The Introduction of a Preoperative MRI Protocol Significantly Reduces Unplanned Return to the Operating Room in the Treatment of Pediatric Osteoarticular Infections

Background: Pediatric osteoarticular infection can cause severe morbidity. Some infectious loci may be difficult to identify clinically, and there may be more than one. There is little agreement regarding the appropriate use of preoperative magnetic resonance imaging (MRI) in this setting. After noting an unacceptably high rate of unplanned returns to the operating room for recurrent infection, clinicians at a tertiary care children’s hospital noticed many patients had adjacent foci of infection on postoperative MRI. As a result, patients experienced prolonged treatment courses and multiple surgeries. An interdisciplinary team instituted practice guidelines whereby all patients with suspected osteoarticular infection underwent MRI for planned debridement during a reserved morning slot with a surgical suite on hold to proceed directly to surgery if indicated. Images were reviewed in real time to form the surgical plan. Young patients that required sedation for MRI were taken to surgery under the same anesthetic used for MRI without being awakened. The purpose of our retrospective study is to determine if implementing the practice guidelines for acute management of osteoarticular infection reduced unplanned returns to the operating room. Methods: A total of 93 patients with osteoarticular infection were included in this study. A total of 40 cases, group A, were treated before implementing practice guidelines; 53 cases, group B, were treated after implementing practic...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Selected Items Source Type: research

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ABSTRACT Objective: To report on a case of malignant hyperthermia in a child after a magnetic resonance imaging of the skull was performed using sevoflurane anesthesia. Case description: A 3-year-old boy admitted to the pediatric intensive care unit after presenting clinical and laboratory findings consistent with unspecified viral meningoencephalitis. While the patient was sedated, a magnetic resonance imaging of the skul was performed using propofol followed by the administration of sevoflurane through a laryngeal mask in order to continue anesthesia. Approximately three hours after the start of the procedure, the patien...
Source: Revista Paulista de Pediatria - Category: Pediatrics Source Type: research
ConclusionNo patient experienced adverse events directly related to gadoterate meglumine. Only two adverse events were reported to have occurred in the initial 2  h after the exam, while the rest were reported on the 24-h follow-up call. The higher reported rate of adverse events in this study may be related to concomitant sedation/anesthesia as well as to overreporting from parents on the 24-h follow-up questionnaire. The study confirms a good safety profi le for gadoterate meglumine in this very sensitive population.
Source: Pediatric Radiology - Category: Radiology Source Type: research
CONCLUSION Resuscitative endovascular balloon occlusion of the aorta decreased blood flows of the IVC, HV, and PV and increased blood flow of the SVC. This result could be explained by the collateral flow from the lower body to the SVC. A better understanding of the effect of REBOA on the venous and portal venous systems may help control liver injury.
Source: Journal of Trauma and Acute Care Surgery - Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research
CONCLUSION: PN injury can occur as one of the complications following epicardial VT ablation procedures, and may prevent successful ablation of these arrhythmias. PN displacement by using large balloon catheters into the epicardial space seems to be feasible and reproducible, avoid procedure-related morbidity, and improve ablation success when performed in selected centers and by experienced operators. PMID: 31984128 [PubMed]
Source: World Journal of Cardiology - Category: Cardiology Authors: Tags: World J Cardiol Source Type: research
Conclusions: Our study demonstrated that the rich-club reorganization in functional brain networks is characterized by switching of rich-club nodes between the high-order cognitive and sensory and motor networks during propofol-induced alteration of consciousness and natural sleep. These findings will help understand the common neurological mechanism of pharmacological and physiological unconsciousness.
Source: NeuroImage: Clinical - Category: Radiology Source Type: research
AbstractPurpose of ReviewTranscarotid artery revascularization (TCAR) is a novel hybrid procedure that reverses carotid flow and places a stent using surgical access of the carotid artery in the neck under local anesthesia. We discuss the indications for carotid revascularization, the clinical rationale for TCAR, and evidence for its potential role in the management of carotid stenosis.Recent FindingsResults from pre-clinical studies, prospective single-arm studies, and comparative analyses of registry data indicate that TCAR results in low amounts of periprocedural microembolization, cerebral lesions detectable on magneti...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
G Arora, N SahniJournal of Postgraduate Medicine 2020 66(1):51-53 Sheehan's syndrome (SS) is caused by infarction of the pituitary gland usually precipitated by hypotension due to massive uterine hemorrhage during the peripartum period. Once SS develops, it becomes a major comorbidity for the young females and predisposes them to further medical, obstetric, and anesthetic complications. Herein, we report the perioperative anesthetic management of a 28-year-old female, already diagnosed with SS precipitated by urosepsis and septicemic shock in a previous pregnancy, now presenting with twin pregnancy for elective cesare...
Source: Journal of Postgraduate Medicine - Category: Internal Medicine Authors: Source Type: research
ConclusionThere is no anatomical relation between otolaryngologic surgery, the hypoglossal nerve and recurrent laryngeal branch of the vagus nerve. This Tapia’s syndrome case is possibly caused by nerve compression of the two nerves due to anaesthesia cannula. Ginkgo leaf extract, methylcobalamin and mouse nerve growth factor could be used as an alternative treatment plan in case of steroid contraindications.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
Conclusions: Incidental intracranial hemorrhages are relatively common among infants born by vaginal delivery. They are often of little clinical significance within the first years of life and have unlikely consequences for later neurodevelopment either. Despite their benign character, investigators should be prepared to share this information with parents competently as the findings can cause parental anxiety, and especially as the popularity of MRI as a research tool is increasing.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
CONCLUSIONS: Propofol is a hypnotic drug with a safe profile of efficacy and adverse events. Indeed, when administered by non-anesthesiologists, quick access to emergency care must be provided, especially in airway events. The use of propofol in other scenarios must be better studied, aiming to reduce the limitations of its administration by general pediatricians. PMID: 31926134 [PubMed - as supplied by publisher]
Source: Jornal de Pediatria - Category: Pediatrics Authors: Tags: J Pediatr (Rio J) Source Type: research
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