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Tuesday Morning General Pediatric Anesthesia Poster Discussions and Poster Sessions of General Pediatric and Pediatric Cardiac Anesthesia

October 14, 2003 at the ASA annual meeting was a busy morning for those interested in pediatric anesthesia. The above sessions occurred simultaneously. This proved to be a challenge to those trying to cover all bases of the subspeciality. A variety of issues germane to the care of infants and children requiring anesthesia for surgery or diagnostic procedures were covered this fall. A special emphasis was given to the well-represented cluster of free standing posters related to pediatric cardiac anesthesia.

The morning (09:00 to 10:30) posters were not discussed in the order published in the abstract booklet, this order will be followed for the members not able to attend the meeting. There were eight posters slated for discussion:

A-1445 ÿA Multicenter, Randomized Study To Determine the Pharmacokinetics and Pharmacodynamics of Fenoldopam Mesylate in Pediatric Patients . Susan T. Verghese, MD; Gregory B. Hammer, MD; George Lavandosky, MD; Myron Yaster, MD; Joseph R. Tobin, MD; Departments of Anesthesiology and Pediatrics, Children's National Medical Center and George Washington University, Washington DC.

In this multicenter study of this unique drug used to lower blood pressure for hypotensive anesthetic techniques the findings were presented by Dr. Verghese. Fenoldopam 1.0-1.2 mcg/kg/min was found to cause clinically significant reductions in MAP in pre-adolescent children; while greater dosages conveyed little additional benefit. This effect is consistent with PK/PD findings in adults.

A-1446 Risk Factors for Severe Postoperative Vomiting in Pediatric Patients.ÿ Mehernoor F. Watcha, MD; Christopher Lee, MD; Jun Park, MS. Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA

The aim of this study presented by Dr. Meb Watcha, was to identify patient, surgical and anesthetic factors associated with an increased risk for severe postoperative vomiting (POV) as 3 episodes in the first 24 hours after anesthesia. Multiple logistic regression on data extracted from 52,269 computerized anesthetic records identified factors associated with 3 episodes or more of postoperative vomiting in children. ASA 1 or 2 females above the age of 11 years, with a previous history of POV, undergoing long surgical procedures (e.g. middle ear surgery), on an outpatient basis were the pediatric patients with the highest risk for severe POV. These patients may benefit from multimodal POV prophylaxis while sparing the other less affected 2/3rds of the pediatric patient the cost burden

A-1447 ÿThe Effects of Alterations in Ventilation on Cerebral Oxygen Saturation among Infants after Bidirectional Superior Cavopulmonary Connection Stephen A. Stayer, MD; Ahmed Alomrani, MD; Tia Tortoriello, MD; Zeev Perles, MD; Mott R. Antonio, MD; Divisions of Pediatric Cardiovascular Anesthesiology and Pediatric Cardiology, Baylor College of Medicne, Houston, TX.

This study addressed the fact that after bidirectional superior cavopulmonary connection (BSCPC), increasing pH and lowering pCO2 will increase cerebral vascular resistance and lower pulmonary vascular resistance. However, hyperventilation has been shown to decrease PaO2 after BSCPC. The purpose of this study was to determine the effects of alterations in ventilation on cerebral oxygen saturation (rSO2), systemic oxygenation, and hemodynamics among infants after BSCPC. These authors found out that infants may develop significant hypoxemia. Avoiding hyperventilation, and possibly producing mild hypoventilation will optimize both systemic and cerebral oxygen saturation. BSCPC infants benefit from normoventilation and even mild hypercapnia when appropriate. Dr. Jerry Lerman made a comment from the audience that perhaps high-frequency oscillating ventilation (HFO) might have been the better mode of ventilation as the intrathoracic pressures should remain normal in this setting..

A-1448 -ÿMilrinone and Nitric Oxide: Combined Effect on Pulmonary Artery Pressures Following Cardiopulmonary Bypass in Children. Vadim Khazin, MD; Yefim Kaufman, MD; Lior Sasson, MD; Peter Szmuk, MD; Tiberiu Ezri, MD; Anesthesiology, Edith Wolfson Medical Center, Hulon, Israel.

