Changes in cerebral oxygenation based on intraoperative ventilation strategy.

Introduction: Cerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO) using near-infrared spectroscopy (NIRS). Changes in rSO have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation.

Refractory Hypotension after Liver Allograft Reperfusion: A Case of Dynamic Left Ventricular Outflow Tract Obstruction.

Hypotension after reperfusion is a common occurrence during liver transplantation following the systemic release of cold, hyperkalemic, and acidic contents of the liver allograft. Moreover, the release of vasoactive metabolites such as inflammatory cytokines and free radicals from the liver and mesentery, compounded by the hepatic uptake of blood, may also cause a decrement in systemic perfusion pressures. Thus, the postreperfusion syndrome (PRS) can materialize if hypotension and fibrinolysis occur concomitantly within 5 min of reperfusion.

Pain management following myringotomy and tube placement: intranasal dexmedetomidine versus intranasal fentanyl.

Purpose: Despite the brevity of the procedure, bilateral myringotomy and tympanostomy tube placement (BMT) can result in significant postoperative pain and discomfort. As the procedure is frequently performed without intravenous access, non-parenteral routes of administration are frequently used for analgesia. The current study prospectively compares the efficacy of intranasal (IN) dexmedetomidine with IN fentanyl for children undergoing BMT.

Propofol and remifentanil for rapid sequence intubation in a pediatric patient at risk for aspiration with elevated intracranial pressure.

Aspiration is a significant cause of anesthetic morbidity, occurring most commonly during the induction of anesthesia. For patients with a high likelihood of aspiration, rapid sequence intubation (RSI) techniques may minimize this risk by reducing the time between the loss of protective airway reflexes and the placement of a cuffed endotracheal tube. Although RSI frequently involves the administration of a neuromuscular-blocking agent (NMBA) such as succinylcholine or rocuronium, there are times when the administration of an NMBA is contraindicated or undesirable.

Accuracy of noninvasive and continuous hemoglobin measurement by pulse co-oximetry during preoperative phlebotomy.

Background: In recent years, the continuous noninvasive hemoglobin measurement has been offered by devices using advanced pulse oximetry technology. Accuracy has been established in healthy adults as well as in surgical and intensive care unit patients but not in the setting of acute hemorrhage. In this study, we evaluated the accuracy of such a device in the clinical setting of preoperative phlebotomy thereby mimicking a scenario of acute blood loss.

Accuracy of the CNAP monitor, a noninvasive continuous blood pressure device, in providing beat-to-beat blood pressure readings in the prone position.

Study Objective: To assess the accuracy of a noninvasive continuous arterial pressure (CNAP) monitor in patients who are positioned prone in the operating room.

Design: Prospective study.

Setting: Operating room at a children's hospital.

Hemodynamic changes following the administration of propofol to facilitate endotracheal intubation during sevoflurane anesthesia.

Background: The common intravenous anesthetic agent, propofol, is frequently reported to have negative inotropic and chronotropic effects. In the pediatric population, propofol is commonly used after inhalation induction to facilitate endotracheal intubation without the need for a neuromuscular blocking drug agent. In this setting, we have noted that propofol administration is commonly followed by tachycardia.

Ultrasound-guided trunk and core blocks in infants and children.

Regional anesthetic techniques for perioperative analgesia in children are being increasingly utilized with the reported advantages of providing superior analgesia, decreasing opioid consumption, and reducing opioid-related adverse effects. The following article reviews the available literature regarding core and trunk blocks in infants and children; specifically, transversus abdominis plane, ilioinguinal/iliohypogastric nerve, rectus sheath, lumbar plexus, and paravertebral and intercostal nerve blockade. The common indications and potential complications and adverse effects for each block are presented.

Cerebral oximetry monitoring during preoperative phlebotomy to limit allogeneic blood use in patients undergoing cardiac surgery.

Preoperative phlebotomy can minimize the need for allogenic blood products. Frequently, removed blood is replaced with intravenous fluids to maintain euvolemia (acute normovolemic hemodilution [ANH]). During cardiopulmonary bypass (CPB), ANH may present problems when the circuit prime causes further hemodilution and unacceptably low hemoglobin.

Pain management after comprehensive stage 2 repair for hypoplastic left heart syndrome.

Achieving optimal pain control for children after complex cardiac surgery can be challenging. Recently, the hybrid approach to palliation of hypoplastic left heart syndrome (HLHS) was introduced as an alternative to the classic Norwood procedure. The second stage of the hybrid approach is a complex procedure known as comprehensive stage 2 (CS2).

Cardiac arrest following ketamine administration for rapid sequence intubation.

Given their relative hemodynamic stability, ketamine and etomidate are commonly chosen anesthetic agents for sedation during the endotracheal intubation of critically ill patients. As the use of etomidate has come into question particularly in patients with sepsis, due to its effect of adrenal suppression, there has been a shift in practice with more reliance on ketamine. However, as ketamine relies on a secondary sympathomimetic effect for its cardiovascular stability, cardiovascular and hemodynamic compromise may occur in patients who are catecholamine depleted.

Chest wall rigidity in two infants after low-dose fentanyl administration.

Since its introduction into clinical practice, it has been known that fentanyl and other synthetic opioids may cause skeletal muscle rigidity. Involvement of the respiratory musculature, laryngeal structures, or the chest wall may impair ventilation, resulting in hypercarbia and hypoxemia. Although most common with the rapid administration of large doses, this rare adverse effect may occur with small doses especially in neonates and infants.

Perioperative management of the pediatric patient with traumatic brain injury.

TBI and its sequelae remain a major healthcare issue throughout the world. With an improved understanding of the pathophysiology of TBI, refinements of monitoring technology, and ongoing research to determine optimal care, the prognosis of TBI continues to improve. In 2003, the Society of Critical Care Medicine published guidelines for the acute management of severe TBI in infants, children, and adolescents.

Dexmedetomidine as part of balanced anesthesia care in children with malignant hyperthermia risk and egg allergy.

Malignant hyperthermia is an acute hypermetabolic crisis triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When anesthesia care is provided to malignant hyperthermia-susceptible patients, a total intravenous anesthesia technique with propofol is frequently chosen. However, coexisting allergies to egg and soybeans may contraindicate the use of propofol.

Pain management after surgery for single-ventricle palliation using the hybrid approach.

The hybrid pathway for the management of patients with hypoplastic left heart syndrome was pioneered at our institution and is the preferred approach compared with the traditional Norwood pathway. Patients undergoing this surgery are generally <6 months of age, and pain management in this age group after surgery for complex congenital heart disease (CHD) may be particularly challenging. We retrospectively reviewed our pain-management strategy after stage 1 hybrid procedure (HS1) and evaluated its efficacy, especially in the setting of early tracheal extubation.