Our study compared the three primary outcomes of pausing, agitation, and respiratory complications between the two groups, and we found no difference in respiratory complications. However, the GAP group had more pausing and less agitation than the GAS group.

There are limited data in the pediatric population regarding the incidence of, risk factors for, and means to prevent perioperative hypothermia. The Institute for Healthcare Improvement Model for quality improvement (QI) methodology was used to bundle the most effective techniques to prevent hypothermia. A multidisciplinary QI team was assembled with the goal to decrease the incidence of perioperative hypothermia by 50%. The baseline incidence of hypothermia was determined and causes identified using a flowchart and a cause-and-effect diagram. Pareto charts were formed and opportunities to decrease the incidence of perioperative hypothermia were trialed. The baseline incidence of hypothermia was 8.9%. Implementation of a standardized temperature management bundle in the operating rooms decreased the incidence to 4.2%. The QI methodology was useful to bundle the most effective techniques to prevent hypothermia, resulting in standardized perioperative care and a sustained reduction in the incidence of perioperative hypothermia.

Pharmacogenomic studies have revealed a wide variation in the metabolism of codeine to its active metabolite, morphine. A particular subset of patients, known as ultrarapid metabolizers, possesses multiple copies of the CYP2D6 gene responsible for codeine metabolism. This has been linked to serious morbidity and mortality in pediatric patients leading to considerable debate regarding the use of codeine for analgesia in the pediatric population. The current study surveyed the current practice of codeine prescription in pediatric health care providers from a single tertiary care pediatric hospital. Of the 298 responders, 43.3% (129 of 298) continue to prescribe codeine for pain management in children. The vast majority of codeine prescribers were primary health care providers (89.1%). Most of the primary care practitioners were in office-based (42.6%) or hospital-based (45.7%) group practices. There was no significant difference in codeine use based on years of experience. Given the risks associated with this practice, increased education targeting this group appears warranted.