randomized trial evaluating low doses of propofol infusion after intravenous ketamine for ambulatory pediatric magnetic resonance imaging

Our study compared the discharge time after pediatric magnetic resonance imaging [MRI] following sedation with propofol infusion dose of 100, 75 and 50 mcg/kg/min given after a bolus dose of ketamine and propofol. One hundred children of American Society of Anesthesiologists status 1/2, aged 6 months to 8 years, scheduled for elective MRI were enrolled and randomized to three groups to receive propofol infusion of 100, 75 or 50 mcg/kg/min [Groups A, B, and C, respectively]. After premedicating children with midazolam 0.05 mg/kg intravenous [i.v.], sedation was induced with bolus dose of ketamine and propofol [1 mg/kg each] and the propofol infusion was connected. During the scan, heart rate, noninvasive blood pressure, respiratory rate, and oxygen saturation were monitored. The primary outcome that is, discharge time was shortest for Group C [44.06 +/- 18.64 min] and longest for Group A [60.00 +/- 18.66 min], the difference being statistically and clinically significant. The secondary outcomes that is, additional propofol boluses, scan quality and awakening time were comparable for the three groups. The systolic blood pressure at 20, 25 and 30 min was significantly lower in Groups A and B compared with Group C. The incidence of sedation related adverse events was highest in Group A and least in Group C. After a bolus dose of ketamine and propofol [1 mg/kg each], propofol infusion of 50 mcg/kg/min provided sedation with shortest discharge time for MRI in children premedicated with midazolam 0.05 mg/kg i.v. It also enabled stable hemodynamics with less adverse events

Intrapartum performance of patients presenting with diabetes mellitus in pregnancy

To investigate the intrapartum performance of pregnancies complicated by diabetes mellitus [DM]. A pilot study [April-June 2005] of medical records of patients with DM admitted into the labour wards of the Maternity Hospital, Kuwait, was undertaken. Consecutive patients, matched for age and parity with the study group and with no medical complications, admitted for induction of labour during the study period served as the control. The ethnicity, obstetric/medical history and antenatal course of the index pregnancy were extracted. The intrapartum, postpartum and the neonatal outcome were documented. Statistical analysis was performed using 2 and alternative Welch t tests. During the study period, 3,005 patients were delivered at the hospital, and 177 of these [the study population] presented with DM, an incidence of 5.9%. Another 177 patients admitted for induction of labour served as the control. Of the 177 study patients, 86 [48.6%] were Kuwaitis, and the remaining 91 [51.4%] were non-Kuwaitis, of whom 41 were Arabs [23.2%], 34 Indians [19.2%], and 16 Asians [9%]. Of the controls, 65 [36.7%] and 112 [63.3%] were Kuwaitis and non-Kuwaitis, respectively. Of the 177 study patients, 128 [72.3%] presented with gestational DM. The significant complications were pregnancy-induced hypertension [13, 7.3%] and premature rupture of membranes [14, 7.9%]. The incidence of caesarean section in the study population [58, 32.8%] was significantly higher than that of the controls [35, 19.8%; p = 0.008]. Although the mean gestational ages at delivery in both groups were comparable [p = 0.669], the mean birth weight in the study group was significantly higher, 3.315 +/- 0.605 vs. 3.160 +/- 0.594 kg [p = 0.012]. The neonatal complications in the diabetic patients were shoulder dystocia [4, 2.3%] and Erb's palsy [12, 1.1%]; there were more perinatal deaths [3] in the control group. The incidence of DM was high, and the rate of caesarean section significant. The maternal and neonatal morbidity were high. A prospective study is recommended for enhanced management guidelines

Insulin resistance in women with recurrent spontaneous miscarriage of unkown aetiology

The objective of this study was to explore the role of insulin resistance in women with recurrent spontaneous miscarriage [RSM]. Patients with 3 consecutive spontaneous miscarriages were classified as having RSM. Thirty-five non-pregnant women presenting with RSM in our specialized RSM clinic constituted the study population, while 30 non-pregnant, parous, fertile women without RSM served as controls. The study and control patients were matched for age, ethnicity and body mass index [BMI]. Blood was extracted from these patients for fasting blood glucose and fasting insulin simultaneously, and a battery of investigations including ultrasonography was performed on all the patients with RSM. There was no significant difference in the mean fasting glucose for the study and control patients [5.5 +/- 0.7 vs. 5.3 +/- 0.6 mmol/dl] and in the mean fasting insulin [15.0 +/- 5.1 and 12.9 +/- 2.9 mU/l]. There was a significant difference between the mean parity of the study and control patients [0.7 +/- 0.7 vs. 1.7 +/- 0.5, p < 0.0001] and also the mean number of miscarriages [4.2 +/- 1.2 vs. 0.1 +/- 0.4, p < 0.0001]. There was, however, no significant difference in the insulin resistance of both groups as calculated using the Homeostasis Model Assessment and the fasting glucose insulin ratio of <4.5. Insulin resistance was not significantly associated with RSM in our study. Further studies may be needed

relationship of recurrent spontaneous miscarriage with reproductive failure

To investigate the reproductive performance of non-pregnant women with recurrent spontaneous miscarriage [RSM] and the association between RSM and polycystic ovary syndrome [PCOS] in reproductive failure. Subjects and Fifty non-pregnant women with 3 or more consecutive RSM attending our RSM clinic were evaluated prospectively. Detailed history and physical examination were completed. Extensive laboratory investigations, ultrasonographic, radiological and specialized procedures/tests were performed. Those patients who did not achieve pregnancy within the first 6 months of follow-up had appropriate treatment options implemented. The outcome of any subsequent pregnancies was analyzed. The mean age of the patients was 33.8 +/- 4.6 years [range 22-43 years]. The aetiological factors associated with RSM were chromosome anomaly, uterine abnormality, antiphospholipid syndrome, PCOS and infections; 40% were 'unexplained'. Thirty patients [60%] were able to achieve viable pregnancies which progressed to term, resulting in live births. Fourteen of the other 20 patients had high body mass index [BMI] >30 and evidence of PCOS. Of these 20 patients, 13 eventually achieved pregnancies which ended again in first-second-trimester abortions [cause undetermined]. The remaining 7 patients [4 with high BMI] who had a combination of male factor/protracted PCOS/ovarian failure did not achieve pregnancies. The association of RSM with PCOS resulted in poor reproductive performance, which may progress to reproductive failure