Ibrahim Abu-Shahwan

Effect of propofol on emergence behavior in children after sevoflurane general anesthesia

Background:  Emergence agitation (EA) is a postoperative behavior that may occur in children undergoing general anesthesia with inhaled agents.

Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia

Background:  Emergence agitation or delirium is a known phenomenon that may occur in children undergoing general anesthesia with inhaled agents. Our aim was to test the hypothesis that the addition of a small dose of ketamine at the end of sevoflurane anesthesia will result in a decrease in the incidence and severity of such phenomenon.

Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy.

Purpose:  The aim of this study was to evaluate the safety and efficacy of a combination of propofol and remifentanil deep sedation in spontaneously breathing children less than 7 years of age undergoing upper and/or lower gastrointestinal endoscopy.

Ambulatory anesthesia and the lack of consensus among Canadian pediatric anesthesiologists: a survey

Background:  The purpose of this study was to assess the current selection criteria for outpatient surgery in children among Canadian pediatric anesthesiologists.

Parents are reluctant to use technological means of communication in pediatric day care

Purpose: We hypothesized that advanced information and communication technology (ICT) would be acceptable to parents in a pediatric surgical, and diagnostic imaging day care setting.Methods: After Ethics Committee approval, we distributed surveys, over a one-month period, to parents of children arriving for day care surgery or diagnostic imaging. Parents indicated their acceptance of various proposed modes of postoperative discussion of healthcare i.e.; face-to-face, videophone, or telephone. Parents were also asked to describe their receptiveness to scheduling non-emergency hospital appointments online and to receiving electronic media describing their child’s surgery and postoperative management. Parental education, income, and familiarity with the Internet were also assessed.Results: A total of 451 surveys (84% response rate) were returned. Most parents (95%) had access to the Internet and 70% did their banking online. Forty-two percent of the parents had at least a university education and 63% had an annual family income >

Patient selection criteria for ambulatory surgery in children

50,000 Canadian. The majority of parents (98%) accepted face-to-face interaction, while only 35% and 37% of parents were receptive to videophone and telephone interviews, respectively. Computer availability (P=0.001) and online banking (P=0.011) were the only variables that predicted those parents who were in favour of using videophone technology. Parents were receptive to instruction electronic media (80%) and booking appointments online (61%).Conclusions: A well-educated and technologically sophisticated parent population does not favour advanced communication technologies over simple, face-to-face interaction in an in-hospital setting. These parents are prepared to receive technology-based information about their child’s surgery and to schedule non-emergency hospital appointments online.RésuméObjectif: Nous avons émis l’hypothse que des technologies d’information et de communication (TIC) avancées seraient considérées comme acceptables par les parents dans le contexte des soins de jour en pédiatrie chirurgie, et en imagerie diagnostique.Méthode: Après avoir obtenu l’aval du comité d’éthique, nous avons distribué des questionnaires pendant un mois aux parents d’enfants admis pour des chirurgies ou des imageries diagnostiques aux soins de jour. Les parents ont indiqué leur acceptation de diverses méthodes proposées de discussion postopératoire des soins de santé, nommément : face à face, visiophone, ou téléphone. Nous avons également demandé aux parents de décrire leur réceptivité face à la prise de rendez-vous hospitaliers non urgents en ligne et à la réception de documents électroniques décrivant la chirurgie de leur enfant et la prise en charge postopératoire. La formation des parents, leurs revenus et leur aisance sur Internet ont aussi été évalués.Résultats: Au total, 451 questionnaires (taux de réponse de 84%) ont été retournés. La plupart des parents (95%) bénéficiaient d’un accès Internet et 70% effectuaient leurs transactions bancaires en ligne. Quarante-deux pour cent des parents avaient au moins une formation universitaire et 63% affichaient un revenu familial annuel τ 50 000 dollars canadiens. La majorité des parents (98%) consentaient à une interaction face à face, alors que seulement 35% et 37% des parents considéraient, respectivement, le visiophone et les entrevues téléphoniques comme moyens de communication appropriés. L’accès à un ordinateur (P=0,001) et les transactions bancaires en ligne (P=0,011) constituaient les seules variables prédisant quels parents seraient réceptifs à l’utilisation d’un visiophone. Les parents jugeaient appropriés l’envoi électronique de documents éducatifs (80%) et la prise de rendez-vous en ligne (61%).Conclusions: Une population de parents bien éduquée et à l’aise avec les technologies avancées ne préfère pas les moyens de communications à la fine pointe de la technologie en remplacement des interactions simples, face à face, dans un contexte hospitalier. Ces parents sont cependant prêts à recevoir des renseignements électroniques concernant la chirurgie de leur enfant et àprendre des rendez-vous hospitaliers non urgents en ligne.

Post-operative confusion and the practice of pediatric anesthesia

RESULTS: Fifty-one (43%) members replied. There was no consensus among members for most conditions. Only a few clear-cut agreements were evident. The majority of members (over 80%) would agree to provide anesthesia for an asymptomatic child with recurrent otitis media, rectal T of 38°C, and with or without chronic nasal discharge for bilateral miringotomy and tube placement (BMT), asymptomatic child with sickle cell disease for cast change, asymptomatic child with asthma and fever for BMT, morbidly obese child with congested nose for BMT, and well controlled insulin dependent diabetes mellitus (IDDM) in a child for MRI. Most members (86%) would refuse to provide anesthesia in an asymptomatic child with sickle cell disease for tonsillectomy. In the table below are listed the most significant result of our survey.

Propofol remifentanil deep sedation for gastrointestinal endoscopy in children

METHODS: A standardized questionnaire was sent to 120 members of the Canadian Pediatric Anesthesia Society. Members were given 13 case scenarios involving 5 year old children with different medical condition. Each underwent a different surgery/procedure but emerged with the same post-op behavior. Members were asked to choose from the following treatment options: midazolam, fentanyl, propofol, or one other drug, if any, of their choice to treat post-op confusion.

Les parents résistent à l’idée d’utiliser des moyens technologiques de communications dans les soins pédiatriques de jour

INTRODUCTION: Gastrointestinal flexible endoscopy has become an important diagnostic and therapeutic procedure in children. In many medical centers, the use of general anesthesia for upper and lower gastrointestinal endoscopy has been replaced by intravenous sedation (1). Limited data are available on the use of propofol remifentanil sedation in children (2,3). The aim of our study was to evaluate the safety and efficacy of remifentanil propofol combination for deep sedation in children undergoing gastrointestinal endoscopy.