Search Our Scientific Publications & Authors

Anesth Prog 2020 Jun;67(2):109-120

Associate Clinical Professor, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California.

Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Read More

Medicine (Baltimore) 2020 Jul;99(27):e20765

Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Gui yang, China.

Background: Remimazolam is a newly developed benzodiazepine as an alternative of conventional sedatives in the procedure of anesthesia. For the purpose of evaluating the efficacy and safety of remimazolam sedation during an endoscopy, we will perform a systematic review and meta-analysis of randomized controlled trials that compared remimazolam with midazolam and/or placebo.

Methods: We will search PubMed, Embase, Web of Science, and the Cochrane Controlled Register of Trials (CENTRAL) from inception to December 2019 for randomized controlled trials that investigated efficacy and safety of remimazolam during an endoscopy. Read More

Curr Opin Anaesthesiol 2020 Aug;33(4):533-538

aDepartment of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany bAnesthesiology Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates cDepartment of Anesthesiology and Intensive Care Medicine, CHRU de Nancy, Nancy, France.

Purpose Of Review: The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA.

Recent Findings: Safety always has to be first priority. Read More

Endosc Int Open 2020 Jul 30;8(7):E959-E966. Epub 2020 Jun 30.

Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.

Colonoscopy is an invasive procedure that may cause patients pain and discomfort. Routine use of sedation, while effective, is expensive and requires logistical planning. Virtual reality (VR) offers immersive, three-dimensional experiences that distract the attention and might comfort patients. Read More

J Gastrointest Cancer 2020 Jul 4. Epub 2020 Jul 4.

Department of Surgical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.

Background: Abdominal and back pain is present in up to 80% of patients with pancreatic cancer and represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in relief of pain of upper abdominal malignancy. Dexmedetomidine is alpha-2 adrenoceptor highly selective agonist approved for procedural sedation use. Read More

Echocardiography 2020 Jun 30. Epub 2020 Jun 30.

Department of Cardiology, Kings College Hospital, London, UK.

Recently, there has been an increasingly minimalistic approach to transcatheter aortic valve replacement (TAVR), with most procedures now performed under conscious sedation without real time transesophageal echocardiography (TEE) guidance. Proponents of echo should not feel discouraged by this; it is the initial insights that were gained with procedural TEE during the early years of TAVR that have allowed the procedure's gradual maturation and sophistication. Experienced centers that have promoted extensive TAVR TEE programs continue to maximize the benefits of echocardiography in both procedural planning and execution. Read More

Singapore Med J 2020 Jun 26. Epub 2020 Jun 26.

Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.

Introduction: Although ketamine is one of the commonest medications used in procedural sedation of children, to our knowledge, there is currently no published report on predictors of respiratory adverse events during ketamine sedation in Asian children. We aimed to determine the incidence of and factors associated with respiratory adverse events in children undergoing procedural sedation with intramuscular (IM) ketamine in a paediatric emergency department (ED) in Singapore.

Methods: A retrospective analysis was done of all children who underwent procedural sedation with IM ketamine in the paediatric ED between 1 April 2013 and 31 October 2017. Read More

J Emerg Med 2020 Jun 18. Epub 2020 Jun 18.

Department of Emergency Medicine, UC San Diego Medical Center, San Diego, California; Division of Medical Toxicology, UC San Diego Medical Center, San Diego, California.

Background: Methohexital is a short-acting barbiturate used for procedural sedation in the emergency department (ED). As with other sedatives, adverse effects with methohexital include excess sedation and hypotension, but this agent can also lower the seizure threshold. We report a patient who developed a generalized seizure after administration of methohexital. Read More

Clin Oral Investig 2020 Jun 16. Epub 2020 Jun 16.

Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, 48109-1078, USA.

Objectives: Currently, procedural sedation in the clinical setting relies heavily on the use of pulse oximetry to monitor hypoxemia. Different studies suggest that incidence of hypoxemia and incidence of arterial oxygen desaturation are reduced by early intervention via capnography monitoring. The aim of this article was to discuss the importance of implementing capnography monitoring during procedural sedations performed in a dental setting and determine whether additional capnographic monitoring reduces the incidence of arterial oxygen desaturation and the overall complications rate. Read More

Cardiovasc Intervent Radiol 2020 Jun 17. Epub 2020 Jun 17.

Department of Interventional Radiology, St George's University of London, London, UK.

