The effect of intranasal administration of remifentanil on intubating conditions and airway response after sevoflurane induction of anesthesia in children.

Background: Intubation without the use of muscle relaxants in children is frequently done before IV access is secured. In this randomized controlled trial, we compared intubating conditions and airway response to intubation (coughing and/or movement) after sevoflurane induction in children at 2 and 3 min after the administration of intranasal remifentanil (4 mcg/kg) or saline.

Methods: One hundred eighty-eight children, 1-7-yr old, were studied.

Decreasing variability in faculty ratings of student case presentations: a faculty development intervention focusing on reflective practice.

Background: Faculty perceptions of medical student knowledge are often based on case presentations, but their assessment of student performance can vary significantly based on content, presentation skill, and interpersonal characteristics.

Purpose: To determine if a brief faculty development intervention could significantly decrease (>or= 20%) faculty members' variability in rating student case presentations in the ambulatory setting.

Methods: During the 1998-99 academic year, we videotaped 10 third-year medical students during one well-child presentation.

Differences in severity-adjusted pediatric hospitalization rates are associated with race/ethnicity.

Objective: Racial/ethnic disparities in health care delivery have been well described, but little is known about such disparities for children who seek emergency care. The objective of this study was to test the hypothesis that severity-adjusted emergency department pediatric admission rates are associated with race/ethnicity.

Methods: Secondary analyses were conducted of an established database of 16 emergency departments that participated in a national study to validate the Pediatric Risk of Admission II score, which is used to measure severity of illness.

Clinical spectrum and histopathologic features of chronic hepatitis C infection in children.

Objective: To define the natural history and outcomes of children infected with hepatitis C virus (HCV) at birth or in early childhood.

Study Design: This retrospective, prospective study identified 60 HCV-infected children through a transfusion look-back program (group 1) and by referrals (group 2). Perinatal/transfusion history, clinical course, and laboratory studies were correlated with findings from 42 liver biopsy specimens.

Association of emergency department care factors with admission and discharge decisions for pediatric patients.

Objective: We evaluated overutilization or underutilization of inpatient resources to measure the emergency department (ED) decision-making process and its association with the following care factors: annual pediatric volume, presence or absence of a pediatric emergency medicine specialist; and presence or absence of ED residents.

Study Design: Block random selection, using the three care factors, of 16 hospitals with pediatric intensive care units. The Pediatric Risk of Admission (PRISA II) Score was used to measure illness severity.

Immunohistochemical analyses of MUC5AC mucin expression in sinus mucosa of children with sinusitis and controls.

Objectives: The purpose of this study was to analyze MUC5AC protein expression in sinus mucosal specimens of children with and without chronic sinusitis.

Methods: Morphometric, histologic, and immunohistochemical analyses were carried out on sinus mucosa of 7 children with chronic sinusitis and 6 children without sinusitis.

Results: MUC5AC protein was expressed in a subset of goblet cells in the surface epithelium, but not in the submucosal glands in either pediatric population.

Stable prevalence but changing risk factors for sudden infant death syndrome in child care settings in 2001.

Objective: A total of 20% of sudden infant death syndrome (SIDS) cases in the 1990s occurred in child care settings. This is much higher than the 8% expected from Census Bureau data. Factors that were associated with child care SIDS included older age; white race; older, more educated mothers; and unaccustomed prone position.

CINRG randomized controlled trial of creatine and glutamine in Duchenne muscular dystrophy.

We tested the efficacy and safety of glutamine (0.6 gm/kg/day) and creatine (5 gm/day) in 50 ambulant boys with Duchenne muscular dystrophy in a 6-month, double-blind, placebo-controlled clinical trial. Drug efficacy was tested by measuring muscle strength manually (34 muscle groups) and quantitatively (10 muscle groups).

The Pediatric Risk of Hospital Admission score: a second-generation severity-of-illness score for pediatric emergency patients.

Objective: To develop and validate a second-generation severity-of-illness score that is applicable to pediatric emergency patients. The Pediatric Risk of Admission (PRISA) score was developed in a single hospital and was recalibrated and validated in 2, previous, small studies from academic pediatric hospitals. This study was performed to develop and validate a score in a larger sample of diverse hospitals.

What do adolescents want? An exploratory study regarding end-of-life decision-making.

Purpose: To explore whether differences exist between chronically ill and healthy adolescents with regard to their attitudes about end-of-life (EOL) issues.

Methods: A convenience sample of 25 adolescents without and 25 with a chronic illness, aged 13 to 21 years, were surveyed in hospital clinics, using a 25-item instrument; 60% were female and 76% were African-American. Items were developed based on previous research, interviews with health care providers, and a focus group with patients.

Increases in serum levels of troponin I are associated with cardiac dysfunction and disease severity in pediatric patients with septic shock.

Objectives: Myocardial cell injury may contribute to cardiac dysfunction in septic shock. Troponin I is a biochemical marker of myocardial cell injury and death. We hypothesized that troponin I is increased in pediatric patients with septic shock and correlates with cardiac dysfunction and disease severity.

Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children.

