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: A prospective observational case series of children receiving light general anesthesia for magnetic resonance imaging (MRI) was performed. Our purpose was to examine the merit of anesthesia and recovery/discharge times of combined remifentanil and propofol total intravenous anesthesia (TIVA) in spontaneously breathing children.: After IRB approval and informed consent, 56 patients receiving Remi/Propofol TIVA (Remifentanil 10 μg·ml−1 Propofol 10 mg·ml−1) were observed. Blood pressure, respiratory rate, endtidal CO2 (PECO2), oxygen saturation and temperature were recorded at the start and finish of anesthesia. In addition, induction and recovery times were noted. Recovery time was from scan completion until discharge from the initial recovery area. Discharge time was from scan completion to discharge home.: Fifty-six patients received Remi/Propofol TIVA. The mean Remi/Propofol recovery and discharge times were 8.9 and 28.2 min, respectively. There was a statistically significant decrease in respiratory rate and increase in CO2 from the start to the end of the procedure. During the scan, seven patients moved. One patient experienced postprocedure nausea and or vomiting.: The combination of remifentanil and propofol for TIVA may be an effective method of light general anesthesia in pediatric patients undergoing MRI. [ABSTRACT FROM AUTHOR]

In the neonate, umbilical venous catheters (UVC) are inserted and advanced blindly to a predetermined length from the umbilicus. The reported rates for UVC misplacement into the liver (and occasionally the spleen) range from 20 to 37%. Radiographs are routinely used to confirm the positioning of UVCs. This involves movement of often critically ill infants, as well as radiation exposure. This pilot study examines the potential value of confirming UVC placement in neonates using ECG.In critically ill neonates, a conductive Johans ECG adapter was connected to a UVC. A satisfactory tracing (lead II) was obtained (right arm lead connected to the adapter) when the UVC was filled with saline solution allowing the catheter tip to become a unipolar ECG electrode. The UVC was then advanced from the umbilicus until the tip reached the inferior vena cava (IVC) within the thoracic region, as demonstrated by appearance of normal sized QRS complexes with small P-waves. A small QRS indicated the catheter was below the diaphragm. The appearance of a tall positive P-wave indicated the tip was at the right atrium level. The UVC was then withdrawn until the P-wave size returned to normal. The final UVC position was later confirmed by X-ray.Eight neonates were studied. The figure shows typical ECG tracings when the UVC was placed in the liver, IVC, and right atrium, respectively. Three malpositioned catheters were detected (2 into liver and 1 into spleen).Based on these cases, the insertion of UVCs in neonates can be guided with ECG by observing sequential and characteristic alterations in P-waves and QRS complexes, thereby reducing the use of X-rays. In addition, this technique could prove to be beneficial in remote healthcare facilities where X-ray machines may not be readily available and quick intravenous access is required to transport sick neonates to major centers. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess clinical signs of airway patency, airway intervention requirements and adverse events in 100 children receiving propofol total intravenous anesthesia for magnetic resonance imaging, with spontaneous ventilation and oxygenation via nasal prongs.Airway patency was clinically assessed and stepwise interventions were performed until a satisfactory airway was achieved. Propofol requirements, vital signs, procedure times and adverse events were also recorded.Ninety-three per cent of children had no signs of airway obstruction when positioned with a shoulder roll only, two required a chin lift, four required an oral airway and one required lateral positioning. The mean propofol induction dose was 3.9 mg·kg−1 (range 1.8–6.4 mg·kg−1). The mean propofol infusion rate was 193 μg·kg−1·min−1 (range 150–250 μg·kg−1·min−1). The initial and final mean respiratory rates were 26 and 23 b·min−1 (P < 0.05). Movement was more likely at lower infusion rates (mean 175 μg·kg−1·min−1). There were no respiratory or cardiovascular complications (calculated risk: 95% CI = 0–3%). The mean time from end of scan to discharge home was 44 min.This study demonstrates good preservation of upper airway patency and rapid recovery using general anesthetic doses of propofol in children. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Essential ultrasound techniques of the pediatric airway," by S. Stafrace and colleagues in the 2016 issue.