Abraham Rosenbaum

The place of premedication in pediatric practice.

Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence‐based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. Studies applicable to one culture and to one hospital system (albeit multicultural) may not apply elsewhere. Moreover, the study of hospital‐related distress begins at the start of the patient’s journey and ends long after hospital discharge; it cannot be focused completely on just the moment of anesthetic induction. Taking an example from actual practice experience, the trauma caused by the actual giving of a premedication to a child who absolutely does not want it and may struggle may not be recorded in a study but could form a significant component of overall effect and later psychological pathology. Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro–con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re‐evaluate a practice, which was universal historically and now in many centers is more selective.

Preoperative Melatonin and Its Effects on Induction and Emergence in Children Undergoing Anesthesia and Surgery

Background:Studies conducted in adults undergoing surgery reported a beneficial effect of oral melatonin administered before surgery. There is a paucity of such data in children undergoing anesthesia and surgery. Methods:Children undergoing surgery were randomly assigned to receive preoperatively oral midazolam 0.5 mg/kg or oral melatonin 0.05 mg/kg, 0.2 mg/kg, or 0.4 mg/kg. The primary outcome of the study was preoperative anxiety (Yale Preoperative Anxiety Scale). The secondary outcomes were the children’s compliance with induction (Induction Compliance Checklist), emergence behavior (Keegan scale), and parental anxiety (State-Trait Anxiety Inventory). Results:Repeated measures ANOVA showed that children who received melatonin at any of the three doses were more anxious compared with children who received midazolam (P < 0.001). Parental anxiety did not differ on the basis of the experimental condition (P = ns). The melatonin groups showed a dose-response effect on emergence behavior. Children who received melatonin developed less emergence delirium compared with those who received midazolam (P < 0.05), and the effect was dose related; the incidence after 0.05 mg/kg melatonin was 25.0%, incidence after 0.2 mg/kg melatonin was 8.3%, and incidence after 0.4 mg/kg melatonin was 5.4%. Conclusions:Midazolam is more effective than melatonin in reducing children’s anxiety at induction of anesthesia. Melatonin showed a direct dose-dependent effect on emergence delirium.

Beyond pain: predictors of postoperative maladaptive behavior change in children

Objectives & Aim:  Using well‐validated measures and controlling for potential confounding variables such as pain and surgical and anesthetic technique, the goal of this project was to identify the incidence of and risk factors for the development of behavior change in children after surgery.

Ethnicity and parental report of postoperative behavioral changes in children

To examine the role of ethnicity and language in parent report of childrens postoperative behavioral recovery.

New Metabolic Lung Simulator: Development, Description, and Validation

AbstractObjectiveIndirect calorimetry, the determination of airway carbon dioxide elimination % MathType!MTEF!2!1!+- % feaagaart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqr1ngB % PrgifHhDYfgasaacH8srps0lbbf9q8WrFfeuY-Hhbbf9v8qqaqFr0x % c9pk0xbba9q8WqFfea0-yr0RYxir-Jbba9q8aq0-yq-He9q8qqQ8fr % Fve9Fve9Ff0dmeaabaqaciGacaGaaeqabaWaaeaaeaaakeaadaqada % qaaGqaaiaa-zfadaWgaaWcbaGaa83qaiaa-9eadaWgaaadbaGaa8Nm % aaqabaaaleqaaaGccaGLOaGaayzkaaaaaa!3CC0!

Novel Portable Device Measures Preoperative Patient Metabolic Gas Exchange

\left( {V_{CO_2 } } \right)

Monitoring of O2 Uptake and CO2 Elimination During Anesthesia and Surgery

and oxygen uptake % MathType!MTEF!2!1!+- % feaagaart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqr1ngB % PrgifHhDYfgasaacH8srps0lbbf9q8WrFfeuY-Hhbbf9v8qqaqFr0x % c9pk0xbba9q8WqFfea0-yr0RYxir-Jbba9q8aq0-yq-He9q8qqQ8fr % Fve9Fve9Ff0dmeaabaqaciGacaGaaeqabaWaaeaaeaaakeaadaqada % qaaGqaaiaa-zfadaWgaaWcbaGaa83tamaaBaaameaacaWFYaaabeaa % aSqabaaakiaawIcacaGLPaaaaaa!3BFC!