Biomedical subjects

Jayant K Deshpande

Publications and source records attributed to Jayant K Deshpande.

7 recordsLinked to original sources

PubMed2006

Isoflurane therapy for severe refractory status asthmaticus in children.

OBJECTIVE: To describe the use of inhaled isoflurane in a series of children with life-threatening asthma. DESIGN: Retrospective case series. SETTING: Pediatric intensive care unit of a tertiary-care children's hospital. Ten children ranging in age from 1 to 16 years with 11 episodes of severe asthma requiring invasive mechanical ventilation in the pediatric intensive care unit over a 5-year period. RESULTS: Isoflurane resulted in an improvement in arterial pH and a reduction in partial pressure of arterial carbon dioxide (PaCO(2)) in all the 11 instances. This effect was sustained in 10 cases and led to clinical improvement and rapid weaning from mechanical ventilation. One child failed to show sustained response and was placed on veno-venous extracorporeal membrane oxygenation. One child died secondary to anoxic brain injury sustained prior to hospitalization. Hypotension was the major side effect, and occurred in 8 children necessitating vasopressor support. CONCLUSIONS: Isoflurane improves arterial pH and reduces partial pressure of arterial carbon dioxide in mechanically ventilated children with life-threatening status asthmaticus who are not responsive to conventional management.

Adolescent↗

PubMed2006

Tailoring the Institute for Health Care Improvement 100,000 Lives Campaign to pediatric settings: the example of ventilator-associated pneumonia.

In December 2004, the Institute for Healthcare Improvement launched a campaign to save 100,000 lives by implementing evidence-based interventions in six areas, five of which are relevant to children. Working collaboratively, the Child Health Corporation of America, National Associate of Children's Hospitals and Related Institutions, and National Initiative for Children's Health Care Quality provided a series of Web-enabled seminars on how the campaign initiatives might be adapted for pediatric settings. Ventilator-associated pneumonia (VAP) is an example of how interventions based on evidence in adult settings may need to be tailored in pediatric settings. The authors describe how assessing and implementing parts of the VAP bundle led to reduction in VAP in two children's hospitals.

Adolescent↗

PubMed2006

Prospective, longitudinal evaluation of health related quality of life in the pediatric spina bifida population undergoing reconstructive urological surgery.

PURPOSE: Spina bifida, the most frequent permanently debilitating birth defect, results in major urological problems of voluntary bladder control and bowel function, which may impair quality of life. We prospectively assessed quality of life in patients with spina bifida using child and parent reports simultaneously. This study had 3 goals, that is to 1) document baseline health related quality of life in patients with spina bifida preoperatively, 2) study health related quality of life, reporting differences between parents and children, and 3) study changes in health related quality of life prospectively at preoperative and postoperative intervals. MATERIALS AND METHODS: Patients with spina bifida who were 2 to 18 years old and required reconstructive urological surgery in 2004 were included in the study. Demographic survey and the validated PedsQL 4.0 health related quality of life questionnaire were used preoperatively and postoperatively. A clinical outcomes data set was completed after the clinician saw the patient. PedsQL 4.0 subscales were scored using the algorithms provided. RESULTS: The response rate was 100%. Mean participant age was 10.3 years. Preoperatively child physical and psychosocial health and school functioning were significantly higher than parent reports (p <0.001). Overall health related quality of life in patients with spina bifida was lower than in healthy children (62.4 vs 85, p <0.001). Six weeks postoperatively significant differences in health related quality of life reporting between parents and children had lowered. Six months postoperatively child emotional and social functioning scores were higher than parent scores (p <0.001). No correlation was found between health related quality of life, and clinical and demographic factors due to insufficient sample size. CONCLUSIONS: Children with spina bifida recorded higher health related quality of life scores than parents/guardians. This health related quality of life study addresses concerns that impact daily quality of life in patients with spina bifida. Future health related quality of life studies in patients with spina bifida should use child self-reports.

Adolescent↗

PubMed2005

Procedural sedation in the pediatric patient.

The demand for safe and effective procedural sedation for children is rapidly increasing because of the increased awareness about procedure-related anxiety even in young infants and children. The development of short-acting sedatives, improved monitoring, and new regulatory requirements have led to the evolution of new paradigms of safe, effective, and resource-efficient systems for providing procedural sedation outside the operating rooms by anesthesiologists and nonanesthesiologists.

Anesthesia↗

PubMed2005

Pediatric anesthesiology: thoughts on the future.

Pediatric anesthesiology has made a significant contribution to child health and will be necessary for progress in the health sciences and outcomes related to child health in the future. It is likely that the practice of pediatric anesthesiology will remain an interesting and rewarding but demanding profession for the next generations of physicians. Despite this favorable professional profile, stiff competition for resources will come from other segments of the health care community. This article outlines a multidimensional strategy for pediatric anesthesiology to sustain its progress as a profession and contribute to the health of our children.

Anesthesiology↗

PubMed2005

Improving timely surgical antibiotic prophylaxis redosing administration using computerized record prompts.

BACKGROUND: Timely prophylactic antibiotic administration aids in preventing postoperative superficial surgical site infections. However, during lengthy surgical procedures, redosing of prophylactic antibiotics may be unintentionally omitted. We assessed the utility of a computerized reminder as part of the anesthesia charting system to increase the rate of timely intraoperative prophylactic antibiotic redosing. METHODS: A retrospective observational analysis was performed on consecutive patients undergoing non-cardiac surgical procedures at a university-affiliated hospital prior to and after the institution of a computerized reminder system. The reminder system presented the clinician with a series of on-screen dialog boxes prior to the redose time for the specific prophylactic antibiotic administered preoperatively. Antibiotic redosing was defined as appropriate if it occurred within 30 min prior to or after the due time, calculated as twice the half-life of the specific antibiotic. Patients were excluded if the case duration was less than twice the half-life of the administered prophylactic antibiotic, or if no prophylactic antibiotic was given. RESULTS: A total of 287 cases were included in the study (148 pre-intervention, 139 post-intervention). Patient age, case length, and American Society of Anesthesiologists (ASA) score stratification did not differ between the groups. Use of the reminder system resulted in an increase in the appropriate redosing of antibiotics from 20% prior to institution of the reminder to 58% after institution (p < 0.001). CONCLUSIONS: A computerized reminder system is an effective tool to assist in appropriate intraoperative redosing of prophylactic antibiotics during lengthy surgical procedures.

Adult↗

PubMed2004

Do-not-resuscitate orders for pediatric patients who require anesthesia and surgery.

This clinical report addresses the topic of preexisting do-not-resuscitate (DNR) orders for children undergoing anesthesia and surgery. Pertinent issues addressed include the rights of children, surrogate decision-making, the process of informed consent, and the roles of surgeons and anesthesiologists. The reevaluation process of DNR orders called "required reconsideration" can be incorporated into the process of informed consent for surgery and anesthesia. Care should be taken to distinguish between goal-directed and procedure-directed approaches to DNR orders. By giving parents or other surrogates and clinicians the option of deciding from among full resuscitation, limitations based on procedures, or limitations based on goals, the child's needs are individualized and better served.

Anesthesia↗