This CIRSE Standards of Practice document provides best practices for the safe administration of procedural sedation and analgesia for interventional radiology procedures in adults. The document is aimed at health professionals involved in the provision of sedation and analgesia during interventional radiology procedures. The document has been developed by a writing group consisting of physicians with internationally recognised expertise in interventional radiology, and analgesia and sedation. Read More

Pediatr Rheumatol Online J 2020 Jun 17;18(1):52. Epub 2020 Jun 17.

Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.

Background: Sacroiliitis is commonly seen in enthesitis-related arthritis (ERA), a subtype of juvenile idiopathic arthritis (JIA). Sacroiliitis is characterized by the inflammation of the sacroiliac (SI) joints (+/- adjacent tissues). The treatment options include systemic therapy with or without corticosteroid SI joint injections. Read More

Turk J Anaesthesiol Reanim 2020 Jun 4;48(3):215-222. Epub 2019 Oct 4.

Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Objective: Radiation therapy is indicated in many solid tumours in children. Absolute immobility is required to precisely position children for optimal delivery of radiation energy to the target tissues, improve success rate and reduce the damage to nearby normal tissues. Intranasal (IN) administration of drugs is well tolerated, effective and fast acting. Read More

J Neonatal Perinatal Med 2020 ;13(2):159-165

Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, NC, USA.

Background: Given the limited available evidence on chloral hydrate safety in neonatal populations and the discrepancy in chloral hydrate acceptance between the US and other countries, we sought to clarify the safety profile of chloral hydrate compared to other sedatives in hospitalized infants.

Methods: We included all infants <120 days of life who underwent a minor procedure and were administered chloral hydrate, clonidine, clonazepam, dexmedetomidine, diazepam, ketamine, lorazepam, midazolam, propofol, or pentobarbital on the day of the procedure. We characterized the distribution of infant characteristics and evaluated the relationship between drug administration and any adverse event. Read More

Children (Basel) 2020 Jun 10;7(6). Epub 2020 Jun 10.

Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.

There are guidelines on lactation following maternal analgo-sedative exposure, but these do not consider the effect of maternal fasting or fluid abstention on human milk macronutrient composition. We therefore performed a structured search (PubMed) on 'human milk composition' and screened title, abstract and full paper on 'fasting' or 'abstention' and 'macronutrient composition' (lactose, protein, fat, solids, triglycerides, cholesterol). This resulted in six papers and one abstract related to religious fasting ( = 129 women) and observational studies in lactating women ( = 23, healthy volunteers, fasting). Read More

Curr Opin Anaesthesiol 2020 Aug;33(4):483-489

Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Purpose Of Review: Growing concerns about the environmental effects of volatile anaesthetics are likely to lead to increased use of intravenous anaesthetic drugs. Pharmacokinetic/pharmacodynamic (PKPD) models can increase the accuracy of intravenous drug titration, especially in populations that differ from the 'average.' However, with a growing number of PKPD models, and other technology available to date, it can be hard to see the wood for the trees. Read More

Curr Opin Anaesthesiol 2020 Aug;33(4):506-511

Lecturer in Pharmacology (Education), Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.

Purpose Of Review: Anaesthesia and sedation are ubiquitous in contemporary medical practice. Developments in anaesthetic pharmacology are targeted on reducing physiological disturbance whilst maintaining or improving titrateability, recovery profile and patient experience. Remimazolam is a new short-acting benzodiazepine in the final stages of clinical development. Read More

Arch Dis Child Educ Pract Ed 2020 Jun 10. Epub 2020 Jun 10.

Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar

JGH Open 2020 Jun 9;4(3):490-496. Epub 2019 Dec 9.

Department of Gastroenterology Henry Ford Health System Detroit Michigan USA.

Aims: Constipation associated with opioid therapy for chronic pain may negatively impact colonoscopy success. This retrospective, observational study using administrative data and electronic medical records evaluated the impact of opioid use on colonoscopy outcomes.

Methods And Results: Procedural codes were used to identify patients who had a screening colonoscopy at two Henry Ford Health System centers (January 2015-December 2016). Read More

Cleve Clin J Med 2020 Jun 8. Epub 2020 Jun 8.

Cleveland Clinic Lerner College of Medicine, Education Institute; Department of General Anesthesiology and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic.

Resuming procedural sedation services for elective procedures during the COVID-19 pandemic requires unique considerations to ensure safety for patients and providers. Guidelines for resuming these procedures, including timing, screening and testing, use of personal protective equipment, and case planning are discussed. Approaches to procedural sedation can be modified to reduce the risk of droplet or aerosol transmission by decreasing nasal cannula oxygen supplementation flows. Read More

Ophthalmol Retina 2020 Jun 5. Epub 2020 Jun 5.

