Amplitude-reduction alert criteria and intervention during complex paediatric cervical spine surgery.

Objective: To determine the utility of widely used intraoperative neuromonitoring (IONM) alert criteria and intervention for predicting postoperative outcome following paediatric spinal surgery. Methods: Retrospective analysis of somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) in consecutive cervical spine fixations. An intervention protocol followed amplitude-reductions in SSEPs (≥50 %) and/or MEPs (≥80 %). Alert breaches were reversed when SSEP/MEP amplitude was restored to > 50 %/20 % of baseline. Sensorimotor function was assessed preoperatively and 3-months postoperatively via the Modified McCormick Scale score (MMS). We explored associations between postoperative outcome, demographic/surgical and IONM variables. Results: Forty-five procedures in 38 children (mean age:9 ±â€¯4 years;55 % female) were monitored, 42 %of which breached alert criteria. Instrumentation (6/19,32 %) and hypotension (5/19,26 %) were common causes for alert and the majority (13/19,68 %) were reversed following intervention. There was an association between pre- and post-MMS and the type of breach (p = 0.002). All children with worse postoperative MMS (3/38,8%) had irreversible breaches. Conclusions: IONM in this small sample accurately detected neurological injury. The majority of breaches reversed following an intervention protocol. Irreversible breaches frequently led to worse postoperative sensorimotor function. Significance: An intervention protocol which reversed IONM alerts never resulted in postoperative worsening of sensorimotor function.

Actualización en dispositivos supraglóticos para la vía aérea pediátrica / Paediatric supraglottic airway devices update

ABSTRACT Introduction: Following the introduction of the laryngeal mask in the 1980s, several similar devices have been developed, changing paediatric airway management under anaesthesia. This reflective article describes and examines the different paediatric supraglottic airway devices currently available in the U.K. Methodology: This perspective article is based on a narrative review of articles that discussed paediatric supraglottic airway devices using Cochrane, meddling, Ovid and pubmed databases as well as text books. Results: As new devices continue to be developed with a clear indication of clinical relevance and genuine advantages, so high quality research will also continue to be required in order to improve features in new devices.

RESUMEN Introducción: Con posterioridad a la introducción de la máscara laríngea en los años 1980 se han venido desarrollando varios dispositivos similares, los cuales han cambiado el manejo de la vía aérea pediátrica en anestesia. Este artículo de reflexión describe y examina los distintos dispositivos supraglóticos para la vía aérea pediátrica disponibles actualmente en el Reino Unido. Metodología: Este artículo de opinión se basa en una revisión de los artículos que tratan el tema de los dispositivos supraglóticos para la vía aérea pediátrica, realizada en las bases de datos Cochrane, Medline, Ovid y PubMed y también en los libros de texto. Resultados: A medida que se desarrollan dispositivos nuevos con indicación clara de pertinencia clínica y ventajas genuinas, se necesitarán también estudios de alta calidad a fin de mejorar las características de dichos dispositivos.

El abismo fiscal y las oportunidades de cambio / The fiscal cliff and opportunities for change

Modern Colombia with an estimated population of 48 million inhabitants has embarked on a transition towards universal health care for its citizens. In doing so the country will inevitably face both epidemiological and financial pressures. These challenges for health policy makers in Colombia are common to all modern economies and ultimately will shape the health care service the nation delivers. Bound within this context, the quest for improved surgical outcomes for an ageing, increasingly comorbid population will require new thinking and as such represents an exciting opportunity for anaesthesiologists to engage in innovations that will improve patient care.