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https://www.readbyqxmd.com/read/29239957/american-college-of-surgeons-children-s-surgery-verification-quality-improvement-program-what-anesthesiologists-need-to-know-now
#1
Melissa Brooks Peterson, Constance S Houck, Jayant K Deshpande, Randall P Flick
A task force of pediatric surgical specialists with the support of The American College of Surgeons recently launched a verification program for pediatric surgery, the Children's Surgery Verification quality improvement program, with the goal of improving pediatric surgical, procedural, and perioperative care. Included in this program are specific standards for the delivery of pediatric anesthesia care across a variety of practice settings. We review the background, available evidence, requirements for verification, and verification process and its implications for the practice of pediatric anesthesia across the country...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29232530/pediatric-endoscopic-pilonidal-sinus-treatment-a-revolutionary-technique-to-adopt-in-children-with-pilonidal-sinus-fistulas-our-preliminary-experience
#2
Ciro Esposito, Serena Izzo, Francesco Turrà, Mariapina Cerulo, Giovanni Severino, Alessandro Settimi, Marta Iannazzone, Lorenzo Masieri, Giuseppe Cortese, Maria Escolino
AIM: This study aimed to report our preliminary experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT). PATIENTS AND METHODS: We retrospectively reviewed the reports of 15 patients, 6 girls and 9 boys, with an average age of 16 years (range 13-18) with noninfected pilonidal sinus disease who underwent PEPSiT in our institution over an 18-month period. Four cases were redo-procedures, for recurrence of disease after open excision repair. Surgical outcomes of sinus healing, recurrence of disease, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated and a comparison analysis with classic open repair was performed...
December 12, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/29189536/incidence-of-fractures-from-perioperative-blood-pressure-cuff-use-tourniquet-use-and-patient-positioning-in-osteogenesis-imperfecta
#3
Brian T Sullivan, Adam Margalit, Vaibhav S Garg, Dolores B Njoku, Paul D Sponseller
BACKGROUND: Osteogenesis imperfecta (OI) is a rare connective tissue disease with varying severity. Patients with OI are highly susceptible to skeletal fractures. Optimal perioperative management of these patients is not well defined. We investigated the risks associated with intraoperative use of noninvasive blood pressure (NIBP) cuffs, tourniquets, and intra-arterial catheters, and patient positioning in children with OI. METHODS: We retrospectively reviewed records of patients younger than 21 years with OI who underwent surgery with general anesthesia from 2010 to 2016 at our tertiary care center...
November 16, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29181580/ionizing-radiation-from-computed-tomography-versus-anesthesia-for-magnetic-resonance-imaging-in-infants-and-children-patient-safety-considerations
#4
REVIEW
Michael J Callahan, Robert D MacDougall, Sarah D Bixby, Stephan D Voss, Richard L Robertson, Joseph P Cravero
In the context of health care, risk assessment is the identification, evaluation and estimation of risk related to a particular clinical situation or intervention compared to accepted medical practice standards. The goal of risk assessment is to determine an acceptable level of risk for a given clinical treatment or intervention in association with the provided clinical circumstances for a patient or group of patients. In spite of the inherent challenges related to risk assessment in pediatric cross-sectional imaging, the potential risks of ionizing radiation and sedation/anesthesia in the pediatric population are thought to be quite small...
November 27, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/29148123/donohue-syndrome-a-review-of-literature-case-series-and-anesthetic-considerations
#5
REVIEW
Alana Kirkwood, Grant Stuart, Louise Harding
BACKGROUND: Donohue syndrome is a rare autosomal recessive disorder of insulin resistance, causing a functional defect in insulin receptor function, and affecting the ability of the insulin to bind the receptor. Features include severe hyperinsulinism and fasting hypoglycemia, along with severe failure to thrive despite feeding. An accelerated fasting state results in muscle wasting, decreased subcutaneous fat, and an excess of thick skin. A reduced thoracic diameter is accentuated by increased abdominal distension, which impacts on respiratory reserve...
November 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29124404/pediatric-patients-receiving-naloxone-within-48%C3%A2-h-of-anesthesia-a-case-control-study
#6
Vinay K Donempudi, Juraj Sprung, Toby N Weingarten
PURPOSE: Excessive narcotization in pediatric surgical patients has not been well characterized. This report describes the use of postoperative naloxone in pediatric patients. METHODS: Pediatric surgical patients from January 1, 2010, through June 30, 2016, who underwent general anesthesia and received naloxone within 48 h postoperatively were identified and matched 1:1 with controls by age, sex, and procedure. Cases and controls underwent retrospective chart review...
November 9, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/29106918/use-of-intraoperative-nuclear-imaging-leads-to-decreased-anesthesia-time-and-real-time-confirmation-of-lesion-removal
#7
Joseph C Fusco, Brittani K N Seynnaeve, Alexander J Davit, Michael R Czachowski, Judith M Joyce, Barbara A Gaines, Marcus M Malek
BACKGROUND: Lymphatic mapping to guide sentinel lymph node biopsy (SLNB) typically requires lymphoscintigraphy prior to surgery. In young pediatric patients, this process often requires intubation in the nuclear medicine suite followed by transport to the operating room (OR). METHODS: We reviewed 14 pediatric cases in which a portable nuclear imaging camera was utilized to perform the entirety of the SLNB in the OR. RESULTS AND CONCLUSION: This method, utilizing intraoperative nuclear imaging, helped to confirm removal of the sentinel lymph node in real time, decreased anesthesia time, and avoided transport of a sedated or intubated child...
