Brain MRI without anesthesia in children less than 3 months old.

INTRODUCTION: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p = 0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6 min (range, 6-30 min). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

Resonancia magnética cerebral sin anestesia en niños menores de 3 meses / Brain MRI without anesthesia in children less than 3 months old

Introducción: El uso de anestesia general en niños pequeños conlleva riesgos, a corto y largo plazo. El objetivo de este estudio fue evaluar la eficacia de la técnica de resonancia magnética (RM) cerebral sin anestesia mediante fijación con colchón en niños menores de 3 meses. Pacientes y métodos: Estudio prospectivo de casos y controles realizado en el año 2019. Los casos fueron pacientes menores de 3 meses con indicación de RM craneal, estables y sin soporte ventilatorio; las resonancias se realizaron usando la técnica de dar de comer y dormir y un colchón inmovilizador. Los controles fueron pacientes de la misma edad y sexo, inestables clínicamente, derivados para realizar RM craneal con anestesia general. Tres radiólogos pediátricos evaluaron el éxito de la RM (si respondía a la pregunta clínica), si era necesario repetirla y calificaron la presencia de artefactos de movimiento en una escala del 1 al 4. Resultados: 47 casos fueron incluidos en este estudio (28 niños, 19 niñas; media: 31 días de vida), de los cuales (89%) 42 RM fueron llevadas a cabo de manera exitosa. Los estudios realizados de manera ambulatoria se asociaron a mayor posibilidad de fallo de la técnica que los realizados a ingresados (valor de p 0,02). El 60% de las RM de los casos realizados tuvieron calidad óptima y el 30%, subóptima (artefacto de movimiento en una o dos secuencias). No se detectaron problemas de seguridad con esta técnica. La media de duración de los estudios fue de 16,6 minutos (rango 6-30 minutos). El 100% de las RM de los controles bajo anestesia general se llevaron a cabo con éxito, con una calidad óptima en el 89% y subóptima en el 11% restante. En el primer año de experiencia con esta técnica, de 47 RM realizadas, se evitó el uso de anestesia general a 42 recién nacidos. Conclusión: La técnica de dar de comer y dormir y fijación con colchón neumático para realizar RM sin anestesia puede realizarse de forma eficaz y segura en niños menores de 3 meses.(AU)

Introduction: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. Patients and methods: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. Results: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. Conclusion: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.(AU)

Ileocolic intussusception: Ultrasound-guided hydrostatic reduction with sedation and analgesia.

INTRODUCTION: The first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction. MATERIAL AND METHODS: We retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies. RESULTS: In the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p = 0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08). CONCLUSION: Ultrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.

Brain MRI without anesthesia in children less than 3 months old. / Resonancia magnética cerebral sin anestesia en niños menores de 3 meses.

INTRODUCTION: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

[Effect of acute myocardial ischemia on pulmonary venous flow pattern. Experimental study with transesophageal echocardiography]. / Efecto de la isquemia miocárdica aguda sobre el patrón del flujo venoso pulmonar. Estudio experimental con ecocardiografía transesofágica.

Pulmonary venous flow (PVF) has been analyzed by Doppler echocardiography in various cardiopathies, but up to now no studies of its behavior in acute myocardial ischemia have been reported. The purpose of this study is to describe the changes observed in the normal pattern of PVF with myocardial ischemia in an experimental model. Thoracotomy and pericardiectomy with exposure of the heart were performed on 19 mongrel dogs, weighing between 18 and 25 kg anesthetized with intravenous sodium pentobarbital. Pulmonary venous and mitral flows were analyzed by transesophageal echocardiography with pulsed Doppler and simultaneous recording of intracavitary pressures in left atrium (LA) and left ventricle (LV) before and after 30 minutes of partial occlusion of the middle portion of the anterior descending coronary artery distal to the first diagonal branch. The variables examined included maximal velocities and time-velocity integrals of antegrade systolic(s) and diastolic (D) PVF, mitral rapid filling flow (E) and left ventricular isovolumic relaxation time (LVIRT). The pressures directly measured were mean left atrial pressure (MLAP), systolic and diastolic pressures of the LV. Results included a decrease in peak velocities and time-velocity integrals of PVF (S and D) with myocardial ischemia, S velocity from 70.1 +/- 14.8 to 49.5 +/- 13.8 cm/sec (p < 0.001) and D from 41.4 +/- 16.5 to 29.5 +/- 11.4 cm/sec (p = 0.001), with an increase in LVIRT from 65.8 +/- 8.6 to 76.0 +/- 12.6 msec (p < 0.006) and elevation of the mean pressure of the LA from 4.3 +/- 1.0 to 6.4 +/- 1.5 mmHg (p < 0.001). This findings suggest that acute myocardial ischemia alters the normal pattern of PVF, producing a significant decrease in peak velocities and time-velocity integrals of antegrade systolic and diastolic flows as well as an increase in LVIRT and MLAP, which taken together may reflect altered diastolic function of the LV.

