瑞芬太尼可唤醒麻醉在小儿斜视矫正手术中的应用

目的 探索瑞芬太尼可唤醒麻醉在不同麻醉方法下儿童斜视矫正术中的优越性,旨在为该类手术选择适宜的麻醉方法.方法 将斜视患儿60例随机分为3组：瑞芬太尼-丙泊酚组（RP组）,芬太尼-丙泊酚组（FP组）,喉罩组（LMA组）.记录唤醒时间（从停用镇静药至唤醒成功时间）及手术时间,分别于麻醉诱导前（T1）,牵拉眼肌时（T2）,唤醒前（T3）,唤醒成功时（T4）,手术结束时（T5）时记录脑电双频谱指数（BIS）、平均动脉压（MAP）、心率（HR）和呼气末二氧化碳分压（PETCO2）;记录术中体动,呼吸抑制和唤醒时痛感的发生情况.结果 所有患儿各时点MAP、HR、血氧饱和度（SpO2）和BIS均在正常范围,T2时PETCO2较T1时明显升高,各组间比较差异无统计学意义（P＞0.05）.与FP组和LMA组比较,RP组唤醒时间缩短,差异有统计学意义（P＜0.05）;与RP组和LMA组比较,FP组手术刺激较强时体动发生率增加,呼吸抑制发生率升高,差异有统计学意义（P＜0.05）;与FP组和LMA组比较,RP组唤醒时痛感减少,差异有统计学意义（P＜0.05）.结论 瑞芬太尼复合丙泊酚麻醉,提供了稳定的血流动力学状态,唤醒时间短,不良反应少,适宜于儿童斜视矫正术,非常有利于提高小儿斜视矫正手术的手术成功率.     

Everyday memory difficulties in children and adolescents with Fetal Alcohol Spectrum Disorder

ABSTRACT

Purpose: To investigate whether significant differences exist in everyday memory between youth with Fetal Alcohol Spectrum (FASD) compared with a nonexposed (NE) control group, while controlling for socioeconomic status and other comorbidities.

Methods: Caregiver ratings using the Everyday Memory Questionnaire were obtained for 105 youth (9–17 years of age). Scores were compared between youth with a FASD diagnosis (N = 41; 56% male) and the NE group (N = 64; 53% male) using multivariate analysis of variance.

Results: Significantly poorer scores were found across all domains of everyday memory in youth with FASD (p<0.01 for all comparisons). Findings maintained significance after controlling for group differences in socioeconomic status, presence of learning, and attention disorders, as well as exposure to other teratogens.

Conclusions: This study provides important insights regarding the memory issues that underlie daily functional challenges faced by youth with FASD and the need for future intervention research.     

Implementing an inpatient integrative medicine consult service for children with pain: A qualitative analysis

ObjectivesComplementary and integrative medicine (CIM) therapies show clinical benefits with minimal side effects, yet challenges to effective integration in hospital settings remain. The current study aimed to better understand the process of integration of CIM therapies at a large urban pediatric hospital from the perspectives of providers, parents, and administrators.DesignThe study employed an applied medical ethnography.SettingThe ethnography was conducted before, during, and after an Integrative Medicine Pain Consult Service (IM Pilot) was implemented at a large urban pediatric hospital during the spring of 2017.Main outcome measuresFieldwork interviews, participant observations, and document review captured aspects of the integration of CIM over a 6-month study period. Ethnographic analysis included thematic content analysis. Participants included providers (n = 10), administrators (n = 5), and parents of patients (n = 11).ResultsEmergent themes from analysis of the interviews and field notes were organized according to the socio-ecological model. Themes included facilitating factors for CIM pain management at the intrapersonal and community levels (Alignment with Parental Perceptions of Child Needs and Provider Desire to Offer Care, Alignment of CIM with Spiritual Beliefs and Community Norms) and barriers at the interpersonal, organizational, and political levels (Inter-professional Challenges, Lack of Logistics in Place for Referrals and Triaging Patients with Pain, Lack of Remuneration/Insurance Reimbursement for Care).ConclusionsTo address barriers, future efforts to implement integrative pain management programs in pediatric hospital settings may consider testing implementation strategies, including engaging program champions and family advocates, providing education on CIM professions and therapies to hospital staff, and billing for provider time rather than individual CIM therapies.     

Functional characterization of plantar pressure patterns in gait of typically developing children using dynamic pedobarography

BackgroundAbnormal foot posture is a common complaint presented in pediatric and pediatric orthopedic clinics. Functional, objective assessment of foot posture, with the potential for early identification of pathologic foot deformities, has, however, been lacking to date. While quantifying functional and regional impulses via dynamic pedobarography can improve the clinical assessment of children’s feet, normative values have not yet been reported or characterized.Research QuestionThe objectives of this study were to: (1) quantify and characterize the pattern and spectrum of foot impulses in walking-aged, typically developing children; and (2) compare these to impulses from non-disabled adults.MethodsFoot impulses of 102 participants (52 female) in five pre-determined age groups (2−3, 4–6, 7–10, 11−14, 15−17 years) were examined using dynamic pedobarography. Each pressure map (3 per foot per child) was divided according to anatomical foot regions: the hallux, heel, medial forefoot, lateral forefoot, lesser toes (D2 to D5), and midfoot. The impulse was calculated for each region and used to generate regional percent impulses and impulse ratios to assess anteroposterior and mediolateral balance within the foot.ResultsThe impulse through the midfoot was highest in the youngest age group, with a corresponding lower impulse through the medial forefoot. As age advanced, the midfoot impulse decreased (p = 0.001), and the forefoot balance shifted slightly more medially (%Medial Forefoot: p = 0.004; Medial-Lateral Forefoot Balance: p = 0.019). When compared to adults, there were no significant differences between 15−17 year old children and adults in any of the regional percent impulses and impulse ratios. This indicates that skeletal maturity of the foot by late adolescence results in functional characteristics seen in adults.SignificanceThe age-standardized norms of functional and regional impulse measures in children reported in this study can be used as a comparative benchmark in the clinical assessment of children presenting with various foot deformities.     

Wilms tumor: progress to date and future considerations

Wilms tumor is the most common tumor of renal origin found in children. In the last 50 years, remarkable progress has been made in the treatment and understanding of children with Wilms tumor. Through the development of multiagent chemotherapy and cooperative pediatric interdisciplinary groups conducting large randomized controlled clinical trials, survival has improved dramatically. In the next century it is expected that 80% of children with Wilms tumor will be long-term survivors. Therapy is progressing towards a risk-based management based not only on stage and histology but also incorporated genetic markers. This article reviews progress to date and possible future directions in the treatment of Wilms Tumor.     

Acute upper extremity flaccid paralysis in a 5 year old child secondary to enterovirus infection

The incidence of acute flaccid paralysis has been on a declining trend with the global efforts on eradication of polio virus. A few scattered clusters of acute flaccid paralysis associated with pathogens like enterovirus other than polio virus and flaviviruses have recently come to limelight. This is a case of acute onset flaccid paralysis of left upper extremity in a fully immunized 5 year old child in New York.