American College of Cardiology Body Mass Index Counseling Quality Improvement Initiative.

Overweight/obesity, prevalent cardiovascular risk factors in children, can be associated with increased risk of adverse outcomes in children with heart disease. The American College of Cardiology (ACC) developed quality metrics including a BMI metric related to identifying and counseling overweight and obese children presenting to cardiology clinics. This metric was used for a multicenter collaborative learning Quality improvement (QI) Project through the ACC Quality Network (QNet).

Development of quality metrics for ambulatory pediatric cardiology: Chest pain.

Objective: As part of the American College of Cardiology Adult Congenital and Pediatric Cardiology Section effort to develop quality metrics (QMs) for ambulatory pediatric practice, the chest pain subcommittee aimed to develop QMs for evaluation of chest pain.

Design: A group of 8 pediatric cardiologists formulated candidate QMs in the areas of history, physical examination, and testing. Consensus candidate QMs were submitted to an expert panel for scoring by the RAND-UCLA modified Delphi process.

Development of Quality Metrics in Ambulatory Pediatric Cardiology.

The American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Section had attempted to create quality metrics (QM) for ambulatory pediatric practice, but limited evidence made the process difficult. The ACPC sought to develop QMs for ambulatory pediatric cardiology practice. Five areas of interest were identified, and QMs were developed in a 2-step review process.

Unipolar ventricular pacing reduces inappropriate shocks from a separate cardioverter defibrillator in a post-Fontan patient.

This report describes a 20-year-old man with complex congenital heart disease and inappropriate epicardial implantable cardioverter defibrillator (ICD) shocks secondary to double counting of ventricular-paced spikes and QRS complexes from a separate bipolar epicardial dual-chamber pacemaker. Adjusting to a unipolar paced-ventricular mode resolved any double counting via pacemaker-ICD interaction.

Anaesthesia for caesarean delivery: low-dose epidural bupivacaine plus fentanyl.

To determine the acceptability of epidural bupivacaine-induced sixth thoracic (T6) sensory blockade and the analgesic efficacy of epidural fentanyl 50 microg, 24 parturients undergoing elective caesarean section were given a test dose of lidocaine 60 mg plus epinephrine followed by 10 ml of either 0.5 % bupivacaine (control group) or 0.5 % bupivacaine plus 50 microg fentanyl (fentanyl group) in a randomized double-blind manner.

Alternating patient position following the induction of obstetric epidural analgesia does not affect local anaesthetic spread.

To assess the influence of gravity on epidural-induced sensory blockade during the first stage of labour, 60 parturients were recruited to a randomized, controlled, single-blinded study. In all cases an epidural catheter was placed with the patient in the left lateral position. Thereafter, patients were randomized to one of three groups.

Delivery room analgesia: an analysis of maternal satisfaction.

On the first post-partum day, 324 mothers completed a questionnaire designed to assess maternal perception of delivery room experience. Antenatal pain expectation, actual pain severity, analgesia received, as well as maternal satisfaction and choice of analgesia for future deliveries were recorded. Forty-five percent of primiparae and 36% of multiparae reported that they anticipated suffering extreme pain during delivery.

Horseshoe lung with left lung hypoplasia and critical pulmonary venous stenosis.

Horseshoe lung is a rare congenital anomaly characterized by an isthmus of the pulmonary parenchyma that extends posterior to the pericardial reflection at the cardiac apex and across the midline. There is unilateral, usually right-lung hypoplasia and most cases are associated with the scimitar syndrome. We present the case of an infant with horseshoe lung but with hypoplasia of the left lung and levocardia that was not associated with the scimitar syndrome.

The distance from the skin to the subarachnoid space can be predicted in premature and former-premature infants.

Purpose: Spinal anesthesia can be technically challenging in young infants. We studied whether the distance between the skin and the lumbar subarachnoid space in premature and former-premature young infants could be predicted prior to lumbar puncture.

Methods: The distance from skin entry point to tip of the spinal needle was measured using a caliper after lumbar spinal anesthesia at the L4-5 interspace.

A comparison of three techniques for acute postoperative pain control following major abdominal surgery.

Study Objectives: To compare the analgesic efficacy of a nonsteroidal antiinflammatory drug (NSAID) alone (basic pain treatment) with that of NSAID in conjunction with either intravenous (IV) patient-controlled analgesia (IV-PCA) or intermittent epidural morphine (epidural morphine), among patients recovering from major intraabdominal surgery; and to assess the fixed and variable costs of providing the respective acute pain treatment modalities.

Design: Prospective, nonrandomized study.

Setting: Postanesthesia care unit (PACU) and surgical departments of a large referral hospital.

Surgical management of spinal stenosis: a comparison of immediate and long term outcome in two geriatric patient populations.

This retrospective study was performed to assess and compare the immediate safety and long term outcome of surgical decompression of spinal stenosis when performed for geriatric patients aged 65-74 years (Group A) and those >75 years (Group B) of age. Some 283 patients were studied (179 and 104 patients in Groups A and B, respectively). The mean follow-up time was 41.

Observations on the safety and efficacy of surgical decompression for lumbar spinal stenosis in geriatric patients.

