Tracheal intubation of healthy pediatric patients without muscle relaxant: a survey of technique utilization and perceptions of safety.

UNLABELLED: We conducted a survey of Society for Pediatric Anesthesia anesthesiologists practicing within the United States to determine the frequency of tracheal intubation of healthy infants and children using an inhaled anesthetic without muscle relaxation (IAWMR). We also examined reasons for the use of this technique. Of all responders who listed their most often used technique for tracheal intubation of healthy infants and children, IAWMR was chosen over intubation with a muscle relaxant by 38.1% and 43.6%, respectively. Anesthesiologists who most often used IAWMR for tracheal intubation of healthy infants and children had over twice the odds (odds ratio [OR] 2.30 for infants, 95% confidence interval [CI] 1.18-4.50; P = 0.015) of classifying their own practice as nonacademic, and one-third the odds (OR 0.34 for infants, 95% CI 0.17-0.68; P = 0.002) of conducting more than half of their cases in a supervisory role. Anesthesiologists who use IAWMR to tracheally intubate healthy pediatric patients most commonly selected as their reasons the lack of need for a muscle relaxant and the desire to avoid both succinylcholine and the excessive duration of nondepolarizing muscle relaxants. IMPLICATIONS: Inhaled anesthetic without muscle relaxation is the most often used method of intubation for more than one third of Society for Pediatric Anesthesia anesthesiologists when tracheally intubating healthy, fasted pediatric patients undergoing elective procedures. The frequency of this practice seems to be highest in nonacademic practices.

Pediatric sedation with analgesia.

Sedation with analgesia is frequently required to perform painful or invasive procedures in children. The best medication combination for pediatric sedation with analgesia is yet to be identified. Sixty-four of 243 total sedation with analgesia procedures from January 1994 through August 1995 were randomly chosen for descriptive retrospective review and analysis. Four minor complications from the procedures were identified, and recovery was complete in all cases. One medication combination (fentanyl 1 microg/kg with propofol 1.5 to 2 mg/kg, followed by an infusion of 150 microg/kg/min) provided the shortest mean time to dismissal (17.8 minutes v 38 minutes) when compared with other combinations used. No episodes of respiratory depression, hypotension, or nausea and vomiting occurred in the fentanyl/propofol group. These results show that fentanyl/propofol was superior to other medications used during this study period for pediatric sedation with analgesia. Prospective comparison of this medication combination with other short-acting agents in patients undergoing both elective and emergency procedures is necessary.

Do children who experience laryngospasm have an increased risk of upper respiratory tract infection?

BACKGROUND: Laryngospasm is the most frequently reported respiratory complication associated with upper respiratory infection and general anesthesia in retrospective studies, but prospective studies have failed to demonstrate any increase in risk. METHODS: A case-control study was performed to examine whether children with laryngospasm were more likely to have an upper respiratory infection on the day of surgery. The parents of all patients (N = 15,183) who were admitted through the day surgery unit were asked if their child had an active or recent (within 2 weeks of surgery) upper respiratory infection and were questioned about specific signs and symptoms to determine if the child met Tait and Knight's definition of an upper respiratory infection. Control subjects were randomly selected from patients whose surgery had occurred within 1 day of the laryngospasm event. RESULTS: Patients who developed laryngospasm (N = 123) were 2.05 times (95% confidence interval 1.21-3.45) more likely to have an active upper respiratory infection as defined by their parents than the 492 patients in the control group (P < or = 0.01). The development of laryngospasm was not related to Tait and Knight's definition for an upper respiratory infection or to recent upper respiratory infection. Children with laryngospasm were more likely to be younger (odds ratio = 0.92, 95% confidence interval 0.87-0.99), to be scheduled for airway surgery (odds ratio = 2.08, 95% confidence interval 1.21-3.59), and to have their anesthesia supervised by a less experienced anesthesiologist (odds ratio = 1.69, 95% confidence interval 1.04-2.7) than children in the control group. CONCLUSION: Laryngospasm was more likely to occur in children with an active upper respiratory infection, children who were younger, children who were undergoing airway surgery, and children whose anesthesia were supervised by less experienced anesthesiologists. Understanding the risk factors and the magnitude of the likely risk should help clinicians make the decision as to whether to anesthetize children with upper respiratory infection.

Partial tetrasomy 9 in a liveborn infant.

An unusual rearrangement of chromosome 9 was identified in a male infant with multiple congenital malformations. The rearrangement appeared as a fusion of two number 9 chromosomes with similar long-arm breakpoints. Since the infant also possessed two normal 9's, the presence of the additional chromosome resulted in partial tetrasomy; 47,XY, + tdic(9;9)(q22;q22). Clinical and autopsy examinations revealed many features reminiscent of trisomy 13. The tdic was functionally monocentric, although some evidence of activity at the second centromere was observed. Both parents had normal karyotypes, and C-banding demonstrated that at least one of the 9h regions on the tdic was likely to be of maternal origin.