Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
When are parents helpful? A randomized clinical trial of the efficacy of parental presence for pediatric anesthesia.
To examine the utility of parental presence to alleviate anxiety in a narrow age range of children undergoing outpatient surgery. We hypothesized that parental presence would lower anxiety scores as measured by the modified Yale Preoperative Anxiety Scale (mYPAS) at two time-points during pediatric outpatient surgery, i.e., separation from parents and placement of the face mask for anesthetic induction. ⋯ Our results suggest that anxiety levels in children undergoing day surgical procedures differ as a function of parental presence at the point when children are separated from parents. Future research should examine the types of interactions that occur during this time-point that may explain this finding.
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High volume tubing is used to deliver carbon dioxide during laparoscopic procedures. Failure to prime the tubing with carbon dioxide prior to abdominal insufflation may result in the delivery of nitrogen-containing air to the abdominal cavity. We report a case in which initial insufflation of laparoscopic gas resulted in immediate cardiovascular collapse requiring prolonged resuscitation. Persistent intracranial emboli following the arrest may have resulted from nitrogen contamination of the delivered gas. ⋯ Persistence of emboli following endoscopic procedures suggests that the entrained gas is insoluble. Room air contamination increases the potential for catastrophic events during laparoscopy and other endoscopic procedures.
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The outcome of patients with preoperative renin-angiotensin system (RAS) blockade, achieved either by angiotensin converting enzyme inhibitors or angiotensin receptor blocking agents, was assessed using 30-day mortality as a primary end point. ⋯ Examination of 883 cases of AAA repair showed increased mortality associated with preoperative RAS blockade. A better understanding of perioperative pharmacology and physiology of RAS blockade is needed as well as future studies to identify causality.