Introduction of a paediatric anaesthesia comic information leaflet reduced preoperative anxiety in children.

BACKGROUND: The aim of the study was to determine whether the introduction of a paediatric anaesthesia comic information leaflet reduced preoperative anxiety levels of children undergoing major surgery. Secondary objectives were to determine whether the level of understanding of participants and other risk factors influence STAIC-S (State-Trait Anxiety Inventory for Children-State subscale) score in children. METHODS: We performed a randomized controlled parallel-group trial comparing preoperative anxiety between two groups of children aged >6 and <17 yr. Before surgery, the intervention group received a comic information leaflet at home in addition to routine information given by the anaesthetist at least 1 day before surgery. The control group received the routine information only. The outcome measure was the difference between STAIC-S scores measured before any intervention and after the anaesthetist's visit. A multiple regression analysis was performed to explore the influence of the level of education, the anxiety of parents, and the childrens' intelligence quotient on STAIC-S scores. RESULTS: One hundred and fifteen children were randomized between April 2009 and April 2013. An intention-to-treat analysis on data from 111 patients showed a significant reduction (P=0.002) in STAIC-S in the intervention group (n=54, mean=-2.2) compared with the control group (n=57, mean=0.90). The multiple regression analysis did not show any influence on STAIC-S scores of the level of education, parental anxiety, or the intelligence quotient of the children. CONCLUSIONS: A paediatric anaesthesia comic information leaflet was a cheap and effective means of reducing preoperative anxiety, measured by STAIC-S, in children. CLINICAL TRIALS REGISTRATION: NCT 00841022.

Ultrasonographic anatomic variations of the major veins in paediatric patients.

BACKGROUND: The aim of our study was to describe the anatomic relationships in internal jugular (IJV), subclavian (SCV), and femoral (FV) vein sites. METHODS: One hundred and forty-two children had a two-dimensional (2D) ultrasound (US) evaluation of IJV, SCV, and FV sites. They were enrolled according to their age: 0-1 month old (n=9), 1 month old to 2 yr old (n=61), 2-6 yr old (n=22), 6-12 yr old (n=32), and 12-18 yr old (n=18). RESULTS: We found about 7.7% variation for the IJV. The most common anatomic variations were a lateral (nine children) or anterior (nine children) position of the IJV to the carotid artery. Regardless of the age category, about 9.8% of the anatomic variations were found for the FV. The most common anatomic variation in our study was that the FV ran anteromedially to the femoral artery (17 children). Anatomic variation of the SCV, regardless of age category, was about 7.4%. The most common anatomic variation was the SCV, which ran medially (10 children) to the subclavian artery. CONCLUSIONS: The relevant percentages of anatomic variations obtained for all these areas support at least a systematic US screening before attempting to obtain central venous access, ideally using a US-guided technique.

Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography.

BACKGROUND: Dynamic variables are accurate predictors of fluid responsiveness in adults undergoing mechanical ventilation. They can be determined using respiratory variation in aortic flow peak velocity (▵Vpeak), arterial pulse pressure [▵PP and pulse pressure variation (PPV)], or plethysmographic waveform amplitude [▵POP and pleth variability index (PVI)]. These indices have not been validated in children. We studied the ability of these variables to predict fluid responsiveness in mechanically ventilated children. METHODS: All results are expressed as median [median absolute deviation (MAD)]. Thirty mechanically ventilated children were studied after undergoing general anaesthesia. Mechanical ventilation was maintained with a tidal volume of 10 ml kg(-1) of body weight. ▵PP, PPV, ▵POP, PVI, ▵Vpeak, and aortic velocity-time integral were recorded before and after volume expansion (VE). Patients were considered to be responders to VE when the aortic velocity-time integral increased more than 15% after VE. RESULTS: VE induced significant changes in ▵PP [13 (MAD 4) to 9 (5)%], PPV [15 (5) to 9 (5)%], ▵POP [15 (10) to 10 (6)%], PVI [13 (6) to 8 (5)%], and ▵Vpeak [16 (9) to 8 (3)%] (P<0.05 for all). Differences in ▵PP, ▵POP, PPV, and PVI did not reach statistical significance. Only ▵Vpeak was significantly different between responders (R) and non-responders (NR) to VE [22 (3) vs 7 (1)%, respectively; P<0.001]. The threshold ▵Vpeak value of 10% allowed discrimination between R and NR. CONCLUSIONS: In this study, ▵Vpeak was the most appropriate variable to predict fluid responsiveness.

[Design and evaluation of the quality of information written for scanner and magnetic resonance imaging in neuropediatrics]. / Conception et évaluation de la qualité d'une information écrite sur le scanner et l'imagerie par résonance magnétique en neuropédiatrie.

INTRODUCTION: We designed written information concerning two medical imaging techniques: the computed tomography scanner and the magnetic resonance imaging (MRI), and we evaluated the quality of the information in particular its readability. METHODS: Written information concerning scanner and MRI were elaborate starting from a reference frame based on a lexicon of the good practices. The written information sheets were initially reviewed by eight doctors, 45 nurses and by 26 couples of parents of hospitalized children, and finally by the communication and juridical services of our hospital. They were asked to improve the lexico-syntactic readability in order to increase the comprehension of the written information. Seventy-two couples of parents of hospitalized children who had not taken part of the protocol before evaluated the final version of the documents. The quality of the documents was evaluated using the scores of readability of Flesch and the Flesch-Kincaid, and a questionnaire of comprehension, managed before and after the delivery of written information. RESULTS: A total of 144 persons participated in the study. The number of right answers after reading written information increased by 38 % and by 35 % for the scanner and MRI information's respectively. Flesch and Flesch-Kincaid scores were not improved in the revised version of the written information compared to the first version. CONCLUSION: Although readability scores for information sheets were low, our results suggest that they brought information, which contributed to a better understanding of these two medical imaging techniques by parents.

Peritoneal infection: a possible redox disease.

In a recent report, pertaining to Bacteroidesfragilis peritonitis, the influence of oxidation-reduction (redox) potential provided experimental evidence for B. fragilis penetration into Hela cell monolayers (using 3D imaging techniques). Bacteria grown under oxidizing conditions (+mV redox) penetrated into tissue cells unlike that of reducing conditions (-mV redox). The present results emphasise the significance of the level of redox potential during infection with an interpretation based on anaerobe/aerobe environmental flux, triggering the invasive mechanism.