A randomized trial comparing laryngeal mask airway to endotracheal tube in children undergoing upper gastrointestinal endoscopy.

Although the efficacy of laryngeal mask airway (LMA) has been demonstrated for securing patency of the airway in children, it has not yet been compared to endotracheal tube (ET) in this population. This study aimed to compare the safety and efficacy of LMA vs. ET in children undergoing elective diagnostic upper gastrointestinal endoscopies. Sixty ASA I-III patients were randomly allocated to ET (Group I) or LMA (Group II). A set of cardiovascular and respiratory parameters were obtained before, during and after the endoscopic procedure. The recovery time and the time to discharge were also registered. The cardiovascular and respiratory parameters evaluated in the study varied across the different evaluation periods. However, they remained within physiological ranges and were not different between groups. The median (range) recovery time was 4 (2-10) min and the time to discharge was 58 (36-88) min in the ET group and 3 (1-7) min and 50 (35-67) min in the LMA group (P > 0.10), respectively. In a 16 month-old, 80 cm and 10 kg girl, we failed to secure the patency of the airway with LMA. In conclusion, the LMA was as effective and safe as ET for securing the airway of children undergoing diagnostic upper endoscopies. However, the 3% failure rate occurred with LMA.

Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care.

The present study was performed in order to identify the cost of drugs used without documenting them in the patients' file and the wastage of drugs in a pediatric anesthesiology ward. In a prospective, blinded, observational design, drug utilization of 610 consecutive patients, undergoing an elective or emergency surgical procedure was evaluated. The number of undocumented drugs per 100 requested units and the number of wasted drugs per 100 requested units were computed and multiplied by its corresponding unitary cost. The median undocumented cost was 92.4 US dollars (95% CI 17.2-216.6 dollars) per 100 requested units. Succinylcholine (40 mg/2 mL) was the main undocumented drug; its use was not documented in approximately 50% cases in which this neuromuscular blocking agent was requested. However, rocuronium and nalbuphine had the highest unjustified cost, 770.6 dollars and 847.0 dollars per 100 requested units, respectively. Ketorolac, diclofenac, metamizol, furosemide, methylprednisolone, sodium bicarbonate, and cisatracurium were requested and documented. The median cost of wasted drug was 141.8 dollars (95% CI 55.8-448.2 dollars) per 100 requested drugs. More than 80% of adrenaline, naloxone, flunitrazepam, ephedrine, and cisatracurium were wasted. However, the highest cost of wasted drugs was for ondansetron, cisatracurium, methylprednisolone, and rocuronium. The uncontrolled availability and use of drugs may represent an important amount of resources wasted without any awareness of the staff in a department of pediatric anesthesia.