subject specialist teachers (NMSSTs) must learn or relearn the subject matter of mathematics to teach secondary mathematics. This study investigates what professional learning activities NMSSTs participate in to gain subject matter content knowledge in mathematics, wh...

Cimethidine pre-anesthetic. A prophylactic method against Mendelson's syndrome in cesarean section

DEFF Research Database (Denmark)

Qvist, N; Storm, K

1983-01-01

Twenty patients undergoing cesarean section received cimethidine 400 mg intramuscularly as pre-anesthetic approximately 70 minutes prior to gastric aspiration. The average pH was 5.05, as against 2.97 in the control group (p less than 0.01). No significant reduction in the aspirated volumes...... in the infants. Hence, cimethidine is a safe and useful pre-anesthetic for patients undergoing cesarean section, irrespective of indication and, consequently, much to be preferred to oral antacids....

Laryngeal sarcoidosis: presentation and management in the pediatric population.

Science.gov (United States)

Strychowsky, Julie E; Vargas, Sara O; Cohen, Ezra; Vielman, Rene; Son, Mary Beth; Rahbar, Reza

2015-09-01

Sarcoidosis is a disease characterized by systemic non-necrotizing granulomas of unknown etiology. Laryngeal sarcoidosis is extremely uncommon, especially among pediatric patients. The clinical presentation and management of this entity in the pediatric population are poorly understood. A comprehensive search in PubMed was conducted to identify all cases in the published literature. We also present a case of isolated pediatric laryngeal sarcoidosis and outline the multidisciplinary approach to evaluation and management. A previously healthy 13-year-old female presented with a five-month history of mild dysphonia, dyspnea on exertion, and diffuse supraglottic edema. Biopsy showed non-necrotizing granulomas. Treatment with methotrexate led to marked improvement. The literature search identified seven previously published cases of pediatric laryngeal sarcoidosis, four in which disease was isolated to the larynx. All patients presented with a symptomatic and diffusely edematous supraglottis. Diagnoses were based on supraglottic biopsies showing non-necrotizing granulomas; all other possible etiopathologies were excluded. Three patients responded to corticosteroid therapy alone, one patient to tumor necrosis factor (TNF) inhibitor and methotrexate, and the remainder to a combination of corticosteroid therapy and surgical debulking. Laryngeal sarcoidosis in the pediatric population is challenging to diagnose and manage. When epithelioid granulomas are encountered histologically, other causes of granulomatous inflammation must be ruled out before a diagnosis of sarcoidosis can be made. Corticosteroid therapy alone may be ineffective. Medical therapy with methotrexate alone or in combination with TNF inhibitors versus surgical debulking alone or as part of multimodality treatment should be considered. A multidisciplinary approach with involvement of an otolaryngologist, pathologist, and rheumatologist is suggested. Copyright © 2015 Elsevier Ireland Ltd. All rights

PET imaging in pediatric neuroradiology: current and future applications

Energy Technology Data Exchange (ETDEWEB)

Kim, Sunhee [Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States); Salamon, Noriko [UCLA David Geffen School of Medicine at UCLA, Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA (United States); Jackson, Hollie A.; Blueml, Stefan [Keck School of Medicine of USC, Department of Radiology, Childrens Hospital Los Angeles, Los Angeles, CA (United States); Panigrahy, Ashok [Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States); Keck School of Medicine of USC, Department of Radiology, Childrens Hospital Los Angeles, Los Angeles, CA (United States)

2010-01-15

Molecular imaging with positron emitting tomography (PET) is widely accepted as an essential part of the diagnosis and evaluation of neoplastic and non-neoplastic disease processes. PET has expanded its role from the research domain into clinical application for oncology, cardiology and neuropsychiatry. More recently, PET is being used as a clinical molecular imaging tool in pediatric neuroimaging. PET is considered an accurate and noninvasive method to study brain activity and to understand pediatric neurological disease processes. In this review, specific examples of the clinical use of PET are given with respect to pediatric neuroimaging. The current use of co-registration of PET with MR imaging is exemplified in regard to pediatric epilepsy. The current use of PET/CT in the evaluation of head and neck lymphoma and pediatric brain tumors is also reviewed. Emerging technologies including PET/MRI and neuroreceptor imaging are discussed. (orig.)

PET imaging in pediatric neuroradiology: current and future applications

International Nuclear Information System (INIS)

Kim, Sunhee; Salamon, Noriko; Jackson, Hollie A.; Blueml, Stefan; Panigrahy, Ashok

2010-01-01

Molecular imaging with positron emitting tomography (PET) is widely accepted as an essential part of the diagnosis and evaluation of neoplastic and non-neoplastic disease processes. PET has expanded its role from the research domain into clinical application for oncology, cardiology and neuropsychiatry. More recently, PET is being used as a clinical molecular imaging tool in pediatric neuroimaging. PET is considered an accurate and noninvasive method to study brain activity and to understand pediatric neurological disease processes. In this review, specific examples of the clinical use of PET are given with respect to pediatric neuroimaging. The current use of co-registration of PET with MR imaging is exemplified in regard to pediatric epilepsy. The current use of PET/CT in the evaluation of head and neck lymphoma and pediatric brain tumors is also reviewed. Emerging technologies including PET/MRI and neuroreceptor imaging are discussed. (orig.)

The Molecular Mechanisms of Anesthetic Action: Updates and Cutting Edge Developments from the Field of Molecular Modeling

Directory of Open Access Journals (Sweden)

Edward J. Bertaccini

2010-07-01

Full Text Available For over 160 years, general anesthetics have been given for the relief of pain and suffering. While many theories of anesthetic action have been purported, it has become increasingly apparent that a significant molecular focus of anesthetic action lies within the family of ligand-gated ion channels (LGIC’s. These protein channels have a transmembrane region that is composed of a pentamer of four helix bundles, symmetrically arranged around a central pore for ion passage. While initial and some current models suggest a possible cavity for binding within this four helix bundle, newer calculations postulate that the actual cavity for anesthetic binding may exist between four helix bundles. In either scenario, these cavities have a transmembrane mode of access and may be partially bordered by lipid moieties. Their physicochemical nature is amphiphilic. Anesthetic binding may alter the overall motion of a ligand-gated ion channel by a “foot-in-door” motif, resulting in the higher likelihood of and greater time spent in a specific channel state. The overall gating motion of these channels is consistent with that shown in normal mode analyses carried out both in vacuo as well as in explicitly hydrated lipid bilayer models. Molecular docking and large scale molecular dynamics calculations may now begin to show a more exact mode by which anesthetic molecules actually localize themselves and bind to specific protein sites within LGIC’s, making the design of future improvements to anesthetic ligands a more realizable possibility.

Evaluation of undergraduate clinical learning experiences in the subject of pediatric dentistry using critical incident technique

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S Vyawahare

2013-01-01

Full Text Available Introduction: In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student′s perceptions should be considered in any discussion of their education, but there has been no systematic examination of India′s undergraduate dental students learning experiences. Aim: This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students′ viewpoint using critical incident technique (CIT. Study Design: The sample group for this investigation came from all 240 3 rd and 4 th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. Results: They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1 The instructor; 2 the patient; 3 the learning process; and 4 the learning environment. Conclusion: The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

Anesthetic management of cardiac patient for cataract surgery

International Nuclear Information System (INIS)

Farooq, F.B.; Sultan, S.T.

2003-01-01

We are reporting the successful anesthetic management of a 6 years old child, who had cyanotic congenital heart disease and underwent an operation for cataract extraction. Ketamine was used for the induction and maintenance of anesthesia. Ventilation was assisted manually by using laryngeal masks. (author)

Non-surgical management of a pediatric “intoed” gait pattern – a systematic review of the current best evidence

Directory of Open Access Journals (Sweden)

Uden H

2012-01-01

Full Text Available Hayley Uden1, Saravana Kumar21Podiatry Department, University of South Australia, Adelaide, South Australia, Australia; 2Post Doctoral Senior Research Fellow, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, AustraliaBackground: An intoed gait pattern is one of the most common referrals for children to an orthopedic consultation. Parental concern as to the aesthetics of the child’s gait pattern and/or its symptomatic nature will primarily drive these referrals during a child’s early developmental years. Whilst some of these referrals prove to be the result of a normal growth variant, some children will present with a symptomatic intoed gait pattern. Various treatments, both conservative and surgical, have been proposed including: braces, wedges, stretches and exercises, shoe modifications, and surgical procedures. However, which treatments are effective and justified in the management of this condition is not clear within the literature. The aim of this systematic review was to therefore identify and critique the best available evidence for the non-surgical management of an intoed gait pattern in a pediatric population.Method: A systematic review was conducted of which only experimental studies investigating a management option for an intoeing gait pattern were included. Studies needed to be written in English, pertaining to a human pediatric population, and published within a peer reviewed journal. Electronic databases were searched: Ovid (Medline, EMBASE, AMED, PubMed, SportDiscus, CINAHL, and Cochrane Library. The National Health and Medical Research Council’s designation of levels of hierarchy and the Critical Appraisal Skills Programme cohort studies critical appraisal tool were used.Results: Five level IV studies were found. The studies were of varied quality and with mixed results. Gait plates, physiologic/standardized shoes, and orthotic devices (with gate plate extension

Intrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis.

Science.gov (United States)

Bucklin, Brenda A; Chestnut, David H; Hawkins, Joy L

2002-01-01

Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women. Relevant clinical studies were identified using electronic and manual searches of the literature covering the period from 1989 to 2000. Searches used the following descriptors: intrathecal analgesia, spinal opioids, epidural analgesia, epidural local anesthetics, and analgesia for labor. Data were extracted from 7 randomized clinical trials comparing analgesic measures, incidence of motor block, pruritus, nausea, hypotension, mode of delivery, and/or Apgar scores. Combined test results indicated comparable analgesic efficacy 15 to 20 minutes after injection with single-injection intrathecal opioid administration. Intrathecal opioid injections were associated with a greater incidence of pruritus (odds ratio, 14.01; 99% confidence interval, 6.9 to 28.3), but there was no difference in the incidence of nausea or in the method of delivery. Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.

Pediatric anesthesia and neurotoxicity. What the radiologist needs to know

Energy Technology Data Exchange (ETDEWEB)

Barton, Katherine; Nickerson, Joshua P.; Higgins, Timothy [The University of Vermont College of Medicine, Department of Radiology, Burlington, VT (United States); Williams, Robert K. [The University of Vermont College of Medicine, Department of Anesthesiology, Burlington, VT (United States)

2018-01-15

The use of cross-sectional imaging in the pediatric population continues to rise, particularly the use of MRI. Limiting motion artifact requires cooperative subjects who do not move during imaging, so there has been an increase in the need for pediatric sedation or anesthesia. Over the last decade, concern has increased that exposure to anesthesia might be associated with long-term cognitive deficits. In this review we report current understanding of the effects of anesthesia on the pediatric population, with special focus on long-term developmental and cognitive outcomes, and suggest how radiologists can use new technologies or imaging strategies to mitigate or minimize these potential risks. (orig.)

Pediatric anesthesia and neurotoxicity. What the radiologist needs to know

International Nuclear Information System (INIS)

Barton, Katherine; Nickerson, Joshua P.; Higgins, Timothy; Williams, Robert K.

2018-01-01

The use of cross-sectional imaging in the pediatric population continues to rise, particularly the use of MRI. Limiting motion artifact requires cooperative subjects who do not move during imaging, so there has been an increase in the need for pediatric sedation or anesthesia. Over the last decade, concern has increased that exposure to anesthesia might be associated with long-term cognitive deficits. In this review we report current understanding of the effects of anesthesia on the pediatric population, with special focus on long-term developmental and cognitive outcomes, and suggest how radiologists can use new technologies or imaging strategies to mitigate or minimize these potential risks. (orig.)

Anesthetic management of external cephalic version.

Science.gov (United States)

Chalifoux, Laurie A; Sullivan, John T

2013-09-01

Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery. Copyright © 2013 Elsevier Inc. All rights reserved.

Pharmacological management of obesity in pediatric patients.

Science.gov (United States)

Boland, Cassie L; Harris, John Brock; Harris, Kira B

2015-02-01

To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated. © The Author(s) 2014.

System for integrated adherence monitoring: real-time non-adherence risk assessment in pediatric kidney transplantation.