Dr. Khazin presented data addressing the management options of perioperative pulmonary hypertension that include but are not limited to NO and milrinone. An advantage of NO is the lack of systemic hemodynamic effect as it is administered directly to the pulmonary circulation. This group assessed the effect of a combination of milrinone or nitric oxide (NO) versus each drug given alone, in reducing pulmonary artery pressures following CPB in children undergoing surgical repair of congenital heart defects. The authors concluded that a combination of milrinone and NO produced a more pronounced decrease in PAP than each drug separately.

A-1449 ÿCerebrovascular Hemodynamics in Children during Anesthetic Emergence: Propofol vs Desflurane. Ross Barlow, MD; Cengiz Karsli, MD; Igor Luginbuehl, MD; Bruno Bissonnette, MD; Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Dr. Barlow presented a study investigating the effects of propofol versus desflurane and measured the effects on cerebral blood flow using middle cerebral artery blood flow velocity. Remifentanil was used throughout the study period. There was a 54% increase in middle cerebral artery blood flow velocity when propofol was discontinued and desflurane was added at 1 MAC concentration. Heart rate and mean systemic arterial pressure did not change, which was thought to be due to the concurrent use of remifentanil. The authors concluded that desflurane should be used with caution in children with altered cerebral compliance.

A-1450 ÿPeak Inflation Pressure (PIP) Measured at the Tracheal End (PTrach) of the Endotracheal Tube (ETT) Is More Accurate Than PIP Measured by the Ventilator (Pvent) in Children with Respiratory Failure. B. Craig Weldon, MD; Rogelio H. dela Cruz, MD; Michael J. Banner, PhD, Anesthesiology and Pediatrics, University of Florida, Gainesville, Florida.

Dr. Craig Weldon presented a study comparing the measurement of peak inspiratory pressure (PIP) at the very tip of the endotracheal tube (ETT) tip as opposed to mean PIP as measured by the mechanical ventilator. The distal ETT PIP was measured by means of an internal sideport catheter embedded by the manufacturer. As was suspected by the investigators, the distal ETT PIP was significantly lower (p < 0.05) compared to the PIP reported by the ventilator. It was also noted that the difference between the two PIP measurements was greatest in situations where the peak inspiratory flow rates were high. The authors concluded that caution should be used when considering make a change in mechanical ventilator settings based on ventilator-reported PIPs. Furthermore, the difference between the two PIPs (Pvent) and (PTrach) in children with respiratory failure is exaggerated at high flow ventilator rates. Members of the audience asked if PIP measurement should routinely be measured at the distal ETT tip. Dr. Weldon responded that in an ideal environment, PTrach measurement would be preferred.

A-1451 ÿReduction in Perioperative Blood Loss Following Surgery for Scoliosis: A Prospective, Randomized, Double Blind Examination of Epsilon Aminocaproic Acid

Ivan Florentino-Pineda, MD; Dale E. Williams, MD, PhD; George H. Thompson, MD, Department of Anesthesiology, University Hospitals of Cleveland, Cleveland, Ohio.

This study, presented by Dr. Pineda, examined the impact of epsilon aminocaproic acid (EAA) on the perioperative blood loss occurring during surgical correction of idiopathic scoliosis in adolescents. EAA was chosen, as it is an antifibrinolytic shown to reduce perioperative blood loss in other populations. A total of 36 patients were studied, 19 patients received EAA and 17 were in the control group. Analysis of variance detected no statistically significant differences between groups preoperatively. Total perioperative blood loss was less in the EAA group (1,389 ml vs. 1,720 ml; p 0.05). Furthermore, postoperative hemoglobin (8.4 gm/dL vs. 7.2 gm/dL; p < 0.001) and hematocrits (25.2% vs. 21.8%; p < 0.001) were significantly higher in the Amicar group while total autologous blood transfusions were lower (1.0 unit vs. 1.6 units; p 0.05). The authors concluded the use of EAA during anesthesia for scoliosis repair should lead to a practice of reduced autodonation and a significantly reduced need for blood transfusion.

