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Intranasal dexmedetomidine was comparable to oral pentobarbital sedation for TTEcho sedation in infants and did not increase the risk of clinically important adverse events. Intranasal dexmedetomidine appears to be an effective "rescue" sedative for both failed pentobarbital and dexmedetomidine sedation. Dexmedetomidine could be a safer option for repeated sedation in children, but further studies are needed to assess long-term consequence of repeated sedation in this high-risk population.

Late onset central hypoventilation syndrome is a neurological disorder that can present with postoperative respiratory complications and delayed emergence in children after anesthesia. We present a child who had unanticipated respiratory complications following an elective tonsillectomy who eventually required a tracheostomy and long-term ventilatory support.

We utilized QI methodology to design and implement a project which led to greater standardization of clinical practice within a large pediatric anesthesia group. Based on an understanding of system issues impacting our clinical practice, we designed and tested interventions that led to a significant reduction in the incidence of serious airway events and airway cardiac arrests.

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Gastrostomy tube placement is typically a routine surgical procedure with little concern for morbidity and mortality. However, in patients with Duchenne muscular dystrophy (DMD), this is not the case. Patients with DMD present a unique clinical dilemma since they often do not require gastrostomy tube placement until their physical status has deteriorated to the point that they have respiratory insufficiency or failure and clinically significant cardiomyopathy. An understanding of the pathophysiology of this disorder and a proactive approach to perioperative management are important to ensure a positive patient outcome.