Randomized trial of success of pediatric anesthesiologists learning to use two video laryngoscopes.

OBJECTIVES: The primary purpose of this study was to establish the ability of pediatric anesthesiologists to learn to use two video laryngoscopes - the GlideScope(®) system (GS) and the Karl Storz Direct Coupled Interface, DCI(®), (KS). BACKGROUND: The number of intubation attempts required to attain proficiency with a video laryngoscope is not known. METHODS: Baseline intubation times, using direct laryngoscopy, were determined for each anesthesiologist on 20 children. Anesthesiologists were then randomized to perform 20 intubations with the GS or KS before crossing over to the other device. RESULTS: There were 193 successful intubations and eight failed intubations (4.0%) with the GS. Median time-to-intubation with the GS for each anesthesiologist ranged from 24.5 to 32.8 s. There were 193 successful intubations and three failed intubations (1.5%) with the KS (P > 0.05 vs failed attempts with GS). Median time-to-intubation with the KS ranged from 21.9 to 31.1 s. For both the GS and KS, five of eight anesthesiologists met the study definition of 'Success'. There was no correlation between median time-to-intubation with all laryngoscopes combined and years since completion of training. The distribution of Cormack and Lehane scores was almost identical for the GS and KS; there were fewer grade III or IV scores than with direct laryngoscopy (P = 0.03; Fischer's exact test). Mean and median times on intubation no. 16-20 were shorter for the KS than for the GS. CONCLUSIONS: Although only 65% of anesthesiologists attained the stringent study definition of 'Success', all rapidly leaned to use both video laryngoscopes.

Health-related quality of life in pediatric ulcerative colitis patients on conventional medical treatment compared to those after restorative proctocolectomy.

PURPOSE: Health-related quality of life (HRQL) is not well studied in proctocolectomy patients with pediatric onset of ulcerative colitis (UC). We aimed to (1) compare the HRQL of proctocolectomy patients with those treated with conventional therapy and (2) determine factors that influence HRQL in UC patients < 18 years. METHODS: Chart review was done on patients diagnosed with pediatric onset of UC (<18) at the Stollery Children's Hospital. HRQL was evaluated in 88 patients using disease- and age-specific questionnaires; IMPACT III (<18) and Inflammatory Bowel Disease Questionnaire (IBDQ; ≥18). Demographics, disease characteristics, disease index (PUCAI), HRQL EuroQoL visual analog scale (EQ-5D/VAS) were collected and analyzed from all patients. RESULTS: Sixty-five respondents completed the IMPACT III (74 %) and 23 patients completed the IBDQ (26 %). Thirty-three surgical patients (34 %) responded (mean IMPACT III score = 148.9 ± 12.7; mean IBDQ = 171.2 ± 40.1). There was no significant difference in IMPACT III scores of surgical patients vs. medically treated patients (148.9 ± 12.7 vs. 140.6 ± 19.4, p = 0.09). Patients with high IMPACT scores (>143 points) were most likely to be in remission (p = 0.05), they were less likely to be on medication (p < 0.05), have parent/guardian with postsecondary education (p = 0.01), did not suffer from fatigue (p < 0.01), and did not report depression (p < 0.02). The IMPACT correlation with PUCAI (adjusted r (2) = 0.33) and EQ-VAS (adjusted r (2) = 0.45) was strong. CONCLUSIONS: Surgical patients reported to have a HRQL comparable to or better than the nonsurgical patients. Depression, fatigue, parent/guardian education, and drugs influence HRQL.

The "fear factor" for surgical masks and face shields, as perceived by children and their parents.

OBJECTIVE: The goal was to determine whether young children and their parents prefer physicians wearing clear face shields or surgical masks. METHODS: Eighty children (4-10 years of age) and their guardians were recruited from a pediatric emergency department. A survey and color photographs of the same male and female physicians wearing face shields and surgical masks were distributed. The parents were asked to decide which set of physicians they would prefer to care for their children and with which set of physicians they thought their children would be most comfortable. The children then were asked to decide which set of physicians they would prefer to take care of them and why. The children also were asked whether they found any of the physicians frightening and, if so, why. RESULTS: Fifty-one percent of parents preferred the pictures of physicians wearing face shields, and 62% thought that their children would choose the physicians in the face shields because their faces were visible and therefore less frightening. However, 59% of children stated that either set of physicians would be fine and neither was frightening; if given a choice, 49% would choose physicians in face shields. CONCLUSIONS: Physicians and parents have a perception that surgical masks are frightening to all children. Our study has shown that this perception is not completely true. Face shields may be a better choice, however, because both parents and children would prefer this option.

The association between iron deficiency and febrile seizures in childhood.

PURPOSE: The purpose of this study was to determine the association between iron deficiency and febrile seizures in a large cohort of children aged 6 to 36 months. METHODS: A retrospective case control study with 361 patients who presented with febrile seizures to the emergency department and 390 otherwise healthy controls who presented with a febrile illness to the emergency department were reviewed to determine iron status using the MCV, RDW, and hemoglobin. RESULTS: A total of 9% of cases had iron deficiency (ID) and 6% had iron deficiency anemia (IDA), compared to 5% and 4% of controls respectively. The conditional logistic regression odds ratio for ID in patients with febrile seizures was 1.84 (95% CI, 1.02-3.31). CONCLUSION: Children with febrile seizures were almost twice as likely to be iron deficient as those with febrile illness alone. The results suggest that screening for ID should be considered in children presenting with febrile seizure.