Bradycardia during induction of anesthesia with sevoflurane in children with Down syndrome.

Background: Bradycardia is a complication associated with inhaled induction of anesthesia with halothane in children with Down syndrome. Although bradycardia has been reported after anesthetic induction with sevoflurane in these children, the incidence is unknown.

Objectives: In this study we compared the incidence and characteristics of bradycardia after induction of anesthesia with sevoflurane in children with Down syndrome to healthy controls.

Gene based prediction of clinically localized prostate cancer progression after radical prostatectomy.

Purpose: Accurate estimates of recurrence risk are needed for optimal treatment of patients with clinically localized prostate cancer. We combined an established nomogram and what to our knowledge are novel molecular predictors into a new prognostic model of prostate specific antigen recurrence.

Materials And Methods: We analyzed gene expression profiles from formalin fixed, paraffin embedded, localized prostate cancer tissues to identify genes associated with prostate specific antigen recurrence.

Simple, reliable replacement of pilot balloons for a variety of clinical situations.

When a pilot balloon fails or is an impediment to an intubation, such as via a pediatric laryngeal mask, options are generally limited to a tracheal tube exchange. Simple and effective solutions are described to replace a pilot balloon in a variety of clinical situations by using equipment that is readily available in operating rooms. Equipment such as intravenous catheters or epidural clamp connectors provides reliable, light weight, and streamlined substitutions for pilot balloons when connected to the pilot-cuff inflation line.

Anesthetic management of children with an anterior mediastinal mass.

Study Objective: To review the anesthetic management and perioperative course of children with an anterior mediastinal mass.

Design: Retrospective review.

Setting: University-affiliated children's hospital.

Simultaneous bilateral intraocular surgery in children.

Background: Simultaneous bilateral intraocular surgery (SBIS), defined as sequential bilateral intraocular surgery completed in one visit to the operating room, is a controversial topic. The reluctance of ophthalmologists to perform SBIS has been mainly attributable to concerns about bilateral catastrophic complications (endophthalmitis, expulsive hemorrhage, or retinal detachment). Herein we report our experience with SBIS in children and review the literature.

Blood loss, replacement, and associated morbidity in infants and children undergoing craniofacial surgery.

Background: Pediatric craniofacial reconstruction (CFR) procedures involve wide scalp dissections with multiple osteotomies and have been associated with significant morbidity. The aim of this study was to document the incidence of clinically important problems, particularly related to blood loss, and perform a risk factor analysis.

Methods: Records of all patients who underwent craniofacial surgery at the Children's Hospital of Philadelphia between December 1, 2001 and January 1, 2006 were reviewed.

Should experienced open prostatic surgeons convert to robotic surgery? The real learning curve for one surgeon over 3 years.

Objective: To critically analyse the learning curve for one experienced open surgeon converting to robotic surgery for radical prostatectomy (RP).

Patients And Methods: From February 2006 to December 2008, 502 patients had retropubic RP (RRP) while concurrently 212 had robot-assisted laparoscopic RP (RALP) by one urologist. We prospectively compared the baseline patient and tumour characteristics, variables during and after RP, histopathological features and early urinary functional outcomes in the two groups.

Robot-assisted laparoscopic prostatectomy: analysis of an experienced open surgeon's learning curve after 300 procedures.

To critically analyse the learning curve for a single experienced open surgeon converting to robotic surgery. From February 2006 to July 2009, 300 patients underwent a robot-assisted laparoscopic prostatectomy (RALP) by a single urologist. This study is a prospective analysis of the baseline patient and tumour characteristics, intraoperative and postoperative data, and histopathologic features.

Quality of life three years after diagnosis of localised prostate cancer: population based cohort study.

Objective: To quantify the risk and severity of negative effects of treatment for localised prostate cancer on long term quality of life.

Design: Population based, prospective cohort study with follow-up over three years.

Setting: New South Wales, Australia.

Stage migration in localized prostate cancer has no effect on the post-radical prostatectomy Kattan nomogram.

Objective: To investigate the effect of prostate-specific antigen (PSA) testing on stage migration in an Australian population, and its consequences on the prognostic accuracy of the post-radical prostatectomy (RP) Kattan nomogram, as in North America widespread PSA testing has resulted in prostate cancer stage migration, questioning the utility of prognostic nomograms in this setting.

Patients And Methods: The study comprised 1008 men who had consecutive RP for localized prostate cancer between 1991 and 2001 at one institution. Two groups were assessed, i.

Pediatric difficult airway management: current devices and techniques.

The anesthesiologist confronting the difficult pediatric airway is presented with a unique set of challenges. Adult difficult airway management techniques, such as awake or invasive approaches to airway management, often cannot be applied to children because of inadequate cooperation. Consequently, awake intubation in pediatrics is uncommon; most intubations are performed under general anesthesia or deep sedation.

Management of the difficult infant airway with the Storz Video Laryngoscope: a case series.

The incorporation of video technology into laryngoscopes provides an additional option for the management of difficult intubations. We report the successful use of the Miller 1 Storz Video Laryngoscope in seven infants with difficult direct laryngoscopy.

The efficacy of the Storz Miller 1 video laryngoscope in a simulated infant difficult intubation.

Background: Several studies have shown video laryngoscopy to be a useful technique in the management of patients in whom glottic exposure by direct laryngoscopy is difficult. We conducted this study as a preliminary investigation comparing the Storz DCI Miller 1 video laryngoscope (VL, Karl Storz GmbH, Tuttlingen, Germany) and direct laryngoscopy with a Miller 1 laryngoscope (DL) in an infant manikin model simulating difficult direct laryngoscopy. We hypothesized that compared with DL, VL would provide a better glottic view but would be associated with a longer time to intubation because of the different skill set required when using video intubation.

Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent.

Anesthetic goals for procedures involving resections close to the motor cortex include immobility, analgesia, and a level of consciousness that allows for the ability to follow motor commands. Remifentanil as a single agent is an attractive choice, particularly when ventilation is controlled. The successful use of large-dose remifentanil infusion during an awake craniotomy in a 16 year-old man and the subsequent severe acute opioid tolerance is presented.