Wait two weeks before performing elective surgery on children presenting with recent symptoms of an upper respiratory infection, say the authors of a study published in the November 2007 issue of the journal Anesthesiology. The research suggests that the two-week delay reduces the likelihood of adverse respiratory events in patients intubated with a laryngeal mask airway, the standard alternative to tracheal intubation in children with URI.

"The anesthetic care of a patient with an upper respiratory tract infection who is to undergo surgery is a somewhat controversial and ambiguous issue," says Samuel H. Ward, MD, associate clinical professor of anesthesiology at UCLA. "Patients who have a URI may be at higher risk for airway-related complications during and after receiving anesthesia. There is a great debate about how long to wait after the URI to schedule surgery and if elective surgery should be cancelled because of a URI."

The researchers surveyed 831 children scheduled to undergo general anesthesia with an LMA to determine each child's potential symptoms of URI. Perioperative incidents of adverse respiratory events were then recorded, including laryngospasm, bronchospasm, coughing, airway obstruction and oxygen desaturation. The researchers discovered that adverse events doubled in the 27 percent of children who presented for surgery with URI symptoms that were less than two weeks old. Incidents of adverse respiratory events were higher in children undergoing ENT surgery and during cases that involved multiple attempts to insert the LMA, according to the study.

While the occurrence of adverse respiratory events associated with LMA use was low and the complications were easily managed, the study's authors conclude that anesthesia management "with the use of LMA in children more than two weeks after a URI is a safe technique and seems to be a suitable time interval for elective surgery."

A California hospital has been fined $25,000 because it didn't have proper written policies and procedures in place regarding the use of the PONV drug droperidol.

Garden Grove Hospital in Orange County, Calif., was one of nine California facilities fined by the state's Department of Public Health pursuant to a law that took effect Jan. 1, 2007. The law calls for fines of up to $25,000 for health and safety violations that put patients at risk.

Since 2001, droperidol has had an FDA "black box" warning over concerns that the tranquilizer can contribute to fatal heart rhythm abnormalities at doses of more than 25mg.

Hospital pharmacy and staff were unaware of the black box warning and didn't perform proper cardiac monitoring for patients before and after dosage, according to an account published in the Orange County Register.

A Garden Grove Hospital anesthesiologist reportedly used droperidol while performing a rapid detox method that involves cleansing the opiate receptors in the patient's brain of the narcotics while the patient is under anesthesia. The day after the original citation, the hospital stopped using droperidol as an anti-nausea medication.

Uvulopalatopharyngoplasty (UPPP), the surgical removal of unnecessary palatal and oropharyngeal tissue, can reduce the amount of time that patients need to use continuous positive airway pressure or even eliminate the need for its use, according to a study presented at the American College of Chest Physicians' annual meeting last week.

Researchers from the University of Florida - Jacksonville looked at how well the procedure worked for 63 obstructive sleep apnea patients between the ages of 18 and 80 who underwent UPPP. Over the seven-year study period, the apnea effectively ceased in approximately one-third of the patients. Those who experienced residual apnea and required continued use of CPAP set the machine at a lower setting, the study noted. The researchers also found that UPPP reduced the mean apnea-hyponea index, a measurement of the number of times a patient stops breathing per hour, and was associated with improvements in oxygen levels and other sleep parameters.

Although UPPP is most frequently performed in inpatient facilities where a patient can be observed during an overnight stay, it's possible to be done safely and effectively in an ambulatory setting. According to a study published in the April 2006 issue of Otolaryngology - Head and Neck Surgery, outpatient UPPP is safe if patients are carefully screened for co-morbidities, most notably cardiopulmonary issues or apnea-related arrhythmias, which would restrict them from the outpatient procedure.