The self-reporting of psychiatric medications in patients scheduled for elective surgery.

STUDY OBJECTIVE: To determine by survey the percentage of patients, over the age of 21 years, reporting for elective surgery who also are taking psychotropic medications. DESIGN: Institution-approved, anonymous survey. SETTING: Teaching hospital. PATIENTS: 169 patients who were scheduled for elective surgery. INTERVENTIONS: After completion of the preoperative evaluation by members of the anesthesia care team, all patients were given an institution-approved survey of medications they were taking in addition to their nonpsychiatric medications. The survey listed 33 drugs known to affect central nervous system neurotransmitters, and included the most commonly prescribed antidepressants, antipsychotics, benzodiazapines, and lithium. Over-the-counter drugs known to affect mood, such as melatonin, also were included in the survey. Patients were not asked the indications for the medications, and no psychiatric questions were asked of the patients. MEASUREMENTS AND MAIN RESULTS: 300 surveys were distributed, and 169 patients completed the survey for a response rate of 53%. Forty-three percent of all patients who completed the survey admitted to taking one or more of the psychotropic medications. Of these patients, 35% were taking antidepressants, 34% were taking benzodiazapines, 19% were taking combination therapies, and 11% took antipsychotics, lithium, or over-the-counter drugs such as melatonin. CONCLUSION: The number of patients taking psychotropic medications and who present for elective surgery is high. The anesthetic implications of this drug usage are essentially unknown. Additional study of these medications and their impact on anesthetic care is warranted.

Total intravenous anesthesia for children undergoing brief diagnostic or therapeutic procedures.

STUDY OBJECTIVE: To compare the quality of anesthesia with propofol, ketamine, or etomidate in children undergoing brief diagnostic or therapeutic procedures. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: 971 pediatric oncology patients undergoing brief diagnostic or therapeutic procedures outside the operating room during a one-year period. INTERVENTIONS: Total intravenous anesthesia was administered primarily with ketamine, etomidate, or propofol for oncology-related procedures such as bone marrow aspiration, lumbar puncture, radiologic imaging, and radiation therapy. Quality assurance data were collected for all patients, including anesthetic technique, dosage, and the occurrence of specific adverse events during anesthesia and recovery periods. MEASUREMENTS AND MAIN RESULTS: There were 279 anesthesia-related occurrences, comprised almost entirely of five specific events: vomiting, hypoxemia (SpO2 less than 94%), tachycardia, agitation, and myoclonus. Ketamine was associated with vomiting (14.6%), agitation (15.0%), and tachycardia (19.5%). Etomidate was also associated with vomiting (9.9%) and agitation (1.2%). Hypoxemia was rare except in the propofol group (15.7%) and was easily managed with supplemental oxygen, but occasionally required manually assisted ventilation via face mask. In patients receiving propofol vomiting (0.5%) and agitation (1.2%) were rare. CONCLUSIONS: Anesthesia with propofol, ketamine, or etomidate is safe and efficacious for children undergoing brief procedures. Propofol is associated with a decreased incidence of postanesthetic agitation and vomiting. Its association with respiratory depression is confirmed.

Use of propofol for the prevention of chemotherapy-induced nausea and emesis in oncology patients.

Nausea and vomiting associated with antineoplastic chemotherapy are distressing and may keep patients from complying with chemotherapy protocols. No drug has emerged among many as an effective antiemetic. It has been speculated that propofol may have intrinsic antiemetic properties. We report the use of low-dose continuous infusion propofol in three oncology patients to treat chemotherapy-associated nausea and vomiting. A bolus of 0.1 mg.kg-1 followed by a continuous infusion of 1 mg.kg-1.hr-1 was effective in both prevention and treatment of nausea and vomiting. All three patients were alert, reported low nausea scores by visual analogue scale, and had no episodes of vomiting. When the infusion was discontinued, nausea and vomiting were noted in two patients. Propofol, given in a subanaesthetic infusion, was safe and effective as an antiemetic in these three patients.

Use of homologous platelet survival in differential diagnoses of chronic thrombocytopenia in childhood.

Twenty-one children with chronic thrombocytopenia of obscure etiology, 19 of whom had normal numbers of bone marrow megakaryocytes, were evaluated in order to determine if factors extrinsic to the platelets themselves (presumably antibodies) caused the thrombocytopenia. The rapid destruction of platelets by such antibodies has been demonstrated to cause idiopathic thrombocytopenic purpura (ITP). History, physical examination, and routine laboratory studies were unable to provide an exact diagnosis in these patients. Measurement of platelet survival, using sodium chromate Cr 51 labeled homologous platelets obtained from unrelated donors, permitted a clear separation of these children into two groups. One group (11 patients) had a markedly shortened platelet life span, and was considered to have chronic ITP. The other group (10 patients) had a normal or only slightly reduced platelet life span. Thus, the destruction of platelets by extrinsic factors could be ruled out. Since the diagnosis of chronic ITP was excluded, splenectomy could be avoided in these patients since it is rarely useful in children with nonimmune forms of chronic thrombocytopenia. Homologous platelet survival measurement is a useful diagnostic tool in certain children with chronic thrombocytopenia.