Science.gov (United States)

Pai, Ahna L H; Rausch, Joseph; Tackett, Alayna; Marsolo, Keith; Drotar, Dennis; Goebel, Jens

2012-06-01

This study reports initial results of the development of the SIAM, a non-adherence risk assessment system for tacrolimus and sirolimus for the pediatric kidney transplant population. Forty-eight youths between 10 and 25 yr of age diagnosed with chronic kidney disease or a kidney transplant used an electronic pill bottle (EM; time stamps each bottle opening) to dispense their medication for at least 30 days or until their next clinic appointment. Youth also completed a self-report adherence measure, and standard deviations were calculated for the last four medication serum trough levels obtained for each patient. Estimation models were developed for each medication (i.e., SIAM(TACRO) and SIAM(SIRO) ) to assign weights to these clinically available adherence measures (self-report and trough levels) for the calculation of a non-adherence risk composite score. SIAM(TACRO) models included both self-report and tacrolimus trough levels and significantly predicted EM. For sirolimus, the model predictive of adherence as measured by EM consisted of the standard deviation of sirolimus trough levels only (SIAM(SIRO) ). Non-adherence risk can be effectively assessed using clinically available assessment tools. However, the best methods for using self-report and trough levels to predict non-adherence likely differ based on the medication for which adherence is being assessed. © 2012 John Wiley & Sons A/S.

Chronicle of pediatric radiology

International Nuclear Information System (INIS)

Benz-Bohm, Gabriele; Richter, Ernst

2012-01-01

The chronicle of pediatric radiology covers the following issues: Development of pediatric radiology in Germany (BRD, DDR, pediatric radiological accommodations); development of pediatric radiology in the Netherlands (chronology and pediatric radiological accommodations); development of pediatric radiology in Austria (chronology and pediatric radiological accommodations); development of pediatric radiology in Switzerland (chronology and pediatric radiological accommodations).

Analysis of a Pediatric Home Mechanical Ventilator Population.

Science.gov (United States)

Amirnovin, Rambod; Aghamohammadi, Sara; Riley, Carley; Woo, Marlyn S; Del Castillo, Sylvia

2018-05-01

The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appropriate. The most common diagnosis requiring the use of home mechanical ventilation was neuromuscular disease (53%), followed by chronic pulmonary disease (29%). The median length of stay in the pediatric ICU decreased significantly after the implementation of a ventilator ward (70 d [30-142] vs 36 d [18-67], P = .02). The distribution of subjects upon discharge was home (71%), skilled nursing facility (24%), and died (4%), with an increase in the proportion of subjects discharged on PEEP and those going to nursing facilities over time ( P = 0.02). The evolution of home mechanical ventilation has allowed earlier transition out of the pediatric ICU and with increasing disposition to skilled nursing facilities over time. There has also been a change in ventilator management, including increased use of PEEP upon discharge, possibly driven by changes in ventilators and in-patient practice patterns. Copyright © 2018 by Daedalus Enterprises.

Local anesthetics: New insights into risks and benefits

NARCIS (Netherlands)

Lirk, P.

2014-01-01

Conventional local anesthetics in contemporary use block the voltage-gated sodium channel by binding to a specific site on the inner facet of the channel pore. Only little fractions of local anaesthetic are thought to participate in nerve blockade, the rest is absorbed into surrounding tissues or

Serum Adiponectin, Visfatin, and Omentin Compared between Non-pregnant and Pregnant Women in Overall, Non-obese, and Obese subjects

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Chantacha Sitticharoon, M.D., Ph.D.

2018-05-01

Full Text Available Objective: This study aimed to compare serum adiponectin, visfatin, and omentin between non-pregnant and pregnant women in overall, non-obese, and obese subjects. Methods: There were 40 pregnant and 33 non-pregnant women classified by body mass index (BMI into non-obese or obese subjects. Fasting blood samples were collected in the morning for the non-pregnant group and before delivery for the pregnant group. Results: Plasma glucose levels were significantly lower, but plasma insulin levels were significantly higher in pregnant when compared to non-pregnant women in overall, non-obese, and obese women (p<0.05 all. The homeostasis model assessment of insulin resistance (HOMA-IR was significantly higher, but the quantitative insulin sensitivity check index (QUICKI was significantly lower only in obese pregnant when compared to obese non-pregnant women (p<0.01 all. However, in non-obese women, HOMA-IR and QUICKI were comparable between pregnant and non-pregnant women. Serum adiponectin, visfatin, and omentin were significantly lower in pregnant compared to non-pregnant women in overall, non-obese, and obese groups (p<0.05 all. In pregnant women, serum adiponectin and omentin levels were significantly lower in obese compared to non-obese pregnant women while serum visfatin levels were comparable in both groups. Serum adiponectin levels were highest followed by omentin and visfatin, respectively in both non-obese and obese pregnant groups. These results indicated that lower serum adiponectin, visfatin, and omentin in pregnant women might contribute to higher insulin resistance in pregnancy. Furthermore, serum adiponectin and omentin were reduced in increasing adiposity similarly to non-pregnant women. Conclusion: Lower serum adiponectin, visfatin, and omentin in pregnant women might lead to decreased insulin sensitivity in these women.

Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study

OpenAIRE

Mohamed Idris; Nasil Sakkir; Kishore Gopalakrishna Naik; Nandakishore Kunijal Jayaram

2014-01-01

Background: The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed. Aim: A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alve...

Non-contrast MRA using an inflow-enhanced, inversion recovery SSFP technique in pediatric abdominal imaging

International Nuclear Information System (INIS)

Serai, Suraj; Towbin, Alexander J.; Podberesky, Daniel J.

2012-01-01

Abdominal contrast-enhanced MR angiography (CE-MRA) is routinely performed in children. CE-MRA is challenging in children because of patient motion, difficulty in obtaining intravenous access, and the inability of young patients to perform a breath-hold during imaging. The combination of pediatric-specific difficulties in imaging and the safety concerns regarding the risk of gadolinium-based contrast agents in patients with impaired renal function has renewed interest in the use of non-contrast (NC) MRA techniques. At our institution, we have optimized 3-D NC-MRA techniques for abdominal imaging. The purpose of this work is to demonstrate the utility of an inflow-enhanced, inversion recovery balanced steady-state free precession-based (b-SSFP) NC-MRA technique. (orig.)

Efficacy of Ketamine in Pediatric Sedation Dentistry: A Systematic Review.

Science.gov (United States)

Oh, Samuel; Kingsley, Karl

2018-05-01

Ketamine has been used as a safe and effective sedative to treat adults and children exhibiting high levels of anxiety or fear during dental treatment. Pediatric dentistry often involves patients with high levels of anxiety and fear and possibly few positive dental experiences. Patient management can involve behavioral approaches, as well as the use of sedation or general anesthesia with a variety of agents, including midazolam, diazepam, hydroxyzine, meperidine, and ketamine. The aim of this study was to investigate the clinical efficacy of ketamine use in pediatric sedation dentistry through systematic review and analysis. A systematic review of publications between 1990 and 2015 was conducted using PubMed and MEDLINE databases maintained by the US National Library of Medicine and the National Institutes of Health. The keywords used were (ketamine) AND (dental OR dentistry) AND (sedation). The abstract and title of all potential publications were then screened for clinical trials and to remove non-English articles, non-human or animal trials, and other non-dental or non-relevant studies. A total of 1,657 citations were initially identified, reviewed, and screened, eventually resulting in inclusion of 25 clinical trials in this systematic review. Nineteen studies evaluated ketamine effects in pediatric dental sedation using oral (non-invasive) administration, three involved subcutaneous or intramuscular injection, and three were completed intravenously. Evidence analysis of these trials revealed the majority (n = 22/25) provided strong, positive evidence for the use of ketamine (alone or in combination) to reduce dental anxiety and behavioral non-compliance with the remainder suggesting equivocal results. Additional endpoints evaluated in some studies involved dosage, as well as time to achieve sedation effect. The use of ketamine (alone or in combination) can provide safe, effective, and timely sedation in pediatric patients regardless of the route of

Obesity prevention in pediatrics: A pilot pediatric resident curriculum intervention on nutrition and obesity education and counseling.

Science.gov (United States)

Gonzalez, Jose L; Gilmer, Loise

2006-09-01

Obesity is a highly burdensome public health issue associated with premature death, multiple comorbid disabilities and staggering healthcare costs. Between 1980-2000, the prevalence of obesity among children and adolescents nearly tripled. Obesity subjects youth to social stigmatization and discrimination. These economic and personal burdens mandate targeted prevention and detection educational programs for all individuals at risk. The most cost-effective method of approaching this obesity epidemic is through education of health professionals. As part of an "Obesity Prevention in Pediatrics" curriculum, postgraduate-year (PGY)-2 residents first observed and then participated in the dietary evaluation and counseling of pediatric patients and their families. Attitudinal questionnaires, multiple-choice knowledge examinations and a pre-established checklist of desired skills and behaviors provided evaluation of the curriculum's effect on the participants' ability and willingness to manage actually obese or at-risk pediatric patients and their families. Attitudinal survey and knowledge test scores from control PGY-3 residents generally confirmed that their knowledge and counseling skills on obesity prevention and management were well below expectation. Following participation in the curriculum, study residents' knowledge tended to improve, as did their level of comfort in counseling obese and at-risk children, adolescents and their parents. Implementation of an "Obesity Prevention in Pediatrics" curriculum appears to improve participants' knowledge base as well as their skills and level of personal comfort in the recognition, evaluation and management, including counseling, of both obese and at-risk pediatric patients and their families.

Comparison of invasive and oscillometric blood pressure measurement techniques in anesthetized camelids.

Science.gov (United States)

Aarnes, Turi K; Hubbell, John A E; Lerche, Phillip; Bednarski, Richard M

2012-08-01

This study assessed the accuracy of the oscillometric method for arterial blood pressure (ABP) monitoring in anesthetized camelids. Twenty camelids were anesthetized and systolic ABP (SABP), mean ABP (MABP), and diastolic ABP (DABP) were measured directly and using the oscillometric method. The mean difference between SABP measurements was -9.9 ± 21.9 mmHg with a range of -76 to 54 mmHg, and the 95% limits of agreement (LOA) were -33 to 53 mmHg. The difference between DABP measurements was -1.8 ± 15.6 mmHg with a range of -81 to 36 mmHg, and the 95% LOA were -32 to 29 mmHg. The difference between MABP measurements was -2.9 ± 17.0 mmHg with a range of -81 to 36 mmHg, and the 95% LOA were -30 to 36 mmHg. Accurate ABP monitoring in anesthetized camelids cannot be accomplished using the oscillometric method.

Status of non-HDL-cholesterol and LDL-cholesterol among subjects with and without metabolic syndrome.

Science.gov (United States)

Khan, Sikandar Hayat; Asif, Naveed; Ijaz, Aamir; Manzoor, Syed Mohsin; Niazi, Najumusaquib Khan; Fazal, Nadeem

2018-04-01

To to compare non-high-density lipoprotein and low-density lipoprotein cholesterol among subjects with or without metabolic syndrome, glycation status and nephropathic changes. The comparative cross-sectional study was carried out from Dec 21, 2015, to Nov 15, 2016, at the department of pathology and medicine PNS HAFEEZ and department of chemical pathology and clinical endocrinology (AFIP), and comprised patients of either gender visiting the out-patient department for routine screening. They were evaluated for anthropometric indices, blood pressure and sampled for lipid profile, fasting plasma glucose, glycated haemoglobin, insulin, and urine albumin-to-creatinine ratio. Subjects were segregated based upon presence (Group1) or absence (Group2) of metabolic syndrome based upon criteria of National Cholesterol Education Programme and the International Diabetes Federation. Differences in high and low density lipoprotein cholesterols were calculated between the groups. Of the 229 subjects, 120(52.4%) were women and 109(47.6%) were men. Overall, there were 107(46.7%) subjects in Group 1, and 122(53.3%) in Group 2. Non-high-density lipoprotein cholesterol was significantly different between subjects with and without metabolic syndrome as per both the study criteria (p<0.05 each). . Non-high-density lipoprotein cholesterol levels were higher in subjects with metabolic syndrome.

