Continuing promise 2009--assessment of a recent pediatric surgical humanitarian mission.

PURPOSE: Surgical organizations have begun to focus their efforts on providing humanitarian assistance in international communities. Most surgeons do not have previous international experience and lack an understanding of what is expected and what care they can provide. The unknown factors include case types, patient volume, postoperative care, and equipment. This abstract presents humanitarian assistance mission and highlights the importance of preparation, host nation involvement, and understanding the local politics of each country. METHODS: In April to July 2009, the USNS (United States Naval Ship) Comfort deployed to provide humanitarian assistance to 7 countries through Central and South America. Data collected included numbers and types of procedures, rate of rejection of patients for operation, patient age, American Society of Anesthesiology (ASA) score, and length of procedure. RESULTS: These data represent the total mission of Continuing Promise 2009 including a total of 1137 surgical procedures of which 340 were pediatric (<18 years old). The average number of pediatric cases for each country in 7 days was 48.3 ± 21.4, with a range of 24 to 84. The average age was 7.5 years (range, 1 month to 18 years). In partnership with host physicians, preoperative screening occurred over 2 to 3 days for every 7 operative days. We maintained a low threshold for rejection (rate of 43%; range, 21%-62%) and average ASA score of 1.3. Including all pediatric subspecialties, the most frequent procedures were inguinal (23%) and umbilical (14%) hernias. Although these were the most frequent procedure, the range and variety of cases varied widely. We had a very low early complication rate (1.2%), including 3 wound infections and 1 early hernia recurrence. CONCLUSIONS: Our data represent the largest collection to date on the pediatric surgical care of children in a humanitarian effort. Our experience can be used to identify the most likely types of cases in South and Central America and as a model for the safe and efficient treatment of children in a developing country.

Extraluminal use of the Arndt pediatric endobronchial blocker in an infant: a case report.

PURPOSE: Attaining lung isolation in the infant undergoing thoracic anesthesia can be challenging for the anesthesiologist. We describe a novel approach to performing lung isolation in an infant undergoing thoracotomy for lobectomy using an Arndt pediatric endobronchial blocker via an extraluminal technique. CLINICAL FEATURES: Lung isolation in an infant was achieved through the use of an Arndt pediatric endobronchial blocker placed externally to an endotracheal tube. The blocker's placement was facilitated through the use of a pediatric fibreoptic brochoscope placed through the guidewire of the extraluminally placed bronchial blocker. CONCLUSION: This novel technique may provide an easier and more reliable method of attaining single lung ventilation in infants and small children.

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.