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Pediatric And Anesthesiology

Zulfiqar Ahmed, Christine Mai, Katherine G Skinner, Myron Yaster
Dr. Estela Melman (1939-present), Professor in the Department of Anesthesiology, the American British Cowdray Medical Center, Mexico, is an influential pioneer who has shaped the scope and practice of pediatric anesthesia in Mexico and throughout the world. Her early work to reintroduce neural blockade into routine pediatric anesthetic care, particularly the caudal approach to the epidural space, helped to transform current anesthesia practice. Based on a series of interviews held with Dr. Melman between 2016 and 2017, this article reviews the remarkable career of a pioneering pediatric anesthesiologist...
December 2018: Paediatric Anaesthesia
Laura Bogusaite, Ilona Razlevice, Laura Lukosiene, Andrius Macas
BACKGROUND Adequate preoperative information for pediatric patients and their families can prevent preoperative anxiety and improve postoperative outcome. The aim of this study was to conduct a survey to determine the preoperative information needs of children and their parents before anesthesia for elective surgery. MATERIAL AND METHODS Two healthcare centers enrolled children from 10 to 17 years of age who had planned elective surgery under general or regional anesthesia, and their parents and anesthesiologists...
December 4, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Carol Nhan, Meredith Young, Ilana Bank, Peter Nugus, Rachel Fisher, Milène Azzam, Lily H P Nguyen
Objective: Emergent medical crises, such as acute airway obstruction, are often managed by interdisciplinary teams. However, resident training in crisis resource management traditionally occurs in silos. Our objective was to compare the current state of interdisciplinary crisis resource management (IDCRM) training of otolaryngology residents with other disciplines. Methods: A survey study examining (1) the frequency with which residents are involved in interdisciplinary crises, (2) the current state of interdisciplinary training, and (3) the desired training was conducted targeting Canadian residents in the following disciplines: otolaryngology, anesthesiology, emergency medicine, general surgery, obstetrics and gynecology, internal medicine, pediatric emergency medicine, and pediatric/neonatal intensive care...
April 2018: OTO open
Nareman D H Khaleel, Waleed M M Mahmoud, Oliver Olsson, Klaus Kümmerer
Chlorprothixene (CPTX) is an antipsychotic drug of the thioxanthene class. Although it is widely used as a tranquillizer in psychiatry, anesthesiology, pediatrics, and in general medical practice, there is a gap in knowledge regarding its occurrence and fate in the environment. Therefore, we provide for the first-time data on the environmental fate and ecotoxicity of CPTX and its potential photo-transformations products (PTPs). Firstly, two standardized biodegradation tests (Closed Bottle test (CBT) and Manometric Respiratory test (MRT)) were performed to assess CPTX's environmental biodegradability...
November 8, 2018: Water Research
Michal Frelich, Jan Divák, Vojtěch Vodička, Michaela Masárová, Ondřej Jor, Roman Gál
BACKGROUND Postoperative nausea and vomiting (PONV) is a common complication of pediatric anesthesia, but the overall incidence of PONV in patients undergoing adenoidectomy is unknown. The aim of this controlled study was to compare the effect of dexamethasone administration with placebo to reduce PONV in children undergoing endoscopic adenoidectomy under general anesthesia. MATERIAL AND METHODS A randomized placebo-controlled study included 118 pediatric patients who underwent elective endoscopic adenoidectomy under general anesthesia...
November 22, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Antoinette Esce, David A Rodeberg, David H Rothstein, Marybeth Browne, Derek Wakeman
BACKGROUND: Team training programs adapt crew resource management principles from aviation to foster communication and prevent medical errors. Although multiple studies have demonstrated that team training programs such as TeamSTEPPS improve patient outcomes and safety across medical disciplines, limited data exist about their application to pediatric surgical teams. The purpose of this study was to investigate usage and perceptions of team training programs by pediatric surgeons and anesthesiologists...
