Safety and efficacy of intrathecal morphine in early onset scoliosis surgery.

Intrathecal morphine (IM) is a popular adjunct for pain management in spinal deformity surgery for idiopathic scoliosis. It has not been studied in patients with early onset scoliosis (EOS). We retrospectively reviewed EOS patients undergoing growth-friendly surgery who received IM or did not receive IM (non-IM).

The safety and efficacy of intrathecal morphine in pediatric spinal deformity surgery: a 25-year single-center experience.

Purpose: Pre-incision intrathecal morphine (IM) is a popular adjunct in adolescent idiopathic spinal deformity surgery. This study represents our 25-year experience with IM in all diagnostic groups undergoing posterior spinal fusion (PSF) and segmental instrumentation (SI).

Methods: Our prospective Pediatric Orthopaedic Spine Database (1992-2018) identified all patients undergoing PSF and SI.

Potential Makeshift Solution to Coronavirus Disease 2019-Related N95 Mask Shortage.

N95 respirator masks are used by medical providers for respiratory protection from airborne pathogens of transmissible diseases. In extreme situations or pandemics, when N95 masks may be in short supply, the American Society of Anesthesiologists (ASA) reported that some groups created their own N95 mask utilizing an anesthesia circuit mask plus a filter for use in short but high-risk procedures. The makeshift option for personal protective equipment was tested with a qualitative respirator mask fit test.

A prospective randomised study on efficacy of music for decreasing preoperative anxiety in children.

Background: The operating room can be a frightening environment for paediatric patients. This study investigated whether music medicine can mitigate preoperative anxiety in children.

Materials And Methods: One hundred and fifty children undergoing general anaesthesia were randomised to listen to music of the child's choice, lullaby music or no music before induction.

Impact of multidisciplinary engagement in a quality improvement blood conservation protocol for craniosynostosis.

Objective: Patients undergoing open cranial vault remodeling for craniosynostosis frequently experience substantial blood loss requiring blood transfusion. Multiple reports in the literature have evaluated the impact of individual blood conservation techniques on blood transfusion rates during craniosynostosis surgery. The authors engaged a multidisciplinary team and assessed the impact of input from multiple stakeholders on the evolution of a comprehensive quality improvement protocol aimed at reducing or eliminating blood transfusion in patients undergoing open surgery for craniosynostosis.

Intrathecal Morphine in the Presence of a Syrinx in Pediatric Spinal Deformity Surgery.

Background: Intrathecal morphine (IM) is a popular adjunct for pain relief during pediatric spinal deformity surgery. There is no literature regarding its usefulness and safety in the presence of a spinal cord syrinx for patients undergoing spinal instrumentation. Anesthesiologists have previously been reluctant to use IM in the presence of any syrinx.

ECG-ELECTRODE INDUCED HYPOPIGMENTATION.

Skin reactions following the application of electrocardiography (ECG) electrodes have been reported in adults and children, and are postulated to result from contact with the conductive gel or adhesive used on the electrodes. Although contact dermatitis is the usual cause of such reactions, contact depigmentation or hypopigmentation may also occur. We report a case of hypopigmentation in a healthy boy following continuous electrocardiography monitoring during general anesthesia for dental rehabilitation.

PERIPHERAL INTRAVENOUS CATHETER PROBLEMS IN INFANTS AND CHILDREN PRESENTING FOR ANESTHESIA AND SURGERY.

Background: Anesthesia providers frequently rely upon in-situ peripheral intravenous catheters (IVs) during the perioperative care of pediatric patients. IV dysfunction can result in complications including inability to administer medications for resuscitation, extravasation of tissue-toxic medications, and incomplete induction of anesthesia. This study was performed to prospectively assess the frequency of IV dysfunction in children presenting for anesthesia care.

Intrathecal morphine attenuates acute opioid tolerance secondary to remifentanil infusions during spinal surgery in adolescents.

Introduction: The unique pharmacokinetic properties of remifentanil with a context-sensitive half-life unaffected by length of infusion contribute to its frequent use during anesthetic management during posterior spinal fusion in children and adolescents. However, its intraoperative administration can lead to increased postoperative analgesic requirements, which is postulated to be the result of acute opioid tolerance with enhancement of spinal N-methyl-D-aspartate receptor function. Although strategies to prevent or reduce tolerance have included the coadministration of longer acting opioids or ketamine, the majority of these studies have demonstrated little to no benefit.

Intrathecal morphine analgesia in idiopathic scoliosis surgery: does sex or racial group affect optimal dosing?

Background: We previously determined the intrathecal morphine optimal dose to maximize analgesia in patients undergoing idiopathic scoliosis surgery while minimizing adverse effects. Our purpose was to determine if this protocol was equally effective across sex and racial groups.