October 9, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29106868/the-use-of-ct-scan-in-foreign-body-aspiration-in-children-a-6-years-experience
#8
Vincent Pitiot, Margaux Grall, Dominique Ploin, Eric Truy, Sonia Ayari Khalfallah
INTRODUCTION: A foreign body aspiration is a risky situation, common in pediatric emergency. The "gold standard" to rule out a foreign body or proceed to its extraction, is rigid bronchoscopy (RB) under general anesthesia. However, RB is an intrusive exam with possible complications. Depending on authors, RB in emergency is a procedure at risk of complications in 4-17% of cases. Advances in radiology allow CT-scanners of fast acquisition and high definition, which could be used as an alternative to RB...
November 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29094418/total-intravenous-anesthesia-vs-single-pharmacological-prophylaxis-to-prevent-postoperative-vomiting-in-children-a-systematic-review-and-meta-analysis
#9
REVIEW
Maximilian S Schaefer, Peter Kranke, Stephanie Weibel, Robert Kreysing, Janika Ochel, Peter Kienbaum
BACKGROUND: Postoperative nausea and postoperative vomiting are frequent but often missed complications after general anesthesia in pediatric patients. Because inhaled anesthetics are known to trigger postoperative vomiting, total intravenous anesthesia is often administered in high-risk children to avoid the use of inhalational anesthesia. Since inhalational anesthesia might be advantageous in some situations, the question is raised whether administration of pharmacological prophylaxis offers equal protection from postoperative vomiting compared with total intravenous anesthesia alone...
December 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29070163/dental-caries-experience-in-texan-children-with-cleft-lip-and-palate
#10
Sabrina Sunderji, Bhavini Acharya, Catherine Flaitz, Brett Chiquet
PURPOSE: The purpose of this study was to assess the caries experience in the primary dentition of children born with cleft lip and palate (CLP). METHODS: A retrospective chart review was conducted on subjects between two and six years old recruited from a university-based pediatric dentistry residency clinic. The number of dental visits and professional fluoride applications, the plaque index and treatment modality, and the presence/location of caries, white spot lesions, and enamel hypoplastic lesions were compared between CLP patients and healthy age- and gender-matched controls...
September 15, 2017: Pediatric Dentistry
https://www.readbyqxmd.com/read/29067271/development-of-a-youth-report-measure-of-dpn-symptoms-conceptualization-and-content-validation
#11
Joanne Moser, Terri Lipman, David R Langdon, Katherine B Bevans
AIMS: To develop a content valid youth-report measure of diabetic peripheral neuropathy (DPN) symptoms. METHODS: Semi-structured interviews with 5 clinicians and 15 youth aged 8-17 with diabetes were conducted to elicit and clarify youth's DPN experiences. A systematic review of existing adult-report DPN symptom measures was conducted to identify item concepts representative of each experience. The concepts were transformed into items that were iteratively revised based on cognitive interviews (n = 13 youth aged 8-17) and readability analyses...
September 2017: Journal of Clinical & Translational Endocrinology
https://www.readbyqxmd.com/read/29051964/identification-of-quality-improvement-areas-in-pediatric-mri-from-analysis-of-patient-safety-reports
#12
Camilo Jaimes, Diana J Murcia, Karen Miguel, Cathryn DeFuria, Pallavi Sagar, Michael S Gee
BACKGROUND: Analysis of safety reports has been utilized to guide practice improvement efforts in adult magnetic resonance imaging (MRI). Data specific to pediatric MRI could help target areas of improvement in this population. OBJECTIVE: To estimate the incidence of safety reports in pediatric MRI and to determine associated risk factors. MATERIALS AND METHODS: In a retrospective HIPAA-compliant, institutional review board-approved study, a single-institution Radiology Information System was queried to identify MRI studies performed in pediatric patients (0-18 years old) from 1/1/2010 to 12/31/2015...
October 19, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/29050714/when-does-intraoperative-blood-loss-occur-during-pediatric-scoliosis-correction
#13
Sean Wahlquist, Montri Wongworawat, Scott Nelson
BACKGROUND: The purpose of our study was to assess the relationship between amount of blood loss and surgical stage in pediatric patients undergoing posterior spinal fusion for deformity correction to determine: (1) when the highest rate of blood loss occurred; (2) what percentage of total blood loss occurred during deformity correction and closure; and (3) how to predict remaining blood loss during a procedure. Blood loss following exposure and placement of the final pedicle screw is often underestimated, which may result in lack of sufficient blood product availability...
