Should ovarian cryopreservation be offered to girls with cancer.

Current therapy of childhood cancer makes long-term survival a realistic outcome for most patients. However, some treatment regimens entail a significant risk of infertility. No established method for preservation of female fertility is currently available. Ovarian cryopreservation is an experimental technology that is being offered with increasing frequency to women undergoing cancer therapy. It has not yet been reported in children and adolescent girls. The aim of this review is to stimulate discussion on the possibility of performing ovarian cryopreservation in pre-menarcheal girls in advance of therapies that may induce ovarian failure. We present a multi-disciplinary discussion of the risks and benefits associated with the procedure and propose guidelines for its implementation. We propose that all girls about to receive treatment that has a high risk for infertility be offered consultation about the possibility of ovarian cryopreservation.

Preemptive analgesia and local anesthesia as a supplement to general anesthesia: a review.

General anesthesia (GA) and local anesthesia (LA) evolved on separate tracks. Procedures that could not be performed under LA were typically conducted under GA. Decoding of afferent linkage of peripheral noxious stimuli has provided important understanding that may change the way we traditionally treat surgical pain. In the 1980s, animal studies suggested that preemptive peripheral blocking of painful (nociceptive) stimuli to the central nervous system with regional anesthesia or LA and nonsteroidal analgesics could be beneficial in attenuating postoperative pain. Clinical studies based on this knowledge suggest combining LA with GA, and perhaps non-steroidal analgesics with or without narcotics, to reduce the severity of postoperative pain. General anesthetics can be given in lower minimal alveolar concentration when combined with LA, and recovery characteristics are superior. Increasing evidence suggests that the combined use of GA and LA may reduce the afferent barrage of surgery, and that preemptive analgesia may reduce postoperative pain and should be used in patient care. This article reviews the evidence supporting the combined use of LA or analgesics with GA or sedation to provide improved pain management after surgery.

A pediatric sedation/anesthesia program with dedicated care by anesthesiologists and nurses for procedures outside the operating room.

OBJECTIVE: To examine the performance of a pediatric sedation team working according to a specific protocol and to assess parental satisfaction with the service. STUDY DESIGN: A descriptive observational study of all procedures performed by the sedation team (comprising sedation-trained pediatric intensive care nurses and dedicated anesthesiologists) in a university hospital over 6 years. Data collected included demographics, procedure and location, sedation staff present, sedation failure, drugs used, requirements for escalation of sedation, complications, and parental satisfaction. RESULTS: Sedation was provided for 8760 procedures in 5554 children. The sedation nurse started 1769 (20%) procedures using triclofos sodium and required the assistance of the anesthesiologist in 115 (6.5%) cases. The remaining 6991 (80%) cases were performed by the anesthesiologist, predominantly using propofol (in 72.5% of cases). No cases were deferred as a result of insufficient sedation. Adverse events were recorded in 153 (1.7%) children. Of these, 132 (86%) were mild decreases in oxygen saturation. Three children were not discharged as a result of oversedation. Feedback indicated that 95% of parents were very satisfied with the sedation service. CONCLUSION: A dedicated sedation team using a written protocol provides a service with minimal case cancellation, zero sedation failure, very good safety, and excellent parental satisfaction.

Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients.

PURPOSE: The purpose of this study was to compare the effectiveness of midazolam (MDZ) alone to a combination of MDZ and hydroxyzine (MDZH) when sedating young children for dental treatment. METHODS: This was a prospective, double-blinded, crossover clinical study of young uncooperative children in need of at least 2 restorative visits. Twenty-eight children, ages 21 to 56 months, with a mean age of 36.6 months, participated in this study. The subjects were assigned randomly to receive either 0.5 mg/kg of oral MDZ 20 minutes prior to the beginning of dental treatment or the combination of 0.3 mg/kg oral MDZ with 3.7 mg/kg of hydroxyzine 30 minutes before treatment. The alternative drug regimen was administered at the second appointment. All subjects also received 50% nitrous oxide and were restrained with a papoose board. The child's behavior (quiet or crying, relaxed or moving) was evaluated every 5 minutes by an experienced pediatric dentist who was unaware of the drug given to the child. At the conclusion of treatment, each session was evaluated for overall effectiveness. RESULTS: Regardless of the type of premedication, more patients exhibited quiet behavior at the beginning of treatment, with an increase in crying and movement toward the end of treatment. Regarding movement, a significant difference was observed during the first 20 minutes between the 2 regimens. MDZ showed more children exhibiting movement. During the first 30 minutes of treatment, more children cried in the MDZ group, while MDZH presented more children asleep or quiet. No significant differences were found in behavior as a function of the order the sedative regimens were given. No significant differences between the 2 regimens regarding overall behavior and success (t=0.655 at 27 degrees of freedom; P=.518) were found. CONCLUSIONS: The combination of hydroxyzine (3.7 mg/kg) with MDZ (0.3 mg/kg) administered 30 minutes before treatment resulted in safe and effective sedation for the dental treatment of young children. This combination's use might be more advantageous when compared to MDZ alone, resulting in less crying and movement during the first 30 and 20 minutes, respectively.