Infliximab and surgical treatment of complex anal Crohn's disease.

AIM: Perianal fistulae in Crohn's disease are frequently complex, involve the anal sphincter complex and surgical treatment can be associated with poor healing of wounds and damage to the mechanism of continence. The aim of this study was to evaluate the efficacy and duration of response to infliximab in the long-term management of perianal fistulae in Crohn's disease in routine clinical practice. METHOD: A prospectively maintained database was used to identify patients with Crohn's disease and complex anal fistulae who were treated with infliximab (primary treatment, three initial infusions followed by maintenance therapy). Patients who received infliximab for luminal disease or for enterocutaneous, peristomal or rectovaginal fistulae were excluded from this study. RESULTS: Fifty-two patients [25 male, median age 24 (range 15-72) years] were treated with infliximab for perianal Crohn's fistulae for a median of 66 (7-124) months. Twenty-six of the patients underwent pre-infliximab MRI scans and 38 had an examination under anaesthetic (EUA) prior to commencement of treatment, 22 of whom had seton(s) inserted into their fistulae. Maintenance therapy was possible in 42 (81%) of 52 patients. Twenty-two (42.3%) patients had a complete response to treatment, 23 (44.2%) had a partial response and 7 (13.5%) had no response. Less than complete response to infliximab was associated with a greater risk of requiring surgical intervention (Fisher's exact test, d.f. 1, P = 0.005). CONCLUSION: The response rates of Crohn's related complex perianal fistulae to infliximab are good. Complete response is associated with a reduced need for surgical intervention.

A comparison of deep vs. awake removal of the laryngeal mask airway in paediatric dental daycase surgery. A randomised controlled trial.

Dental anaesthesia provides a potential conflict between anaesthetist and surgeon because of the shared airway. The laryngeal mask airway (LMA) has helped to improve airway control for these procedures, but there is little evidence for best practice on the timing of their removal after airway surgery in the paediatric population. We compared 'awake' and 'deep' removal of the LMA in 196 patients aged from 2 to 15 years in a randomised, controlled study. We found that average peripheral oxygen saturation (SpO2) was lower in the deep group and this was statistically significant (96.2% vs. 94.9%, p = 0.04). It was also found that the deep group had a higher incidence of patients with SpO2 < 95% (p = 0.003) and of patients who coughed (p = 0.003). We conclude that the LMA should be taken out awake in these patients.