Interhospital transport to paediatric intensive care by specialised staff: experience of the South Thames combined transport service, 1998-2000.

The South London Combined Transport Service retrieved 1536 children aged 1 month to 16 years to paediatric intensive care (PIC) units usually in south London, over a 2.5 year period. Eighty one per cent of cases were for general PIC, the specialist cases being mainly cardiac and neurosurgical. The service commenced as part of a national framework for improved PIC and offers children with complex needs a safe specialist transfer. Clinician and parental satisfaction with the service appears high, although there are considerable service pressures. Intensive care beds were successfully located, helping to reduce fragmentation of PIC for this population.

The role of the paediatric nurse in promoting paediatric right to consent.

This article examines the processes involved in obtaining informed consent focusing on the abilities and legalities related to a child's right to consent. Most authors who have researched when a child may be considered competent to give a valid consent propose that the child must be 14 years old and thus able to think abstractly and consider the risks and benefits of the planned treatment. Qualitative research on this topic reveals that a child's previous life experiences can influence their ability to comprehend the intervention. This suggests children under 14 years of age may be regarded as competent. The confusion around the prevailing legal situation is examined. The role of the paediatric nurse is explored to distinguish areas in which the nurse could potentially make a contribution to the process of gaining consent from children. The paediatric nurse's role as an assessor, educator and evaluator are identified.

Desflurane for outpatient general anesthesia in third molar extraction cases.

PURPOSE: The purpose of this study was to evaluate the use of desflurane, a new volatile anesthetic agent, in a standardized endotracheal anesthetic technique for the removal of third molars in ambulatory patients. PATIENTS AND METHODS: Data were kept on 50 American Society of Anesthesiology (ASA) Class I and II patients undergoing oral endotracheal general anesthesia for removal of third molars. A standardized anesthetic technique was used on all patients. Induction was achieved with a bolus of propofol followed by neuromuscular paralysis with succinylcholine and then intubation. A 70% nitrous oxide, 30% oxygen, and desflurane mixture was titrated until there was no movement, and a local anesthetic was administered. The procedure was then completed in a standard fashion. The parameters measured included the length of surgery, the time from gas shutoff to extubation, the time from arrival in the postanesthesia care unit to achieving an Aldrete system score for discharge with an escort, the incidence of nausea and vomiting, and amnesia of the procedure. RESULTS: This study showed that the use of desflurane as the primary anesthetic agent for procedures of less than 1 hour is a useful technique. The agent is expensive, but the decreased recovery time and minimal side effects may offset this expense. CONCLUSION: The desflurane anesthetic technique provides a satisfactory surgical environment in selected patients. It results in rapid postanesthesia recovery and discharge times, thus reducing costs.

Cine MRI in the evaluation of the Proplast-Teflon TMJ interpositional implant.

Proplast-Teflon (Vitek Inc., Houston, TX, U.S.A.) interpositional implants (PTIPIs) have been removed from the market due to complications that include severe bony destruction of both condyle and fossa as a result of exuberant foreign body giant cell reaction. As per Food and Drug Administration recommendations, the radiologist will often be called to evaluate the status of these implants in the large population that received them. We present a case of bilateral PTIPIs with nonreducing anterior displacement of the meniscal prosthesis made more apparent by cine MRI. Extensive granulomatous reaction in the temporal bone exhibited mobility with cine.

Heterosexual social competence, anxiety, avoidance and self-judged physical attractiveness.

The relationship between self-judged physical attractiveness and opposite-sex behavior was examined as part of a large survey on the interaction patterns of 963 college students. The findings suggest that a self-rated negative physical image is related to significantly high levels of heterosexual difficulties.