A first-pass cost analysis of propofol versus barbiturates for children undergoing magnetic resonance imaging.

Intravenous (IV) propofol was compared with IV thiopental/pentobarbital as a sedative for children undergoing magnetic resonance imaging (MRI) of the brain or spine. Fifty-eight outpatients (aged 11 mo to 6 1/2 yr, ASA grade I and II) were enrolled in the study and randomized to two groups. After IV cannulation, Group I received IV propofol (1-2 mg/kg), followed immediately by a propofol infusion (75-100 micrograms.kg-1.min-1). Group II received IV thiopental (1-3 mg/kg) followed by a pentobarbital bolus (2-3 mg/kg). Supplemental thiopental doses (1-2 mg/kg) were administrated to maintain adequate sedation. Discharge time and postanesthesia recovery scores were determined by an independent blinded observer. Time of recovery to full consciousness in Group I was significantly less than in Group II (19 +/- 7 min vs 35 +/- 20; P < 0.005). Time to discharge was also significantly less in Group I (24 +/- 6 min vs 40 +/- 11; P < 0.05). A preliminary cost analysis was applied to the clinical data obtained and to a theoretical model of a pediatric MRI center. Cost analysis of anesthesia services revealed added drug costs ($1600.76 per year for the propofol group) but significant savings of postanesthesia care unit (PACU) nursing time ($5086.67 per year). Outcomes such as patient morbidity and technical quality of the MRI scans did not differ significantly between the two groups. In conclusion, analysis of the clinical data suggests that propofol may be more suitable than barbiturates for children undergoing outpatient procedures despite its higher price.

Cocaine exposure in utero: perinatal development and neonatal manifestations--review.

The question of whether cocaine exposure in utero increases the risk of major structural malformations remains controversial. Most animal studies have demonstrated that cocaine can have a teratogenic effect. The ultimate association between cocaine exposure and fetal development must be inferred from human data. The relative effects of cocaine exposure, exposure to other illicit drugs and alcohol and deficient prenatal care are difficult to assess. Little specific information is available about the amount, duration, and timing of cocaine use during the nine months of pregnancy. Unlike the case with many other teratogens, cocaine exposure at any point in pregnancy can result in some abnormality. The extent of damage and the organ involved depend on the particular stage of morphogenesis. A large scale prospective human study is needed to confirm the suggested teratogenic effects. Since it involves an illicit drug such a study is obviously difficult to perform.