Children's Hospital of Philadelphia, Philadelphia, PA.

Objective: To compare respiratory outcomes following treatment of retinopathy of prematurity (ROP) between infants treated with laser under general anesthesia to infants treated with intravitreal bevacizumab under bedside sedation.

Design: Retrospective cohort study.

Subjects: 138 consecutive infants treated for ROP from September 2010 to September 2018 at one institution. Read More

J Invasive Cardiol 2020 Jun 8. Epub 2020 Jun 8.

11800 Carmel Creek Road, San Diego, CA 92130 USA.

Background: Left atrial appendage closure (LAAC) using the Watchman device has become a well-established, world-wide therapeutic alternative to oral anticoagulation in high-risk patients for bleeding with paroxysmal, persistent atrial fibrillation (Afib) or permanent Afib. Currently, in the United States, LAAC procedures are performed under general anesthesia (GA). We present the feasibility, effectiveness, and safety of LAAC under moderate conscious sedation (MCS). Read More

Anesth Analg 2020 Jun 4. Epub 2020 Jun 4.

Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, South Australia - 5011, Australia.

Current evidence suggests that Coronavirus Disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm), and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6. Read More

Pediatr Int 2020 Jun 5. Epub 2020 Jun 5.

Department of Pediatrics, Oita University, Faculty of Medicine, Yufu, Japan.

Background: Pediatric procedural sedation (PPS) has been established worldwide as standard practice for several decades. However, there are no comprehensive guidelines or multi-facility databases of PPS in Japan, and the current status of PPS and PPS-related adverse events is unclear. The objectives of this study were to investigated the current status of PPS and clarify the adverse events and risk factors in Japan. Read More

J Invasive Cardiol 2020 Jun;32(6):206-210

11800 Carmel Creek Road, San Diego, CA 92130 USA.

Background: Transcatheter mitral valve repair (TMVR) using the MitraClip system (Abbott Vascular) has become a world-wide, well-established therapeutic alternative to symptomatic patients with severe mitral regurgitation (MR) and prohibitive surgical risk. Currently, TMVRs are performed under general anesthesia. Herein, we aimed to present the effectiveness and safety of TMVR under moderate conscious sedation (MCS). Read More

BMC Anesthesiol 2020 May 30;20(1):132. Epub 2020 May 30.

Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, China.

Background: Propofol provides a prominent sedation effect in colonoscopy. However, anesthesia and sedation induced with propofol in the elderly might result in cardiopulmonary complications, especially when it is combined with opoids in the regimen. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the overall propofol requirement in elderly patients during colonoscopy while the procedural sedation satisfaction and the hemodynamic stability were not compromised. Read More

Top Magn Reson Imaging 2020 May 29. Epub 2020 May 29.

Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH.

Periprocedural anxiety is a major cause of morbidity, particularly for interventional radiology procedures that often depend on conscious sedation. Management of anxiety and pain during image-guided procedures has traditionally relied on pharmacologic agents such as benzodiazepines and opioids. Although generally safe, use of these medications risks adverse events, and newer noninvasive, nonpharmacologic techniques have evolved to address patient needs. Read More

Med J Malaysia 2020 May;75(Suppl 1):24-27

Anesthesiologist, Yogyakarta, Indonesia.

Background: Procedural sedation and analgesia (PSAA) or monitoring anaesthesia care (MAC) must provide analgesia, amnesia and hypnosis with complete and rapid recovery that suits a particular operative procedure with minimum side effects. For a child undergoing a procedure, a major deciding factor is whether it is painful or not. Deep Sedation is required during the procedures to allay the anxiety, pain, and movement. Read More

BMC Anesthesiol 2020 May 28;20(1):131. Epub 2020 May 28.

Department of General Surgery, Heidelberg University Hospital, Heidelberg, Germany.

Background: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) require adequate sedation or general anesthesia. To date, there is lack of consensus regarding who should administer sedation in these patients. Several studies have investigated the safety and efficacy of non-anesthesiologist-administered sedation for ERCP; however, data regarding anesthesiologist-administered sedation remain limited. Read More

Eur J Emerg Med 2020 May 25. Epub 2020 May 25.

Emergency Department, CHU de Bordeaux, Bordeaux, France.

Objectives: Propofol is widely used today outside the operating room to facilitate painful procedures. The objective of this retrospective study was to evaluate the frequency and type of complications related to a propofol-based procedural sedation protocol used in a French emergency department.

