Applying conflict management strategies to the pediatric operating room

Overall, this was quite a useful paper.  The strengths included sensible observations about the relevance of communication failure and conflict to patient care, and a very useful list of specific suggestions for managing conflicts, illustrated with well thought out examples. From the introduction: Communication failures are regularly identified as a root cause of sentinel events […]

Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group

Cranial vault reconstruction is performed in children with craniosynostosis in order to increase the cranial volume and thus prevent complications associated with raised intracranial pressure.   Procedures are normally performed in infancy, the period of rapid brain growth.  Different centres perform different operations in patients of different ages, making comparison of risk and benefit of different […]

Physico-chemical stability of Plasma-Lyte 148 and Plasma-Lyte 148 + 5% Glucose with eight common intravenous medications

Summary This paper looks at whether dilutions of eight commonly used critical care agents (morphine, midazolam, fentanyl, ketamine, clonidine, aminophylline, salbutamol and frusemide) are stable in Plasmalyte 148 and Plasmalyte 148 + 5% Glucose, compared to dilutions in 0.9% sodium chloride or 5% Glucose.  This is important as Plasmalyte 148 is generally accepted as a safer and more efficacious maintenance […]

Chewing gum for 1 h does not change gastric volume in healthy fasting subjects. A prospective observational study

Summary Valencia et al present a prospective observational study that is relevant for anaesthetists managing adolescent patients. They examined the impact on gastric volume of chewing gum for 1 hr in an otherwise fasted well adult. It is a simple but well designed and well described study, with each subject being their own control. A […]

Comparison of caudal epidural block with paravertebral block for renal surgeries in pediatric patients: A prospective randomised, blinded clinical trial

Summary Narasimhan et al report a single-blind RCT to compare the analgesic efficacy of ultrasound guided single-shot caudal and paravertebral blocks in children undergoing pyeloplasty. The study has an elegantly simple design and the methodology is well described. The same medication (0.2% ropivacaine with 1:200,000 adrenaline) is delivered by one of two different routes with […]

Quality control and stability of ketamine, remifentanil, and sufentanil syringes in a pediatric operating theatre.

Summary This paper looks at whether or not syringes of ketamine and remifentanil (and sufentanil) are chemically stable once diluted and if degradation leads to concentration error.  It also looks at drug concentration errors due to serially diluted syringes. They have a system whereby pharmacy or nurses prepare a “stock” (master) syringe of more concentrated drug in […]

A randomized-controlled, double-blind study to evaluate the efficacy of caudal midazolam, ketamine and neostigmine as adjuvants to bupivacaine on postoperative analgesic in children undergoing lower abdominal surgery.

Summary Shirmohammadie et al (Acta Biomed 2018;89(4):513-518) report a double-blind RCT to evaluate the efficacy of caudal midazolam, ketamine and neostigmine as adjuvants to bupivacaine in children. The authors studied 80 children aged 1-3 years undergoing elective inguinal hernia repair and/or urethroplasty for hypospadias for 24 hours where caudal block was the only pre-emptive analgesia […]

Randomized trial of acupuncture with antiemetics for reducing postoperative nausea in children

Summary Study type: Single centre RCT from Oregon, USA, of acupuncture in addition to routine antiemetic prophylaxis, for postoperative nausea and vomiting (PONV) in children having adenotonsillectomy. Design: Inclusion: 3-9 year-old children undergoing day-case tonsillectomy +/- adenoidectomy. Exclusion: History of PONV/motion sickness, on steroids, BMI>35, OSA. Intervention: Acupuncture needles inserted at pericardium 6 (P6) point […]

Real-Time Ultrasound Improves Accuracy of Caudal Block in Children.

Summary One in five caudal blocks are outside the caudal space in a high-volume paediatric centre Study type: A single-blinded prospective observational trial using ultrasound to assess whether local anaesthetic was injected into the caudal space using the palpation method in 109 children up to 7 years of age. Methods: Caudal injections were performed using […]

Allergy alerts – The incidence of parentally reported allergies in children presenting for general anesthesia.

This prospective audit documents self-reported allergies in patients presenting for elective surgery at a tertiary paediatric hospital assessing the nature and severity of self-reported reactions. Self-reported reactions were assessed by an immunologist and an anaesthetist. Each was then assessed as ‘likely allergy’, ‘no allergy’, ‘insufficient evidence’, or ‘contact dermatitis’. Drug reactions were classified as either […]