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Publications (60)
Study objective
To evaluate the pharmacokinetics and safety of liposomal bupivacaine in pediatric patients undergoing spine or cardiac surgery.
Design
Multicenter, open-label, phase 3, randomized trial (PLAY; NCT03682302).
Setting
Operating room.
Patients
Two separate age groups were evaluated (age group 1: patients 12 to <17 years undergoing sp...
A multicenter study to evaluate the pharmacokinetics and safety of liposomal bupivacaine for postsurgical analgesia in pediatric patients aged 6 to less than 17 years (PLAY) ☆
Tracheoesophageal fistula (TEF) is an abnormal connection between the trachea and esophagus. Rare acquired TEF arises from trauma, caustic fluids ingestion, and iatrogenic injuries (ventilation, esophageal atresia repair, radiation, or tracheal/esophageal stents). We discuss the diagnosis, anesthetic management, and surgical correction of battery s...
Administering anesthesia to patients with pheochromocytoma may cause an exacerbation of catecholamine secretion from the pheochromocytoma secondary to drug administration, stress, or manipulation of the tumor. We present a pediatric patient with undiagnosed multiple endocrine neoplasia type 2B (pheochromocytoma, thyroid carcinoma, and mucosal neuro...
Drug testing is used in the perioperative setting, chronic pain clinic, and the workplace. One to two percent of anesthesia residents have documented evidence of substance abuse. The relapse rate of abuse among residents is extremely high. Detection of these drugs is most often done by an initial screening immunoassay and confirmation by more sophi...
Mapleson systems are known as carbon dioxide washout or flow-controlled breathing systems. The Mapleson A system is best for spontaneous respiration with the advantage of less waste of fresh gas flows and should not be used for controlled ventilation. The Mapleson D uses more fresh gas flows (set higher in order to avoid rebreathing of alveolar gas...
Pulse oximetry is a noninvasive technique to estimate the arterial oxygen saturation (SaO2) of hemoglobin. It is based on the differential absorption of light by oxyhemoglobin and deoxyhemoglobin. The oxygenated hemoglobin allows red light through and absorbs infrared light, while the deoxygenated hemoglobin allows infrared light through and absorb...
A 33 year-old female at 38 weeks gestation with a history of Complex Regional Pain Syndrome (CRPS) Type 1 of the upper extremities, diagnosed 13 years prior to this admission, was scheduled for an elective cesarean section (C-Section). She refused neuraxial anesthesia and requested general anesthesia. This abstract discusses the general anesthesia...
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.
Randomized, single-blinded, prospective study.
Operating room at The Children's Hospital.
Pediatric patients (aged 2-18 years) scheduled for dental surgery under general ane...
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 v...
Labels and medications with similar appearances have the potential to harm patients and cause delays in hospital services. We report a problem involving the Maxtec MAX-1 and MAX-11 oxygen sensors which are commonly used on anesthesia machines. These oxygen sensors have nearly identical labels which resulted in inadvertent interchanging of the senso...
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 anest...
To determine whether the covering of healthy children during anesthetic induction reduces hypothermia at the end of minor surgeries.
Randomized, single-blinded, prospective study.
Operating room and postoperative recovery area of a university-affiliated hospital.
50 ASA physical status 1 patients, aged 6 months to 3.5 years, scheduled for simple ur...
Following an uneventful delivery under epidural analgesia, a 17-year-old female patient was referred to the pain clinic because of numbness and pain of the left big toe for 1 2 2 Months. An orthopedic consultation had ruled out foot injury and concluded that the pain was radicular and secondary to nerve damage from the epidural analgesia. A pain cl...
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,...
A 10-day-old boy treated in the intensive care unit and operating room due to hyperkalemia and renal failure. After admission to the intensive care unit and treatment for hyperkalemia, the patient required insertion of dialysis catheter in the operating room. Treatment for hyperkalemia continued while the patient was under general anesthesia. The o...
The scope and application of the American Society of Anesthesiologists Physical Status (ASA PS) classification has been called into question and interobserver consistency even by specialist anesthesiologists has been described as only fair. Our purpose was to evaluate the consistency of the application of the ASA PS amongst a group of pediatric ane...
The purpose of this work was to identify demographic, medical, and psychosocial variables that predict radiation therapy-related distress among pediatric patients with cancer.
Seventy-nine children between the ages of 2 and 7 years were consecutively enrolled in the study. Radiation therapy-related distress was measured by rates of anesthesia, obse...
This study addressed variation in the use-dependent inactivation (UDI) of high-threshold tetrodotoxin-resistant Na⁺ currents (TTX-R currents) and action potential firing behavior among acutely isolated rat dorsal root ganglion (DRG) cells. UDI was quantified as the percent decrease in current amplitude caused by increasing the current activation ra...