December 2018: Journal of Surgical Research
Sylvia Kramer, Martin Krebs, Claudia Spies, Shahab Ghamari, Claudia Höhne, Karin Becke, Christoph Eich, Andreas Hoeft, Julius Wermelt, Richard K Ellerkmann
The upcoming and ongoing debate on neurotoxicity of anesthetics at a young age put a new spotlight on the emergence delirium of children (paedED). The European Society for Anesthesiology published a consensus guideline on prevention and therapy in 2017 which can be a useful guidance in daily clinical practice. Patient data management systems with their clear documentation concerning pain/therapy of pain and paedED will be valuable tools in order to assess the real incidence of paedED. Differentiating between pain/agitation and paedED migth not always be easy...
November 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Lanair Amaad Lett, Whitney U Orji, Ronnie Sebro
OBJECTIVE: To evaluate trends in racial, ethnic, and sex representation at US medical schools across 16 specialties: internal medicine, pediatrics, surgery, psychiatry, radiology, anesthesiology, obstetrics and gynecology, neurology, family practice, pathology, emergency medicine, orthopedic surgery, ophthalmology, otolaryngology, physical medicine and rehabilitation, and dermatology. Using a novel, Census-derived statistical measure of diversity, the S-score, we quantified the degree of underrepresentation for racial minority groups and female faculty by rank for assistant, associate, and full professors from 1990-2016...
2018: PloS One
Hugo Rodrigues, Ricardo Cobucci, Antônio Oliveira, João Victor Cabral, Leany Medeiros, Karen Gurgel, Tházio Souza, Ana Katherine Gonçalves
BACKGROUND: Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). OBJECTIVE: To estimate burnout among different medical residency specialties. METHODS: A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018...
2018: PloS One
Joanna Miller, Emuejevoke Chuba, Stacie Deiner, Samuel DeMaria, Daniel Katz
Despite increasing representation in medicine, women continue to be a minority in academic practice and leadership, especially in male-dominated fields like anesthesiology. Differences in compensation and participation in leadership may represent barriers to career advancement for women in anesthesiology. Key factors for promotion in academic anesthesiology are research, funding, and publication. As such, designation as a first or senior author on a publication in a professional journal may act as currency for promotion...
November 9, 2018: Anesthesia and Analgesia
Andrew D Franklin, Jenna H Sobey, Eric T Stickles
Proper planning and communication between psychiatry and anesthesiology teams is vital to conferring the greatest therapeutic benefit to children presenting for electroconvulsive therapy while minimizing risk. Anesthesia for the child undergoing electroconvulsive therapy should ideally provide deep hypnosis, ensure muscle relaxation to reduce injury, have minimal effect on seizure dynamics, and allow for rapid recovery to baseline neurologic and cardiopulmonary status. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment...
January 2019: Child and Adolescent Psychiatric Clinics of North America
Robinder G Khemani, Lincoln Smith, Yolanda M Lopez-Fernandez, Jeni Kwok, Rica Morzov, Margaret J Klein, Nadir Yehya, Douglas Willson, Martin C J Kneyber, Jon Lillie, Analia Fernandez, Christopher J L Newth, Philippe Jouvet, Neal J Thomas
BACKGROUND: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. METHODS: In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment...
October 22, 2018: Lancet Respiratory Medicine
Thomas J Papadimos, Evadne G Marcolini, Mehrnaz Hadian, George E Hardart, Nicholas Ward, Mitchell M Levy, Stanislaw P Stawicki, Judy E Davidson
OBJECTIVES: Outbreaks of disease, especially those that are declared a Public Health Emergency of International Concern, present substantial ethical challenges. Here we start a discourse (with a continuation of the dialogue in Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care) concerning the ethics of the provision of medical care, research challenges and behaviors during a Public Health Emergency of International Concern with a focus on the proper conduct of clinical or epidemiologic research, clinical trial designs, unregistered medical interventions (including vaccine introduction, devices, pharmaceuticals, who gets treated, vulnerable populations, and methods of data collection), economic losses, and whether there is a duty of health care providers to provide care in such emergencies, and highlighting the need to understand cultural diversity and local communities in these efforts...