Pediatric fibromyalgia

Directory of Open Access Journals (Sweden)

J. Ablin

2012-09-01

Full Text Available Fibromyalgia (FM is currently defined as chronic widespread pain (CWP with allodynia or hyperalgesia to pressure pain. It is classified as one of the large group of soft-tissue pain syndromes. Pain is the cardinal symptom of FM; however, most patients also experience additional symptoms such as debilitating fatigue, disrupted or non-restorative sleep, functional bowel disturbances, and a variety of neuropsychiatric problems, including cognitive dysfunction, anxiety and depressive symptoms. Its pathogenesis is not entirely understood, although it is currently believed to be the result of a central nervous system (CNS malfunction that increases pain transmission and perception. FMS usually involves females, and in these patients it often makes its first appearance during menopause. But it is often diagnosed both in young as well as elderly individuals. Pediatric FMS is a frustrating condition affecting children and adolescents at a crucial stage of their physical and emotional development. Pediatric FMS is an important differential diagnosis to be considered in the evaluation of children suffering from widespread musculoskeletal pain, and must be differentiated from a spectrum of inflammatory joint disorders such as juvenile idiopathic arthritis (JIA, juvenile ankylosing spondylitis, etc. The management of pediatric FMS is centered on the issues of education, behavioral and cognitive change (with a strong emphasis on physical exercise, and a relatively minor role for pharmacological treatment with medications such as muscle relaxants, analgesics and tricyclic agents.

Recognition of anesthetic barbiturates by a protein binding site: a high resolution structural analysis.

Directory of Open Access Journals (Sweden)

Simon Oakley

Full Text Available Barbiturates potentiate GABA actions at the GABA(A receptor and act as central nervous system depressants that can induce effects ranging from sedation to general anesthesia. No structural information has been available about how barbiturates are recognized by their protein targets. For this reason, we tested whether these drugs were able to bind specifically to horse spleen apoferritin, a model protein that has previously been shown to bind many anesthetic agents with affinities that are closely correlated with anesthetic potency. Thiopental, pentobarbital, and phenobarbital were all found to bind to apoferritin with affinities ranging from 10-500 µM, approximately matching the concentrations required to produce anesthetic and GABAergic responses. X-ray crystal structures were determined for the complexes of apoferritin with thiopental and pentobarbital at resolutions of 1.9 and 2.0 Å, respectively. These structures reveal that the barbiturates bind to a cavity in the apoferritin shell that also binds haloalkanes, halogenated ethers, and propofol. Unlike these other general anesthetics, however, which rely entirely upon van der Waals interactions and the hydrophobic effect for recognition, the barbiturates are recognized in the apoferritin site using a mixture of both polar and nonpolar interactions. These results suggest that any protein binding site that is able to recognize and respond to the chemically and structurally diverse set of compounds used as general anesthetics is likely to include a versatile mixture of both polar and hydrophobic elements.

The efficacy of local anesthetics in reducing post operative pain after appendectomy

Directory of Open Access Journals (Sweden)

Masood Baghaee vaji

2004-09-01

Full Text Available Reducing post operative pain is a common issue in surgeries. This study was to evaluate the efficacy of wound infiltration with local anesthetics in reducing postoperative pain after appendectomy. This is a double-blind, placebo-controlled, randomized clinical trial on 40 patients with non-complicated acute appendicitis. Cases received a combination of lidocaine hydrochloride and bupivacaine hydrochloride after appendectomy and before closing the wound. Controls received the same volume of saline solution. Injections were done both under the fascia of external oblique muscle and intradermal. Pain assessment was done by two pain measuring scales, VAS and NRS, in 4, 8, 12 and 24 hours after the operation. Cases and controls were the same in age, sex, and history of opium addiction. Pain peaked in the 8th hour after operation in both groups and reduced afterwards. Pain assessments showed the same pattern using the NRS and VAS measuring scales. T-test showed the pain to be significantly less in cases comparing with the controls in all time points. No significant difference was seen in the time of receiving the first analgesic after the operation but the frequency of analgesic consumption was significantly lower in controls. This study showed local anesthetic infiltration to be effective in reducing the postoperative pain in patients undergoing appendectomy which is in contrast with the previous studies. This may be due to a different infiltration technique or pain assessment in the first 24 hours after the operation.

Study of the anesthetic efficacy of inferior alveolar nerve block using articaine in irreversible pulpitis.

Science.gov (United States)

Ahmad, Zeeshan H; Ravikumar, H; Karale, Rupali; Preethanath, R S; Sukumaran, Anil

2014-01-01

The purpose of this study was to determine the anesthetic efficacy of inferior alveolar nerve block (IANB) using 4% articaine and 2% lidocaine supplemented with buccal infiltration. Forty five patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth were included in the study. The first group of 15 patients received 2% lidocaine with 1:200000 epinephrine, the second group 2% lidocaine with 1: 80,000 epinephrine and the third group of 15 subjects received 4% articaine with 1:100000 epinephrine. During the access cavity preparation those patients who complained of pain received an additional buccal infiltration. The percentage of subjects who got profound anesthesia and failure to achieve anesthesia were calculated and tabulated using a visual analog scale. The results revealed that 87% of subjects who received 4% Articaine with 1:100,000 epinephrine got satisfactory anesthesia with inferior alveolar nerve block alone. Only 2 (13%) subjects received an additional buccal infiltration and none of the patients failed to obtain complete anesthesia with articaine. In comparison only 40% of subjects got complete anesthesia with 2% lidocaine with 1:200000 and 60% with 2% lidocaine with 1:80,000. It can be concluded that 4% articaine can be used effectively for obtaining profound anesthesia for endodontic procedures in patients with irreversible pulpitis.

Prognosis and predictors of convulsion among pediatric lupus nephritis patients

International Nuclear Information System (INIS)

Beiraghdar, Fatemeh; Einollahi, Behzad; Taheri, Saeed; Panahi, Yunes; Maddani, Abbas; Esfahani, Taher; Sharifi-Bonab, Mir Mohsen

2009-01-01

In this study, we aimed to analyze features and outcome of convulsion in pediatric lupus nephritis patients. We retrospectively reviewed data of 14 Iranian children with lupus nephritis who developed seizures and compared them with a group of the same number of well matched pediatric lupus nephritis patients. Higher serum creatinine levels and higher frequencies of anemia and lymphopenia were observed in the convulsion group. Multivariable logistic regression analysis revealed that the only risk factor for development of convulsion in pediatric lupus patients with nephritis was lymphopenia. Survival analysis showed that convulsion had no impact on patient and renal function outcomes in our pediatric lupus nephritis subjects. In conclusion, we found that lymphopenia is a predictive factor for convulsion occurrence in our patients and special attention to neurological status assessment may be needed in this situation. (author)

Describing pediatric dysphonia with nonlinear dynamic parameters

Science.gov (United States)

Meredith, Morgan L.; Theis, Shannon M.; McMurray, J. Scott; Zhang, Yu; Jiang, Jack J.

2008-01-01

Objective Nonlinear dynamic analysis has emerged as a reliable and objective tool for assessing voice disorders. However, it has only been tested on adult populations. In the present study, nonlinear dynamic analysis was applied to normal and dysphonic pediatric populations with the goal of collecting normative data. Jitter analysis was also applied in order to compare nonlinear dynamic and perturbation measures. This study’s findings will be useful in creating standards for the use of nonlinear dynamic analysis as a tool to describe dysphonia in the pediatric population. Methods The study included 38 pediatric subjects (23 children with dysphonia and 15 without). Recordings of sustained vowels were obtained from each subject and underwent nonlinear dynamic analysis and percent jitter analysis. The resulting correlation dimension (D2) and percent jitter values were compared across the two groups using t-tests set at a significance level of p = 0.05. Results It was shown that D2 values covary with the presence of pathology in children. D2 values were significantly higher in dysphonic children than in normal children (p = 0.002). Standard deviations indicated a higher level of variation in normal children’s D2 values than in dysphonic children’s D2 values. Jitter analysis showed markedly higher percent jitter in dysphonic children than in normal children (p = 0.025) and large standard deviations for both groups. Conclusion This study indicates that nonlinear dynamic analysis could be a viable tool for the detection and assessment of dysphonia in children. Further investigations and more normative data are needed to create standards for using nonlinear dynamic parameters for the clinical evaluation of pediatric dysphonia. PMID:18947887

β–Cyclodextrin–Propyl Sulfonic Acid Catalysed One-Pot Synthesis of 1,2,4,5-Tetrasubstituted Imidazoles as Local Anesthetic Agents

Directory of Open Access Journals (Sweden)

Yan Ran

2015-11-01

Full Text Available Some functionalized 1,2,4,5-tetrasubstituted imidazole derivatives were synthesized using a one-pot, four component reaction involving 1,2-diketones, aryl aldehydes, ammonium acetate and substituted aromatic amines. The synthesis has been efficiently carried out in a solvent free medium using β-cyclodextrin-propyl sulfonic acid as a catalyst to afford the target compounds in excellent yields. The local anesthetic effect of these derivatives was assessed in comparison to lidocaine as a standard using a rabbit corneal and mouse tail anesthesia model. The three most potent promising compounds were subjected to a rat sciatic nerve block assay where they showed considerable local anesthetic activity, along with minimal toxicity. Among the tested analogues, 4-(1-benzyl-4,5-diphenyl-1H-imidazol-2-yl-N,N-dimethylaniline (5g was identified as most potent analogue with minimal toxicity. It was further characterized by a more favourable therapeutic index than the standard.

Computed tomography depiction of small pediatric vessels with model-based iterative reconstruction

Energy Technology Data Exchange (ETDEWEB)

Koc, Gonca; Courtier, Jesse L.; Phelps, Andrew; Marcovici, Peter A.; MacKenzie, John D. [UCSF Benioff Children' s Hospital, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States)

2014-07-15

Computed tomography (CT) is extremely important in characterizing blood vessel anatomy and vascular lesions in children. Recent advances in CT reconstruction technology hold promise for improved image quality and also reductions in radiation dose. This report evaluates potential improvements in image quality for the depiction of small pediatric vessels with model-based iterative reconstruction (Veo trademark), a technique developed to improve image quality and reduce noise. To evaluate Veo trademark as an improved method when compared to adaptive statistical iterative reconstruction (ASIR trademark) for the depiction of small vessels on pediatric CT. Seventeen patients (mean age: 3.4 years, range: 2 days to 10.0 years; 6 girls, 11 boys) underwent contrast-enhanced CT examinations of the chest and abdomen in this HIPAA compliant and institutional review board approved study. Raw data were reconstructed into separate image datasets using Veo trademark and ASIR trademark algorithms (GE Medical Systems, Milwaukee, WI). Four blinded radiologists subjectively evaluated image quality. The pulmonary, hepatic, splenic and renal arteries were evaluated for the length and number of branches depicted. Datasets were compared with parametric and non-parametric statistical tests. Readers stated a preference for Veo trademark over ASIR trademark images when subjectively evaluating image quality criteria for vessel definition, image noise and resolution of small anatomical structures. The mean image noise in the aorta and fat was significantly less for Veo trademark vs. ASIR trademark reconstructed images. Quantitative measurements of mean vessel lengths and number of branches vessels delineated were significantly different for Veo trademark and ASIR trademark images. Veo trademark consistently showed more of the vessel anatomy: longer vessel length and more branching vessels. When compared to the more established adaptive statistical iterative reconstruction algorithm, model

Computed tomography depiction of small pediatric vessels with model-based iterative reconstruction

International Nuclear Information System (INIS)

Koc, Gonca; Courtier, Jesse L.; Phelps, Andrew; Marcovici, Peter A.; MacKenzie, John D.

2014-01-01

Computed tomography (CT) is extremely important in characterizing blood vessel anatomy and vascular lesions in children. Recent advances in CT reconstruction technology hold promise for improved image quality and also reductions in radiation dose. This report evaluates potential improvements in image quality for the depiction of small pediatric vessels with model-based iterative reconstruction (Veo trademark), a technique developed to improve image quality and reduce noise. To evaluate Veo trademark as an improved method when compared to adaptive statistical iterative reconstruction (ASIR trademark) for the depiction of small vessels on pediatric CT. Seventeen patients (mean age: 3.4 years, range: 2 days to 10.0 years; 6 girls, 11 boys) underwent contrast-enhanced CT examinations of the chest and abdomen in this HIPAA compliant and institutional review board approved study. Raw data were reconstructed into separate image datasets using Veo trademark and ASIR trademark algorithms (GE Medical Systems, Milwaukee, WI). Four blinded radiologists subjectively evaluated image quality. The pulmonary, hepatic, splenic and renal arteries were evaluated for the length and number of branches depicted. Datasets were compared with parametric and non-parametric statistical tests. Readers stated a preference for Veo trademark over ASIR trademark images when subjectively evaluating image quality criteria for vessel definition, image noise and resolution of small anatomical structures. The mean image noise in the aorta and fat was significantly less for Veo trademark vs. ASIR trademark reconstructed images. Quantitative measurements of mean vessel lengths and number of branches vessels delineated were significantly different for Veo trademark and ASIR trademark images. Veo trademark consistently showed more of the vessel anatomy: longer vessel length and more branching vessels. When compared to the more established adaptive statistical iterative reconstruction algorithm, model

Using simulators to teach pediatric airway procedures in an international setting.

