Assessment of fluid responsiveness in children using respiratory variations in descending aortic flow.

Background: The primary aim of the current study was to investigate the ability of respiratory variations in descending aortic flow, measured with two-dimensional echo at the suprasternal notch (ΔVpeak dAo), to predict fluid responsiveness in anesthetized mechanically ventilated children. In addition, variations in peak descending aortic flow measured with apical transthoracic echo (ΔVpeak LVOT) were examined for the same properties.

Methods: Twenty-seven patients under general anesthesia were investigated in this prospective observational study.

The effect of dexmedetomidine on motor-evoked potentials during pediatric posterior spinal fusion surgery: a retrospective case-control study.

Purpose: Motor-evoked potentials (MEPs) are frequently used in pediatric posterior spinal fusion surgery (PSFS) to detect spinal cord ischemia. Dexmedetomidine is increasingly being used as an adjunct to total intravenous anesthesia, but its effect on MEP amplitude has been variably reported. The purpose of this study was to evaluate the effect of an infusion of dexmedetomidine on the amplitude of MEPs.

Recommendations for the management of MPS IVA: systematic evidence- and consensus-based guidance.

Introduction: Mucopolysaccharidosis (MPS) IVA or Morquio A syndrome is an autosomal recessive lysosomal storage disorder (LSD) caused by deficiency of the N-acetylgalactosamine-6-sulfatase (GALNS) enzyme, which impairs lysosomal degradation of keratan sulphate and chondroitin-6-sulphate. The multiple clinical manifestations of MPS IVA present numerous challenges for management and necessitate the need for individualised treatment. Although treatment guidelines are available, the methodology used to develop this guidance has come under increased scrutiny.

Recommendations for the management of MPS VI: systematic evidence- and consensus-based guidance.

Introduction: Mucopolysaccharidosis (MPS) VI or Maroteaux-Lamy syndrome (253200) is an autosomal recessive lysosomal storage disorder caused by deficiency in N-acetylgalactosamine-4-sulfatase (arylsulfatase B). The heterogeneity and progressive nature of MPS VI necessitates a multidisciplinary team approach and there is a need for robust guidance to achieve optimal management. This programme was convened to develop evidence-based, expert-agreed recommendations for the general principles of management, routine monitoring requirements and the use of medical and surgical interventions in patients with MPS VI.

Repeated nonanesthetic malignant hyperthermia reactions in a child.

A series of life-threatening nonanesthetic-related MH reactions in a child was the inspiration for a proactive, novel solution allowing for early prehospital, potentially lifesaving intravenous dantrolene administration. Multidisciplinary collaboration is essential and parent education must be comprehensive and ongoing. This case underlines the importance of considering nonanesthetic MH susceptibility in the child who has a history of unspecified myopathy and who presents with fever and total body stiffness.

Midline posterior glossectomy and lingual tonsillectomy in obese and nonobese children with down syndrome: Biomarkers for success.

Objectives/hypothesis: To examine outcomes following midline posterior glossectomy (MPG) plus lingual tonsillectomy (LT) for the treatment of significant obstructive sleep apnea (OSA) in children with Down syndrome (DS).

Methods: Patients with DS who had persistent OSA following tonsillectomy and adenoidectomy (TA) and were relatively intolerant of positive airway pressure (PAP) therapy were evaluated by physical examination and sleep/CINE magnetic resonance imaging to determine the etiology of upper airway obstruction. Patients with relative macroglossia underwent MPG plus LT if required.

Erratum to: Managing the challenging pediatric airway: Continuing Professional Development.

Erratum to: Can J Anesth/J Can Anesth (2015) 62:1000–1016 DOI 10.1007/s12630-015-0423-y. In the article entitled: "Managing the challenging pediatric airway: Continuing Professional Development" published in the September 2015 issue, Can J Anesth 2015; DOI: 10.

Managing the challenging pediatric airway: Continuing Professional Development.

Purpose: This module will give the anesthesia provider the information needed to identify, prepare for, and clinically manage a difficult airway in children.

Principal Findings: Although the incidence of difficult intubation is lower in children than in adults, the anesthesiologist who even occasionally cares for children must be prepared to manage the pediatric patient with a known or suspected difficult airway. Many of the predictors of a difficult intubation that are useful in adults do not apply to children.

US-guided percutaneous needle biopsy of anterior mediastinal masses in children.

Background: Anterior mediastinal masses in children are clinically challenging, requiring prompt histological diagnosis.

Objective: The purpose of this study was to review the experience with US-guided percutaneous core needle biopsy (PCNB) of anterior mediastinal masses in children, particularly with respect to safety and diagnostic accuracy.

Materials And Methods: We retrospectively reviewed the clinical presentation, imaging, sedation approach, procedural details and pathology results of US-guided PCNB of mediastinal masses that occurred during an 8-year period (2001-2008).

Physiological changes in transperitoneal versus retroperitoneal laparoscopy in children: a prospective analysis.

