Circulating High Mobility Group Box-1 Does Not Predict Pulmonary Arterial Hypertension in Children with Congenital Heart Disease: A Prospective Cohort Study.

Objectives: Pulmonary arterial hypertension (PAH) is a devastating complication of pediatric congenital heart disease (CHD). A recent study has identified the protein high mobility group box-1 (HMGB1) as a diagnostic tool in adults with CHD-associated PAH. HMGB1 levels in adults with CHD-associated PAH correlated with mean pulmonary artery pressure and pulmonary vascular resistance, and HGMB1 levels fell in response to sildenafil therapy.

Efficacy of the Subtenon Block in Children Undergoing Strabismus Surgery: A Systematic Review and Meta-Analysis.

Purpose: To investigate the efficacy of the subtenon block in preventing postoperative complications in children undergoing strabismus surgery.

Design: Systematic review and meta-analysis.

Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Scopus, Web of Science, and clinicaltrials.

Predicting Perioperative Respiratory Adverse Events in Children With Sleep-Disordered Breathing.

Background: No evidence currently exists to quantify the risk and incidence of perioperative respiratory adverse events (PRAEs) in children with sleep-disordered breathing (SDB) undergoing all procedures requiring general anesthesia. Our objective was to determine the incidence of PRAEs and the risk factors in children with polysomnography-confirmed SDB undergoing procedures requiring general anesthesia.

Methods: Retrospective review of all patients with polysomnography-confirmed SDB undergoing general anesthesia from January 2009 to December 2013.

Surgical Closure of Atrial Septal Defects in Young Children-A Review of Anesthesia Care in Sternotomy and Thoracotomy Approaches.

Objectives: To review and compare the anesthetic management of atrial septal defect (ASD) closures via mini lateral thoracotomy and sternotomy approaches.

Design: Retrospective analysis.

Setting: Single- center pediatric quaternary care hospital.

Dexamethasone as an adjuvant to peripheral nerve block.

Background: Peripheral nerve block (infiltration of local anaesthetic around a nerve) is used for anaesthesia or analgesia. A limitation to its use for postoperative analgesia is that the analgesic effect lasts only a few hours, after which moderate to severe pain at the surgical site may result in the need for alternative analgesic therapy. Several adjuvants have been used to prolong the analgesic duration of peripheral nerve block, including perineural or intravenous dexamethasone.

A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children.

Background: Treatment of neuropathic pain in children is challenging, and requires a multimodal approach of pharmacologic, physical, and psychological therapies; however there is little evidence to guide practice. Amitriptyline and gabapentin are first-line drugs for treating neuropathic pain in adults, yet no studies have examined their efficacy, or compared them directly, to determine which might be better for pain relief and sleep disturbance in children.

Methods: After informed consent was obtained, 34 patients aged 7-18 years diagnosed with complex regional pain syndrome type I (CRPS I) or a neuropathic pain condition were randomly allocated to receive either amitriptyline or gabapentin.

L-carnitine reduces susceptibility to bupivacaine-induced cardiotoxicity: an experimental study in rats.

Background: The primary aim of this study was to evaluate the effect of acute administration of L-carnitine 100 mg·kg iv on susceptibility to bupivacaine-induced cardiotoxicity in rats.

Methods: In the first of two experiments, L-carnitine 100 mg·kg iv (n = 10) or saline iv (n = 10) was administered to anesthetized and mechanically ventilated Sprague-Dawley rats following which an infusion of bupivacaine 2.0 mg·kg·min iv was given until asystole occurred.

Are Parents Getting it Right? A Survey of Parents' Internet Use for Children's Health Care Information.

Background: The use of the Internet to search for medical and health-related information is increasing and associated with concerns around quality and safety.

Objective: We investigated the current use and perceptions on reliable websites for children's health information by parents.

Methods: Following institutional ethics approval, we conducted a survey of parents/guardians of children presenting for day surgery.

The construction and implementation of a novel postburn pruritus scale for infants and children aged five years or less: introducing the Toronto Pediatric Itch Scale.

The authors' objectives were to design, refine, validate and implement a behavior-anchored postburn pruritus scale for children aged 5 years or less. We engaged a range of professionals involved in the care of children with burns. We used Q-methodology in interprofessional team exercises to identify and stratify itch behaviors into categories of increasing severity, and then iteratively refined these into a draft scale.

Early postoperative patient-controlled analgesia ratio predicts 24-hour morphine consumption and pain in children undergoing scoliosis surgery.

Background: The identification of patients at risk for developing severe postoperative pain and/or opioid-related side effects is difficult due to a lack of sensitive indicators. The patient-controlled analgesia (PCA) ratio of demands to deliveries is a potential tool for early identification of patients who experience severe postoperative pain. The authors hypothesized that the PCA ratio is able to predict morphine requirement in the first 24 hours after scoliosis surgery.

Effectiveness of preoperative screening for sickle cell disease in a population with a newborn screening program: a cohort study.

Purpose: Published clinical practice guidelines recommend that all patients from ethnic groups with a high prevalence of sickle cell disease (SCD) undergo preoperative screening for this hemoglobinopathy. Newborn Screening Ontario initiated a universal sickle hemoglobinopathy screening program in 2006 as part of its regional newborn screening program. The primary objective of this study was to determine the effectiveness of selective preoperative screening for SCD based on at-risk ethnicity in Ontario, a region that has a universal newborn sickle hemoglobinopathy screening program.