November 2018: Critical Care Medicine
Miles Berger, Katie J Schenning, Charles H Brown, Stacie G Deiner, Robert A Whittington, Roderic G Eckenhoff, Martin S Angst, Sinziana Avramescu, Alex Bekker, Marek Brzezinski, Greg Crosby, Deborah J Culley, Maryellen Eckenhoff, Lars I Eriksson, Lis Evered, Jim Ibinson, Richard P Kline, Andy Kofke, Daqing Ma, Joseph P Mathew, Mervyn Maze, Beverley A Orser, Catherine C Price, David A Scott, Brendan Silbert, Diansan Su, Niccolo Terrando, Dian-Shi Wang, Huafeng Wei, Zhoncong Xie, Zhiyi Zuo
As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks...
December 2018: Anesthesia and Analgesia
Chukwudi Chiaghana, Christopher Giordano, Danielle Cobb, Terrie Vasilopoulos, Patrick J Tighe, Joshua W Sappenfield
BACKGROUND: In the 1990s, emergency medicine (EM) physicians were responsible for intubating about half of the patients requiring airway management in emergency rooms. Since then, no studies have characterized the airway management responsibilities in the emergency room. METHODS: A survey was sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, whether an anesthesiologist was available "in-house" 24 hours a day, and whether there was a protocol for anesthesiologists to assist as backup during intubations...
October 8, 2018: Anesthesia and Analgesia
C Lévin, N Thilly, M Dousak, G Beraud, M Klesnik, S Uhan, D Nathwani, B Beovic, C Pulcini
OBJECTIVES: To assess the perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance, and then to identify the characteristics of junior physicians associated with appropriate practices of antibiotic use. METHOD: European junior physicians received an email invitation to complete a 49 item web questionnaire between September 2015 and January 2016. We present the French data. Multivariate regression models were used to identify the characteristics of junior physicians associated with appropriate prescription practices and with consideration of the antibiotic prescription consequences...
September 25, 2018: Médecine et Maladies Infectieuses
John M Flynn, Brendan M Striano, Wallis T Muhly, Blair Kraus, Wudbhav N Sankar, Vaidehi Mehta, Michael Blum, Barbara DeZayas, Jeffrey Feldman, Ron Keren
BACKGROUND: As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis. METHODS: With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up...
September 19, 2018: Journal of Bone and Joint Surgery. American Volume
Kevin J Kovatch, Allison R Powell, Kevin Green, Chelsea L Reighard, Glenn E Green, Virginia T Gauger, Deborah M Rooney, David A Zopf
BACKGROUND: Pediatric-specific difficult airway guidelines include algorithms for 3 scenarios: unanticipated difficult tracheal intubation, difficult mask ventilation, and cannot intubate/cannot ventilate. While rare, these instances may require front-of-neck access (FONA) to secure an airway until a definitive airway can be established. The aim of this study was to develop a pediatric FONA simulator evaluated by both anesthesiology and otolaryngology providers, promoting multidisciplinary airway management...
September 18, 2018: Anesthesia and Analgesia
L Baumann Kreuziger, K Karkouti, J Tweddell, M P Massicotte
Despite the development of catheter-based interventions for ischemic and valvular heart disease, hundreds of thousands of people undergo open heart surgery annually for coronary artery bypass graft (CABG), valve replacement or cardiac assist device implantation. Cardiac surgery patients are unique because therapeutic anticoagulation is required during cardiopulmonary bypass. Developmental hemostasis and altered drug metabolism affect management in children. This narrative review summarizes the current evidence-based and consensus guidelines regarding perioperative, intraoperative and postoperative antithrombotic therapy in patients undergoing cardiac surgery...
November 2018: Journal of Thrombosis and Haemostasis: JTH
Zeferino Demartini, Luana Antunes Maranha Gatto, Tatiane Coghetto da Rocha, Adriano Keijiro Maeda, Adriana Valerio, Gelson Luis Koppe, Alexandre Novicki Francisco
Intracranial aneurysm surgery is commonly performed using pinned head holders, which pose a higher risk for the pediatric population. Several authors recommend avoiding the use of this device when it is not strictly necessary, and this is currently possible considering advances in anesthesiology and monitoring. As the literature on microsurgery without skull clamp use is scant, we report the case of a 15-year-old boy presenting with a subarachnoid hemorrhage after rupture of a middle cerebral artery aneurysm...
2018: Pediatric Neurosurgery
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