RESUMEN
OBJECTIVE: This case series aimed to summarize our experience in usage of remifentanil in neonates undergoing non-cardiac surgery. BACKGROUND: Physiology of neonates and infants is different from that of adults. Immaturity of their vital organ systems narrows a safety margin of perioperative management including anesthesia. Remifentanil has favorable characteristics for pediatrics such as short duration of action and rapid elimination. Although remifentanil was introduced into clinical practice since 1996, its application to neonatal anesthesia has not been validated yet. METHODS: This is a 14-month retrospective case series of neonates receiving remifentanil during non-cardiac surgery at a tertiary care pediatric hospital in Japan. Patients' characteristics, intraoperative data, and complications were retrieved from medical records. RESULTS: A total of 68 neonates underwent non-cardiac surgery under general anesthesia, of whom 48 received remifentanil. Infusion rate was 0.14 (0.04-0.35) mcg/kg/min (median, range). No intractable adverse events including postoperative apnea were detected. CONCLUSION: Remifentanil is generally feasible to neonatal surgical population.
RESUMEN
BACKGROUND: Previous studies have shown ultrasound guidance (USG)for arterial cannulation being advantageous compared to palpation technique, but little is known about its performance by novices. OBJECTIVE: This study was to compare the utility of USG radial artery cannulation with palpation technique in terms of success rate, real-time to placement, number of attempts and complications. MATERIAL AND METHOD: After IRB approval, a randomized prospective study was performed November 2009-October 2010. Ten third-year residents, having performed USG vascular catheterization as yet less than 3 times, were coached on the pork-phantom during a workshop for real time ultrasound-guided vascular access. For the study patients were randomized to US-guided technique (US-group) and palpation (P-group); ten patients for each resident. RESULTS: One hundred adult patients undergoing neurosurgery were enrolled. There were no statistically significant differences between US-group vs. P-group in success rate (78% vs. 82%; p = 0.62), time to success (60 (12.8, 547.0) vs. 52 (6.9, 639.0) sec; p = 0.22), and number of attempts (1 (1, 4) vs. 1 (1, 3); p = 0.79). Most common complication was puncture hematoma (US-group 26% vs. P-group 24%; p = 0.82). Success was defined as no change in catheterization site, performer and technique. CONCLUSION: Regarding success rate, attended time, or number of attempts for radial arterial cannulation, we did not find any benefit of ultrasound guidance compared to palpation technique. Our findings were not in accordance to other trials. However, we have to consider operators in our study being in experienced in ultrasound-guided procedures but not in palpation techniques.