Methods: This retrospective study reviewed the records over a 6-year period of all patients-adults and children-who received propofol for procedural sedation according to a pre-established protocol. Read More

An Pediatr (Barc) 2020 May 23. Epub 2020 May 23.

Servicio de Pediatría, Hospital General Universitario de Albacete, Albacete, España.

Introduction: The procedural sedation scale of the Niño Jesús Hospital (Madrid) (SSPNJH) has not been validated.

Patients And Methods: A prospective analytical study was conducted in 2 hospitals on patients ≥ 6 months undergoing invasive procedures using sedation-analgesia with propofol or midazolam and fentanyl. All were monitored using the bispectral index (BIS). Read More

Plast Reconstr Surg Glob Open 2020 Apr 21;8(4):e2735. Epub 2020 Apr 21.

Michigan State University College of Human Medicine, Grand Rapids, Mich.

Background: Pediatric emergency department (ED) visits are common. Many are due to injury, which require procedural treatments with sedation. There are many well researched independent predictors of adverse events for pediatric procedural sedation. Read More

Pediatr Emerg Care 2020 May 15. Epub 2020 May 15.

From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.

Objectives: Pediatric procedural sedation (PS) has been performed with increasing frequency by pediatric emergency physicians for recent years. Accreditation Council for Graduate Medical Education Pediatric Emergency Medicine fellowship core competency requirements do not specify the manner in which fellows should become proficient in pediatric PS. We surveyed the variety of training experience provided during fellowship and whether those surveyed felt that their training was sufficient. Read More

Cureus 2020 Apr 16;12(4):e7693. Epub 2020 Apr 16.

Gastroenterology, State University of New York (SUNY) Upstate Medical University, Syracuse, USA.

Millions of endoscopic procedures are performed in the US every year and the use of procedural sedation analgesia (PSA) is increasing with more procedures being performed outside the operating theater and gaining popularity due to reduced costs. Patients having endoscopic procedures usually expect that they would be deeply sedated during the procedure despite verbal counseling during pre-procedure clinic visits and are often dissatisfied with procedural awareness and discomfort. In order to better educate patients, written supplementary reading material was provided to the patients, which stated a clear goal of comfort during the procedure rather than deep sedation. Read More

Int Anesthesiol Clin 2020 ;58(3):41-46

Department of Anesthesiology and Perioperative Medicine, University of Louisville Medical Center, Louisville, Kentucky.

Br J Anaesth 2020 07 27;125(1):e88-e103. Epub 2020 Apr 27.

Division of Global Health Equity, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.

Background: Capnography is universally accepted as an essential patient safety monitor in high-income countries (HICs) yet is often unavailable in low and middle-income countries (LMICs). Increasing capnography availability has been proposed as one of many potential approaches to improving perioperative outcomes in LMICs. This scoping review summarises the existing literature on the effect of capnography on patient outcomes to help prioritise interventions and guide expansion of capnography in LMICs. Read More

Am J Emerg Med 2020 May 3. Epub 2020 May 3.

Department of Emergency Medicine, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA.

Acta Paediatr 2020 May 13. Epub 2020 May 13.

Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.

Aim: This systematic review and meta-analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room.

Methods: Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Read More

J Can Assoc Gastroenterol 2020 Jun 19;3(3):120-126. Epub 2019 Jan 19.

Gastrointestinal Diseases Research Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Background And Aims: Same day bidirectional endoscopies (esophagogastroduodenoscopies [EGD]s and colonoscopies) are routinely performed. However, the best sequence of procedures is unknown, as is whether the use of carbon dioxide (CO) affects the preferred sequence of procedures. This study aims to determine the preferred sequence of procedures and choice of insufflation gas (air or CO) in patients undergoing same day bidirectional endoscopies. Read More

Case Rep Cardiol 2020 11;2020:2040561. Epub 2020 Jan 11.

Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urahune, Minami-ku, Yokohama 2320024, Japan.

Procedural sedation and analgesia for patients with adult congenital heart disease (ACHD) and highly elevated subpulmonic ventricular pressure require proper anesthesia care to prevent a pulmonary hypertensive crisis. We describe the monitored anesthesia care (MAC) of two patients with ACHD (a complete atrioventricular septal defect and congenitally corrected transposition of the great arteries) and highly elevated subpulmonic ventricular pressure. In both patients, preprocedural transthoracic echocardiography was useful for detecting severely elevated subpulmonic ventricular pressure. Read More

J Emerg Trauma Shock 2020 Jan-Mar;13(1):68-72. Epub 2020 Mar 19.

