Oropharyngeal airway diameter during sedation in children with and without developmental delay.

STUDY OBJECTIVE: To determine whether children with developmental delay would have closer apposition of upper airway tissues during sedation, perhaps because of poor coordination of upper airway musculature. DESIGN: Case-control and retrospective chart review. SETTING: Tertiary-care pediatric teaching hospital. PATIENTS: 40 children 3 to 6 years of age, with and without a diagnosis of developmental delay. MEASUREMENTS: Subjects received only pentobarbital sedation by a protocol. Magnetic resonance imaging (MRI) scans of the head were reviewed, and transverse airway diameters at the soft palate and tongue were determined from midline sagittal images. MAIN RESULTS: Age, weight, sedative dose, MRI window level, and window width were not different between patients with and without developmental delay. We found the airway diameter at the level of the soft palate was decreased 40% in children with developmental delay compared with those children without delay, 3 mm (1.4, 5.5 interquartile range) versus 5 mm (3, 8); p = 0.035, power 76%. CONCLUSIONS: The anteroposterior oropharyngeal airway diameter was smaller in children with developmental delay than in those without developmental delay, in static MRI images. It is possible that children with developmental delay are at higher risk for airway obstruction during sedation.

Respiratory complications during anaesthesia in Apert syndrome.

BACKGROUND: Clinical experience with anaesthesia for a series of patients with Apert syndrome (craniosynostosis, midface hypoplasia and syndactyly) has not been reported previously. METHODS: In this review, 10 years of experience was examined at our hospital. There were 145 anaesthetics administered to 18 individuals. RESULTS: There were 16 complications (15 were perioperative wheezing) which occurred in seven patients. In four cases, surgery was cancelled due to intractable wheezing. CONCLUSIONS: We could not demonstrate any benefit from preoperative administration of nebulized albuterol. Paediatric anaesthetists should be aware of this high incidence of respiratory complications in Apert syndrome.

Oxygen in nitrogen versus nitrous oxide during pediatric general anesthesia.

BACKGROUND: Induction of anesthesia decreases lung volumes, giving areas of non-ventilated lung. Nitrogen is a slowly-absorbed gas that could prevent resorption of gases from these closed spaces, preventing atelectasis and improving oxygen saturations during recovery. METHODS: We evaluated oxygen saturations during emergence after intra-operative administration of 33% oxygen in nitrogen versus 33% oxygen in nitrous oxide in 62 children having elective urologic surgery. Patients were randomly assigned to either group A (2.5 L/min air with 0.5 L/min oxygen) or group N (2 L/min nitrous oxide and 1 L/min oxygen). Flowmeters were covered to maintain blinding. Anesthetic technique was standardized (laryngeal mask airway, caudal, halothane, and deep extubation). Patients breathed room air during emergence, while a blinded observer recorded duration of desaturations by stopwatch for 15 min. RESULTS: We found similar desaturations in both groups. The difference in desaturations < 94% at an interim 2-min total probably reflects diffusion hypoxia and was not significant at 15 min. The frequency of desaturations < 87% during emergence was significantly greater in children who were crying during induction. CONCLUSIONS: The intra-operative use of air versus nitrous oxide has no substantial effect on oxygen saturations during emergence from anesthesia in children. These results are consistent with a recently published mathematical model.

Effects of neurokinin receptor antagonists in virus-infected airways.

We investigated the effects of a neurokinin-1 (NK(1)) receptor antagonist (SR-140333) and a NK(2) receptor antagonist (SR-48968) on airway responsiveness and on the function of neuronal M(2) muscarinic receptors, which normally inhibit vagal acetylcholine release, in guinea pigs infected with parainfluenza virus. Antagonists were given 1 h before infection and daily thereafter. Four days later, bronchoconstriction induced by either intravenous histamine (which is partly vagally mediated) or electrical stimulation of the vagus nerves was increased by viral infection compared with control. In addition, the ability of the muscarinic agonist pilocarpine to inhibit vagally induced bronchoconstriction was lost in virus-infected animals, demonstrating loss of neuronal M(2) receptor function. Macrophage influx into the lungs was inhibited by pretreatment with both antagonists. However, only the NK(1) receptor antagonist prevented M(2) receptor dysfunction and inhibited hyperresponsiveness (measured as an increase in either vagally induced or histamine-induced bronchoconstriction). Thus virus-induced M(2) receptor dysfunction and hyperresponsiveness are prevented by a NK(1) receptor antagonist, but not by a NK(2) receptor antagonist, whereas both antagonists had similar anti-inflammatory effects.

VA aligns health professions education with healthcare priorities.

In 1997, the Veterans Health Administration constituted the Associated Health Professions Education Review Committee to provide recommendations for its associated health training programs. The Committee recommended that support for the 54,000 trainees in over 45 non-physician disciplines that train every year in VA facilities be allocated based on patient-focused criteria that emphasize the VA's healthcare priorities. Such priorities include accessible primary care, geriatrics, treatment of substance abuse, chronic care, and rehabilitation. The Committee also placed a high priority on disciplines that demonstrate inter-professional strategies for healthcare delivery and training. Educational institutions and disciplines that address these needs in innovative ways will find opportunities for clinical training in VA settings.