Science.gov (United States)

Schwartz, Marissa A; Kavanagh, Katherine R; Frampton, Steven J; Bruce, Iain A; Valdez, Tulio A

2018-01-01

There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology. The objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting. Pediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale. Participants reported significant subjective improvement in confidence level after use of the simulation models (p easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment. Copyright © 2017 Elsevier B.V. All rights reserved.

A noninvasive monitoring device for anesthetics in fish

DEFF Research Database (Denmark)

Power, Deborah M.; Fuentes, Juan; Harrison, Adrian Paul

2010-01-01

A noninvasive device capable of recording both gill and lateral fin movements was assembled and used to analyze initial and post-treatment activity frequency (Hz) in fish exposed to anesthetics. Exposure of platy fish (Xiphosphorus maculatus) to saponins from quillaja bark (0.185 mM and 0.555 m...

Anesthetic management of a horse with traumatic pneumothorax

OpenAIRE

Chesnel, Maud-Aline; Aprea, Francesco; Clutton, R. Eddie

2012-01-01

A traumatic pneumothorax and severe hemorrhage were present in a mare with a large thoracic wall defect, lung perforation, and multiple rib fractures. General anesthesia was induced to allow surgical exploration. We describe the anesthetic technique, and discuss the management of the ventilatory, hemodynamic, and metabolic disturbances encountered.

Effects of Two Different Anesthetic Solutions on Injection Pain, Efficacy, and Duration of Soft-Tissue Anesthesia with Inferior Alveolar Nerve Block for Primary Molars.

Science.gov (United States)

Elbay, Ülkü Şermet; Elbay, Mesut; Kaya, Emine; Yıldırım, Sinem

The purpose of the study was to compare the efficacy, injection pain, duration of soft tissue anesthesia, and postoperative complications of two different anesthetics (2% lidocaine with 1:80,000 epinephrine and 3% plain mepivacaine) in pediatric patients in inferior alveolar nerve block (IANB) administered by a computer-controlled delivery system (CCDS). The study was conducted as a randomized, controlled-crossover, double-blind clinical trial with 60 children requiring bilateral pulpotomy or extraction of primary mandibular molars. A CCDS was used to deliver 3% mepivacaine to 1 primary tooth and 2% lidocaine to the contralateral tooth with an IANB technique. Severity of pain and efficacy of anesthesia were evaluated using the Face, Legs, Activity, Cry, Consolability Scale, and comfort and side effects were assessed using a questionnaire. Data were analyzed using the Mann-Whitney U, Wilcoxon t, and Fisher exact tests. Patients receiving 2% lidocaine experienced significantly less pain during injection than those receiving 3% mepivacaine, and no significant differences were found in the pain scores during treatments or in postoperative complications between the two anesthetics. The mean durations of anesthesia for 3% mepivacaine and 2% lidocaine were 139.68 minutes and 149.10 minutes, respectively. Plain mepivacaine and 2% lidocaine were similarly effective in pulpotomy and the extraction of primary mandibular molars. Although the use of 3% mepivacaine provided a shorter duration of anesthesia than 2% lidocaine, both solutions showed similar results in terms of postoperative complications.

Hypnosis in pediatrics: applications at a pediatric pulmonary center

Science.gov (United States)

Anbar, Ran D

2002-01-01

Background This report describes the utility of hypnosis for patients who presented to a Pediatric Pulmonary Center over a 30 month period. Methods Hypnotherapy was offered to 303 patients from May 1, 1998 – October 31, 2000. Patients offered hypnotherapy included those thought to have pulmonary symptoms due to psychological issues, discomfort due to medications, or fear of procedures. Improvement in symptoms following hypnosis was observed by the pulmonologist for most patients with habit cough and conversion reaction. Improvement of other conditions for which hypnosis was used was gauged based on patients' subjective evaluations. Results Hypnotherapy was associated with improvement in 80% of patients with persistent asthma, chest pain/pressure, habit cough, hyperventilation, shortness of breath, sighing, and vocal cord dysfunction. When improvement was reported, in some cases symptoms resolved immediately after hypnotherapy was first employed. For the others improvement was achieved after hypnosis was used for a few weeks. No patients' symptoms worsened and no new symptoms emerged following hypnotherapy. Conclusions Patients described in this report were unlikely to have achieved rapid improvement in their symptoms without the use of hypnotherapy. Therefore, hypnotherapy can be an important complementary therapy for patients in a pediatric practice. PMID:12460456

Volatile anesthetics influence blood-brain barrier integrity by modulation of tight junction protein expression in traumatic brain injury.

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Serge C Thal

Full Text Available Disruption of the blood-brain barrier (BBB results in cerebral edema formation, which is a major cause for high mortality after traumatic brain injury (TBI. As anesthetic care is mandatory in patients suffering from severe TBI it may be important to elucidate the effect of different anesthetics on cerebral edema formation. Tight junction proteins (TJ such as zonula occludens-1 (ZO-1 and claudin-5 (cl5 play a central role for BBB stability. First, the influence of the volatile anesthetics sevoflurane and isoflurane on in-vitro BBB integrity was investigated by quantification of the electrical resistance (TEER in murine brain endothelial monolayers and neurovascular co-cultures of the BBB. Secondly brain edema and TJ expression of ZO-1 and cl5 were measured in-vivo after exposure towards volatile anesthetics in native mice and after controlled cortical impact (CCI. In in-vitro endothelial monocultures, both anesthetics significantly reduced TEER within 24 hours after exposure. In BBB co-cultures mimicking the neurovascular unit (NVU volatile anesthetics had no impact on TEER. In healthy mice, anesthesia did not influence brain water content and TJ expression, while 24 hours after CCI brain water content increased significantly stronger with isoflurane compared to sevoflurane. In line with the brain edema data, ZO-1 expression was significantly higher in sevoflurane compared to isoflurane exposed CCI animals. Immunohistochemical analyses revealed disruption of ZO-1 at the cerebrovascular level, while cl5 was less affected in the pericontusional area. The study demonstrates that anesthetics influence brain edema formation after experimental TBI. This effect may be attributed to modulation of BBB permeability by differential TJ protein expression. Therefore, selection of anesthetics may influence the barrier function and introduce a strong bias in experimental research on pathophysiology of BBB dysfunction. Future research is required to investigate

Pediatric Asthma

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... Science Education & Training Home Conditions Asthma (Pediatric) Asthma (Pediatric) Make an Appointment Refer a Patient Ask a ... meet the rising demand for asthma care. Our pediatric asthma team brings together physicians, nurses, dietitians, physical ...

Pediatric sleep apnea

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Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... Untreated pediatric sleep apnea may lead to: High blood pressure Heart or lung problems Slow growth and development

Population pharmacokinetics of methylphenidate hydrochloride extended-release multiple-layer beads in pediatric subjects with attention deficit hyperactivity disorder

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Teuscher NS

2015-05-01

Full Text Available Nathan S Teuscher,1 Akwete Adjei,2 Robert L Findling,3,4 Laurence L Greenhill,5 Robert J Kupper,2 Sharon Wigal6 1PK/PD Associates, Trophy Club, TX, 2Rhodes Pharmaceuticals L.P., Coventry, RI, 3Department of Psychiatric Services and Research, Kennedy Krieger Institute, Baltimore, MD, 4Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, 5Department of Psychiatry, Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, 6AVIDA Inc., Newport Beach, CA, USA Abstract: A new multilayer-bead formulation of extended-release methylphenidate hydrochloride (MPH-MLR has been evaluated in pharmacokinetic studies in healthy adults and in Phase III efficacy/safety studies in children and adolescents with attention deficit hyperactivity disorder (ADHD. Using available data in healthy adults, a two-input, one-compartment, first-order elimination population pharmacokinetic model was developed using nonlinear mixed-effect modeling. The model was then extended to pediatric subjects, and was found to adequately describe plasma concentration–time data for this population. A pharmacokinetic/pharmacodynamic model was also developed using change from baseline in the ADHD Rating Scale (ADHD-RS-IV total scores from a pediatric Phase III trial and simulated plasma concentration–time data. During simulations for each MPH-MLR dose level (10–80 mg, increased body weight resulted in decreased maximum concentration. Additionally, as maximum concentration increased, ADHD-RS-IV total score improved (decreased. Knowledge of the relationship between dose, body weight, and clinical response following the administration of MPH-MLR in children and adolescents may be useful for clinicians selecting initial dosing of MPH-MLR. Additional study is needed to confirm these results. Keywords: population pharmacokinetics, Aptensio XR™, MPH-MLR, methylphenidate

Pediatric Sinusitis

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... ENTCareers Marketplace Find an ENT Doctor Near You Pediatric Sinusitis Pediatric Sinusitis Patient Health Information News media interested in ... sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of ...

Comparative analysis of assessment methods for operational and anesthetic risks in ulcerative gastroduodenal bleeding

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Potakhin S.N.

2015-09-01

Full Text Available Aim of the investigation: to conduct a comparative analysis of methods of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding. Materials and methods. A retrospective analysis ofthe extent of the surgical and anesthetic risks and results of treatment of 71 patients with peptic ulcer bleeding has been conducted in the study. To evaluate the surgical and anesthetic risks classification trees are used, scale ТА. Rockall and prognosis System of rebleeding (SPRK, proposed by N. V. Lebedev et al. in 2009, enabling to evaluate the probability of a fatal outcome. To compare the efficacy ofthe methods the following indicators are used: sensitivity, specificity and prediction of positive result. Results. The study compared the results ofthe risk assessment emergency operation by using these methods with the outcome ofthe operation. The comparison ofthe prognosis results in sensitivity leads to the conclusion that the scales ТА. Rockall and SPRK are worse than the developed method of classification trees in recognizing patients with poor outcome of surgery. Conclusion. The method of classification trees can be considered as the most accurate method of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding.

Comparison of invasive and oscillometric blood pressure measurement techniques in anesthetized camelids

OpenAIRE

Aarnes, Turi K.; Hubbell, John A.E.; Lerche, Phillip; Bednarski, Richard M.

2012-01-01

This study assessed the accuracy of the oscillometric method for arterial blood pressure (ABP) monitoring in anesthetized camelids. Twenty camelids were anesthetized and systolic ABP (SABP), mean ABP (MABP), and diastolic ABP (DABP) were measured directly and using the oscillometric method. The mean difference between SABP measurements was −9.9 ± 21.9 mmHg with a range of −76 to 54 mmHg, and the 95% limits of agreement (LOA) were −33 to 53 mmHg. The difference between DABP measurements was −1...

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017.

Science.gov (United States)

Neal, Joseph M; Barrington, Michael J; Fettiplace, Michael R; Gitman, Marina; Memtsoudis, Stavros G; Mörwald, Eva E; Rubin, Daniel S; Weinberg, Guy

2018-02-01

The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block.

LENUS (Irish Health Repository)

O'Donnell, Brian D

2009-07-01

Ultrasound guidance facilitates precise needle and injectate placement, increasing axillary block success rates, reducing onset times, and permitting local anesthetic dose reduction. The minimum effective volume of local anesthetic in ultrasound-guided axillary brachial plexus block is unknown. The authors performed a study to estimate the minimum effective anesthetic volume of 2% lidocaine with 1:200,000 epinephrine (2% LidoEpi) in ultrasound-guided axillary brachial plexus block.