We performed orotracheal intubation in 153 consecutive pediatric patients undergoing cardiac catheterization. Auscultation of bilateral breath sounds was confirmed. By fluoroscopy, the tip of the endotracheal tube (ETT) was seen in the right mainstem bronchus in 18 patients (11.

Recalibration of the pediatric risk of admission score using a multi-institutional sample.

Study Objective: Case-mix adjustment is a critical component of quality assessment and benchmarking. The Pediatric Risk of Admission (PRISA) score is composed of descriptive, physiologic, and diagnostic variables that provide a probability of hospital admission as an index of severity. The score was developed and validated in a single tertiary pediatric hospital emergency department (ED) after exclusion of children with minor injuries and illnesses.

Partial pressure of carbon dioxide in extremely low birth weight infants supported by nasal prongs continuous positive airway pressure.

Objective: Traditionally, delivery room management of extremely low birth weight (ELBW) infants consisted of immediate intubation and mechanical ventilation. There have been recent reports of success using nasal prongs continuous positive airway pressure (NCPAP) in this population. Data on the partial pressure of carbon dioxide (PCO(2)) in spontaneously breathing ELBW infants is very limited.

Ketamine and midazolam is an inappropriate preinduction combination in uncooperative children undergoing brief ambulatory procedures.

Background: We prospectively studied the effects of intramuscular (i.m.) ketamine alone, or combined with midazolam, on mask acceptance and recovery in young children who were uncooperative during induction of anaesthesia.

Pediatric red blood cell transfusions increase resource use.

Objective: To test the hypothesis that red blood cell transfusions are associated with increased resource utilization and mortality in critically ill children.

Methods: Five pediatric intensive care units (PICUs) participated in a retrospective, cohort analysis (1996-1999). Children with a hemoglobin value View Article and Find Full Text PDF

Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol.

Background: Emergence agitation in children is frequently associated with the use of the new highly insoluble volatile anaesthetics. Rapid emergence has been cited as one of the possible causes. Propofol also permits rapid emergence from general anaesthesia but is not associated with agitation.

Risk of resistant infections with Enterobacteriaceae in hospitalized neonates.

Objective: To determine the risk factors associated with progression from colonization to infection with health care-associated antimicrobial-nonsusceptible Enterobacteriaceae (ANE) in critically ill neonates.

Study Design: During a 3-year period (1998 to 2000), surveillance rectal cultures were performed on neonates admitted to our Level III neonatal intensive care unit after a cluster of four cases of ANE infection were identified in 1998. ANE were defined as members of the Enterobacteriaceae family that exhibited nonsusceptibility to ceftazidime or laboratory evidence of extended spectrum beta-lactamase (ESBL) production.

Caudal anesthesia in children: effect of volume versus concentration of bupivacaine on blocking spermatic cord traction response during orchidopexy.

Unlabelled: In this study we compared the intensity and level of caudal blockade when two different volumes and concentrations of a fixed dose of bupivacaine were used. Fifty children, 1-6 yr old, undergoing unilateral orchidopexy received a caudal block with a fixed 2 mg/kg dose of bupivacaine immediately after the induction. Group 1 (n = 23) received 0.

Neuroselective sensory electrodiagnostic evaluation of 4% liposomal topical lidocaine.

Unlabelled: We used a neuroselective transcutaneous electrical stimulus to determine the onset time of cutaneous anesthesia with 4% liposomal lidocaine under occluded and nonoccluded conditions. The pain tolerance threshold (PTT) was used to atraumatically evaluate nociception. Twenty adult volunteers had liposomal lidocaine applied to the volar surface of each forearm for durations ranging from 0 through 30 min (at 5-min intervals) under occluded and nonoccluded conditions.

The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children.

Unlabelled: Desflurane and sevoflurane anesthesia are associated with emergence agitation in children. In this study, we examined the effect of a single intraoperative dose of fentanyl on emergence characteristics in children undergoing adenoidectomy. One hundred children, 2-7 yr old, were randomly assigned to receive desflurane or sevoflurane for maintenance of general anesthesia after an inhaled induction with sevoflurane and a 2.

Testing anal sphincter tone predicts the effectiveness of caudal analgesia in children.

Unlabelled: In this study, we examined the effectiveness of caudal blocks and correlated it with the laxity of the patients' anal sphincter before emergence from anesthesia in 178 children undergoing inguinal and/or penile surgery. Bupivacaine 0.25% in a volume of 0.

The effects of the simulated Valsalva maneuver, liver compression, and/or Trendelenburg position on the cross-sectional area of the internal jugular vein in infants and young children.

Unlabelled: We calculated the effects of the simulated Valsalva (V), liver (L) compression, and Trendelenburg (T) position on the cross-sectional area (CSA) of the right internal jugular vein by using planimetry (Aloka ultrasound machine) in 84 infants and young children. Eight combinations of positions and interventions were studied for each patient, with the patient supine, in the T position, during the simulated V maneuver, with L compression and a combination of maneuvers. Data were analyzed by using Friedman's chi(2) test and Wilcoxon's signed rank test.