Nonoperating room anesthesia for children.

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) cases performed in pediatric patients have increased over the past decade. It is imperative for the anesthesia provider to be familiar with the nuances of this environment and the myriad of cases to ensure delivery of safe and efficient care. RECENT FINDINGS: Though case volume has increased, sedative agents have largely remained unchanged. NORA sites must meet the same operating room standards and expectations of anesthesia established by the American Society of Anesthesiologists. Despite the increasing NORA volume and efforts to instill a similar culture of safety as the operating room complex, NORA cases present challenges with limited resources and access to the patient, highlighting the need for resident and fellow training to include NORA experiences. SUMMARY: Experience working in the NORA environment helps provide, maintain, and improve the cognitive fitness and resilience that an anesthesiologist needs to tackle the complexities from the variety of NORA cases and locations. Patient factors aside, procedural considerations can affect the anesthetic plan, so understanding the nuances of the procedure helps the anesthesia provider provide safe and efficient care.

Pediatric Anesthesia Considerations for Interventional Radiology.

Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan. Several unique pediatric patient populations with specific procedural implications and anesthetic considerations who will benefit from additional periprocedural planning are discussed.

The Fontan patient.

Improved surgical and medical management has led to an increase in survival after staged univentricular palliative procedures. Subsequently, this improved survival has led to an increase in the number of patients who will present for noncardiac surgical interventions with Fontan physiology. A comprehensive understanding of normal Fontan physiology and the perturbations that the proposed surgical procedure will likely have is necessary to care for and design a comprehensive anesthetic plan that takes into account the effects of anesthetic agents, ventilation strategies, cardiovascular drugs, and various other perioperative factors. Applying the knowledge presented in this article should enable the anesthesiologist with the necessary principles to care for the patient with Fontan physiology.

Intraoperative latex hypersensitivity: do not overlook Penrose drains.

We report a case of intraoperative latex hypersensitivity to Penrose surgical drains (Ansell, Massillon, Ohio). To our knowledge, there has been no previous report of such a reaction with this device.

Preinduction techniques for pediatric anesthesia.

PURPOSE OF REVIEW: Preparing pediatric patients for their surgical experience is a complex process that may be facilitated by pharmacologic and non-pharmacologic techniques. Several techniques often utilized in the preoperative setting to decrease the anxiety level of pediatric patients and their parents include the administration of a sedative premedicant, parental presence during induction, and a variety of other non-pharmacologic modalities. These techniques may be useful, alone or in combination, to decrease anxiety levels in children and parents. This article reviews the most recent literature available on a variety of preinduction techniques in children. RECENT FINDINGS: Recent studies have evaluated various pharmacologic and non-pharmacologic preinduction techniques in children. Preoperative administration of midazolam, alone or combined with other pharmacologic agents, is the most effective technique at reducing anxiety in the child and parent. Although the literature supports the use of non-pharmacologic preinduction techniques, these modalities are time consuming, expensive, and do not consistently provide anxiolysis. Therefore, non-pharmacologic modalities are typically combined with pharmacological premedicants. SUMMARY: Although a variety of preinduction techniques exist, the most popular technique involves administering a sedative premedication, such as midazolam. Administering a premedicant will reliably decrease anxiety, improve cooperation during induction, and improve parental satisfaction. In addition, other preinduction strategies such as parental presence during induction may play a role in reducing anxiety levels in select children and their parents, and should be considered.

Development of a broadband picosecond infrared spectrometer and its incorporation into an existing ultrafast time-resolved resonance Raman, UV/visible, and fluorescence spectroscopic apparatus.

We have constructed a broadband ultrafast time-resolved infrared (TRIR) spectrometer and incorporated it into our existing time-resolved spectroscopy apparatus, thus creating a single instrument capable of performing the complementary techniques of femto-/picosecond time-resolved resonance Raman (TR3), fluorescence, and UV/visible/infrared transient absorption spectroscopy. The TRIR spectrometer employs broadband (150 fs, approximately 150 cm(-1) FWHM) mid-infrared probe and reference pulses (generated by difference frequency mixing of near-infrared pulses in type I AgGaS2), which are dispersed over two 64-element linear infrared array detectors (HgCdTe). These are coupled via custom-built data acquisition electronics to a personal computer for data processing. This data acquisition system performs signal handling on a shot-by-shot basis at the 1 kHz repetition rate of the pulsed laser system. The combination of real-time signal processing and the ability to normalize each probe and reference pulse has enabled us to achieve a high sensitivity on the order of deltaOD approximately 10(-4) - 10(-5) with 1 min of acquisition time. We present preliminary picosecond TRIR studies using this spectrometer and also demonstrate how a combination of TRIR and TR3 spectroscopy can provide key information for the full elucidation of a photochemical process.