Gabapentin (1-aminomethyl-cyclohexaneacetic acid) is an amino acid that has the structure of the neurotransmitter γ-aminobutyric acid (GABA). It is a novel drug used for the treatment of postoperative pain with antihyperalgesic properties and a unique mechanism of action. Gabapentin and the related, more potent compound pregabalin have been shown to be beneficial in the treatment of neuropathic pain as well as postoperative pain following spinal surgery and hysterectomy. This study reviews five aspects of gabapentin: (1) chemical and structural characteristics; (2) pharmacokinetics and pharmacodynamics; (3) application in acute pain management; (4) adverse effects; and (5) drug safety. Overall, gabapentin has been reported to be a safe and efficacious drug for the treatment of postoperative pain.

BackgroundIn 1988 South Korea opened its cigarette market to foreign companies under the threat of US trade sanctions. Despite strong social stigma against female smoking in South Korea, and restrictions on tobacco marketing to women and children, smoking rates among young Korean females increased from 1.6% in 1988 to 13% in 1998. Previous analyses describe how Asian countries have been targeted by transnational tobacco companies for new markets, with Asian females offering substantial future growth potential. An understanding of the strategies used by TTCs to increase smoking among Korean females is critical to public health efforts to adopt a stronger gender perspective in implementing the Framework Convention on Tobacco Control.MethodsInternal documents of transnational tobacco corporations were systematically searched using keywords focused on the targeting of the female market since market liberalisation in 1988. Industry documents were analysed alongside primary and secondary data on the tobacco industry in South Korea.ResultsTTCs have targeted Korean females since the late 1980s, conducting market research to understand consumer preferences, cultural characteristics and social changes affecting women and girls. Brands designed to appeal to females have focused on "slim" and "superslim" cigarettes, "light" and "mild" claims, and marketing which appeals to the growing numbers of young women entering the labour force. Strategies for overcoming legal restrictions on marketing to women and children have included the use of company rather than brand names, retail distribution at venues frequented by females, trademark diversification and sponsorship.ConclusionGiven the high male smoking rates in South Korea, tobacco control efforts have given limited attention to girls and women. The limited data available on female smoking behaviour suggests that, despite legal restrictions and social stigma, smoking among females has increased since market opening, notably within younger age groups. In addition to more detailed trend data, there is an urgent need for the development and implementation of gender-sensitive tobacco control measures. Part of South Korea's accession to the FCTC should include emphasis on measures to address the strategic targeting of Korean females by TTCs.

The current COVID‐19 pandemic has had a global impact on vaccination rates. Delays in routine healthcare and immunization have led to a rise in concerns about resurgence of vaccine‐preventable diseases around the world. With the release and distribution of COVID‐19 vaccines, plans to improve immunization rates need to be explored and implemented across disciplines. One approach would be the consideration of perioperative vaccinations; however, the effects of anesthesia and surgery on the immune response and complications associated with vaccination during the perioperative period are still poorly understood, and opinions are divided. To ascertain the value of a perioperative vaccination program, it is important to understand the basics of immunization and common vaccinations; the potential vaccine complications in the pediatric cohort; the implications of anesthesia and surgery on the immune response; and current recommendations. In addition, we believe it is important to discuss the logistics and feasibility of coordinating perioperative immunization should this become a regular opportunity.

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How to cite this article: Geng-Ramos G, Cronin J, Challa C, et al. Anesthesia and surgery for positive COVID-19 asymptomatic pediatric patients: How long should we wait?.

Background Children with SARS‐CoV‐2 infection are at increased risk for postanesthesia complications. There is minimal data regarding how long that elevated complication risk persists beyond initial SARS‐CoV‐2 diagnosis. Aims We investigated postanesthesia complications in children with SARS‐CoV‐2 infection within 90 days of diagnosis. Methods We completed a single‐center, retrospective, case–control study of pediatric patients with confirmed SARS‐CoV‐2 infection within 90 days undergoing anesthesia between January 3–October 7, 2020. Each SARS‐CoV‐2 positive patient was matched 1:2 by age and type of procedure with a non–SARS‐CoV‐2 cohort. The primary outcome was the rate of all postanesthesia complications within 30 days of the procedure, defined as unplanned escalations of care within 48 h, cardiac, respiratory, thrombotic, and hemorrhagic events within 30 days. Secondary outcomes were 30‐day mortality and hospital length of stay. Results Of the 341 patients included, 114 patients were SARS‐CoV‐2 positive and 227 were SARS‐CoV‐2 negative. Patients with a positive test 0–7 days prior to anesthesia had an increased risk difference in all postanesthesia complications within 30 days (19.9, 95% CI [4.7, 35.1], p = .001) and increased risk difference in length of hospital stay (7.8, 95% CI [1.2, 14.4], p < .001). Patients who underwent anesthesia greater than 42 days from SARS‐CoV‐2 diagnosis had an increased risk difference in cardiac complications within 30 days (4.3, 95% CI [0.9, 10.0], p = .029). There was no increased hospital length of stay among SARS‐CoV‐2 positive patients diagnosed greater than 8 days before anesthetic. There were no deaths within 30 days of anesthetic. Conclusions Postanesthesia complications are higher in children who undergo anesthesia within 7 days of SARS‐CoV‐2 diagnosis. Additional cardiac risk may persist beyond the immediate period of initial diagnosis. Larger samples are needed to further evaluate the risk of delayed postanesthesia complications and guide optimal timing of surgery.

Trigeminocardiac reflex (TCR) is a physiological response that occurs due to stimulation of the trigeminal nerve, resulting in vagus nerve activation, parasympathetic dysrhythmia, and sympathetic hypotension. The pediatric population is vulnerable to TCR due to higher resting vagal tone, which can result in ischemia and death. This study reports two cases of TCR during adenotonsillectomy. Placement and rapid opening of a Crowe‐Davis retractor led to immediate bradycardia and hypotension in two children undergoing adenotonsillectomy, which resolved upon release of the retractor. Early intraoperative recognition of TCR with removal of mechanical stimulation can resolve vital instability without need for chemical intervention. Laryngoscope, 130:803–805, 2020

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