A-1452 ÿDetermination of Tracheal Tube Size in Perinatal Population. Anatomical and Experimental Study. Bruno Marciniak, MD; Pierre Fayoux, MD; Laurent Devisme, MD, Clinique d'ORL Departement d'Anesthesie Reanimation 2, CHRU, Lille, France.

The aim of this study presented by Dr. Marciniak, was to identify the anatomical dimensions of the larynx and trachea and to determine the proper tube size in relation to the age. The larynxes and tracheas from 150 post-mortem babies (from 25 wks gestation to 3 months of age) without malformations were collected. The anatomical measurements were obtained from fresh larynxes. Each larynx was intubated to clinically estimate the largest tube size that could be passed without friction or deformation. Then, each larynx was intubated using a calibrated extensible balloon with diameters corresponding to the external diameter of a tracheal tube. The balloon was inflated with 20 cm H2O pressure and connected to a low pressure manometer. The pressure changes were evaluated during the intubation. The tube size retained corresponded to the largest diameter passing through the larynx without inducing pressure elevation or with a pressure normalization shorter than 10 minutes. The anatomical measurements were compared with the intubation data. The authors concluded that premature laryngeal structures present an elasticity allowing the passage of a tube with a higher size than predicted. This observation was no longer valid after approximately 36 weeks post-conceptual age.

The preceding poster discussion abstracts as well as the following summarized free-standing poster session for issues related to pediatric anesthesia can be viewed in their entirety at ASA 2003 Annual meeting website (http://www.asa-abstracts.com/). Please select Tuesday, October 14, 2003 poster sessions, 1444-1452and 1368-1397.

A-1368 ÿEffect of Midazolam on Required Dose of Sevoflurane for Equianesthetic State

Charles R. Schrock, MD; David J. Murray, MD, Department of Pediatric Anesthesiology, Washington University, St. Louis, Missouri, United States.

Summary: In a randomized controlled trial in children, bispectral monitoring was utilized to assess equi-hypnotic anesthetic states. Midazolam significantly reduces the dose of sevoflurane required to produce an equi-hypnotic anesthetic.

A-1369 ÿAccuracy of Needleless Systems in Intravenous Administration of Small Volume Drugs to Infants and Children. Susan T. Verghese, MD; Raafat S. Hannallah, MD; Steven Soldin, PhD, Department of Anesthesiology, Children's National Medical Center and George Washington University Medical Center, Washington, District of Columbia, United States.

Summary: The valved needleless system is an acceptable alternative to needles in delivering small volumes of injected drugs.

A-1370 ÿIs Bilateral Monitoring of Cerebral Oxygen Saturation Necessary during Neonatal Aortic Arch Reconstruction? Dean B. Andropoulos, MD; Laura K. Diaz, MD; Charles D. Fraser, Jr., MD; Emmett D. McKenzie, MD; Stephen A. Stayer, MD, Division of Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.

Summary: Bilateral monitoring of cerebral oxygen saturation during aortic arch reconstruction utilizing regional low-flow cerebral perfusion (RLFP) revealed significant differences. Bilateral monitoring may detect cerebral desaturation of the left hemisphere during RLFP.

A-1371 ÿSurface Area of CPB Circuit Is Associated with Increased tPA Secretion in Children. Michael J. Eisses, MD; Christer Jonmarker, MD; Jeremy M. Geiduschek, MD; Lynn D. Martin, MD; Wayne L. Chandler, MD, Department of Anesthesiology, Children's Hospital and Regional Medical Center, Seattle, Washington.

Summary: Ratios of circuit surface area (m2) to blood volume (L) greater than 0.6 are associated with increased levels of active tPA at the beginning of CPB in children.

