Vidya Chidambaran

Ketamine as an adjunct to fentanyl improves postoperative analgesia and hastens discharge in children following tonsillectomy – a prospective, double-blinded, randomized study

Objective:u2002 To evaluate the effect of ketamine, as an adjunct to fentanyl, on postoperative analgesia and duration of Postoperative Care Unit (PACU) stay, in children undergoing tonsillectomy.

Anesthesia‐ and opioids‐related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984–2012

Although commonly performed, tonsillectomy is not necessarily a low‐risk procedure for litigation. We have reviewed malpractice claims involving fatal and nonfatal injuries following tonsillectomy with an emphasis on anesthesia‐ and opioid‐related claims and their characteristics.

Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study

Chronic postsurgical pain (CPSP) affects half a million children annually in the United States, with dire socioeconomic consequences, including long‐term disability into adulthood. The few studies of CPSP in children are limited by sample size, follow‐up duration, non‐homogeneity of surgical procedure and factors evaluated.

Cost‐effectiveness of intravenous acetaminophen and ketorolac in adolescents undergoing idiopathic scoliosis surgery

Enhanced recovery after surgery protocols increasingly use multimodal analgesia after major surgeries with intravenous acetaminophen and ketorolac, despite no documented cost‐effectiveness of these strategies.

Anesthetic and pharmacologic considerations in perioperative care of obese children

PURPOSEnAnesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children.nnnSOURCEnMEDLINE and PubMed peer-reviewed manuscripts in obesity and pediatric anesthesia. When there was no information in pediatric literature, we included adult studies in our review.nnnPRINCIPAL FINDINGSnDefining obesity in a growing child is based on body mass index percentiles specific to age and sex. The precursors of adult obesity-related comorbidities are often seen in obese children. Respiratory and cardiovascular comorbidities increase perioperative risk in the severely obese child [>99th percentile]. Obstructive sleep apnea is highly prevalent and requires consideration of opioid sparing techniques and careful postoperative disposition. A detailed discussion on the effect of obesity on pharmacokinetics of different commonly used anesthetics and analgesics is presented, with current recommendations on dosing.nnnCONCLUSIONnOptimal and safe anesthetic management of an obese child requires thoughtful pre-procedure assessment and meticulous perioperative management tailored to associated comorbidities, with heightened awareness of potential perioperative complications. There remains a need for improved guidelines for risk stratification, drug dosing and postoperative disposition in this patient population.

Correction to: Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

The original article can be found online.