Association of neck circumference and obesity status with elevated blood pressure in children.

High blood pressure (BP) and overweight/obesity are increasingly prevalent in children. We examined the associations of excess weight indicators including neck circumference (NC) and body mass index (BMI) with high BP in children. We hypothesized that high NC is associated with elevated BP. We utilized cross-sectional anthropometric and BP data on 1058 children aged 6-18 years. Patients were classified into weight and NC categories according to published guidelines. Prehypertension was defined as systolic or diastolic BP levels between 90th and 95th percentile for gender, age and height. Hypertension signifies systolic and/or diastolic BP levels ≥ 95th percentile for age, gender and height. The prevalence of elevated BP was 29.2% (prehypertension=10.1%, hypertension=19.1%). The prevalence of overweight and obesity was 19.0 and 18.7%, respectively. Rates of wide NC increased progressively with BMI categories by 8.8, 29.4 and 68.7% among normal weight, overweight and obese children, respectively. Within each BMI category, the unadjusted odds ratio for elevated BP was significantly higher in children with wide NC than those with normal NC (normal weight OR=1.78 (1.0-3.1), P=0.04); overweight OR=2.74 (1.5-5.2), P=0.001); obese OR=2.44 (1.3-4.6), P=0.006)). Increasing NC and BMI are associated with elevated BP in children. Joint presence of wide NC and high BMI is associated with significantly high rates of elevated BP. NC measurement may be a helpful tool to detect the presence of elevated BP in children.

Does an objective system-based approach improve assessment of perioperative risk in children? A preliminary evaluation of the 'NARCO'.

BACKGROUND: This study evaluated whether an objective tool would provide a more reliable and valid assessment of perioperative risk compared with the ASA-physical status (ASA-PS) in children. METHODS: A system-based risk assessment tool was developed using these categories: Neurological, Airway, Respiratory, Cardiovascular, and Other (NARCO) with a subcomponent grading surgical severity (SS). Anaesthesiologists reviewed the preoperative assessments and assigned NARCO, SS, and ASA-PS scores independently. Perioperative outcomes were recorded by trained observers. Validity and reliability of the tools were evaluated. RESULTS: NARCO correlated with ASA-PS (ρ=0.664; P<0.01) supporting its criterion validity. Inter-rater reliability of the measures was supported (intraclass correlation coefficients 0.71-0.96; κ 0.43-0.87) except for the Airway category. Measures of exact agreement were slightly better for NARCO compared with ASA-PS. NARCO, SS, and ASA-PS scores correlated significantly with perioperative escalation of care, adverse events (AE), hospital length of stay, and admission status. Correlations between NARCO and ASA-PS and outcomes improved when SS was factored into their coding. There were significant, but low, correlations between all measures and mortality. The odds of having escalation of care, AE, and mortality were 5-47 times greater among children with higher risk scores. CONCLUSIONS: Findings suggest that all measures of outcome have acceptable to excellent reliability with a slight improvement in agreement for the NARCO compared with the ASA-PS. This study supports the validity of both the NARCO and the ASA-PS in predicting perioperative risk in children with a slight improvement in correlations when combined with the SS score.

Post dural puncture headache in obstetric patients: experience from a West African teaching hospital.

BACKGROUND: This prospective, non-randomised study examined the frequency and severity of post dural puncture headache in 96 Ghanaian women who consented to spinal anaesthesia for caesarean section at the Korle Bu Teaching Hospital, Accra, Ghana. METHOD: Spinal anaesthesia was performed using 22-gauge (n = 22), 25-gauge (n = 46) or 26-gauge (n = 38) Quincke needles. Patients were followed up to determine the incidence and severity of post spinal headache. RESULT: The overall incidence of post dural puncture headache was 8.3%, but was significantly higher (33%) in patients in whom 22-gauge Quincke needles were used than in the other two groups (4% and 5% respectively: P = 0.003). Most patients rated their headache as mild to moderate on a 10-cm visual analogue scale. CONCLUSIONS: In view of the high incidence of headache and the need for treatment associated with the use of the 22-gauge Quincke needle, we recommend that this should not be used in the obstetric population. We are also aware that the incidence of post dural puncture headache could be further reduced by the use of small calibre pencil-point needles but these are currently very expensive and many obstetric units in developing countries may not be able to afford them.

Pneumocephalus with headache complicating labour epidural analgesia: should we still be using air?

Pneumocephalus is a rare complication of epidural block which typically occurs when the loss of resistance to air technique is used to identify the epidural space. We present a case of pneumocephalus with headache in a parturient following apparently uncomplicated labour epidural analgesia.

Anaesthetic dilemma: spinal anaesthesia in an eclamptic patient with mild thrombocytopenia and an "impossible" airway.

We present our anaesthetic management of a 27-year-old woman with antepartum eclampsia, mild thrombocytopenia, difficult airway and clinical evidence of impending upper airway obstruction. She required urgent delivery by caesarean section, which was conducted uneventfully under spinal anaesthesia. We discuss the management conundrums presented by this case and why we chose spinal anaesthesia over other anaesthetic options.

Intraosseous infusion in an emergency situation: a case report.

An 18-month-old boy who had cardiopulmonary arrest secondary to penicillin anaphylaxis was successfully resuscitated by intraosseous administration of emergency resuscitative medications because peripheral vascular access was impossible. He was discharged 2 weeks later in a satisfactory clinical condition.