A-1372 ÿOral Pentobarbital Is Superior to Chloral Hydrate for Infant Sedation for MRI and CT Scan. Keira P. Mason, MD; David Zurakowski, PhD; Victoria Karian, R.N.; Linda Connor, R.N.; Patricia E. Burrows, MD, Anesthesia, Radiology, Children's Hospital, Boston, Massachusetts.

Summary: Oral pentobarbital is a safe and effective method of providing infant sedation for MRI and CT scan. Consideration should be given to replacing chloral hydrate with oral pentobarbital for sedation for radiologic imaging studies.

A-1373 ÿHemodynamic Effects of Remifentanil in Children with and without Atropine. Charles Chanavaz, MD; Olivier Tirel, MD; Eric Wodey, MD, PhD; Lotfi Senhadji, PhD; Claude Ecoffey, MD, SAR2(GRCV EA3194), CHU Pontchaillou Universite Rennes 1, Rennes, France.

Summary: The hemodynamic profile of remifentanil (RE) was characterized in children with and without atropine. RE decreased the blood pressure and the cardiac index mainly because of the heart rate fall. Atropine reduces the HR decrease induced by RE but it avoids only partly cardiac index impairment.

A-1374 ÿEffect of Rocuronium and Cis-atracurium on Lung Function in Children. Gavin F. Fine, MBBCh; Peter J. Davis, MD; Rebecca Mutich, R.R.T.; Kathleen M. Fertal, BSN; Etsuro K. Motoyama, MD, Anesthesiology and Pulmonology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.

Summary: Rocuronium and cis-atracurium may induce mild and sometimes significant lower airway obstruction. Lung volumes and static compliance of the respiratory system, however, are minimally affected.

A-1375 ÿMidazolam and Delirium in Children. Charles R. Schrock, MD; David J. Murray. MD, Department of Pediatric Anesthesiology, Washington University, St. Louis, Missouri, United States.

Summary: In a randomized trial, midazolam does not increase the incidence or severity of delirium in children when the control group has a like hypnotic state titrated by Bispectral monitoring.

A-1376 ÿPre-Anesthetic Preparation of Pediatric Outpatients: A Design for a Pediatric Pre-Anesthetic Evaluation (PAE) Program. Helen V. Lauro, MD; David S. Fishman, MD; Jeffrey Lampert, MD; Rebecca Twersky, MD, Anesthesiology, State University of New York, Downstate Medical Center/The Long Island College Hospital, Brooklyn, New York.

Summary: Limited hospital organizational resources often result in great variability in pediatric preoperative programs and anesthesia education. Details of our pediatric PAE program, pediatric easy-pass eligibility tool, demographics, satisfaction, and comments and implications are discussed.

A-1377 ÿBispectral IndexT-Guided Sevoflurane Anesthesia Decreases Oculocardiac Reflex during Strabismus Surgery in Children. Daelim Jee, MD, PhD; Chungwon Yi, MD, Anesthesiology, Yeungnam University College of Medicine, Daegu, Republic of Korea.

Summary: Titration of sevoflurane administration using bispectral indexT monitoring decreases the incidence of oculocardiac reflex during strabismus surgery in children.

A-1378 ÿEffect of Remifentanil on Heart Rate Variability and RR Interval in Children during General Anesthesia with Sevoflurane. Olivier Tirel, MD; Charles Chanavaz, MD; Lotfi Senhadji, PhD; Claude Ecoffey, MD; Eric Wodey, MD, PhD, SAR2, CHU Pontchaillou University Rennes 1, Rennes, France.

Summary: The study aim was to evaluate the effect of RE on autonomic nervous system in children during general anesthesia with sevoflurane, using a spectral analysis of the RR intervals. The parasympathic inhibition by atropine did not prevent RE's negative chronotropic effect.

A-1379 ÿTotal Intravenous Anesthesia Using Propofol and Remifentanil Compared to Balanced Anesthesia Using Sevoflurane and Remifentanil in Ambulatory and Inpatient Pediatric Surgery. Sven Albrecht, MD; Joachim Schmidt, MD; Birgit Fritsch, MD; Joerg Fechner, MD Department of Anesthesiology, University of Erlangen, Erlangen, Germany.