This retrospective study examines the results of surgical decompression of the lumbar spinal canal in 122 geriatric patients (age range 75-89 years) treated under general anesthesia by the same surgeon between the years 1990 and 1999. Patient demographics, perioperative complications, pain profiles before surgery and at the time of data collection (December 2000), as well as overall mortality were recorded. One hundred and twenty-two patients were studied.

Patient-controlled bupivacaine wound instillation following cesarean section: the lack of efficacy of adjuvant ketamine.

Study Objective: To assess the analgesic efficacy of ketamine when administered as an adjuvant to bupivacaine for patient-controlled wound instillation following cesarean section.

Design: Prospective, randomized, double-blind study.

Setting: Large referral hospital.

[Spinal anesthesia in premature infants--indications, technical aspects and results].

Purpose: To present our experience with spinal anesthesia in premature and former premature infants, and to focus on technical aspects and pitfalls enlightened with increasing experience.

Methods: The perioperative course of all premature and former premature infants below 60 weeks postconceptual age undergoing spinal anesthesia within an 35-month-period was analyzed. Lumbar puncture was performed while the patient was held seated at L4-5 or L5-S1.

Fast-track eligibility of geriatric patients undergoing short urologic surgery procedures.

Unlabelled: Our primary objective was to assess the feasibility of geriatric patients (>65 yr) bypassing the postanesthesia care unit (PACU) after ambulatory surgery. A secondary objective was to compare recovery profiles when using three different maintenance anesthetics. Ninety ASA physical status I--III consenting outpatients (>65 yr) undergoing short urologic procedures were randomly assigned to one of three anesthetic treatment groups.

Spinal anesthesia in 62 premature, former-premature or young infants--technical aspects and pitfalls.

Purpose: To highlight technical aspects and pitfalls of spinal anesthesia (SA) in infants.

Methods: The medical history and perioperative course of all infants who underwent SA over a 28-month period were collected (retrospectively in the first 20).

Results: Sixty-two infants underwent surgery under SA.

Anesthetic techniques for pharyngeal flap surgery: effects on postoperative complications.

Objective: To assess the effects of 2 different anesthetic techniques on early complications after superior pharyngeal flap surgery.

Design: Randomized, prospective, single-blind study.

Setting: Large referral hospital.

The effect of tourniquet application, tranexamic acid, and desmopressin on the procoagulant and fibrinolytic systems during total knee replacement.

Study Objective: To assess the influence of tourniquet inflation-deflation as well as desmopressin and tranexamic acid (TA) administration on prothrombin fragment 1.2, fibrinogen, plasmin antiplasmin complex, and D-dimer concentrations during total knee replacement.

Design: Randomized, placebo-controlled study.

A comparative study of the postoperative allogeneic blood-sparing effects of tranexamic acid and of desmopressin after total knee replacement.

Background: Tissue hypoxia and reperfusion induce abnormal hemostatic function. Therefore, bleeding after total knee replacement (TKR) may be a result of a tourniquet-induced imbalance of the procoagulant and fibrinolytic systems. Because laboratory confirmation of tourniquet-induced abnormal hemostasis is difficult to obtain, indirect evidence must be sought.

Intrathecal anaesthesia for the elderly patient: the influence of the induction position on perioperative haemodynamic stability and patient comfort.

Ninety elderly (>65 y) patients were studied to assess the influence of patient position during induction of spinal anaesthesia on the incidence of perioperative hypotension and haemodynamic stability. Prior to induction of anaesthesia, Lactated Ringer's solution (8-10 ml/kg) was administered. In the Sitting Group, intrathecal anaesthesia was performed with the patient in the sitting position.

The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Unlabelled: To assess the effect of local anesthetic wound instillation on visceral and somatic pain, we studied 36 patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy. A standard general anesthetic was administered. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above the superficial abdominal fascia such that the tip was at the midpoint of the surgical wound.

Continuous intravenous diclofenac does not induce opioid-sparing or improve analgesia in geriatric patients undergoing major orthopedic surgery.

Study Objective: To assess the analgesic efficacy and perioperative opioid-sparing effects of adjuvant intravenous (IV) diclofenac.

Design: Prospective, controlled, double-blind study.

Setting: Large referral hospital.

Bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements after major abdominal surgery.

Unlabelled: To assess the analgesic efficacy of patient-controlled bupivacaine wound instillation, 50 patients undergoing major intraabdominal surgery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard general anesthetic was administered. On completion of surgery, two multihole 20-gauge epidural catheters were tunneled through the proximal and distal apices of the surgical wound and placed above the fascia such that the tips were at the margin of the first and second thirds of the surgical wound, respectively.

Continuous propofol anaesthesia for patients with myotonic dystrophy.

Myotonic dystrophy, a rare genetic disorder, may pose a serious problem to the anaesthesiologist due to muscular and extramuscular involvement. Thirteen patients, median age 21 yr were anaesthetized by continuous propofol infusion, fentanyl, atracurium and N2O to evaluate this combination in myotonic dystrophy. Intraoperatively, neither exaggerated reactions nor haemodynamic instability was observed.

The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery.

To assess the efficacy and safety of wound instillation of ropivacaine, when administered via a patient-controlled elastometric pump, 50 term parturients undergoing cesarean delivery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard spinal anesthetic was administered. After the surgery, a multihole 20-gauge epidural catheter (B.