Preoperative evaluation in infants and children: recommendations of the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI).

BACKGROUND: The preoperative assessment involves the process of evaluating the patient's clinical condition, which is intended to define the physical status classification, eligibility for anesthesia and the risks associated with it, thus providing elements to select the most appropriate and individualized anesthetic plan. The aim of this recommendation was provide a framework reference for the preoperative evaluation assessment of pediatric patients undergoing elective surgery or diagnostic/therapeutic procedures. METHODS: We obtained evidence concerning pediatric preoperative evaluation from a systematic search of the electronic databases MEDLINE and Embase between January 1998 and February 2012. We used the format developed by the Italian Center for Evaluation of the Effectiveness of Health Care's scoring system for assessing the level of evidence and strength of recommendations. RESULTS: We produce a set of consensus guidelines on the preoperative assessment and on the request for preoperative tests. A review of the existing literature supporting these recommendations is provided. In reaching consensus, emphasis was placed on the level of evidence, clinical relevance and the risk/benefit ratio. CONCLUSION: Preoperative evaluation is mandatory before any diagnostic or therapeutic procedure that requires the use of anesthesia or sedation. The systematic prescription of complementary tests in children should be abandoned, and replaced by a selective and rational prescription, based on the patient history and clinical examination performed during the preoperative evaluation.

Antibacterial activity of the leaves of Phyllanthus discoideus.

The lyophilized aqueous extract (LWE) from the leaves of Phyllanthus discoideus was found to show an antibacterial activity. The alkaloid fraction obtained from LWE inhibited the growth of Escherichia coli and Enterococcus faecium (MIC = 1.6 mg/ml), Pseudomonas aeruginosa (MIC = 0.78 mg/ml), Staphylococcus aureus and Mycobacterium smegmatis (MIC = 0.2 mg/ml). Among the alkaloids identified, viroallosecurinine and securinine showed a high activity. Viroallosecurinine exhibited a MIC of 0.48 micrograms/ml for Ps. aeruginosa and Staph. aureus. This alkaloid is bactericidal since the yields of MIC/MBC were less than 1. The MIC of securinine was 0.500 mg/ml for E. coli, Staph. aureus and Myc. smegmatis. These effects of Phyllanthus discoideus leaf extracts support some of the local uses of the plant in traditional therapy.

[Optimization of the growth of anaerobic bacteria by addition of a perfluorinated oil]. / Optimisation de la croissance des bactéries anaérobies par addition d'une huile perfluorée.

Strict anaerobic bacteria require special conditions of culture; their obtention in the laboratory therefore is difficult especially for poor inocula. A method for stimulating anaerobes growth is described: a perfluorinated oil in which CO2 has been dissolved is added to the classical culture medium. The latency phase of the bacterial growth is strongly decreased especially for poor inocula. Whatever the inoculum and the gas bubbling time are, the rate of growth remains constant. The changes in bubbling times do not induce significant differences in latency time. This technique has been also applied to the starting of lyophilized strains.