Purpose: The choice of minimally invasive surgical approaches in pediatric urology is largely influenced by surgeon preference and experience. Little is known about the differences in physiological variables that might objectively influence the choice of surgical approach. We compared the cerebral and systemic hemodynamic effects of transperitoneal vs retroperitoneal CO(2) insufflation in children.

Percutaneous interventional radiology procedures in patients with epidermolysis bullosa: modifications and challenges.

Objective: The purpose of this study is to describe the role of interventional radiology in palliation and maintenance of nutritional support in children with epidermolysis bullosa, with a focus on safety and required procedural modifications.

Materials And Methods: This was a retrospective study of all patients diagnosed with epidermolysis bullosa who underwent interventional radiology procedures between January 1991 and December 2008 at a pediatric tertiary care institution. The type of epidermolysis bullosa, the patient's age, the indication and type of interventional radiology procedure, modifications used, and complications were recorded.

Clinical adaptation of a pharmacokinetic model of Propofol plasma concentrations in children.

Background: A previously published pharmacokinetic simulation suggested a simple manual infusion regimen to achieve propofol plasma concentrations of 3 microg.ml(-1). This study investigated if a simple variation in propofol infusion rates is able to achieve distinct propofol plasma concentrations and whether these are close to the propofol plasma concentrations predicted by the Kataria model.

The effect of varying continuous propofol infusions on plasma cyclic guanosine 3',5'-monophosphate concentrations in anesthetized children.

Background: The glutamate-nitric oxide-cyclic guanosine 3',5'-monophosphate (cGMP) pathway is potentially an effective target for general anesthetics. Plasma cGMP concentrations are reduced after an increase in predicted plasma propofol concentrations during sedation in healthy adult volunteers. We hypothesized that an increase in measured plasma propofol concentration leads to a reduction in plasma cGMP in anesthetized children.

Management of the patient with a large anterior mediastinal mass: recurring myths.

Purpose Of Review: This editorial review summarizes the current anesthetic management of patients with anterior mediastinal masses.

Recent Findings: With increased appreciation of the correct intraoperative management of these cases severe intraoperative respiratory or cardiovascular collapse is less likely to occur during general anesthesia. Maintenance of spontaneous ventilation is the anesthetic goal whenever possible.

The effect of sevoflurane on cerebral autoregulation in young children as assessed by the transient hyperemic response.

The transient hyperemic response (THR) test is a simple, noninvasive technique to evaluate cerebral autoregulation using transcranial Doppler. It has not yet been used in studies involving children. In this study we evaluated this response in children undergoing general anesthesia using sevoflurane.

Hemodynamic and respiratory effects of pediatric urological retroperitoneal laparoscopic surgery: a prospective study.

Purpose: Our understanding of the effects of retroperitoneal CO(2) insufflation on cardiopulmonary variables in children remains limited. This study was designed to investigate prospectively the effect of CO(2) insufflation in a pediatric population undergoing retroperitoneal laparoscopic surgery.

Materials And Methods: We prospectively evaluated a consecutive series of patients enrolled between July 2003 and August 2004.

Desflurane increases cerebral blood flow velocity when used for rapid emergence from propofol anesthesia in children.

Purpose: Desflurane may be used to replace propofol at the end of anesthesia to facilitate rapid emergence. This study determined the effect of administering desflurane during emergence of anesthesia on middle cerebral artery blood flow velocity (Vmca) in children anesthetized with propofol.

Methods: Thirty healthy children aged one to six years scheduled for orchidopexy or hypospadias repair under general anesthesia were enrolled.

The cerebrovascular response to hypocapnia in children receiving propofol.

Hypocapnia is used to treat acute increases in intracranial pressure during neurosurgery. Cerebrovascular reactivity to carbon dioxide (CCO(2)R) is preserved above 35 mm Hg ETco(2) in children during propofol anesthesia; however, a plateau effect has been suggested below 35 mm Hg. To further delineate this phenomenon, we measured CCO(2)R by transcranial Doppler (TCD) sonography over small increments in ETco(2) in 27 healthy children.

The effect of remifentanil on cerebral blood flow velocity in children anesthetized with propofol.

Background: Cerebrovascular stability and rapid anesthetic emergence are desirable features of a neuroanesthetic regimen. In this randomized crossover study the effect of a low-dose remifentanil infusion on cerebral blood flow velocity (CBFV) in children anesthetized with propofol was evaluated.

Methods: Twenty healthy children aged 1-6 years undergoing urological surgery were enrolled.

Cerebral blood flow velocity in children anaesthetized with desflurane.

Background: Desflurane allows for rapid emergence and changes in depth of anaesthesia which makes it especially suitable for neuroanaesthesia. This study was designed to determine the effects of different desflurane concentrations on cerebral blood flow velocity (CBFV) in healthy children.

Methods: Twenty children, aged 1-7 years undergoing urological surgery were studied.