A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder

Science.gov (United States)

2013-01-01

Background Factors predicting treatment outcome in pediatric patients with obsessive-compulsive disorder (OCD) include disease severity, functional impairment, comorbid disorders, insight, and family accommodation (FA). Treatment of pediatric OCD is often only partly successful as some of these predictors are not targeted with conventional therapy. Among these, insight and FA were identified to be modifiable predictors of special relevance to pediatric OCD. Despite their clinical relevance, insight and FA remain understudied in youth with OCD. This study examined the clinical correlates of insight and FA and determined whether FA mediates the relationship between symptom severity and functional impairment in pediatric OCD. Methods This was a cross-sectional, outpatient study. Thirty-five treatment-naive children and adolescentswith DSM-IV diagnosis of OCD (mean age: 13.11 ± 3.16; 54.3% males) were included. Standard questionnaires were administered for assessing the study variables. Insight and comorbidities were assessed based on clinician’s interview. Subjects were categorized as belonging to a high insight or a low insight group, and the differences between these two groups were analyzed using ANOVA. Pearson’s correlation coefficients were calculated for the remaining variables of interest. Mediation analysis was carried out using structural equation modeling. Results Relative to those in the high insight group, subjects in the low insight group were younger, had more severe disease and symptoms, and were accommodated to a greater extent by their families. In addition, comorbid depression was more frequent in subjects belonging to the low insight group. Family accommodation was positively related to disease severity, symptom severity, and functional impairment. Family accommodation totally mediated the relationship between symptom severity and functional impairment. Conclusions Results support the differences in the diagnostic criteria between adult and

Pediatric constipation therapy using guidelines and polyethylene glycol 3350.

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Bell, Edward A; Wall, Geoffrey C

2004-04-01

To review current guidelines on the treatment of functional constipation in pediatric patients, with an emphasis on the role of polyethylene glycol 3350 (PEG 3350). Primary medical literature published in English was identified by MEDLINE search (1980-May 2003). Recently published treatment guidelines relating to pediatric functional constipation and its pharmacotherapy are assessed and compared. Published trials evaluating PEG 3350 in pediatric subjects are discussed and their results applied to the clinical role and use of this new agent. Constipation is a common disorder among children. A number of factors may play a role. A variety of medications are commonly used for this disorder, although few treatments have undergone evaluation by controlled clinical trials. Consensus guidelines recommend either osmotic laxatives, mineral oil, or their combination for maintenance treatment in concert with patient and parental education and behavioral training. PEG 3350 solution (MiraLax) has been shown in recent clinical studies to be an effective maintenance treatment for pediatric constipation. PEG 3350 is an effective and well-tolerated treatment choice for pediatric constipation, especially as an adjunct to education and behavioral training. PEG 3350 is an option for children with constipation who have failed or are intolerant of other pharmacotherapies.

Pediatric gastroesophageal reflux disease: Current diagnosis and management

NARCIS (Netherlands)

van der Pol, R.J.

2014-01-01

Pediatric gastroesophageal reflux disease (GERD) is a disorder difficult to diagnose and to treat. Due to the current definition of GERD, i.e. gastroesophageal reflux (GER) causing bothersome symptoms and/or complications, diagnosis is subject to broad interpretation. This thesis consists of studies

Factors influencing subjective perceptions of everyday occupations: comparing day centre attendees with non-attendees.

Science.gov (United States)

Argentzell, Elisabeth; Leufstadius, Christel; Eklund, Mona

2012-01-01

Subjective perceptions of everyday occupations are important for the well-being of people with psychiatric disabilities (PD) and are likely to vary with factors such as attending a day centre or not, activity level, self-mastery, sociodemographic and clinical factors. To explore differences in subjective perceptions of occupation and activity level between day centre attendees and non-attendees, and to investigate factors of importance for the subjective perceptions of occupations. The study groups comprised 175 participants: 93 day centre attendees and 82 non-attendees. Data were collected with instruments concerning; subjective perceptions of everyday occupations, activity level, self-mastery, and sociodemographic and clinical factors. Day centre attendees perceived higher levels of occupational value and activity level, while the groups perceived a similar level of satisfaction with daily occupations. For the total sample, self-mastery influenced both valued and satisfying everyday occupations while only value was affected by activity level. Satisfaction with daily occupation increased with age and both value and satisfaction increased with lower levels of psychiatric symptoms. Day centres provide perceptions of occupational value and stimulate activity. Non-differences between the groups regarding satisfaction with everyday occupations implied, however, that day centres might not cover all relevant occupational needs.

The pediatric NAFLD fibrosis index: a predictor of liver fibrosis in children with non-alcoholic fatty liver disease

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Pietrobattista Andrea

2009-05-01

Full Text Available Abstract Background Liver fibrosis is a stage of non-alcoholic fatty liver disease (NAFLD which is responsible for liver-related morbidity and mortality in adults. Accordingly, the search for non-invasive markers of liver fibrosis has been the subject of intensive efforts in adults with NAFLD. Here, we developed a simple algorithm for the prediction of liver fibrosis in children with NAFLD followed at a tertiary care center. Methods The study included 136 male and 67 female children with NAFLD aged 3.3 to 18.0 years; 141 (69% of them had fibrosis at liver biopsy. On the basis of biological plausibility, readily availability and evidence from adult studies, we evaluated the following potential predictors of liver fibrosis at bootstrapped stepwise logistic regression: gender, age, body mass index, waist circumference, alanine transaminase, aspartate transaminase, gamma-glutamyl-transferase, albumin, prothrombin time, glucose, insulin, triglycerides and cholesterol. A final model was developed using bootstrapped logistic regression with bias-correction. We used this model to develop the 'pediatric NAFLD fibrosis index' (PNFI, which varies between 0 and 10. Results The final model was based on age, waist circumference and triglycerides and had a area under the receiver operating characteristic curve of 0.85 (95% bootstrapped confidence interval (CI with bias correction 0.80 to 0.90 for the prediction of liver fibrosis. A PNFI ≥ 9 (positive likelihood ratio = 28.6, 95% CI 4.0 to 201.0; positive predictive value = 98.5, 95% CI 91.8 to 100.0 could be used to rule in liver fibrosis without performing liver biopsy. Conclusion PNFI may help clinicians to predict liver fibrosis in children with NAFLD, but external validation is needed before it can be employed for this purpose.

Malignancy and mortality in pediatric patients with inflammatory bowel disease

DEFF Research Database (Denmark)

de Ridder, Lissy; Turner, Dan; Wilson, David C

2014-01-01

working group of ESPGHAN conducted a multinational-based survey of cancer and mortality in pediatric IBD. METHODS: A survey among pediatric gastroenterologists of 20 European countries and Israel on cancer and/or mortality in the pediatric patient population with IBD was undertaken. One representative...... were diagnosed with IBD (ulcerative colitis, n = 21) at a median age of 10.0 years (inter quartile range, 3.0-14.0). Causes of mortality were infectious (n = 14), cancer (n = 5), uncontrolled disease activity of IBD (n = 4), procedure-related (n = 3), other non-IBD related diseases (n = 3), and unknown...

Trigeminal nerve injury associated with injection of local anesthetics

DEFF Research Database (Denmark)

Hillerup, Søren; Jensen, Rigmor H.; Ersbøll, Bjarne Kjær

2011-01-01

Background. The authors used comprehensive national registry and clinical data to conduct a study of adverse drug reactions (ADRs), in particular neurosensory disturbance (NSD), associated with local anesthetics used in dentistry. Methods. The study included data sets of annual sales of local...

Physiological responses of cacharas Pseudoplatystoma reticulatum submitted to natural anesthetics

Directory of Open Access Journals (Sweden)

Milena Souza dos Santos Sanchez

2014-02-01

Full Text Available The present study the aimed to evaluate the induction time, recovery time and physiological responses of cacharas, Pseudoplatystoma reticulatum, submitted to eugenol and menthol. 42 cacharas were exposed to eugenol 100 mgL-1 (n=14 and menthol 150 mgL-1 (n=14 and the control group (n=14 which were not exposed to any anesthetics. At the time 0 and 24 hours after induction, the bloods of 7 fishes per treatment were collected to measure the hematologic parameters and plasma glucose evaluation. The recovery was conducted in aquariums free of anesthetic, and induction and recovery times were monitored. The results were submitted to analysis of variance (P0.05 for induction time, however the recovery time had a significant reduction (P<0.05 for the menthol 150 mgL-1. There was no treatment effects on hematologic parameters, except for mean corpuscular volume (VCM, which was observed an interaction effect between factors, once fish anesthetized with eugenol showed significant reduction (P<0.05 on VCM 24 hours after anesthesia. Plasma glucose values did not differ at 0 hour after induction. 24 hours after induction, both control group and fishes exposed to eugenol and menthol were significantly reduce in VCM. Eugenol at 100 mgL-1 and menthol at 150 mgL-1 may be safely induced in cachara during biometrics procedures.

Pediatric Dentistese

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Sharath Asokan

2017-01-01

Full Text Available Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pediatric dentist. A new terminology “Pediatric Dentistese” has been coined similar to motherese, parentese, or baby talk. Since baby talk cannot be applied to all age groups of children, pediatric dentistese has been defined as “the proactive development-based individualized communication between the pediatric dentist and the child which helps to build trust, allay fear, and treat the child effectively and efficiently.”

Dissociative anesthetic combination reduces intraocular pressure (IOP in rabbits

Directory of Open Access Journals (Sweden)

Ewaldo de Mattos-Junior

2014-02-01

Full Text Available The aim of this study was evaluate the effects of three anesthetic combinations, ketamine-midazolam, ketamine-xylazine and tiletamine-zolazepam, on IOP in rabbits. In a experimental, blind, randomized, crossover study, six rabbits were anesthetized with each of 3 treatments in random order. Groups KM (ketamine, 30 mg/kg + midazolam, 1 mg/kg; KX (ketamine, 30 mg/kg + xylazine, 3 mg/kg; and TZ (tiletamine + zolazepam, 20 mg/kg. The drugs were mixed in the same syringe injected intramuscularly (IM into the quadriceps muscle. IOP was measured before drug administration (baseline and at 5-minute intervals for 30 minutes. The data were analyzed by a 2-way repeated measures ANOVA followed by Bonferroni test. All groups had significant decreases in IOP compared to baseline (p 0.05. Administration of either ketamine-midazolam, ketamine-xylazine, or tiletamine-zolazepam similarly decrease IOP in rabbits within 30 minutes of injection.

Anesthetic management of adenoidectomy and tonsillectomy assisted by low-temperature plasma technology in children

Directory of Open Access Journals (Sweden)

Meng-meng LI

2014-10-01

Full Text Available Objective　To explore the anesthetic management strategy in children undergoing adenoidectomy and tonsillectomy using low-temperature plasma technology. Methods　Sixty ASA status I children scheduled for adenoidectomy and tonsillectomy with plasma technology in the First Affiliated Hospital of General Hospital of PLA from September to December of 2013 were enrolled in this study. After induction with propofol, sufentanil and cisatracurium, the children were randomly divided into combined inhalation and intravenous anesthesia group (CIIA group, n=30 and total intravenous anesthesia group (TIVA group, n=30. In CIIA group, anesthesia was maintained with continuous infusion of propofol and remifentanil combined with sevoflurane inhalation during the surgery. In TIVA group, anesthesia was maintained only with continuous infusion of propofol and remifentanil. The hemodynamic changes and time for extubation and leaving operating room were recorded, and the emergence agitation was assessed using Pediatric Anesthesia Emergence Delirium (PAED scale. Results　There was no significant difference in hemodynamic changes between the two groups (P>0.05. The total dosages of propofol and remifentanil in TIVA group [10.5±3.4 mg/(kg.h and 16.1±5.3μg/(kg.h, respectively] were significantly higher than those of CIIA group [6.6±2.8 mg/(kg.h, 10.4±4.2 μg/(kg.h, P<0.05]. The times for extubation and leaving operating room were significantly shorter in TIVA group (8.8±3.7min, 6.2±2.9min than in CIIA group (19.8±4.3 min, 13.7±5.2 min, P<0.05, and the rate of emergence agitation during the recovery period in TIVA group (1/30 was significantly less than that in CIIA group (9/30, P<0.05. Conclusion　 Total intravenous anesthesia with tracheal intubation could shorten the recovery time and lessen the emergence agitation during the recovery period, and it may be used as a safe, feasible and convenient anesthetic strategy for adenoidectomy and tonsillectomy with

The Use of Neuraxial Catheters for Postoperative Analgesia in Neonates: A Multicenter Safety Analysis from the Pediatric Regional Anesthesia Network.

