Purpose: The purpose of this structured, evidence-based, clinical update was to identify the best evidence comparing general and regional anesthesia and their influence on delirium or cognitive dysfunction (POCD) in the postoperative period. Source:In June 2005 a structured search of MEDLINE from 1966 to present using OVID software was undertaken. Medical subject headings and textwords describing both delirium and POCD were employed. OVID's Therapy (sensitivity) algorithm was used to maximize the detection of randomized trials. The bibliographies of eligible publications were hand-searched to identify trials not identified in the electronic search. Publications enrolling children were excluded. Levels of evidence and grades of recommendations were scored using Centre for Evidence Based Medicine criteria. Principal findings:A total of 18 unique randomized controlled trials were identified: two evaluating delirium; ten evaluating POCD; and six evaluating both. Outcomes for delirium were abstracted from eight trials that enrolled 765 patients (387 regional anesthesia; 378 general anesthesia). Outcomes for POCD were identified from 16 trials that enrolled 2,708 patients (1,313 regional anesthesia; 1,395 general anesthesia). Both delirium (11-43%) and POCD (15-25%) were relatively common in trials actively seeking these outcomes. Consistent Level 2b evidence suggests no significant increase in delirium in patients receiving general anesthesia compared with those receiving regional anesthesia. Similarly, consistent Level 1 evidence indicates that exposure to general anesthesia is not significantly associated with POCD. Conclusion:Available randomized controlled trials suggest that there is no significant difference in the incidence of delirium or POCD when general anesthesia and regional anesthesia are compared. Objectif Source : En juin 2005, une recherche structurée a été entreprise dans MEDLINE, de 1966 à nos jours, en utilisant le logiciel OVID. Les vedettes-matières et les textes décrivant le délire et le DCPO ont été utilisés. Un algorithme thérapeutique (sensibilité) tiré de OVID a servi à optimaliser la détection d'études randomisées. Les bibliographies des études admissibles ont été fouillées manuellement pour découvrir les études non repérées dans la recherche électronique. Les recherches portant sur des enfants ont été exclues. Les niveaux d'évidence et les degrés de recommandations ont été évalués selon les critères du Centre for Evidence Based Medicine. Constatations principales

No abstract

No abstract

No abstract

Purpose:We hypothesized that advanced information and communication technology (ICT) would be acceptable to parents in a pediatric surgical, and diagnostic imaging day care setting. Methods:After Ethics Committee approval, we distributed surveys, over a one-month period, to parents of children arriving for day care surgery or diagnostic imaging. Parents indicated their acceptance of various proposed modes of postoperative discussion of healthcare i.e.; face-to-face, videophone, or telephone. Parents were also asked to describe their receptiveness to scheduling non-emergency hospital appointments online and to receiving electronic media describing their child's surgery and postoperative management. Parental education, income, and familiarity with the Internet were also assessed.Results: A total of 451 surveys (84% response rate) were returned. Most parents (95%) had access to the Internet and 70% did their banking online. Forty-two percent of the parents had at least a university education and 63% had an annual family income > $50,000 Canadian. The majority of parents (98%) accepted face-to-face interaction, while only 35% and 37% of parents were receptive to videophone and telephone interviews, respectively. Computer availability (P = 0.001) and online banking (P = 0.011) were the only variables that predicted those parents who were in favour of using videophone technology. Parents were receptive to instruction electronic media (80%) and booking appointments online (61%). Conclusions:A well-educated and technologically sophisticated parent population does not favour advanced communication technologies over simple, face-to-face interaction in an in-hospital setting. These parents are prepared to receive technology-based information about their child's surgery and to schedule non-emergency hospital appointments online. Méthode : Après avoir obtenu l'aval du comité d'éthique, nous avons distribué des questionnaires pendant un mois aux parents d'enfants admis pour des chirurgies ou des imageries diagnostiques aux soins de jour. Les parents ont indiqué leur acceptation de diverses méthodes proposées de discussion

No abstract

Introduction:The intercristal line (ICL) is a common clinical landmark used to guide the level for neuraxial techniques. We sought to determine if ultrasonography of the spine, while in clinical positioning for a spinal or epidural anesthetic, confirms the classical teaching that the ICL occurs at the L3/4 intervertebral space. Methods: After obtaining ethics approval and informed consent, non-gravid, elective surgical patients and volunteers were examined in conventional position (seated, spine flexed) for neuraxial techniques by a single observer. The ICL was identified by palpation of the iliac crests and the skin at this level was marked with erasable pen. Paramedian ultrasound (SonoSite® MicroMAXX™ 2-5 MHz curved array probe) identified the vertebral level at which the palpated ICL occurred. The proportion of ultrasound assessments of ICL found at L2/3, L3/4, and L4/5 were compared with Fisher's Exact test. P < 0.05 was considered significant. Results: Thirty-three of fifty males (66.7 %) and fifty of sixty-four females (78.1 %) had an ICL at L3/4. Six males (12.0 %) and ten females (15.6 %) had an ICL at L4/5, P = 0.54. Eleven males (22.2 %) and four females (6.3 %) had an ICL at L2/3, P < 0.02. Height, age, waist circumference, mass, and body mass index were not related to ICL level in males or females. Discussion: In clinically relevant position for neuraxial techniques, the majority of males and females had an ultrasound-measured intercristal line at L3/4. However, significantly more males than females had an intercristal line at L2/3. This should be taken into account when determining a safe needle insertion point for subarachnoid techniques given that up to 10% of the population may have a conus medullaris extending caudal to L2 (1).

Purpose: Patient-controlled epidural analgesia (PCEA) with meperidine provides effective analgesia following thoracotomy. Accumulation of normeperidine, a meperidine metabolite with neuroexcitatory effects, has led to recommendations to limit the use of meperidine postoperatively. The purpose of this study was to determine if the addition of adrenaline to PCEA meperidine decreased meperidine consumption, reduced serum normeperidine levels, and improved analgesia following thoracotomy.Methods: Following Research Ethics approval consenting patients were randomly assigned to PCEA with either meperidine (2 mg·mL -1 ) + adrenaline (2 µg·mL -1 ) or meperidine alone (2 mg·mL -1 ). All patients received a standardized anesthetic and similar perioperative care. Visual analogue pain scores (at rest and with activity), quality of recovery (QoR) scores, and side effects were documented six, 24, and 48 hr postoperatively. Serum levels of meperidine and normeperidine were measured at the same time points.Results: Forty-six patients completed the study protocol. Meperidine consumption (mean ± SD) was similar in the meperidine + adrenaline and the meperidine groups (601 ± 211 mg vs 580 ± 211 mg over 48 hr, respectively; P = 0.744). Serum meperidine levels were similar at all study time points. Serum normeperidine was not detected in any sample. Pain scores, QoR scores, and adverse events were comparable in both study groups. Conclusion:The addition of adrenaline did not influence PCEA meperidine consumption, analgesia outcomes, or QoR. Normeperidine did not accumulate in patients of either study group during the 48-hr study period. Meperidine for patientcontrolled epidural analgesia, with or without adrenaline, provides effective post-thoracotomy analgesia in selected patients.