November 2017: Spine Deformity
https://www.readbyqxmd.com/read/29049043/challenges-of-healthcare-administration-optimizing-quality-and-value-at-an-affordable-cost-in-pediatric-cardiology
#14
Mitchell I Cohen, Patricio A Frias
PURPOSE OF REVIEW: The purpose of this review is to explore the paradigm shift in healthcare delivery that will need to take place over the next few years away from an emphasis on supply-driven health care to better quality transparent-driven health care whose focus is on the consumer's best interest. RECENT FINDINGS: The current healthcare system is fragmented and costs continue to rise. The best way to contain costs is to improve quality to the consumer, the patient...
October 18, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29044830/optimal-management-of-apparatus-dead-space-in-the-anesthetized-infant
#15
REVIEW
Michael R King, Jeffrey M Feldman
Mechanical ventilation of the anesthetized infant requires careful attention to equipment and ventilator settings to assure optimal gas exchange and minimize the potential for lung injury. Apparatus dead space, defined as dead space resulting from devices placed between the endotracheal tube and the Y-piece of the breathing circuit, is the primary source of dead space controlled by the clinician. Due to the small tidal volumes required by infants and neonates, it is easy to create excessive apparatus dead space resulting in unintended hypercarbia or increased minute ventilation in an effort to achieve a desirable PCO2 ...
October 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29038830/a-distance-blended-learning-program-to-upgrade-the-clinical-competence-of-district-non-doctor-anesthesia-providers-in-nepal
#16
Shristi Shah, Stephen Knoble, Oliver Ross, Stephen Pickering
BACKGROUND: Across Nepal, anesthesia at a district level is provided mostly by non-doctor anesthesia providers (anesthesia assistants-AAs). Nepal's Government recognized the need to sustain competence with continuous professional development and to upgrade 6-month trained working AAs to professional equivalence with the new national standard of 12-month training. As they are essential district health workers and AA clinical training sites are full, an innovative distance blended learning, competency-based, upgrade 1-year course was developed and conducted in 2014-2017 for two batches...
December 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29037532/prediction-of-respiratory-collapse-among-pediatric-patients-with-mediastinal-tumors-during-induction-of-general-anesthesia
#17
Yunosuke Kawaguchi, Takeshi Saito, Tetsuya Mitsunaga, Keita Terui, Mitsuyuki Nakata, Gen Matsuura, Katsunori Kouchi, Hideo Yoshida
PURPOSE: Fatality resulting from respiratory collapse (RC) during general anesthesia (GA) induction in children with mediastinal tumors has been reported. We explored potentially useful parameters for predicting the risk of RC based on objective imaging results. METHODS: We retrospectively reviewed the records of 31 patients (median age: 4years; range: 4months-15years) with mediastinal tumors treated between 2000 and 2015. Comparing those with RC under GA induction to those without (RC group vs...
October 2, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29033723/postoperative-pain-management-in-patients-undergoing-thoracoscopic-repair-of-pectus-excavatum-a-retrospective-analysis-of-opioid-consumption-and-adverse-effects-in-adolescents
#18
Ralph Beltran, Giorgio Veneziano, Tarun Bhalla, Brian Kenney, Dmitry Tumin, Bruno Bissonnette, Joseph D Tobias
INTRODUCTION: Although the Nuss procedure provides excellent cosmetic results for the correction of pectus excavatum, the provision of analgesia following such procedures can be challenging. METHODS: The current study retrospectively reviews our experience over a 2.5 year period with thoracic epidural analgesia (TE), paravertebral blockade (PVB), and intravenous opioids delivered via patient-controlled analgesia (PCA) to provide postoperative analgesia. RESULTS: The study cohort included 30 patients (mean age = 15...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29031866/connectivity-changes-after-laser-ablation-resting-state-fmri
#19
Varina L Boerwinkle, Aditya Vedantam, Sandi Lam, Angus A Wilfong, Daniel J Curry
Resting-state functional magnetic resonance imaging (rsfMRI) is emerging as a useful tool in the multimodal assessment of patients with epilepsy. In pediatric patients who cannot perform task-based fMRI, rsfMRI may present an adjunct and alternative. Although changes in brain activation during task-based fMRI have been described after surgery for epilepsy, there is limited data on the role of postoperative rsfMRI. In this short review, we discuss the role of postoperative rsfMRI after laser ablation of seizure foci...
September 28, 2017: Epilepsy Research
https://www.readbyqxmd.com/read/29030933/technical-success-of-the-ultrasound-guided-supra-inguinal-fascia-iliaca-compartment-block-in-older-children-and-adolescents-for-hip-arthroscopy
#20
Elizabeth Eastburn, Maria A Hernandez, Karen Boretsky
BACKGROUND: Hip arthroscopic surgery is performed on older pediatric patients. Fascia iliaca compartment block has proven efficacy in providing analgesia following hip surgery and can be performed with target location of local anesthetic below or above the inguinal ligament. The reported success of ultrasound-guided infra-inguinal fascia iliaca compartment block is lower when compared to traditional landmark technique, while the reliability of supra-inguinal fascia iliaca compartment block is unreported...
November 2017: Paediatric Anaesthesia
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