Science.gov (United States)

Long, Justin B; Joselyn, Anita S; Bhalla, Tarun; Tobias, Joseph D; De Oliveira, Gildasio S; Suresh, Santhanam

2016-06-01

Currently, there is limited evidence to support the safety of neuraxial catheters in neonates. Safety concerns have been cited as a major barrier to performing large randomized trials in this population. The main objective of this study is to examine the safety of neuraxial catheters in neonates across multiple institutions. Specifically, we sought to determine the incidence of overall and individual complications encountered when neuraxial catheters were used for postoperative analgesia in neonates. This was an observational study that used the Pediatric Regional Anesthesia Network database. Complications and adverse events were defined by the presence of at least 1 of the following intraoperative and/or postoperative factors: catheter malfunction (dislodgment/occlusion), infection, block abandoned (unable to place), block failure (no evidence of block), vascular (blood aspiration/hematoma), local anesthetic systemic toxicity, excessive motor block, paresthesia, persistent neurologic deficit, and other (e.g., intra-abdominal misplacement, tremors). Additional analyses were performed to identify the use of potentially toxic doses of local anesthetics. The study cohort included 307 neonates with a neuraxial catheter. There were 41 adverse events and complications recorded, resulting in an overall incidence of complications of 13.3% (95% confidence interval, 9.8%-17.4%). Among the complications, catheter malfunction, catheter contamination, and vascular puncture were common. None of the complications resulted in long-term complications and/or sequelae, resulting in an estimated incidence of any serious complications of 0.3% (95% confidence interval, 0.08%-1.8%). There were 120 of 307 patients who received intraoperative and/or postoperative infusions consistent with a potentially toxic local anesthetic dose in neonates. The incidence of potentially toxic local anesthetic infusion rates increased over time (P = 0.008). Neuraxial catheter techniques for intraoperative

21 CFR 346.10 - Local anesthetic active ingredients.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Local anesthetic active ingredients. 346.10 Section 346.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... ingredient: (a) Benzocaine 5 to 20 percent. (b) Benzyl alcohol 1 to 4 percent. (c) Dibucaine 0.25 to 1...

Serum fetuin-A levels in obese and non-obese subjects with and without type 2 diabetes mellitus.

Science.gov (United States)

Zhou, Zhong-Wei; Ju, Hui-Xiang; Sun, Ming-Zhong; Chen, Hong-Mei; Fu, Qing-Ping; Jiang, Dong-Mei

2018-01-01

Higher fetuin-A expression is linked to both obesity and type 2 diabetes mellitus (T2DM), However, studies in non-obese patients with T2DM are scarce. 345 newly diagnosed T2DM patients and 300 subjects with normal glucose tolerance (NGT) were divided into obese and non-obese subgroups, respectively. Serum fetuin-A and adiponectin levels and related parameters were measured. T2DM patients with obesity had higher fetuin-A levels compared with non-obese patients and obese NGT subjects (p<0.001). Significant correlations were observed between fetuin-A and most metabolic parameters in obese NGT and T2DM subjects, but which was not in non-obese patients with T2DM. The independent associations were found between fetuin-A and free fatty acids, HOMA-IR, C-reactive protein and adiponectin only in obese NGT and T2DM subjects (all p<0.05). The adjusted odds ratios for obesity were increased with increasing quartile of fetuin-A in both T2DM and NGT subjects in logistic regression models (p for trend<0.001), but which was more significant in T2DM patients. Higher serum fetuin-A levels in obese T2DM patients compared with non-obese patients and obese NGT subjects supports the hypothesis that fetuin-A may be as a bridge connecting obesity and obesity-related T2DM. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of different anesthetics on neurovascular coupling

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Franceschini, Maria Angela; Radhakrishnan, Harsha; Thakur, Kiran; Wu, Weicheng; Ruvinskaya, Svetlana; Carp, Stefan; Boas, David A.

2010-01-01

To date, the majority of neurovascular coupling studies focused on the thalamic afferents' activity in layer IV and the corresponding large spiking activity as responsible for functional hyperemia. This paper highlights the role of the secondary and late cortico-cortical transmission in neurovascular coupling. Simultaneous scalp electroencephalography (EEG) and diffuse optical imaging (DOI) measurements were obtained during multiple conditions of event-related electrical forepaw stimulation in 33 male Sprague-Dawley rats divided into 6 groups depending on the maintaining anesthetic - alpha-chloralose, pentobarbital, ketamine-xylazine, fentanyl-droperidol, isoflurane, or propofol. The somatosensory evoked potentials (SEP) were decomposed into four components and the question of which best predicts the hemodynamic responses was investigated. Results of the linear regression analysis show that the hemodynamic response is best correlated with the secondary and late cortico-cortical transmissions and not with the initial thalamic input activity in layer IV. Baseline cerebral blood flow (CBF) interacts with neural activity and influences the evoked hemodynamic responses. Finally, neurovascular coupling appears to be the same across all anesthetics used. PMID:20350606

One lung ventilation using double‑lumen tubes: Initial experience ...

African Journals Online (AJOL)

2014-05-09

May 9, 2014 ... The use of DLT for OLV to enhance thoracic anesthetic practice should be .... Prior to our purchase of a pediatric flexible bronchoscope, verification of DLT ... The short duration of action of local anesthetic agents solely ...

Volume of Anesthetic in 0.5% Marcaine with 1:200,000 Epinephrine Dental Carpule

Science.gov (United States)

2016-04-01

copyrighted material in the thesis manuscript entitled: "Volume of Anesthetic in 0.5% Marcaine with 1:200,000 Epinephrine Dental Carpule" Is...3. School/DepartmenUCenter: Army Postgraduate Dental School, AEGD-2 Program, Fort Hood, TX 4. Phone: (708) 227-2152 5. Type of clearance...X_Thesis _Article _Book _Poster _Presentation _Other 6. Title: "Volume of Anesthetic in 0.5% Marcaine with 1:200,000 Epinephrine Dental Carpule

Wound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery

DEFF Research Database (Denmark)

Kjærgaard, M; Møiniche, S; Olsen, K S

2012-01-01

In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery.......In this systematic review, we evaluated double-blind, randomized and controlled trials on the effect of wound infiltration with local anesthetics compared with the effect of placebo on post-operative pain after lumbar spine surgery....

Dexmedetomidine as the primary anesthetic agent during cardiac surgery in an infant with a family history of malignant hyperthermia

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Aymen Naguib

2011-01-01

Full Text Available Malignant hyperthermia (MH is an acute hypermetabolic crisis triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When providing anesthetic care for MH-susceptible agents, a total intravenous anesthetic (TIVA technique is frequently chosen. When choosing the components for TIVA, several options exist including the combination of propofol or dexmedetomidine with an opioid. We present our experience with the use of dexmedetomidine as a key component of the anesthetic regimen in a 5-month-old infant with a family history of MH. Previous reports of the use of dexmedetomidine in MH-susceptible patients are reviewed and its benefits in such patients discussed.

Approximate Forward Difference Equations for the Lower Order Non-Stationary Statistics of Geometrically Non-Linear Systems subject to Random Excitation

DEFF Research Database (Denmark)

Köylüoglu, H. U.; Nielsen, Søren R. K.; Cakmak, A. S.

Geometrically non-linear multi-degree-of-freedom (MDOF) systems subject to random excitation are considered. New semi-analytical approximate forward difference equations for the lower order non-stationary statistical moments of the response are derived from the stochastic differential equations...... of motion, and, the accuracy of these equations is numerically investigated. For stationary excitations, the proposed method computes the stationary statistical moments of the response from the solution of non-linear algebraic equations....

Anesthetic drug wastage in the operation room: A cause for concern

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Kapil Chaudhary

2012-01-01

Full Text Available Context: The cost of anesthetic technique has three main components, i.e., disposable supplies, equipments, and anesthetic drugs. Drug budgets are an easily identifiable area for short-term savings. Aim: To assess and estimate the amount of anesthetic drug wastage in the general surgical operation room. Also, to analyze the financial implications to the hospital due to drug wastage and suggest appropriate steps to prevent or minimize this wastage. Settings and Design: A prospective observational study conducted in the general surgical operation room of a tertiary care hospital. Materials and Methods: Drug wastage was considered as the amount of drug left unutilized in the syringes/vials after completion of a case and any ampoule or vial broken while loading. An estimation of the cost of wasted drug was made. Results: Maximal wastage was associated with adrenaline and lignocaine (100% and 93.63%, respectively. The drugs which accounted for maximum wastage due to not being used after loading into a syringe were adrenaline (95.24%, succinylcholine (92.63%, lignocaine (92.51%, mephentermine (83.80%, and atropine (81.82%. The cost of wasted drugs for the study duration was 46.57% (Rs. 16,044.01 of the total cost of drugs issued/loaded (Rs. 34,449.44. Of this, the cost of wastage of propofol was maximum being 56.27% (Rs. 9028.16 of the total wastage cost, followed by rocuronium 17.80% (Rs. 2856, vecuronium 5.23% (Rs. 840, and neostigmine 4.12% (Rs. 661.50. Conclusions: Drug wastage and the ensuing financial loss can be significant during the anesthetic management of surgical cases. Propofol, rocuronium, vecuronium, and neostigmine are the drugs which contribute maximally to the total wastage cost. Judicious use of these and other drugs and appropriate prudent measures as suggested can effectively decrease this cost.

Pediatric crisis resource management training improves emergency medicine trainees' perceived ability to manage emergencies and ability to identify teamwork errors.

Science.gov (United States)

Bank, Ilana; Snell, Linda; Bhanji, Farhan

2014-12-01

Improved pediatric crisis resource management (CRM) training is needed in emergency medicine residencies because of the variable nature of exposure to critically ill pediatric patients during training. We created a short, needs-based pediatric CRM simulation workshop with postactivity follow-up to determine retention of CRM knowledge. Our aims were to provide a realistic learning experience for residents and to help the learners recognize common errors in teamwork and improve their perceived abilities to manage ill pediatric patients. Residents participated in a 4-hour objectives-based workshop derived from a formal needs assessment. To quantify their subjective abilities to manage pediatric cases, the residents completed a postworkshop survey (with a retrospective precomponent to assess perceived change). Ability to identify CRM errors was determined via a written assessment of scripted errors in a prerecorded video observed before and 1 month after completion of the workshop. Fifteen of the 16 eligible emergency medicine residents (postgraduate year 1-5) attended the workshop and completed the surveys. There were significant differences in 15 of 16 retrospective pre to post survey items using the Wilcoxon rank sum test for non-parametric data. These included ability to be an effective team leader in general (P < 0.008), delegating tasks appropriately (P < 0.009), and ability to ensure closed-loop communication (P < 0.008). There was a significant improvement in identification of CRM errors through the use of the video assessment from 3 of the 12 CRM errors to 7 of the 12 CRM errors (P < 0.006). The pediatric CRM simulation-based workshop improved the residents' self-perceptions of their pediatric CRM abilities and improved their performance on a video assessment task.

Identification of microRNA signature in different pediatric brain tumors.

Science.gov (United States)

Tantawy, Marwa; Elzayat, Mariam G; Yehia, Dina; Taha, Hala

2018-01-01

Understanding pediatric brain tumor biology is essential to help on disease stratification, and to find novel markers for early diagnosis. MicroRNA (miRNA) expression has been linked to clinical outcomes and tumor biology. Here, we aimed to detect the expression of different miRNAs in different pediatric brain tumor subtypes to discover biomarkers for early detection and develop novel therapies. Expression of 82 miRNAs was detected in 120 pediatric brain tumors from fixed-formalin paraffin-embedded tissues, low-grade glioma, high-grade glioma, ependymoma, and medulloblastoma, using quantitative real-time PCR. Low-expression of miR-221, miR-9, and miR-181c/d and over-expression of miR-101, miR-222, miR-139, miR-1827, and miR-34c was found in medulloblastoma; low expression of miR-10a and over-expression of miR-10b and miR-29a in ependymoma; low expression of miR-26a and overexpression of miR-19a/b, miR-24, miR-27a, miR- 584, and miR-527 in low-grade glioma. Cox regression showed differential miRNA expression between responders and non-responders. The most specific were miR-10a and miR-29a low expression in LGG non-responders, miR-135a and miR-146b over-expression in ependymoma non-responders, and miR-135b overexpression in medulloblastoma non-responders. MicroRNAs are differentially expressed in subtypes of brain tumors suggesting that they may help diagnosis. A greater understanding of aberrant miRNA in pediatric brain tumors may support development of novel therapies.

