Catherine Schoenberg

Distraction with a hand-held video game reduces pediatric preoperative anxiety

Background : Video games have received widespread application in health care for distraction and behavior modification therapy. Studies on the effect of cognitive distraction during the preoperative period are lacking. We evaluated the efficacy of an interactive distraction, a hand‐held video game (VG) in reducing preoperative anxiety in children.

Dexmedetomidine Infusion for Analgesia and Prevention of Emergence Agitation in Children with Obstructive Sleep Apnea Syndrome Undergoing Tonsillectomy and Adenoidectomy

BACKGROUND:Dexmedetomidine, a specific &agr;2 agonist, has an analgesic-sparing effect and reduces emergence agitation. We compared an intraoperative dexmedetomidine infusion with bolus fentanyl to reduce perioperative opioid use and decrease emergence agitation in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy (T&A). METHODS:One hundred twenty-two patients with obstructive sleep apnea syndrome undergoing T&A, ages 2 to 10 years, completed this prospective, randomized, U.S. Food and Drug Administration–approved study. After mask induction with sevoflurane, group D received IV dexmedetomidine 2 &mgr;g · kg−1 over 10 minutes, followed by 0.7 &mgr;g · kg−1 · h–1, and group F received IV fentanyl bolus 1 &mgr;g · kg−1. Anesthesia was maintained with sevoflurane, oxygen, and nitrous oxide. Fentanyl 0.5 to 1 &mgr;g · kg−1 was given to subjects in both groups for an increase in heart rate or systolic blood pressure 30% above preincision values that continued for 5 minutes. Observers in the postanesthesia care unit (PACU) were blinded to treatment groups. Pain was evaluated using the objective pain score in the PACU on arrival, at 5 minutes, at 15 minutes, then every 15 minutes for 120 minutes. Emergence agitation was evaluated at the same intervals by 2 scales: the Pediatric Anesthesia Emergence Delirium scale and a 5-point scale described by Cole. Morphine (0.05 to 0.1 mg · kg−1) was given for pain (score >4) or severe agitation (score 4 or 5) lasting more than 5 minutes. RESULTS:In group D, 9.8% patients needed intraoperative rescue fentanyl in comparison with 36% in group F (P = 0.001). Mean systolic blood pressure and heart rate were significantly lower in group D (P < 0.05). Minimum alveolar concentration values were significantly different between the 2 groups (P = 0.015). The median objective pain score was 3 for group D and 5 for group F (P = 0.001). In group D, 10 (16.3%) patients required rescue morphine, in comparison with 29 (47.5%) in group F (P = 0.002). The frequency of severe emergence agitation on arrival in the PACU was 18% in group D and 45.9% in group F (P = 0.004); at 5 minutes and at 15 minutes, it was lower in group D (P = 0.028). The duration of agitation on the Cole scale was statistically lower in group D (P = 0.004). In group D, 18% of patients and 40.9% in group F had an episode of SPO2 below 95% (P = 0.01). CONCLUSIONS:An intraoperative infusion of dexmedetomidine combined with inhalation anesthetics provided satisfactory intraoperative conditions for T&A without adverse hemodynamic effects. Postoperative opioid requirements were significantly reduced, and the incidence and duration of severe emergence agitation was lower with fewer patients having desaturation episodes.

Emotional intelligence and the relationship to resident performance: a multi-institutional study.

STUDY OBJECTIVE To test the hypothesis that emotional intelligence, as measured by a BarOn Emotional Quotient Inventory (EQ-i), the 125-item version personal inventory (EQ-i:125), correlates with resident performance. DESIGN Survey (personal inventory) instrument. SETTING Five U.S. academic anesthesiology residency programs. PARTICIPANTS Postgraduate year (PGY) 2, 3, and 4 residents enrolled in university-based anesthesiology residency programs. MEASUREMENTS Residents confidentially completed the BarOn EQ-i:125 personal inventory. The deidentified resident evaluations were sent to the principal investigator of a separate data collection study for data analysis. Data collected from the inventory were correlated with daily evaluations of the residents by residency program faculty. Results of the individual BarOn EQ-i:125 and daily faculty evaluations of the residents were compiled and analyzed. MAIN RESULTS Univariate correlation analysis and multivariate canonical analysis showed that some aspects of the BarOn EQ-i:125 were significantly correlated with, and likely to be predictors of, resident performance. CONCLUSIONS Emotional intelligence, as measured by the BarOn EQ-i personal inventory, has considerable promise as an independent indicator of performance as an anesthesiology resident.

Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis.

Study Design. Retrospective uncontrolled case series. Objective. The purpose of this study was to determine the association, if any, between intraoperative blood loss and need for transfusion with the use of periapical (Ponte) osteotomies, as well as other patient and surgical variables among patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal instrumentation and fusion. Summary of Background Data. Blood loss during posterior spinal fusion for AIS can be substantial. Numerous techniques are used to minimize intraoperative blood loss and the need for allogeneic transfusion. However, it is unclear which patient and surgeon variables affect blood loss most significantly. Methods. A review was conducted on consecutive patients with AIS who had undergone posterior spinal fusion from July 1997 to February 2013 by a single primary surgeon at 1 institution. The relationship of estimated blood loss, normalized blood loss (normalized blood loss = estimated blood loss/number of levels fused/patients weight in kilograms), autologous blood retrieved, and allogeneic transfusion received with various patient- and procedure-related variables were analyzed. Results. Estimated blood loss, normalized blood loss, and autologous blood retrieved were higher in patients who underwent periapical Ponte osteotomies (n = 38) (P < 0.0001, P < 0.001, P < 0.01, respectively). The mean major curve correction was 64% in patients without osteotomies, and 65% in patients with osteotomies (P = 0.81). All patients who underwent osteotomies (38/38) received allogeneic transfusion versus 26% (19/73) of those without osteotomies (P < 0.001). The likelihood of transfusion correlated with increasing number of osteotomies and a lower preoperative hemoglobin level (odds ratio, 3.34; P = 0.003; and odds ratio, 0.51; P = 0.02, respectively). Conclusion. In patients with AIS undergoing posterior spinal fusion with instrumentation, performing periapical osteotomies increased all measures of intraoperative blood loss and need for transfusion without substantially improving major curve correction. As expected, a lower preoperative hemoglobin level was observed in patients who received a blood transfusion after posterior instrumentation and fusion. Level of Evidence: 4

A survey of practice patterns in the use of laryngeal mask by pediatric anesthesiologists

Laryngeal mask is frequently the airway device of choice in routine general anesthesia for many procedures in children. Several studies have described the use of laryngeal masks in unconventional situations. This survey was undertaken to assess how laryngeal masks are being used by pediatric anesthesiologists.

A prospective study of bispectral index scoring in mentally retarded patients receiving general anesthesia

STUDY OBJECTIVE To determine whether degree of mental retardation (MR) affects bispectral index scale (BIS) scores during general anesthesia. DESIGN Prospective clinical study. SETTING University Hospital. PATIENTS 80 ASA physical status I, II and III patients with varying degrees of MR, undergoing dental rehabilitation. INTERVENTIONS Patients were grouped into mild, moderate, severe or profound degrees of MR, by an independent registered research nurse according to criteria by the American Psychiatric Association. MEASUREMENTS All patients were given a standard sevoflurane in oxygen anesthetic with ASA standard monitoring. A research assistant who was blinded to study group assignment recorded the BIS scores continuously on a computer and compared the scores at the following time points: awake, induction of anesthesia, intravenous catheter placement, tracheal intubation, start of surgery, end of surgery, awakening to commands, and tracheal extubation. MAIN RESULTS No significant differences in BIS scores existed among the study groups at any time point. No significant difference in slope of induction of anesthesia was noted among the study groups. However, the slope of emergence from anesthesia leading to tracheal extubation showed a significantly longer emergence time in the higher MR groups. CONCLUSION MR does not affect BIS values during general anesthesia.