Carbamazepine was tested on high-threshold TTX-resistant Na+ currents (TTX-R-currents), evoked from acutely isolated rat dorsal root ganglion (DRG) cells. Under control conditions, the TTX-R-currents recorded from different DRG cells varied greatly regarding use-dependent inactivation (TTX-R-current UDI), measured as the percent decrease in current...
When anesthetizing a patient with an anterior mediastinal mass, sudden hypoxaemia and cardiovascular collapse may result from compression of a large airway or vascular structure in the mediastinum. We report the case of a pediatric cancer patient with an anterior mediastinal mass, who developed sudden and fatal hypoxaemia and cardiovascular collaps...
Childhood leukemias represent nearly one third of all cancers in children and present a unique challenge to oncologists, pediatricians, hematologists, and other health professionals. Dr Ching-Hon Pui has assembled an expert team of authors to develop the most comprehensive, clinically-oriented, and authoritative reference dedicated to these disease...
A 9 month-old girl was given subcutaneous isosulfan blue to outline lymphatic channels during surgery for thoracic duct ligation. Her pulse oximetry values rapidly declined to a nadir of 85%, 35 min after dye injection. Arterial blood gases revealed methemoglobinemia ([MetHb] = 6.5%). Although abnormal pulse oximetry has already been reported in as...
To evaluate the efficacy of an interactive intervention in reducing distress related to radiation therapy (RT) among pediatric cancer participants as measured by occurrence of sedation, observed behavioral distress (OBD), and heart rate (HR).
Seventy-nine children receiving RT simulation were assigned randomly to a STARBRIGHT Hospital Pals group (i...
In Reply: Dr Vachon suggests that unequal medical care, rather than anatomic variations in bone structure, explains the higher risk for traumatic LP in black children. Indeed, inadequate access to health care and a poor socioeconomic status are known risk factors for inferior clinical outcomes among underprivileged groups in many settings.¹,2 We ha...
We report the development of stridor and dysphagia in a 5-month-old-infant with acute lymphoblastic leukaemia after the administration of four weekly doses of vincristine during induction therapy. Because direct laryngoscopy revealed bilateral vocal cord paralysis, the patient underwent elective intubation. Extubation was performed 7 days later, af...
We investigated levels of anticipatory distress in 80 pediatric patients, 2 to 7 years old, awaiting their initial radiation therapy (RT) procedure, and we examined demographic, medical, and psychosocial variables associated with their distress. Both observed behavior and heart rate outcomes were employed as measures of distress. Sixty-five percent...
To compare the accuracy of two immobilization techniques for pediatric brain tumor patients.
We analyzed data from 128 treatments involving 22 patients. Patients were immobilized with either a relocatable head frame (12 patients) or a vacuum bag (10 patients). Orthogonal portal films were used as verification images. Errors in patient positioning w...
Patients with thrombocytopenia are at risk for spontaneous or procedure-related hemorrhage. Whether such patients can safely undergo lumbar puncture (LP) without prophylactic platelet transfusion is unknown.
To determine whether an association exists between thrombocytopenia and LP complications among children with acute lymphoblastic leukemia.
Ret...
The mechanism by which normal alkanols longer than ethanol inhibit cation flux through the transient open state of the nicotinic acetylcholine receptor (nAcChoR) is unknown. They might act nonspecifically either by perturbing the lipid bilayer or by binding to many low affinity sites. Alternatively, they might act in a mutually exclusive manner at...
Barbiturates act on many neuronal ion channels by poorly understood mechanisms. The authors investigated the hypothesis that barbiturates inhibit the transient open-channel conformation of the nicotinic acetylcholine receptor (nAchR) by binding to a discrete site.
Inhibition curves of the agonist-stimulated efflux of 8bRb+ from nAchR-rich membrane...
This article reviews current opinions and recent developments in the use of muscle relaxants in children. Initially, the review concentrates on concerns relating to the use of succinylcholme in children, followed by a discussion of some of the pertinent differences between atracurium and vecuronium in infants. Lastly, the recently available relaxan...
A case of bronchospasm occurring after the termination of cardiopulmonary bypass is reported. The complement fractions C3a, C4a and C5a were measured before and right after CPB. Complement activation is not specific to CPB but may occur in any thoracotomy. The statistically significant increase in complement C3a without any pulmonary symptomatology...
difficulties and vocal cord paralysis and stridor and urologic and orthopedic anomalies.2 We present two safe anesthetics on two consecutive days on a patient with a Chiari II malformation managed safely with general anesthesia (intravenous and inhalational anesthesia) followed by a cardiac arrest six hours later by an inadvertent manipulation of t...
