A randomized, single-blinded, prospective study that compares complications between cuffed and uncuffed nasal endotracheal tubes of different sizes and brands in pediatric patients.

STUDY OBJECTIVE: To compare any association between the problematic distal placement of cuffed and uncuffed nasal endotracheal tubes (NETTs) of different sizes and brands in pediatric patients. DESIGN: Randomized, single-blinded, prospective study. SETTING: Operating room at The Children's Hospital. PATIENTS: Pediatric patients (aged 2-18 years) scheduled for dental surgery under general anesthesia whose American Society of Anesthesiologists physical status is not greater than 2. INTERVENTION: Patients were randomly assigned to preformed cuffed (1) RAE (Ring-Adair-Elwyn) endotracheal tube by Mallinckrodt or (2) nasal AGT NETT by Rüsch. MEASUREMENTS: The distance between the tube's distal end and the carina was measured using a fiber optic bronchoscope. Problematic placements were defined where the tip of the tubes was within 0.5 cm of carina. MAIN RESULTS: The odds of a problematic placement was 7 times higher (95% confidence interval of odds ratio, 2.06, 23.4) in patients managed with cuffed tubes than those with uncuffed tubes (P = .002). The distance between the tip of cuffed NETT tubes and carina was significantly less than with uncuffed tubes. CONCLUSIONS: The chances of possible complications were significantly higher with cuffed NETT. The NETT should be kept at least 0.5 cm above carina to avoid possible complications.

Effect of informational Spanish anesthesia video on the level of anxiety and uncertainty with Native Spanish speaking parents. A pilot study.

OBJECTIVES: We hypothesized that showing native Spanish speaking parents, a Spanish video explaining the risks and benefits of anesthesia within two weeks prior to surgery would reduce parental anxiety. METHODS: Subjects were randomly assigned to video-group or non-video-group. Both groups completed PPUS, STAIT and APAIS tests before and after viewing the videos. Parents repeated the same three tests before the operation on the day of the surgery. RESULTS: The results revealed a decrease in 3 points on the APAIS assessment in the non-video-group compared to 5.8 points decrease in the video-group. PPUS assessment revealed an average 1.25 points increase in the non-video-group compared to 11 points decrease in video-group. Due to the extremely low sample size, the statistical significance of the findings cannot be verified by statistical methods. CONCLUSIONS: Hispanic parents who viewed the preanesthesia Spanish-video had lower levels of anxiety compared to those who did not watch the video.

Assessment of anesthesia provides' opinions regarding pediatric induction practices in the state of Oklahoma.

OBJECTIVES: The induction of anesthesia in children is commonly carried out by the administration of inhaled anesthetics via face mask as opposed to an intravenous induction. Thus far, no study has assessed the opinions of anesthesia providers regarding commonly used induction techniques. We surveyed current attitudes among anesthesiologist to understand anesthesia induction techniques in pediatric patients in the community. BACKGROUND: A survey of community anesthesiologists induction of anesthesia methods in children was sent to members of the Oklahoma Society of Anesthesiologists. METHODS/MATERIALS: Three hundred and fifty-seven active members in the Oklahoma Society of Anesthesiologists (OSA) were sent a survey in a three-stage mailing process: 1) an introductory letter and questionnaire, 2) a follow-up reminder, and 3) a thank you letter to maximize response rate. RESULTS: 179 (84 percent) indicated they feel comfortable with the procedure. 77 percent of respondents rated their proficiency in administering pediatric anesthesia at least 8 on a scale of 1 to 10, where 10 denotes "excellent" proficiency. 188 (87 percent) reported they do not feel abusive. Among respondents, the median percentage of practice devoted to pediatric anesthesia was 10 percent. CONCLUSIONS: To evaluate pediatric anesthesia induction techniques, the attitudes of anesthesia providers were assessed. Although 84% of responders felt comfortable with pediatric patients and 77% felt proficient, our data suggests that further education and research can be done to help facilitate a higher percentage who feel comfortable with pediatric induction techniques.

Does the covering of children during induction of anesthesia have an effect on body temperature at the end of surgery?

STUDY OBJECTIVES: To determine whether the covering of healthy children during anesthetic induction reduces hypothermia at the end of minor surgeries. DESIGN: Randomized, single-blinded, prospective study. SETTING: Operating room and postoperative recovery area of a university-affiliated hospital. PATIENTS: 50 ASA physical status 1 patients, aged 6 months to 3.5 years, scheduled for simple urological surgeries. INTERVENTIONS: Subjects were randomly assigned to one of two groups: covered or uncovered. Children in the covered group (Group C) were actively warmed on arrival in the operating room (OR) using cotton blankets and a warm forced-air blanket set at 43°C. Children in the uncovered group (Group U) remained uncovered during the induction of general anesthesia. Children in both groups were actively warmed following placement of surgical drapes. MEASUREMENTS: Temperature (in Celsius) during the study procedure was recorded for each patient. MAIN RESULTS: Mean core body temperature at the end of induction did not differ in the two groups, 36.4°C in Group C and 36.6°C in Group U. Mean core body temperature at the end of surgery did not differ between the two groups: 36.9°C in Group C and 37.0°C in Group U. CONCLUSION: Leaving healthy children uncovered during induction of general anesthesia does not have a clinically significant effect on core temperature at the end of induction or of surgery.

Profound intraoperative metabolic acidosis and hypotension in a child undergoing multilevel spinal fusion.

The prone position may cause cardiovascular system depression. Yet, the mechanisms involved and preemptive measures are not well understood (Edgcombe et al. (2008)). During spinal surgery in the prone position, hypotension may occur. Implicated factors include prolonged abdominal compression impeding venous return resulting in increased blood loss, decreased cardiovascular reserve, and the use of total intravenous anesthesia (TIVA) which has been shown to blunt the sympathetic response more than inhalation anesthesia. We present a case of hypotension during spinal surgery with all its challenges. Hypotension and acidosis persisted despite all supporting measures, and only to improve with supine positioning. Differential diagnosis for such an event are discussed. Although abdominal compression may not be obvious before the start of surgery, compressing the spine during surgery may lead to abdominal compression and hypoperfusion to abdominal organs.