Skin conductance responses in paediatric Harlequin syndrome.

We report a novel and simple application of skin conductance response (SCR) testing for diagnosis of a new-onset iatrogenic Harlequin syndrome in an infant. Isolated ipsilateral facial pallor, complicated by thermally induced systemic sympathetic vasodilatation, and preferential lateral decubitus positioning, mimics harlequin colour change. Correct diagnosis as Harlequin syndrome with facial sympathetic interruption was demonstrated by diminution of SCR.

Comparison of postoperative emesis, recovery profile, and analgesia in pediatric strabismus repair. Rectal acetaminophen versus intravenous fentanyl-droperidol.

BACKGROUND: Postoperative nausea and vomiting comprise significant morbidity in pediatric patients undergoing strabismus repair and can prolong hospitalization. Many authors recommend routine intraoperative opiate analgesia and prophylactic antiemetics. METHODS: A prospective, comparative, randomized study to assess rectal acetaminophen (n = 45) to intravenous fentanyl-droperidol (n = 45) to resolve recovery profile, emesis rate, and adequacy of analgesia in a pediatric strabismus repair population was performed, with standardization of the anesthetic technique. Data on pharmacoeconomic cost-effectiveness analysis, willingness to pay, and willingness to repeat were elucidated. RESULTS: Emesis rate in the acetaminophen group was 9%, and the fentanyl-droperidol group was 13% (not statistically significant). There was a statistically significant shorter wake-up time, time in postanesthesia recovery, time in ambulatory surgery unit, time to first verbal command, time to first oral intake, time to ambulation, and time to return to normal activity in the acetaminophen group (P < 0.05). Postoperative analgesic potency of rectal acetaminophen was adequate and equivalent by Observer Pain Scale. Parental satisfaction was similar by willingness-to-pay and willingness-to-repeat postoperative survey. Cost-effectiveness ratio (i.e., cost per treatment success) for acetaminophen and fentanyl-droperidol groups was $0.33 and $87.91, respectively. CONCLUSIONS: Prophylactic fentanyl-droperidol prolongs the length-to-stay and recovery time and provides no discrete identifiable benefit over acetaminophen alone in this population. Cost-effectiveness analysis strongly favors use of acetaminophen over fentanyl-droperidol prophylaxis in children undergoing primary strabismus surgery.

Preoperative pregnancy testing in adolescents.

Anesthetics and other drugs used during the perioperative period may have teratogenic or abortive effects. The pregnancy status of surgical patients is often unknown. This investigation examined retrospectively the results of 2 yr of mandatory pregnancy testing in 412 adolescent surgical patients. The overall incidence of positive tests was 1.2%. Five of 207 patients aged 15 yr and older tested positive, for an incidence of 2.4% in that group. None of the 205 patients under the age of 15 yr had a positive pregnancy test. We conclude that mandatory pregnancy testing is advisable in adolescent surgical patients aged 15 yr and older.