Summary: In this study we compared total intravenous anesthesia using propofol and remifentanil with balanced anesthesia using sevoflurane and remifentanil for ambulatory and inpatient surgery in 120 children aged 6 months to 16 years.

A-1380 ÿAnesthetic Complications of Mediastinal Masses Associated with Childhood Malignancies. Doralina L. Anghelescu, MD; Alberto J. de Armendi, MD, MA, MBA; John T. Sandlund, MD; Tiebin Liu, MS; Chin-Shang Li, PhD, Division of Anesthesia, St. Jude Children's Research Hospital, Memphis, Tennessee, United States.

Summary: In one hundred and nineteen (119) patients with mediastinal masses the complication rate was 12.8%. Clinical and diagnostic imaging factors with prognostic value for anesthesia complications were: tracheal compression; mainstem bronchus compression, facial edema and venous engorgement

A-1382 ÿEndotracheal Intubation without Neuromuscular Blockade - A Comparision of Remifentanil Infusion Versus Alfentanil Bolus in Pediatric Anesthesia. Victor A. Francis, FCARCSI; Monica S. Chawathe, FRCA; Tazin F. Zatman, FRCA; Isabella M. Auguilera, FRCA; John Mecklenburgh, PhD, Anaesthetics, University Hospital of Wales, Cardiff, Wales, United Kingdom.

Summary: This study compared remifentanil infusion and alfentanil bolus for intubation conditions in children. There was no difference between the groups and none had a symptomatic bradycardia.

A-1383 ÿEvaluation of Oral Transmucosal Ketamine (Lollipop) Premedication in Children: A Comparison with Oral Midazolam. Toshinori Horiuchi, MD; Masahiko Kawaguchi, MD; Koukichi Kurehara, MD; Yoshitaka Kawaraguchi, MD; Hitoshi Furuya, MD, Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan.

Summary: Oral transmucosal ketamine (lollipop) premedication is easy and harmless, but may provide no benefits over oral midazolam in regard to the induction of anesthesia in children.

A-1384 ÿDroperidol for Perioperative Sedation Causes a Transient Prolongation of the QTc Time in Children during Cardiac Surgery. Eckehard A.E. Stuth, MD; Astrid G. Stucke, MD; Joseph A. Cava, MD, PhD; George M. Hoffman, MD; Richard J. Berens, MD, Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Summary: Droperidol causes a significant but transient elevation in QTc time in children during cardiac surgery. The Bazett formula compared to the Friderici correction tends to overestimate QTc at higher heart rates and may exaggerate arrhythmia risks in children.

A-1385 ÿMyocardial Performance Index with Sevoflurane vs. Fentanyl/Midazolam in Infants with a Single Systemic Ventricle. Dean B. Andropoulos, MD; Stuart R. Hall, MD; Catherine M. Ikemba, MD; Benjamin W. Eidem, MD; Stephen A. Stayer, MD, Division of Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.

Summary: Myocardial performance index (MPI), derived echocardiographically, was studied in 18 infants with single systemic ventricle randomized to sevoflurane (S) or fentanyl/midazolam (FM) anesthesia. MPI was unchanged with FM, but may worsen with S.

A-1386 ÿNear Infrared Oximetry (NIRS) Allows Noninvasive Assessment of Regional Oxygenation during Pediatric Coarctation Repair. Richard J. Berens, MD; George M. Hoffman, MD; Fred A. Robertson, MD; Todd J. Troshynski, MD; Eckehard A. Stuth, MD, Anesthesiology and Pediatrics, Med College Wisconsin/Children's Hospital Wisconsin, Milwaukee, Wisconsin.

Summary: NIRS demonstrates predictable trend changes in head and renal perfusion during repair of coarctation of the aorta.

A-1387 ÿHemodynamic Comparison of Sevoflurane, Desflurane and Isoflurane, using a Transoesophageal Doppler in Children. R. Briot, MD; D. Anglade, MD, PhD; J.F. Payen, PhD, MD; C. Jacquot, MD, Dept Anesthesie-Reanimation, CHU, Grenoble, France.

