Saturday, May 24, 2014

Comparison of the Effects of 0.03 and 0.05 mg/kg Midazolam with Placebo on Prevention of Emergence Agitation in Children Having Strabismus Surgery

Cho, Eun Jung M.D.; Yoon, Seung Zhoo M.D., Ph.D.; Cho, Jang Eun M.D., Ph.D.; Lee, Hye Won M.D., Ph.D.
Anesthesiology:
 
 
 Intravenous administration of 0.03 mg/kg of midazolam just before the end of surgery reduces emergence agitation without delaying the emergence time in children having strabismus surgery with sevoflurane anesthesia.


Comparative Analysis of Outcome Measures Used in Examining Neurodevelopmental Effects of Early Childhood Anesthesia Exposure

Ing, Caleb H. M.D., M.S.; DiMaggio, Charles J. Ph.D., M.P.H., P.A.-C.; Malacova, Eva Ph.D.; Whitehouse, Andrew J. Ph.D.; Hegarty, Mary K. M.B.B.S., F.A.N.Z.C.A.; Feng, Tianshu M.S.; Brady, Joanne E. M.S.; von Ungern-Sternberg, Britta S. M.D., Ph.D.; Davidson, Andrew J. M.D.; Wall, Melanie M. Ph.D.; Wood, Alastair J. J. M.D.; Li, Guohua M.D., Dr.P.H.; Sun, Lena S. M.D.

 

Anesthesiology:

 

 Of 781 children studied, 112 had anesthesia exposure. The incidence of deficit ranged from 5.1 to 7.8% in neuropsychological tests, 14.6 to 29.5% in International Classification of Diseases, 9th Revision, Clinical Modification–coded outcomes, and 4.2 to 11.8% in academic achievement tests. Compared with unexposed peers, exposed children had an increased risk of deficit in neuropsychological language assessments and International Classification of Diseases, 9th Revision, Clinical Modification–coded language and cognitive disorders (adjusted risk ratio, 1.57; 95% CI, 1.18 to 2.10), but not academic achievement scores.

 

Wednesday, May 21, 2014



Dehydration Enhances Pain-Evoked Activation in the Human Brain Compared with Rehydration

Ogino, Yuichi MD, PhD; Kakeda, Takahiro RN, PHN, PhD; Nakamura, Koji MD; Saito, Shigeru MD, PhD




Dehydration brings about increased brain activity related to painful stimuli together with enhanced thirst, whereas rehydration with oral rehydration solution  alleviates thirst and decreases brain activity related to painful stimuli.


Death or Neurologic Injury after Tonsillectomy in Children with a Focus on Obstructive Sleep Apnea: Houston, We Have a Problem!


Coté, Charles J. MD; Posner, Karen L. PhD; Domino, Karen B. MD, MPH


Anesthesia & Analgesia:



Deaths or neurologic injury after tonsillectomy due to apparent apnea in children suggest that at least 16 children could have been rescued had respiratory monitoring been continued throughout first- and second-stage recovery, as well as on the ward during the first postoperative night. A validated pediatric-specific risk assessment scoring system is needed to assist with identifying children at risk for OSA who are not appropriate to be cared for on an outpatient basis.



The Effect of Single Low-Dose Dexamethasone on Blood Glucose Concentrations in the Perioperative Period: A Randomized, Placebo-Controlled Investigation in Gynecologic Surgical Patients


Murphy, Glenn S. MD; Szokol, Joseph W. MD; Avram, Michael J. PhD; Greenberg, Steven B. MD; Shear, Torin MD; Vender, Jeffery S. MD; Gray, Jayla BA; Landry, Elizabeth BA

Anesthesia & Analgesia:

Clinicians need not avoid using dexamethasone for nausea and vomiting prophylaxis out of concerns related to hyperglycemia.

Monday, May 19, 2014



Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis

M. Heesen Professor, S. Klöhr Consultant, R. Rossaint Professor and S. Straube Occupational Physician and Researcher

Anaesthesia

Volume 69, Issue 2, pages 143–165, February 2014
 
We conducted a systematic review to determine the harm and benefit associated with prophylactic phenylephrine for caesarean section under spinal anaesthesia. We included 21 randomised controlled trials with 1504 women. The relative risk (95% CI) of hypotension with phenylephrine infusion – as defined by authors – before delivery was 0.36 (0.18–0.73) vs placebo, p = 0.004; 0.58 (0.39–0.88) vs an ephedrine infusion, p = 0.009; and 0.73 (0.55–0.96) when added to an ephedrine infusion, p = 0.02. After delivery, the relative risks of hypotension and nausea and vomiting with phenylephrine compared with placebo were 0.37 (0.19–0.71), p = 0.003, and 0.39 (0.17–0.91), p = 0.03, respectively. There was no evidence that hypertension, bradycardia or neonatal endpoints were affected. Phenylephrine reduced the risk for hypotension and nausea and vomiting after spinal doses of bupivacaine generally exceeding 8 mg, but there was no evidence that it reduced other maternal or neonatal morbidities.