A prospective controlled study to determine the blood propofol concentration in anesthesiologists exposed to propofol vapor in the expired gases of patients receiving propofol-based intravenous sedation

STUDY OBJECTIVE To determine the blood propofol concentration of anesthesiologists who were exposed to the expired gases of patients receiving propofol-based intravenous (IV) sedation. DESIGN Prospective controlled investigation and laboratory analysis. SETTING Operating room of a university hospital and an independent technical laboratory. SUBJECTS 5 anesthesiologists who independently delivered propofol-based IV sedation to patients presenting for first trimester termination of pregnancy. In addition, a patient receiving propofol-based IV sedation was recruited as a positive control. A laboratory technician who never had previous exposure to propofol was recruited as a negative control. INTERVENTIONS Blood samples were obtained from each anesthesiologist before and after an 8-hour work period of anesthesia care of patients as described above. Blood samples were also obtained from the positive control, following propofol-based IV sedation, and the negative control. MEASUREMENTS An independent laboratory determined the blood propofol concentrations using a gas-liquid partition chromatograph and verified the results by repeated measurements in order to avoid a laboratory error. The gas-liquid partition chromatograph had an analytic capability that set the detection limit for propofol at 50 ng/mL. MAIN RESULTS None of the anesthesiologists had detectable blood propofol concentration in either the pre-exposure or post-exposure sample. The positive control and the negative control had detectable and non-detectable blood propofol concentration, respectively. CONCLUSIONS This experiment did not detect propofol in the blood of anesthesiologists who administered propofol-based IV sedation to patients.

Comparison of Changes in Tensile Strength in Three Different Flexible Epidural Catheters Under Various Conditions.

BACKGROUND:Rarely, epidural catheters may fracture upon removal or insertion. Understanding some of the mechanical properties of epidural catheters, such as their tensile strength and how external factors (including temperature) can influence their strength, will aid physicians in making decisions if faced with an entrapped catheter. In the present study, we evaluated the impact in tensile strength when catheters are exposed to 37 ± 1°C, after the removal of the inner metal coil and after the injection of sterile saline through the catheter. METHODS:We analyzed the tensile strength of a total of 120 catheters (19-gauge) from 3 different brands and materials. The reinforced epidural catheters were affixed to opposing, specially designed tensile test fixtures and then installed in an Applied Test System tensile test apparatus. We evaluated the strength of 10 catheters from different brands and materials for each of the following variables: at room temperature (control group), after the removal of the inner wire present in all the flexible catheters tested, injection of normal saline, and at 37 ± 1°C. RESULTS:When compared with their control groups, the Arrow catheter (2.85 kg) was shown to be superior to B-Braun (2.17 kg; P < 0.0001) and Smith catheters (2.33 kg; P < 0.0005). No statistical difference was noted between the Smith and B-Braun catheters (P = 0.39). When comparing catheters after wire removal against their respective control group, no statistical difference was noted. A decrease in tensile strength was noted in the B-Braun catheters (1.53 kg) when tested at 37°C (P ⩽ 0.0001). In contrast, the Smith and the Arrow catheters did not show a statistically significant change when tested at 37°C (P = 1.0 and P = 0.063, respectively). After the injection of normal saline, the Arrow (2.33 kg) and the B-Braun (1.58 kg) catheters showed a decrease in tensile strength (P = 0.0010 and P = 0.0001, respectively). CONCLUSIONS:The current recommendation of injecting saline through an entrapped catheter resulted in a decrease in tensile strength of the Arrow and B-Braun catheters. A decrease in tensile strength also was noted in the B-Braun catheters when tested at 37°C. There is no benefit, at least in terms of tensile strength, in removing the wire or inner coil from any of the tested brands. The Smith catheter was the most resilient, showing no decrease in tensile strength at 37°C and after the injection of normal saline when compared with control.