Obesity in children significantly increases the risk of respiratory complications following surgery for sleep-disordered breathing. Overnight hospitalization for obese children is recommended.

Acute kidney injury (AKI) is common in liver failure prior to orthotopic liver transplantation (OLT) and may complicate the intraoperative course. We describe the logistics of intraoperative continuous renal replacement therapy (CRRT) during OLT and the associated clinical outcomes. We performed a retrospective review of adult patients (age Ͼ 18 years) receiving intraoperative CRRT during OLT at the University of Alberta Hospital between January 1, 1996 and December 31, 2005. Demographic, detailed clinical, and perioperative data, physiologic and laboratory measures, details of renal replacement therapy (RRT) provided, and data on renal recovery and survival were ascertained. Of 636 OLTs, 41 (6.4%) received intraoperative CRRT. The most common indications for OLT in these patients were hepatitis C (34.2%) and alcoholic (29.3%) cirrhosis. The median [interquartile range (IQR)] Model for End-Stage Liver Disease score was 38 (31-43), and 90.2% were classified as Child-Pugh class C. Preoperatively, 70% were in the intensive care unit, 58.5% were mechanically ventilated, and 48.7% required vasopressor support. The median (IQR) duration of intraoperative CRRT was 258 (189-390) minutes, representing 57% of the total operative time. Filter circuit clotting occurred in 40% but was not associated with a shorter CRRT duration (P ϭ 0.41). No other complications were described. CRRT allowed an even or negative intraoperative fluid balance in 92.7%. CRRT was continued in 78% after OLT for a median (IQR) of 5 (3-11) days. Of these, 24 (75%) were transitioned to intermittent hemodialysis for a median (IQR) of 15 (4-39) days. Survival was 97.6% at 1 month and 75.6% at 1 year. Renal recovery to RRT independence occurred in 100% of survivors by 1 year; however, the mean (standard deviation) estimated glomerular filtration rate (eGFR) was 54.7 (19.1) mL/minute/m 2 , with 62.1% having an eGFR Ͻ 60 mL/minute/m 2 . In conclusion, our data suggest that intraoperative CRRT during OLT is achievable and safe. Intraoperative CRRT may be a valuable adjuvant therapy for those with preoperative AKI. Additional investigations are warranted. Liver Transpl 15:73-78, 2009.

The prevalence of laryngomalacia within children presenting with SDB is 3.9%. Our findings support full evaluation of the airway to identify the site of pathology mediating SDB symptoms.

This study re-emphasizes the importance of a sound anesthetic technique in tracheally extubating pediatric patients.

The results of this study suggest that epidural catheter placement via the caudal approach using the Tsui test is an effective and reasonable alternative to direct lumbar and thoracic epidural analgesia in pediatric patients.

The combination of remifentanil and propofol for TIVA may be an effective method of light general anesthesia in pediatric patients undergoing MRI.

No abstract

We found no evidence of an association between dose and duration of sedation/analgesia drugs during the operative and perioperative period and adverse neurodevelopmental outcomes.