PCA-derived factors that may be predictive of postoperative pain in pediatric patients: a possible role for the PCA ratio.

Objective: No method exists to reliably predict which patients will develop severe postoperative pain. The authors hypothesized that data derived from patient-controlled analgesia (PCA) pumps (specifically the ratio of patient demands to pump deliveries) may predict which patients would develop severe pain after scoliosis repair.

Setting: Quaternary, university-affiliated, pediatric hospital.

Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

Introduction: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution.

Methods: A retrospective chart review was performed.

The use of NSAIDs in pediatric scoliosis surgery - a survey of physicians' prescribing practice.

Background: Pediatric scoliosis surgery is associated with considerable postoperative pain requiring opioids for analgesia. Nonsteroidal antiinflammatory drugs (NSAIDs) can be used as adjuvants for analgesia; however, the potential of these agents to affect bone healing raises concerns. No large-scale prospective studies have been performed to evaluate the benefit-to-risk ratio of NSAID use after pediatric scoliosis surgery.

Drug-induced acute pancreatitis in children receiving chemotherapy for acute leukemia: does propofol increase the risk?

Background: The use of propofol is controversial in patients with a history of acute pancreatitis or those taking drugs, including certain chemotherapeutic drugs, that are associated with pancreatitis.

Methods: To investigate this issue, we reviewed the medical records of all children who were diagnosed with pancreatitis while receiving chemotherapy for acute leukemia during a 5-year period.

Results: A temporal relationship between propofol use and development of acute pancreatitis could not be established.

Preparation of the Dräger Fabius GS workstation for malignant hyperthermia-susceptible patients.

Purpose: In order to establish guidelines for the preparation of the Dräger Fabius GS premium anesthetic workstation for malignant hyperthermia-susceptible patients, the authors evaluated the effect of the workstation's exchangeable and autoclavable components on the washout of isoflurane.

Methods: A Dräger Fabius GS workstation was primed with 1.5% isoflurane, and exchangeable components were replaced as follows: Group 1: no replacement (control); Group 2: autoclaved ventilator diaphragm and ventilator hose; Group 3: flushed ventilator diaphragm and ventilator hose; Group 4: autoclaved compact breathing system.

Dose-dependent suppression of the electrically elicited stapedius reflex by general anesthetics in children undergoing cochlear implant surgery.

Background: Cochlear implants stimulate the auditory nerve to enable hearing. Determining appropriate upper and lower limits of stimulation is essential for successful cochlear implantation. The intraoperative evoked stapedius reflex threshold (ESRT) and evoked compound action potential (ECAP) are commonly used to determine the limits of implant stimulation.

Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia.

Purpose: Remifentanil, an ultra short-acting opioid commonly used to supplement general anesthesia, is associated with the development of hyperalgesia that manifests clinically as an increase in postoperative analgesic requirement. This study involving adolescents undergoing scoliosis surgery evaluated whether pre-treatment with morphine prior to commencing remifentanil infusion would decrease the initial 24-hr morphine consumption and pain scores.

Methods: Forty ASA I-II pediatric patients undergoing surgical correction of idiopathic scoliosis were recruited in a prospective, randomized, double-blind fashion to receive 150 microg x kg(-1) morphine or an equal volume saline prior to commencing remifentanil by infusion.

The experience of conducting Mortality and Morbidity reviews in a pediatric interventional radiology service: a retrospective study.

Purpose: To review the experience and impact of conducting multidisciplinary Morbidity and Mortality (M&M) reviews in pediatric interventional radiology (IR) and describe issues, lessons, and recommendations.

Materials And Methods: A dedicated functionality of an existing database was developed to retrospectively analyze pediatric IR M&M issues. Patient demographics, sedation/anesthesia, and procedure type were recorded.

Coadministration of propofol and remifentanil for lumbar puncture in children: dose-response and an evaluation of two dose combinations.

Background: The combination of propofol and remifentanil may be particularly suitable for short-duration procedures such as lumbar puncture. The authors undertook a two-part study to evaluate coadministration of propofol and remifentanil as an anesthetic technique for lumbar puncture in children.

Methods: The first part was a sequential allocation dose-finding study to determine the minimum effective dose of remifentanil when coadministered with 2.

Intraoperative low-dose ketamine does not prevent a remifentanil-induced increase in morphine requirement after pediatric scoliosis surgery.

Background: Remifentanil-based anesthesia is commonly used to facilitate neurophysiologic monitoring during pediatric scoliosis surgery. Acute opioid tolerance and/or hyperalgesia resulting from remifentanil-based anesthesia may involve activation of N-methyl-D-aspartate systems. We hypothesized that low-dose intraoperative infusion of the N-methyl-d-aspartate antagonist ketamine would suppress the development of tolerance and thereby decrease postoperative morphine consumption in children receiving remifentanil-based anesthesia for scoliosis surgery.

Effect of low-dose ketamine on voltage requirement for transcranial electrical motor evoked potentials in children.

Study Design: Randomized controlled trial. OBJECTIVE.: To determine the effect of low-dose ketamine on the voltage needed to elicit maximal amplitude of the motor-evoked response to transcranial electrical stimulation during propofol/remifentanil anesthesia in children undergoing scoliosis surgery.