Methods: We studied 287 patients given a moderate dose of intrathecal morphine of 9 to 19 μg/kg (mean 14 μg/kg): 240 female and 47 male patients and 224 White (W) and 63 African-American (AA) patients.

Continuous intravenous morphine infusion for postoperative analgesia following posterior spinal fusion for idiopathic scoliosis.

Study Design: A retrospective study of postoperative pain management.

Objective: Evaluate the efficacy and safety of continuous intravenous morphine infusion for postoperative pain management in patients with idiopathic scoliosis (IS) undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI).

Summary Of Background Data: Postoperative pain is a common problem following surgery for IS.

An unusual case of ingestion of a moth cocoon in a 14-month-old girl.

We present a case report of a 14-month-old girl who ingested a moth cocoon, which resulted in dramatic symptoms of irritability, drooling, and anorexia. Direct laryngoscopy, bronchoscopy, and esophagoscopy under general anesthesia revealed copious, tenaciously adherent, barbed hairs embedded in her tongue and buccal mucosa. Removal of the hairs with irrigation, suction, and brushing was unsuccessful and was eventually abandoned.

Intrathecal morphine for postoperative analgesia in patients with idiopathic scoliosis undergoing posterior spinal fusion.

Study Design: A retrospective study of postoperative pain management with intrathecal morphine.

Objective: Identify the dosing regimen of intrathecal morphine that safely and effectively provides postoperative analgesia with minimal complications in patients with idiopathic scoliosis undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI).

Summary Of Background Data: Postoperative pain after surgery for idiopathic scoliosis is a concern.

Cardiac arrest in a child with cerebral palsy undergoing sevoflurane induction of anesthesia after preoperative clonidine.

Clonidine is a frequently administered alpha2-adrenergic agonist which can decrease heart rate and blood pressure. We present a case of a 5-year-old child with cerebral palsy and seizure disorder, receiving clonidine for restlessness, who presented for placement of a baclofen pump. Without the knowledge of the medical personnel, the patient's mother administered three doses of clonidine during the evening before and morning of surgery to reduce anxiety.

Anesthetic management for laser excision of recurrent respiratory papillomatosis in a third trimester parturient.

Recurrent respiratory papillomatosis (RRP) is characterized by the development of laryngeal papillomas, which can produce partial to complete upper airway obstruction. Patients with RRP often require intermittent surgical excision to treat symptoms such as hoarseness and stridor, and to control progression of the lesions. The anesthetic management of such patients is challenging, and it requires carefully coordinated care between an anesthesiologist and otolaryngologist.

Clonidine increases duration of bupivacaine caudal analgesia for ureteroneocystostomy: a double-blind prospective trial.

Purpose: We evaluated whether clonidine, when added to bupivacaine, would significantly prolong caudal analgesia and decrease opioid requirements in children undergoing ureteroneocystostomy.

Materials And Methods: A total of 35 children 1 to 10 years old undergoing ureteroneocystostomy received a standardized regimen of general anesthesia, and were randomized to receive a preincision caudal block consisting of either 1 ml/kg 0.125% bupivacaine (controls) or 1 ml/kg 0.

Automatic atrial tachycardia in an infant following general anesthesia.

Automatic atrial tachycardia (AAT) is a rare supraventricular tachyarrhythmia (<10% of all supraventricular tachycardias), which can present in infants or young children. There are no published reports of AAT occurring in an infant or child following noncardiac surgery and general anesthesia. This report describes the management of a previously healthy 5-month-old infant, who developed AAT in the postanesthesia care unit following an uneventful circumcision under general anesthesia.

Assessment of risk factors for emergence distress and postoperative behavioural changes in children following general anaesthesia.

Background: Emergence distress commonly occurs in children recovering from the immediate effects of general anaesthesia. This study was performed to (1) examine whether parental presence in the operating room during emergence from anaesthesia reduces the incidence or severity of emergence distress behaviour, and (2) assess psychosocial risk factors, including child temperament and sleep behaviour, for development of emergence distress.

Methods: A randomized and controlled trial of parental presence at emergence was conducted in 100 ASA class I and II children having general anaesthesia for inguinal or penile surgery.

Management of general anaesthesia in infants and children with a history of idiopathic pulmonary haemorrhage.

Background: Idiopathic pulmonary haemorrhage in infants is a rare disorder that is endemic to metropolitan Cleveland, Ohio. Since 1993, 32 infants with this disorder were diagnosed and treated at our institution, one of them after developing pulmonary haemorrhage during induction of anaesthesia. Of this population, five patients have undergone a total of 10 general anaesthetics at some time after the initial diagnosis of pulmonary haemorrhage.