Attitude and subjective wellbeing of non-compliant mothers to childhood oral polio vaccine supplemental immunization in Northern Nigeria.

Science.gov (United States)

Umeh, Gregory C; Nomhwange, Terna Ignatius; Shamang, Anthony F; Zakari, Furera; Musa, Audu I; Dogo, Paul M; Gugong, Victor; Iliyasu, Neyu

2018-02-08

Attitude and subjective well-being are important factors in mothers accepting or rejecting Oral Polio Vaccine (OPV) supplemental immunization. The purpose of the study was to determine the role of mothers' attitude and subjective wellbeing on non-compliance to OPV supplemental immunization in Northern Nigeria. The study utilized a cross-sectional design to assess attitude and subjective well-being of mothers using previously validated VACSATC (Vaccine Safety, Attitudes, Training and Communication-10 items) & SUBI (Subjective Well-being Inventory-40 items) measures. A total of 396 participants (equal number of non-compliant and compliant mothers) from 94 non-compliant settlements were interviewed, after informed consent. T-test was run to assess difference in mean scores between the non-compliant and compliant mothers on VACSATC and SUBI measures. The research showed a significant difference in mean scores between the non-compliant and compliant groups on VACSATC measure of mothers' attitude (M = 18.9 non-compliant, compared to 26.5 compliant; p  0.05). The research has shown that negative attitude is more commonly present in non-compliant mothers and may be a factor in vaccine refusal in Northern Nigeria.

Periodontal ligament and intraosseous anesthetic injection techniques: alternatives to mandibular nerve blocks.

Science.gov (United States)

Moore, Paul A; Cuddy, Michael A; Cooke, Matthew R; Sokolowski, Chester J

2011-09-01

and Overview. The provision of mandibular anesthesia traditionally has relied on nerve block anesthetic techniques such as the Halsted, the Gow-Gates and the Akinosi-Vazirani methods. The authors present two alternative techniques to provide local anesthesia in mandibular teeth: the periodontal ligament (PDL) injection and the intraosseous (IO) injection. The authors also present indications for and complications associated with these techniques. The PDL injection and the IO injection are effective anesthetic techniques for managing nerve block failures and for providing localized anesthesia in the mandible. Dentists may find these techniques to be useful alternatives to nerve block anesthesia.

Perioperative management of children with obstructive sleep apnea.

Science.gov (United States)

Schwengel, Deborah A; Sterni, Laura M; Tunkel, David E; Heitmiller, Eugenie S

2009-07-01

Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.

Anesthetic Approach to a Patient with Epidermolysis Bullosa: A Case Report

Directory of Open Access Journals (Sweden)

Ersin KOKSAL

2015-09-01

Full Text Available Epidermolysis Bullosa (EB is characterized by fragility and formation of blisters in the skin and mucosal membranes. Due to blisters on the airway and occurring new blisters as a result of anesthetic or surgical procedures may complicate anesthesia management. In this case report, we present the anesthetic approach of a 6 years old case with EB who underwent reconstructive surgery. After premedication and optimal monitorization, intravenous (IV anesthesia and analgesia was administered. Associated with the oropharyngeal lesions and limitation to reach an adequate mouth opening, we preferred the facemask to maintain ventilation. Neither new lesions nor complications were detected during or after surgery. [J Contemp Med 2015; 5(3.000: 192-195

Assessment and management of pain in pediatric otolaryngology.

Science.gov (United States)

Rodríguez, Maria Claudia; Villamor, Perla; Castillo, Tatiana

2016-11-01

Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction. The aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services. Narrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016. 129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services. We present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and

Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy

DEFF Research Database (Denmark)

Salale, Nesrin; Treldal, Charlotte; Mogensen, Stine

2014-01-01

Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult...... with a lidocaine spray proved to be a superior option as topical pharyngeal anesthetic before an UGE....

Laparoscopy in the management of pediatric vesicoureteral reflux

Directory of Open Access Journals (Sweden)

Atul A Thakre

2007-01-01

Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.

[Evaluation of mental and communication functions in mapuche and non mapuche elderly subjects in rural communities in Southern Chile].

Science.gov (United States)

Mella, Rebeca; Alvear, María; Carrillo, Berta; Caire, Victor

2003-11-01

The main predictors of functional impairment in the elderly are alterations in mental or communication functions. To study mental and communication functions in rural elderly subjects of Mapuche and non Mapuche origin. Elderly subjects coming from a rural Mapuche community and a non Mapuche community were studied. Subjects were interviewed at their homes. The communication and mental function assessments of the Functional Autonomy Measurement System were applied. Fifty one Mapuche and 49 non Mapuche subjects with a mean age of 71 +/- 7 and 74 +/- 8 years respectively, were studied. Fifty four percent were female and 31% were illiterate. Twenty six percent had impairment in mental functions. The item with the highest difficulty was memory. The visual function was the most severely impaired among communication items. Mapuche elderly subjects had significantly higher degrees of impairment in mental and communication functions. There is a higher degree of mental and communication impairment among rural Mapuche elderly subjects than in their non Mapuche counterparts.

Participation of the GABAergic system in the anesthetic effect of Lippia alba (Mill.) N.E. Brown essential oil

Energy Technology Data Exchange (ETDEWEB)

Heldwein, C.G.; Silva, L.L. [Departamento de Farmácia Industrial, Universidade Federal de Santa Maria, Santa Maria, RS (Brazil); Reckziegel, P. [Departamento de Fisiologia e Farmacologia, Universidade Federal de Santa Maria, Santa Maria, RS (Brazil); Barros, F.M.C. [Departamento de Farmácia Industrial, Universidade Federal de Santa Maria, Santa Maria, RS (Brazil); Bürger, M.E.; Baldisserotto, B. [Departamento de Fisiologia e Farmacologia, Universidade Federal de Santa Maria, Santa Maria, RS (Brazil); Mallmann, C.A. [Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Santa Maria, RS (Brazil); Schmidt, D.; Caron, B.O. [Departamento de Ciências Agronômicas e Ambientais, Universidade Federal de Santa Maria, Campus de Frederico Westphalen, Frederico Westphalen, RS (Brazil); Heinzmann, B.M. [Departamento de Farmácia Industrial, Universidade Federal de Santa Maria, Santa Maria, RS (Brazil)

2012-04-05

The objective of this study was to identify the possible involvement of the GABAergic system in the anesthetic effect of Lippia alba essential oil (EO). We propose a new animal model using silver catfish (Rhamdia quelen) exposed to an anesthetic bath to study the mechanism of action of EO. To observe the induction and potentiation of the anesthetic effect of EO, juvenile silver catfish (9.30 ± 1.85 g; 10.15 ± 0.95 cm; N = 6) were exposed to various concentrations of L. alba EO in the presence or absence of diazepam [an agonist of high-affinity binding sites for benzodiazepinic (BDZ) sites coupled to the GABA{sub A} receptor complex]. In another experiment, fish (N = 6) were initially anesthetized with the EO and then transferred to an anesthetic-free aquarium containing flumazenil (a selective antagonist of binding sites for BDZ coupled to the GABA{sub A} receptor complex) or water to assess recovery time from the anesthesia. In this case, flumazenil was used to observe the involvement of the GABA-BDZ receptor in the EO mechanism of action. The results showed that diazepam potentiates the anesthetic effect of EO at all concentrations tested. Fish exposed to diazepam and EO showed faster recovery from anesthesia when flumazenil was added to the recovery bath (12.0 ± 0.3 and 7.2 ± 0.7, respectively) than those exposed to water (9.2 ± 0.2 and 3.5 ± 0.3, respectively). In conclusion, the results demonstrated the involvement of the GABAergic system in the anesthetic effect of L. alba EO on silver catfish.

Participation of the GABAergic system in the anesthetic effect of Lippia alba (Mill.) N.E. Brown essential oil

International Nuclear Information System (INIS)

Heldwein, C.G.; Silva, L.L.; Reckziegel, P.; Barros, F.M.C.; Bürger, M.E.; Baldisserotto, B.; Mallmann, C.A.; Schmidt, D.; Caron, B.O.; Heinzmann, B.M.

2012-01-01

The objective of this study was to identify the possible involvement of the GABAergic system in the anesthetic effect of Lippia alba essential oil (EO). We propose a new animal model using silver catfish (Rhamdia quelen) exposed to an anesthetic bath to study the mechanism of action of EO. To observe the induction and potentiation of the anesthetic effect of EO, juvenile silver catfish (9.30 ± 1.85 g; 10.15 ± 0.95 cm; N = 6) were exposed to various concentrations of L. alba EO in the presence or absence of diazepam [an agonist of high-affinity binding sites for benzodiazepinic (BDZ) sites coupled to the GABA A receptor complex]. In another experiment, fish (N = 6) were initially anesthetized with the EO and then transferred to an anesthetic-free aquarium containing flumazenil (a selective antagonist of binding sites for BDZ coupled to the GABA A receptor complex) or water to assess recovery time from the anesthesia. In this case, flumazenil was used to observe the involvement of the GABA-BDZ receptor in the EO mechanism of action. The results showed that diazepam potentiates the anesthetic effect of EO at all concentrations tested. Fish exposed to diazepam and EO showed faster recovery from anesthesia when flumazenil was added to the recovery bath (12.0 ± 0.3 and 7.2 ± 0.7, respectively) than those exposed to water (9.2 ± 0.2 and 3.5 ± 0.3, respectively). In conclusion, the results demonstrated the involvement of the GABAergic system in the anesthetic effect of L. alba EO on silver catfish

Anesthetic Efficacy of Supine and Upright Positions for the Inferior Alveolar Nerve Block: A Prospective, Randomized Study.

Science.gov (United States)

Crowley, Chase; Drum, Melissa; Reader, Al; Nusstein, John; Fowler, Sara; Beck, Mike

2018-02-01

It has been recommended to place patients in an upright position after administration of an inferior alveolar nerve block (IANB), theoretically allowing the anesthetic to diffuse in an inferior direction and resulting in better pulpal anesthesia. The purpose of this study was to compare an upright versus a supine position on the success of pulpal anesthesia when an IANB was administered in asymptomatic teeth. One hundred ten asymptomatic subjects were randomly given IANBs by using 2% lidocaine with 1:100,000 epinephrine while they were in an upright position and supine position at 2 different appointments spaced at least 2 weeks apart. Pulpal anesthesia was measured in the molars, premolars, and incisors with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes of the injection and sustaining the 80 reading for 60 minutes. Success was analyzed by using a mixed model logistic regression. Pulpal anesthesia for the supine position was not statistically more successful than the upright position in the second molars (73% vs 65%), first molars (59% vs 54%), lateral incisors (28% vs 23%), and central incisors (11% vs 8%), respectively. The supine position significantly improved success in the second premolars (63% vs 53%) and first premolars (75% vs 64%). The supine and upright positions were equally successful in the molars and anterior teeth. The supine position was more successful in the premolars. However, clinically, neither position for the IANB administration would provide complete pulpal anesthesia. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease

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Dillman, Jonathan R.; Ladino-Torres, Maria F.; Strouse, Peter J. [University of Michigan Health System, Department of Radiology, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); Adler, Jeremy; DeMatos-Malliard, Vera [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, C. S. Mott Children' s Hospital, Division of Pediatric Gastroenterology, Ann Arbor, MI (United States); McHugh, Jonathan B. [University of Michigan Health System, Department of Pathology, Ann Arbor, MI (United States); Khalatbari, S. [University of Michigan Institute for Clinical Health Research (MICHR), Ann Arbor, MI (United States)

2011-12-15

While MR enterography (MRE) is commonly used to identify segments of bowel affected by Crohn disease in children, there is little data to support this practice. To assess the ability of MRE to identify segments of small bowel and colon affected by pediatric Crohn disease using histopathology as the reference standard. Pediatric MRE examinations performed between April 2009 and December 2010 were identified. Subjects were excluded if they did not have Crohn disease, if they had Crohn disease but no correlative histopathology within 2 months of imaging, or if they had undergone prior bowel resection. Pertinent MRE and histopathology reports were reviewed, and normal and abnormal bowel segments were documented. Thirty-two pediatric MRE examinations were identified with correlative histopathology. MRE had an overall sensitivity of 94% for detecting the presence of Crohn disease, in general. At the bowel segmental level, MRE had a sensitivity of 66%, specificity of 90%, positive predictive value of 85% and negative predictive value of 76%. The terminal ileum was abnormal by MRE in 11 of 15 (73%) subjects lacking a diagnostic biopsy of this bowel segment. MRE successfully identifies small bowel and colon segments affected by pediatric Crohn disease. (orig.)

