Purpose of review
Magnetic resonance imaging (MRI) is an ever-expanding investigation modality in children. This review aims to present current strategies to perform MRI in pediatrics efficiently and safely. The latest evidence on approaches, safety and costs of MRI with no sedation or with sedation provided by anesthesiologists and non-anesthesiologists are outlined and discussed.
Recent findings
MRI under sedation provided by either anesthesiologists or non-anesthesiologists has a low incidence of minor adverse events and rarely severe complications. Propofol infusion with or without dexmedetomidine appears the ideal anesthetic, as it allows spontaneous breathing and fast turnover. Intranasal dexmedetomidine is safe and the most effective medication when a nonintravenous route is employed.
New scanning techniques and patient's preparation methods can increase the chances to successfully perform MRI with no sedation by shortening sequences, reducing artifacts, and improving child's cooperation.
Summary
MRI under sedation can be considered safe. Proper patient selection, clear decision-making and medico-legal pathways are particularly necessary for nurse-only sedated scans. Nonsedated MRIs are feasible and cost-effective but require optimal scanning techniques and patient's preparation to be successful. Further research should be focused on identifying the most effective modalities to perform MRI without sedation and clarify protocols for the nurse-only sedations.
Anesthesia service will likely remain pivotal for complex and critically ill patients and to provide assistance in case of adverse events.
Background: Nausea and vomiting are frequent complications of anesthesia in the postoperative period. Acupuncture at the pericardium point 6 (PC6) is known to be effective in preventing postoperative nausea and vomiting (PONV).
Objectives:The objective of the present study is to investigate the effects of acupuncture performed at the PC6 point in the prevention of PONV in women undergoing elective open hysterectomy under general inhalational anesthesia and to assess its association with plasma serotonin levels. Methods: 97 patients undergoing elective open hysterectomy were randomly divided into two groups: acupuncture group (bilateral acupuncture at PC6, n = 49), and a control group (no acupuncture, n = 48). All patients prophylactically received ondansetron and dexamethasone and, as rescue medication, metoclopramide in case of occurrence of PONV. The primary outcome evaluated was occurrence of nausea and vomiting within 24 hours after surgery. Serotonin plasma levels were measured before and after acupuncture prior to anesthesia induction. For the control group, the repeat measurement was performed 30 minutes after admission to the preoperative unit.Results: Acupuncture at PC6 significantly reduced the incidence of nausea (29.2% vs. 6.1%; p < 0.003), and the need of rescue medication (metoclopramide) (33.3% vs. 10.2%; p < 0.006), but not vomiting (4.2 vs. 4.1; p < 0.98). The plasma serotonin levels between control and acupuncture groups did not differ.
Conclusion:This study shows that acupuncture at PC6 resulted in a lower incidence of postoperative nausea in patients undergoing hysterectomy.
ZrO2 thin films are deposited by the sol–gel dip-coating technique where the thermal annealing temperature and the number of deposited layers determine the properties of this material concerning the application in field-effect transistor (FET) devices in conjunction with SnO2 layer, also produced by sol–gel dip-coating. The best annealing temperature for the ZrO2 film was found as 400[Formula: see text]C, along with a small number of layers and the position of the layer inside the oven, which determines the dominant heat transport mechanism of conduction or convection phenomena. The electrical insulating property of ZrO2 layers was confirmed with the current in the order of pA, even for layers about 100 nm thick. The temperature of 400[Formula: see text]C also leads to a lower leak current through the gate in the device, which is three orders of magnitude lower than the source-drain current (in the order of a tenth of [Formula: see text]A).
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