Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Remifentanil decreases sevoflurane requirements in children.
To establish the effect of increasing concentrations of remifentanil on sevoflurane requirements in children. ⋯ The administration of remifentanil produced a dose-dependent decrease in the minimum alveolar concentration of sevoflurane necessary for inhibition of movement reaction in response to surgical incision. The use of remifentanil may allow for flexible analgesic control and rapid recovery in children anesthetized with sevoflurane.
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To evaluate the equivalency of the prototype of a new infrared ear thermometer (IRT 4000) in comparison to the temperature measurements of a pulmonary artery catheter (PAC) and a continual contact probe on the tympanic membrane. ⋯ Infrared ear thermometers 4000 temperature readings accurately reflect body core temperature and correlate well with the invasive PAC. Infrared ear thermometers may present a clinically useful alternative to the pulmonary artery thermometry for the measurement of core temperature in the perioperative setting or in the intensive care unit.
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Preoperative screening of at-risk patients for sickle cell disease (SCD) is recommended as a method to decrease perioperative morbidity. However, the effectiveness of pre-operative screening in accomplishing this goal has never been demonstrated. We undertook a retrospective study to determine the prevalence of positive test results among those screened preoperatively at our institution and to determine whether amendments to present screening guidelines can be recommended. ⋯ Preoperative screening of 1,906 children identified only one asymptomatic child with undiagnosed SCD and a negative family history, suggesting that routine preoperative screening for SCD is rarely of significant clinical value in our population. Had preoperative screening not been performed, no child requiring preoperative transfusion would have been missed, representing a long-run probability of at least 99.84% that no at-risk child would require transfusion. We recommend that preoperative screening for SCD be undertaken selectively, giving consideration to the risks and benefits of screening to the individual patient.
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Case Reports
Successful near-term pregnancy outcome after repair of a dissecting thoracic aortic aneurysm at 14 weeks gestation.
We report the anesthetic management for a scheduled Cesarean section of a 29-yr-old female who previously had a repair of her dissecting thoracic aortic aneurysm during the 14th week of her pregnancy. ⋯ Aortic dissection in pregnancy may have catastrophic results. Undoubtedly, it presents unique challenges for anesthetic and obstetrical management. With appropriate care and surgical correction of the dissecting aneurysm early in pregnancy, a successful outcome for the pregnancy was possible.