Awake craniotomy anesthetic management using dexmedetomidine, propofol, and remifentanil.

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Prontera, Andrea; Baroni, Stefano; Marudi, Andrea; Valzania, Franco; Feletti, Alberto; Benuzzi, Francesca; Bertellini, Elisabetta; Pavesi, Giacomo

2017-01-01

Awake craniotomy allows continuous monitoring of patients' neurological functions during open surgery. Anesthesiologists have to sedate patients in a way so that they are compliant throughout the whole surgical procedure, nevertheless maintaining adequate analgesia and anxiolysis. Currently, the use of α2-receptor agonist dexmedetomidine as the primary hypnotic-sedative medication is increasing. Nine patients undergoing awake craniotomy were treated with refined monitored anesthesia care (MAC) protocol consisting of a combination of local anesthesia without scalp block, low-dose infusion of dexmedetomidine, propofol, and remifentanil, without the need of airways management. The anesthetic protocol applied in our study has the advantage of decreasing the dose of each drug and thus reducing the occurrence of side effects. All patients had smooth and rapid awakenings. The brain remained relaxed during the entire procedure. In our experience, this protocol is safe and effective during awake brain surgery. Nevertheless, prospective randomized trials are necessary to confirm the optimal anesthetic technique to be used.

Pediatric excretory MR urography: comparative study of enhanced and non-enhanced techniques

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Borthne, Arne S. [Department of Pediatric Radiology, Kirkeveien 166, Ullevaal University Hospital, 0407 Oslo (Norway); Pierre-Jerome, Claude [Department of Central Radiology, Ullevaal University Hospital, Kirkeveien 166, 0407 Oslo (Norway); Gjesdal, Kjell I.; Storaas, Tryggve; Courivaud, Frederic [Department of Medical Physics, Ullevaal University Hospital, Kirkeveien 166, 0407 Oslo (Norway); Eriksen, Morten [Institute of Experimental Research, Ullevaal University Hospital, Kirkeveien 166, 0407 Oslo (Norway)

2003-06-01

Our purpose was to compare the quality of ureteral imaging in pediatric patients using two different MR sequences: the non-enhanced heavily T2-weighted (W) turbo spin-echo sequence (TSE) and the gadolinium-enhanced T1W fast-field-echo sequence (T1 FFE). An experimental study on three pigs was first performed. The TSE, before and after furosemide injection, was followed by the T1 FFE sequence. The clinical study included 11 infants and 10 children. With some modifications the same MR parameters and techniques were used as in the animal study. The TSE with TR 8000 ms and TE 650 ms implied 6 radial stacks each of 40 mm thickness. The T1 FFE included TR 18 ms, TE 2.9 ms, flip angle 60, and 50 slices with thickness 0.7 mm. After post-processing, image reconstructions qualitative and quantitative analysis were performed. Complete visualization of the ureters was achieved in 35 of 42 (83%) cases. Seventy-four percent of the ureters were completely visualized with T1 FFE compared with only 19% with TSE. Sixty-nine percent of the ureters were better imaged with T1 FFE than TSE and 21% equally well imaged. Four ureters (10%), either obstructed or due to poor renal function, were better imaged with TSE. The two sequences are complementary. Visualization of non-obstructed ureters is excellent with T1 FFE and the sequence is superior to TSE. The TSE, however, may be equal to or even better than T1 FFE in visualizing obstructed ureters or ureters draining malfunctioning kidneys. (orig.)

Anesthetic considerations for rapid-onset obesity, hypoventilation, hypothalamic dysfunction, and autonomic dysfunction (ROHHAD) syndrome in children.

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Chandrakantan, Arvind; Poulton, Thomas J

2013-01-01

Rapid-onset obesity, hypoventilation, hypothalamic dysfunction, and autonomic dysfunction is an increasingly common diagnosis in patients who are being seen at tertiary care children's hospitals. We present two cases of anesthetics from the authors' own experience in addition to a comprehensive review of the disorder and anesthetic implications. © 2012 Blackwell Publishing Ltd.

Imaging of primary pediatric lymphoma of bone

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Milks, Kathryn S.; McLean, Thomas W.; Anthony, Evelyn Y.

2016-01-01

Primary pediatric bone lymphoma is a rare form of non-Hodgkin lymphoma. Unlike nodal forms of lymphoma, imaging abnormalities in lymphoma of bone do not resolve rapidly in conjunction with treatment and radiologic findings can remain abnormal for years, making it difficult to evaluate treatment response. To evaluate the utility of imaging in assessment of patients with primary pediatric bone lymphoma. At our institution between 2004 and 2013, six cases of pathology-proven primary pediatric bone lymphoma were diagnosed. Retrospective chart review was performed to assess imaging utilization. Our data were qualitatively compared with existing literature to construct an algorithm for imaging patients with primary lymphoma of bone. Imaging evaluation of patients with primary pediatric bone lymphoma was highly variable at our institution. Conventional imaging was routinely used to evaluate response to treatment, despite lack of appreciable osseous change. Imaging in the absence of symptoms did not alter clinical management. Only positron emission tomography CT (PET/CT) proved capable of demonstrating imaging changes from the pretreatment to the post-treatment scans that were consistent with the clinical response to treatment. Surveillance imaging is likely unnecessary in patients with a known diagnosis of pediatric lymphoma of bone. Pretreatment and post-treatment PET/CT is likely sufficient to assess response. There is little data to support the use of interim and surveillance PET/CT. (orig.)

Hypnosis in pediatrics: applications at a pediatric pulmonary center

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Anbar Ran D

2002-12-01

Full Text Available Abstract Background This report describes the utility of hypnosis for patients who presented to a Pediatric Pulmonary Center over a 30 month period. Methods Hypnotherapy was offered to 303 patients from May 1, 1998 – October 31, 2000. Patients offered hypnotherapy included those thought to have pulmonary symptoms due to psychological issues, discomfort due to medications, or fear of procedures. Improvement in symptoms following hypnosis was observed by the pulmonologist for most patients with habit cough and conversion reaction. Improvement of other conditions for which hypnosis was used was gauged based on patients' subjective evaluations. Results Hypnotherapy was associated with improvement in 80% of patients with persistent asthma, chest pain/pressure, habit cough, hyperventilation, shortness of breath, sighing, and vocal cord dysfunction. When improvement was reported, in some cases symptoms resolved immediately after hypnotherapy was first employed. For the others improvement was achieved after hypnosis was used for a few weeks. No patients' symptoms worsened and no new symptoms emerged following hypnotherapy. Conclusions Patients described in this report were unlikely to have achieved rapid improvement in their symptoms without the use of hypnotherapy. Therefore, hypnotherapy can be an important complementary therapy for patients in a pediatric practice.

[Evaluation of formal elements of Spanish pediatrics journals].

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Aleixandre-Benavent, R; González de Dios, J; Valderrama-Zurián, F J; Bolaños Pizarro, M; Valderrama-Zurián, J C

2007-03-01

Standardization of scientific journals is indispensable for accurate transmission of knowledge, since it guarantees the universality and reproducibility of research. The objective of this study was to evaluate the formal elements of Spanish pediatrics journals. In 2005, we studied the characteristics of Spanish biomedical journals with special emphasis on Spanish pediatrics journals. The form used for the selection of journals for inclusion in the database Indice Médico Español (IME) was employed to evaluate 65 distinct characteristics in each journal. The parameters were grouped in the following five categores: journal presentation, presentation of the articles, scientific and editorial committees, content characteristics, and dissemination parameters. The journals with the highest overall scores were Anales de Pediatría (63 points out of a maximum of 82), followed by Pediatría de Atención Primaria (53 points), Acta Pediátrica Española and Cirugía Pediátrica (55 points each), Pediatrika (53 points), and Revista Española de Pediatría (48 points). The score obtained by Anales de Pediatría places this journal in the top 10 Spanish journals included in IME. Spanish pediatrics journals meet most of the formal elements required of biomedical journals, although some aspects could be improved, such as deficiencies in the frequency and regularity of publication, mention of the dates of manuscript receipt and acceptance, the lack of a clear description of the editorial process of manuscript selection and peer review, the absence of committee members' institutional affiliations, and the absence of articles by non-Spanish authors.

[Occupational hazards, DNA damage, and oxidative stress on exposure to waste anesthetic gases].

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Lucio, Lorena M C; Braz, Mariana G; do Nascimento Junior, Paulo; Braz, José Reinaldo C; Braz, Leandro G

The waste anesthetic gases (WAGs) present in the ambient air of operating rooms (OR), are associated with various occupational hazards. This paper intends to discuss occupational exposure to WAGs and its impact on exposed professionals, with emphasis on genetic damage and oxidative stress. Despite the emergence of safer inhaled anesthetics, occupational exposure to WAGs remains a current concern. Factors related to anesthetic techniques and anesthesia workstations, in addition to the absence of a scavenging system in the OR, contribute to anesthetic pollution. In order to minimize the health risks of exposed professionals, several countries have recommended legislation with maximum exposure limits. However, developing countries still require measurement of WAGs and regulation for occupational exposure to WAGs. WAGs are capable of inducing damage to the genetic material, such as DNA damage assessed using the comet assay and increased frequency of micronucleus in professionals with long-term exposure. Oxidative stress is also associated with WAGs exposure, as it induces lipid peroxidation, oxidative damage in DNA, and impairment of the antioxidant defense system in exposed professionals. The occupational hazards related to WAGs including genotoxicity, mutagenicity and oxidative stress, stand as a public health issue and must be acknowledged by exposed personnel and responsible authorities, especially in developing countries. Thus, it is urgent to stablish maximum safe limits of concentration of WAGs in ORs and educational practices and protocols for exposed professionals. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Does secretin add value in pediatric magnetic resonance cholangiopancreatography?

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Trout, Andrew T.; Podberesky, Daniel J.; Serai, Suraj D.; Towbin, Alexander J.; Ren, Yan; Altaye, Mekebib

2013-01-01

Secretin - a hormone that stimulates pancreatic exocrine secretion - is described to improve visualization of the pancreatic duct by magnetic resonance cholangiopancreatography (MRCP). In our pediatric practice, however, we have not observed substantial benefit with the use of secretin. To determine whether secretin dilates and improves visualization of the pancreatic duct in pediatric MRCP. Retrospective evaluation of secretin-enhanced MRCPs performed over a 15-month period. One reviewer measured the pancreatic duct pre- and post-secretin and two reviewers, blinded to the administration of secretin, assessed image quality and subjective duct visibility. Similar assessments of the biliary tree served as internal controls. We reviewed 20 MRCPs in 17 children. Following secretin administration, there was a small (0.3 mm) but statistically significant increase in pancreatic duct diameter (P = 0.002) and small (<0.2 mm) but significant increase in intrahepatic bile duct diameter (P = 0.0104). On subjective review, there was no significant difference in image quality or duct visibility based on the administration of secretin. Secretin induces dilatation of the pancreatic duct but the value of that effect in pediatric MRCP is suspect given the small change in duct diameter and the lack of improvement in image quality and duct visibility. (orig.)

[Clinical and physiological rationale for use of clonidine with articaine and adrenaline for local anesthesia in pediatric dentistry].

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Mel'nikova, A V; Shugaĭlov, I A

2014-01-01

The study evaluated the effect of local anesthesia with articaine in different combinations with epinephrine and clonidine (articaine (4%) + epinephrine (1:200 000), articaine (4%) + clonidine (1:100 000), articaine (4%) + epinephrine (1:200 000) + clonidine (1:100 000), articaine (4%) + epinephrine (1:400 000) + clonidine (1:100 000)), on a number of physiological parameters in pediatric dental practice that characterize cardiovascular system, patient's degree of adaptation to a stressful situation and efficacy of analgesia. It is shown that in terms of impact on the cardiovascular system and stress adaptation indicators anesthesia including combination of epinephrine (1: 200 000) and clonidine (1: 100 000) in the anesthetic solution is the safest. Furthermore, this method ensures the most appropriate analgesic effect.