Acute epiglottitis is a life-threatening disorder with serious implications to the anesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. Acute epiglottitis can occur at any age. Early diagnosis with careful and rapid intervention of this serious condition is necessary in order to avoid life-threatening complications.

Chlorhexidine is an antiseptic agent, commonly used, in many different preparations, and for multiple purposes. Despite its superior antimicrobial properties, chlorhexidine is a potentially allergenic substance. The following is a review of the current evidence-based knowledge of allergic reactions to chlorhexidine associated with surgical and interventional procedures.

Valproic acid (VPA) is one of the widely prescribed antiepileptic drugs in children with multiple indications. VPA-induced coagulopathy may occur and constitute a pharmacological and practical challenge affecting pre-operative evaluation and management of patients receiving VPA therapy. This review summarizes the different studies documenting the incidence, severity and available recommendations related to this adverse effect.

P Pu ur rp po os se e: : Controlling the cerebral and systemic hemodynamic responses to laryngoscopy and tracheal intubation may play a role in determining clinical outcome in pediatric neurosurgical patients. This study compared the effects of remifentanil and fentanyl on cerebral blood flow velocity (CBFV) and hemodynamic profile during laryngoscopy and tracheal intubation in children under sevoflurane anesthesia.M Me et th ho od ds s: : Sixty healthy children aged two to six years undergoing dental surgery under general anesthesia were enrolled. Each child was randomly assigned to receive a remifentanil or fentanyl infusion, at a rate of 0.75, 1.0, or 1.5 µg·kg -1 ·min -1 after induction of anesthesia with 2% sevoflurane. Middle cerebral artery blood flow velocity was measured by transcranial Doppler (TCD) sonography. Once a baseline set of hemodynamic variables and TCD measurements were recorded, the opioid infusion was started. Measurements were taken at two-minute intervals, starting four minutes prior to laryngoscopy until four minutes following naso-tracheal intubation.R Re es su ul lt ts s: : Remifentanil caused a more significant decrease in mean arterial pressure and CBFV prior to tracheal intubation than did fentanyl (P < 0.001). During laryngoscopy and for two minutes following tracheal intubation, CBFV increased in all remifentanil groups (P < 0.05), whereas it remained stable in all fentanyl groups. C Co on nc cl lu us si io on n: : This study suggests that fentanyl was more effective than remifentanil at preventing increases in CBFV during and immediately following laryngoscopy and tracheal intubation in children undergoing sevoflurane anesthesia. Fentanyl also seemed to provide a more stable hemodynamic profile prior to laryngoscopy and tracheal intubation when compared to remifentanil. ARYNGOSCOPY and tracheal intubation may cause significant cerebral and systemic hemodynamic responses, including tachycardia, hypertension and increased intracranial pressure. [1][2][3] Controlling these responses on induction of anesthesia may be an important factor in improving outcome in pediatric neurosurgical patients. Remifentanil is a µ-opioid receptor agonist, rapidly metabolized by nonspecific esterases throughout the blood and tissues. The elimination half-life of remifentanil is less than ten minutes, compared to 219 min for fentanyl. 4-6 It does not accumulate after prolonged continuous infusion and the blood brain equilibration time is rapid. 5,7 Its use is characterized by rapid and complete offset of opioid effects within minutes of infusion discontinuation. 4 These distinctive pharmacokinetic and pharmacodynamic characteristics make remifentanil a potentially attractive opioid for use in pediatric anesthesia. Comparative data assessing cerebral blood flow velocity (CBFV) on induction and tracheal intubation with remifentanil and fentanyl has not been documented in the pediatric population. ObjectifThe aim of this study was to compare the effects of remifentanil and fentanyl on CBFV and hemodynamic...

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Background:Rapid sequence intubation (RSI) has been an established practice, but is not without risks to patient. In different situations, a modification of the standard RSI technique may be more appropriate. The definition of a modified rapid sequence intubation (MRSI) is not well-documented. The purpose of this survey was to determine the working definition of MRSI as well as the modality of its use.Materials and Methods:This descriptive study consisted of a survey of pediatric anesthesiologists and included basic questions related to the anesthesiologist's experience, practice setting and use of MRSI. Responses were compiled and analyzed to identify the working definition, technique, perceived indications/complications as well as hands-on performance of tracheal intubation during use of MRSI in children.Results:The mean ± SD years in practice of the 228 respondents were 14.9 ± 8.16 years, with pediatric patients comprising 77 ± 33% of their practice. 76.8% completed a fellowship in pediatric anesthesia. 60% of the respondents’ practice setting was at a Children's Hospital. Different respondents agreed with different techniques of MRSI with the majority (65%) defining a MRSI as equivalent to a RSI, but with mask ventilation. The major indication of use of a MRSI was a concern about apnea time tolerance with traditional RSI (74%).Conclusion:Technique of a MRSI varies among pediatric care providers.

This study aimed to review the use of two methods of propofol infusion: a metred burette system where propofol is diluted in Lactated Ringer using the rule of six [ 1 ] or an infusion pump: Medrad Continuum Magnetic resonance (MR) compatible Infusion System (Medrad Inc. Indianola, PA) and to determine the difference, if any, between the total amount of drug delivered, the impact on vital signs, sedation status and discharge time of the patients. With Institutional Review Board (IRB) approval, 140 children aged 0 to 18 years, American Society of Anesthesiologists (ASA) physical status I or II requiring sedation for elective outpatient brain Magnetic Resonance Imaging (MRI) examination were included in the study. A total of 70 patients in each group were studied. The (Mean ± S.D.) total amount of propofol infused was significantly less in the infusion pump group (12.47 ± 7.67 mg/kg) than the metred burette system (15.84 ± 16.13 mg/kg, p = 0.003). There were also significant mean differences in awakening times (26.63 ± 16.35 vs. 37.06 ± 20.98 min, p = 0.006), and discharge times (53.46 ± 21.12 vs. 67.89 ± 26.84 min, p = 0.008) in the infusion pump group versus the buretrol infusion group. This study demonstrates that both infusion techniques preserve haemodynamic stability and are associated with minimal complications. The use of an infusion pump, which consistently maintains accurate dosing, reduces the amount of propofol judged adequate by the anaesthesiologist to achieve sedation in MRI. This leads to a more consistently faster emergence and early discharge after sedation in children undergoing MRI studies.