Summary: The transesophageal doppler Dynemo 3000 allows measurement of pre ejection period (PEP) to left ventricular ejection time (LVET) ratio, an index of cardiac contractility. 30 children were randomized in 3 groups. Increasing gas concentrations impaired PEP/LVET ratio with no differences between the 3 agents.

A-1388 ÿUsefulness of Continuous Systemic Venous Hemoglobin Saturation Monitoring for High-Risk Neonate with Congenital Heart Disease. Mamoru Kadosaki, MD; Takae Kawamura, MD; Kotaro Oyama, MD; Shin Takahasi, MD; Naohisa Mori, MD, Anesthesiology and Pediatric Cardiology, Iwate Medical University Memorial Heart Center, Morioka, Iwate, Japan.

Summary: The on-line monitoring of SvO2 would be useful as indicator of circulatory status in both groups of univentricle and biventricle heart.

A-1389 ÿCyanotic Neonates and Infants before Cardiac Surgery Show Compensatory Decreased Hemoglobin-Oxygen Affinity with Age. Sarah Khan, MD; Ann F. Tuxbury, MD; James A. DiNardo, MD; John M. Watkins-Pitchford, MD, FRCA, Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.

Summary: A novel computer analysis of venous blood gas results from cyanotic neonates and infants before cardiac surgery shows a progressive compensatory reduction in hemoglobin-oxygen affinity with age. The effect is independent of acid-base shifts of the hemoglobin dissociation curve.

A-1390 ÿChanges in Bispectral IndexT (BIST) during Hypothermia and Cardiopulmonary Bypass in the Neonate and Infant. Barry D. Kussman, MBBCh; David Zurakowski, PhD; Lorna Sullivan, RN; Peter J. Davis, MD; Peter C. Laussen, MBBS, Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Boston, Massachusetts.

ummary: Bispectral indexT (BIST) values in neonates and infants during cardiac surgery were in the range of adult values associated with deep levels of hypnosis. Temperature does influence the BIST, but the magnitude of change in BIST with temperature cannot be predicted for the individual patient.

A-1391 ÿPort Access Cardiac Surgery in a Pediatric Population Is a Valid Option. Sergey Preisman, MD; David Mishali, MD; Ilan Keidan, MD; Azriel Perel, MD, Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.

Summary: The Port Access method for the correction of heart defects is feasible in the pediatric population, and provides good results without the compromise of patient's safety. Its successful implementation demands anesthesiologist's expertise in the performance of TEE in children and excellent communication with the surgical team.

A-1392 ÿCerebral Oxygen Saturation Monitoring Is a Useful Adjunct in Assessing Adequacy of Systemic Perfusion in Single Ventricle Physiology after Neonatal Cardiac Surgery. Steven R. Tosone, MD; Bruce E. Miller, MD; Nina A. Guzzetta, MD; Kirk R. Kanter, MD; Joseph M. Forbess, MD, Departments of Anesthesiology and Cardiothoracic Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States.

Summary: We used near infrared spectroscopy monitoring to estimate the adequacy of systemic perfusion in neonates after stage I Norwood palliation of hypoplastic left heart syndrome.

A-1393 ÿTwo-Site Near-Infrared Transcutaneous Oximetry as a Non-Invasive Indicator of Mixed Venous Oxygen Saturation in Cardiac Neonates. George M. Hoffman, MD; Eckehard A. Stuth, MD; Richard J. Berens, MD; Frederick A. Robertson, MD; Todd J. Troshynski, MD, Pediatric Anesthesiology and Critical Care Medicine, Children's Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin.

Summary: Non-invasive tissue saturation monitoring with cerebral and T10-L2 probe sites, reflecting regional beds under different circulatory controls, can supplement and enhance agreement with invasive global measures such as SvO2.

