PubMed Health⌕ Search

Biomedical subjects

Scott D Cook-Sather

Publications and source records attributed to Scott D Cook-Sather.

7 recordsLinked to original sources
PubMed2006

Modern fasting guidelines in children.

Pediatric fasting guidelines are intended to reduce the risk of pulmonary aspiration of gastric contents and facilitate the safe and efficient conduct of anesthesia. Recent changes in these guidelines, while assuring appropriate levels of patient safety, have been directed at improving the overall perioperative experience for infants, children, and their parents. Now after nearly 15 years of practice worldwide, the relative safety and benefits of allowing clear liquids up to 2 hr prior to anesthesia for otherwise healthy children are well established. Shortened fasting periods for breast milk (3 hr), formula (4 hr) and light meals (6 hr) are supported by accumulated experience and an evolving literature that includes evidence of minimal gastric fluid volumes (GFVs) at the time of surgery. Ideal fasting intervals for children with disorders that may affect gastrointestinal transit have yet to be determined.

Child↗
PubMed2006

Neurophysiological monitoring under anesthesia to position a child with extreme lumbar spine flexion for MRI and CT scan.

A novel application of neurophysiological monitoring enabled us safely to anesthetize and position a child with severe lumbosacral spine flexion for diagnostic MRI and CT scan. We conducted a propofol-based anesthetic to optimize somatosensory (SSEP) and transcranial electric motor (tceMEP) evoked potential amplitudes, thereby facilitating dynamic neurological monitoring while fully extending the patient supine. In cases outside the operating room involving extraordinary changes in patient position, anesthesia providers may consider utilizing neurophysiological monitoring.

Adolescent↗
PubMed2005

Inadvertent extra-epidural catheter placement in an infant.

We report the inadvertent passage of an epidural catheter threaded from the caudal space out of a lumbar intervertebral foramen and into the lower thoracic paravertebral space in an infant. We identified the errant catheter by radiography and removed it without sequelae.

Anesthesia, Epidural↗
PubMed2003

A liberalized fasting guideline for formula-fed infants does not increase average gastric fluid volume before elective surgery.

UNLABELLED: Recommended preoperative fasting intervals for infant formula vary from 4 to 8 h. We conducted a prospective, randomized, observer-blinded trial of 97 ASA physical status I and II infants scheduled for elective surgery to determine whether average gastric fluid volume (GFV) recovered from infants formula-fasted for 4 h (liberalized fast, Group L) differed from that recovered from infants allowed clear liquids up until 2 h, but fasted 8 h for formula and solids (traditional fast, Group T). In Group L, 31 of 39 subjects followed protocol and ingested formula 4-6 h before surgery. In Group T, 36 of 58 subjects followed protocol, taking clear liquids 2-5 h before the induction of anesthesia. Thirty subjects had prolonged fasts and were included only in a secondary intent-to-treat analysis. Respective mean age (5.7 +/- 2.3 versus 6.4 +/- 2.4 mo; range, 0.7-10.5 mo), weight (7.5 +/- 1.8 versus 7.5 +/- 1.1 kg), and volume of last feed (4.9 +/- 2.2 versus 4.0 +/- 2.3 oz.) did not vary between Groups L and T. GFV (L: 0.19 +/- 0.38 versus T: 0.16 +/- 0.30 mL/kg) and gastric fluid pH (L: 2.5 +/- 0.5 versus T: 2.9 +/- 1.3) did not vary. For all subjects, GFV (mL/kg) increased with age (Spearman correlation coefficient = +0.23, P = 0.03). Infant irritability and hunger and parent satisfaction were similar between groups. We conclude that average GFV after either a 4- to 6-h fast for infant formula or 2-h fast after clear liquids is small and not significantly different between groups. On the basis of these findings, clinicians may consider liberalizing formula feedings to 4 h before surgery in selected infants. IMPLICATIONS: Healthy infants aged < or =10.5 mo may drink formula up to 4 h before surgery without increasing gastric fluid volume compared with infants allowed clear liquids up to 2 h and formula 8 h before surgery.

Affect↗
PubMed2002

Cisapride does not prevent postoperative vomiting in children.

UNLABELLED: The peripherally acting prokinetic drug cisapride can overcome opioid-induced gastrointestinal paresis and may thereby eliminate a stimulus for postoperative vomiting. We conducted a prospective, randomized, double-blinded, controlled trial of 96 children undergoing inguinal surgery to determine whether cisapride would reduce the incidence of postoperative vomiting after general anesthesia supplemented with morphine. Group C1 patients (n = 38) received cisapride 0.3 mg/kg orally 1 h before surgery and placebo 6 h later, Group C2 (n = 28) received cisapride both before and after surgery, and Group P (n = 30) received placebo. Mean age (5.0 +/- 2.7 yr) and weight (21.0 +/- 8.6 kg), median pain scores and parent satisfaction scores, and incidence of rescue analgesic administration were similar across groups. Contrary to our hypothesis, incidences of postoperative vomiting in the hospital (32% vs 20%, P = 0.33) and at home (53% vs 46%, P = 0.33) did not vary by treatment group (with [C1 and C2] and without [P] cisapride, respectively). There was a trend toward more severe postoperative vomiting (three or more episodes) in children who received cisapride versus those who did not, both in hospital (6% vs 0%, P = 0.3) and at home (22% vs 8%) (P = 0.13). We conclude that cisapride does not prevent postoperative vomiting in this patient population and speculate that factors other than reduced gastrointestinal motility associated with general anesthesia and opioids are more important determinants of postoperative vomiting. IMPLICATIONS: Cisapride does not prevent postoperative vomiting in children and may increase its severity.

Antiemetics↗