Department of Emergency Medicine, UCSF/Fresno, Fresno, CA, USA.

Background: Anterior shoulder dislocations (ASDs) are frequent painful injuries commonly treated in the emergency department. The last decade new potentially less traumatic and painful reduction techniques for ASDs have been introduced. Recent literature comparing best reduction techniques, medication use, and approaches is limited. Read More

Am J Cardiol 2020 Jul 22;127:99-104. Epub 2020 Apr 22.

Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V., (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany.

Transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) has become an established therapy-option for patients with symptomatic severe aortic stenosis. Conscious sedation (CS) has proven to be an alternative to general anesthesia . So far, the outcome of patients undergoing unplanned periprocedural conversion from CS to general anesthesia has not been investigated. Read More

Curr Pain Headache Rep 2020 May 8;24(6):28. Epub 2020 May 8.

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Purpose Of Review: One of the consequences of the opioid epidemic is an increase in the number of opioid-tolerant patients. These patients are at higher risk for readmission and longer hospital stays following surgery. Enhanced recovery after surgery (ERAS) pathways can be used as a framework for providing high-quality comprehensive care to patient population. Read More

Anaesthesia 2020 06;75(6):829-830

Monash Medical Centre, Melbourne, Vic, Australia.

Anaesthesia 2020 06;75(6):830-832

Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.

Ann Gastroenterol 2020 May-Jun;33(3):299-304. Epub 2020 Apr 13.

Department Surgical and Perioperative Sciences, Umeå University, Sunderby Research Unit, Umeå (Lars Enochsson), Sweden.

Background: Difficult or unsuccessful cannulation of the papilla of Vater is associated with complications during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate whether deep sedation facilitates the cannulation and reduces the complication rate.

Methods: Nationwide data from ERCP procedures were registered prospectively in the web-based Swedish Registry for Gallstone Surgery and ERCP (GallRiks). Read More

Anaesth Rep 2020 Jan-Jun;8(1):28-31. Epub 2020 May 4.

Department of Ear, Nose and Throat Surgery Guy's and St Thomas' Foundation Trust London UK.

We report the airway management of a patient with suspected COVID-19 with impending airway obstruction requiring urgent surgical tracheostomy. To our knowledge, this is the first reported case of an awake tracheal intubation in a suspected COVID-19-positive patient. Various modifications were put in place during the awake tracheal intubation and surgical tracheostomy procedures to minimise aerosol generation from the patient, such as avoiding high-flow nasal oxygen, establishing conscious sedation with remifentanil before commencing airway topicalisation and avoiding transtracheal local anaesthetic infiltration. Read More

J Egypt Natl Canc Inst 2019 Nov 19;31(1). Epub 2019 Nov 19.

Department of Radiotherapy and Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: Carcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide. High-dose-rate intracavitary brachytherapy (HDR-ICBT) post external beam radiation therapy (EBRT) is the standard of care in managing locally advanced stage cervical cancer patients. HDR-ICBT is generally performed under general anaesthesia (GA) in operation theatre (OT), but due to logistic reasons, sometimes, it becomes difficult to accommodate all patients under GA. Read More

Curr Opin Anaesthesiol 2020 Jun;33(3):354-360

Baylor College of Medicine Department of Pediatrics, Texas Children's Hospital Palliative Care Team, Houston, Texas, USA.

Purpose Of Review: To familiarize pediatric anesthesiologists with primary palliative care procedural communication skills and recommendations for discussions involving complex medical decision-making or advance care planning, such as discussions about resuscitation status.

Recent Findings: Recent publications highlight the benefits of pediatric palliative care (PPC) for seriously ill patients and their families, and how PPC principles might be applied to perioperative communication and decision-making. Both prospective and retrospective reports reveal improved quality of life, symptom management, and avoidance of unnecessary interventions when PPC is introduced early for a child with serious illness. Read More

Neuroradiology 2020 May 5. Epub 2020 May 5.

Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Study Design: Prospective experimental uncontrolled trial.

Background: Lumbar microinstability (MI) is a common cause of lower back pain (LBP) and is related to intervertebral disc degeneration that leads to inability to adequately absorb applied loads. The term "microinstability" has recently been introduced to denote a specific syndrome of biomechanical dysfunction with minimal anatomical change. Read More

Brain Dev 2020 Aug 28;42(7):477-483. Epub 2020 Apr 28.

Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Japan.

Objective: To evaluate the efficacy and safety of intravenous (i.v.) thiamylal in pediatric magnetic resonance imaging (MRI) sedation. Read More