[Usefulness of the measurement of the left-ventricular isometric relaxation time by echo-Doppler during the administration of dipyridamole or dobutamine as a method of inducing myocardial ischemia]. / Utilidad de la medición del tiempo de relajación isométrica del ventrículo izquierdo con ECO/Doppler durante la administración de dipiridamol o dobutamina como maniobra provocadora de isquemia miocárdica.

Myocardial isquemia prolongs ventricular relaxation. The purpose of this study was to assess the isovolumetric relaxation time of the left ventricle (IVRT) as a parameter of global ventricular relaxation, during the administration of Dipyridamol or Dobutamine intravenously. We studied 58 patients with ischemic heart disease uncovered by the administration of pharmacological agents. They were divided in two groups: 22 patients in the group of Dipyridamole, which was administered intravenously at a dose of 0.84 mg/kg during 10 minutes and 36 patients in the group of Dobutamine administered at a dose of 5, 10, 20, 30 and 40 mcg/kg/min in stepping fashion every three minutes. Coronariography was performed in all patients. The measurements of the maximal velocities of the E and A waves, as well as the deceleration time of the E wave and the pressure half time of the mitral flow did not show significant changes in both groups. If the study was positive by criterion of alteration of the wall motion, the IVRT corrected from the heart rate (IVRT/C) had an increase in 54% (p < 0.01) with respect to baseline values in the same patient in the Dipyridamole group and in the Dobutamine group the increment of the IVRT/C was 26% (p < 0.20). The sensibility (Sen), specificity (Sp) and positive predictive value (PPV) of the IVRT/C increments in detecting proximal significant obstruction of the left anterior descending coronary artery of trivascular disease in the Dipyridamole group was of 50%, 100% and 100% respectively. In the Dobutamine group the Sen was of 74%, the Sp of 60% and the PPV of 89%. Nor Dipyridamol neither Dobutamine produced a significant prolongation of IVRT/C when alterations of wall motion were absent or when the existing alterations were not exacerbated. On the basis of these results we concluded that the measurement of the IVRT/C in studies of myocardial ischemia with pharmacological provocative maneuvers is an additional useful parameter together with segmental alterations of wall motion to differentiate positive from negative studies.

[Diagnosis of thoracic aorta dissection using transesophageal echocardiography]. / Diagnóstico de disección de aorta torácica con ecocardiografía transesofágica.

During a 36 month period there were 20 patients in our hospital with aortic dissection suspected clinically. All of them were examined with transesophageal echocardiography (TEE); 17 were examined with transthoracic echocardiography (TTE); six with computed tomography (CT) and seven with aortography. Twelve patients required surgery: eight with proximal aortic dissection (Type-A), two with distal dissection (Type-B) and two with aortic aneurysm without dissection. With the goal of investigating the utility of TEE for the diagnosis of aortic dissection in our hospital, we compared this and other available methods to the surgery findings. The sensitivity to TEE was 100% and the specificity 92%, with test accuracy at 92%. The sensitivity of the other tests was low: 66% with TTE; 50% with TAC; 57%, with aortography. The specificity was 90% with TTE, and higher with CT and aortography (100%). The ultrasound tests reveal additional information about complications like aortic regurgitation. Transesophageal echocardiography is the best test to examine patients with aortic dissection in our hospital. Computed tomography, aortography and magnetic resonance imaging have indication only to answer specific doubts.