Children with major and severe CHD, undergoing noncardiac surgery, have an increased risk of mortality compared with children without CHD. Further studies need to identify the optimal environment for surgical procedures, develop trained multidisciplinary teams to care for children with CHD, and define management strategies for improving outcomes in this high-risk population.

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Our study demonstrates that, in addition to preoperative markers of critical illness (eg, inotropic support, mechanical ventilation, preoperative cardiopulmonary resuscitation, and acute or chronic kidney injury), the type of lesion (eg, single-ventricle physiology) and the functional severity of the heart disease (eg, severe CHD) are strong predictors of in-hospital mortality in children undergoing noncardiac surgery.

4. Laryngoscope, 2018.

SummaryBackground: Hospital readmissions are being used as a quality metric for hospital reim-

Objective: A high mortality rate is associated with anesthesia in low and middle income countries. The provision of basic and emergency surgical services in developing countries includes safe anesthetic care. We sought to determine the resources available to deliver anesthesia care in low and middle income countries. Methods:A standard World Health Organization tool was used to collect data from 34 Low and Middle-Income Countries (LMICs) regarding infrastructure and capacity of facilities. We then performed a database query to extract information on anesthesia-related capacity.Findings: Twelve countries were excluded for providing data on less than four facilities, leaving 22 countries in our results, with a total of 590 facilities surveyed. Thirty five percent of hospitals had no access to oxygen and 40% had no anaesthesia machines; despite this, 58.5% of hospitals offered general inhalational anesthesia. All facilities reported presence of an anaesthesia provider: a nurse or clinical assistant was present in all 590 facilities. Hospitals with > 200 beds reported a range of 2-10 providers; the average number of anesthesia physicians increased from one to four as the hospital size increased from less than to greater than 300 beds. The majority of facilities were district/rural/community hospitals (34.7%), followed by health centres (23.2%), private/NGO/missions hospitals (16.6%), provincial hospitals (11.7%), and general hospitals (13.1%). Conclusion:The delivery of anesthesia is limited by deficiencies in human resources, equipment availability and system capacity in many low and middle income countries.

The diagnosis of acute Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy is based on clinical characteristics, abnormalities on nerve conduction studies, and nerve biopsy specimens indicating demyelination. Inflammation and edema are also common findings in nerve specimens. Immunotherapy is helpful in these dysimmune conditions. Occasionally the diagnosis is difficult to make, particularly when electrophysiological testing or nerve biopsy findings are not characteristic. The authors found contrast enhancement of lumbosacral roots in patients with chronic inflammatory demyelinating polyradiculoneuropathy and Guillain-Barré syndrome, but not in those with other demyelinating neuropathies. Contrast-enhanced magnetic resonance imaging could be a useful tool in the diagnosis of the dysimmune inflammatory neuropathies.

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