A-1394 ÿManagement of Pulmonary Hypertension after Congenital Heart Surgery. Mamoru Takeuchi, MD, PhD; Tatsuo Iwasaki, MD; Naoyuki Taga, MD, PhD; Katsunori Oe, MD, PhD; Kiyoshi Morita, MD, PhD, Dept. of Anesthesiology and Resuscitology, Okayama University Medical School, Okayama, Okayama Pref., Japan.

Summary: Between January 1991 and February 2003, 676 patients with PH underwent congenital heart surgery in our hospital. There were only 9 early (1.3%) and 14 late death (2.1%). Most of the patients with PH after repair can be controlled by mild hyperventilation and massive vasodilative therapy without nitric oxide.

A-1395 ÿDosing Heparin in Pediatric Patients Undergoing Cardiopulmonary Bypass and the role of Antithrombin III. David A. Rosen, MD; Kathleen R. Rosen, MD; Elizabeth R. Nelson, MPH.; Kelly C. Gustafson, RN; Robert A. Gustafson, MD, Anesthesia, Pediatrics and Surgery, West Virginia Children's Hospital West Virginia University, Morgantown, West Virginia.

Summary: Two different heparin management strategies were evaluated in children: heparin dose response (HDR) and heparin titration test (HTT). 20% had an abnormal level. There were no diiferences between the HDR and HTT technique. Antithrombin III was able to lower an elevated level.

A-1396 ÿImpact of Age on Bispectral IndexT at 1MAC of Sevoflurane. Eric Wodey, MD, PhD; Olivier Tirel, MD; Charles Chanavaz, MD; Jean Yves Bansard, PhD; Lotfi Senhadji, PhD, SAR2, CHU Pontchaillou University Rennes 1, Rennes, France.

Summary: The aim of this study was to evaluate the potential relationship between the age of children and the BiSpectral IndexT using a multiple correspondence analysis. The EEG bispectrum as well as the BIST index (Aspect XPT) measured at 1 MAC of Sevoflurane appear to be strongly related to age of the children.

A-1397 ÿUnrecognized Imposed Resistive Work of Breathing (WOBi) Results in Inadequate Levels of Pressure Support Ventilation (PSV) in Pediatric Patients with Respiratory Failure. B. Craig Weldon, MD; Rogelio H. dela Cruz, MD; Michael J. Banner, PhD, Anesthesiology and Pediatrics, University of Florida, Gainesville, Florida, United States.

Summary: Children may not receive adequate pressure support ventilation when airway pressures are measured at the circuit Y-piece (PY). This is due to an underestimation of imposed resistive work of breathing by PY compared to intratracheal pressure measurements.

These posters/posterdiscussions represented 38 scientific abstracts that provided a challenge to those trying to interact with the presenters in the all-too-short time provided. If one word could be used to describe the morning, IMPRESSIVE, comes to mind.

Table of Contents

• President's Message
• Editor's Corner
• Joint Meeting of SPA and JSPA
• Out and About the ASA
  • Pediatric Clinical Forum at ASA
  • Pediatric Panel: Pediatric Pain Management
  • Controversies in Malignant Hyperthermia, Cases from the MH Hotline
  • American Academy of Pediatrics Secion on Anesthesiology Breakfast Panel
  • Tuesday Morning general Pediatric Anesthesia Poster Discussions and Poster Sessions of General Pediatric and Pediatric Cardiac Anesthesia
• American Academy of Pediatrics Section on Anesthesia and Pain Medicine Update
• Fellows Corner
  • Non-ACGME Approved Fellowship Training Programs for Pediatric Anesthesia
• WEB ONLY
  • SPA Governmental Affairs Committee Report
  • Literature Review: Hyperkalemia and Pyloric Stenosis
  • Literature Review: Early Exposure to Common Anesthetic Agents Causes Widespread Neurodegeneration in the Developing Rat Brain and Persistent Learning Deficits
  • Laryngeal mask insertion in children: a rational approach
  • Remifentanil Infusion for Cleft Palate Surgery in Young Infants
  • Tuesday Morning General Pediatric Anesthesia Poster Discussions and Poster Sessions of General Pediatric and Pediatric Cardiac Anesthesia

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