Administering pediatric patients codeine for pain following adenotonsillectomy surgeries for sleep apnea can cause fatal complications, reports a group of Canadian physicians.

In a letter to the editor appearing in the Aug. 20 issue of the New England Journal of Medicine, Gideon Koren, MD, and other researchers describe the case of a 2-year-old boy who underwent an elective, outpatient tonsillectomy to treat sleep apnea.

The boy was discharged under instructions to be given 10mg to 12.5mg of codeine and 120mg of acetaminophen syrup every 4 to 6 hours. On the second evening after surgery, the boy was feverish and wheezing. The next morning, his mother found him dead.

An autopsy and toxicology tests showed that the his mother had administered the prescribed amounts of the drugs, but that the boy had metabolized the codeine very quickly, according to the reports.

Codeine after a sleep-apnea tonsillectomy is cause for concern because in about one-third of cases, the apnea continues after surgery, say the physicians. "If the apnea doesn't go away, codeine will also suppress the child's breathing," says Dr. Koren in a press release. He advises careful post-op observation.

Kent Steinriede

Engineers at MIT and Cambridge University have created a tissue scaffold that promotes bone and cartilage growth when implanted in joints, a development they say offers innovative treatment options for sports injuries and arthritis.

The scaffold stimulates mesenchymal stem cells in the bone marrow, which gradually produces new bone and cartilage. It could be a more effective, less expensive and less painful way to treat cartilage injuries, says Lorna Gibson, co-leader of the research team at Cambridge University. "If someone had a damaged region in the cartilage, you could remove the cartilage and the bone below it and put our scaffold in the hole," she explains.

Traditionally, cartilage injury treatment involves drilling small holes through existing cartilage into the joint's bone to stimulate the release of stem cells; transplanting cartilage and bone from other areas of the joint; or removing cartilage from the body, stimulating its growth in the lab and re-implanting it in the damaged joint.

The tissue scaffolds, having been proven effective in goats' knees during a 16-week study, have been licensed to Orthomimetics, a British company that will soon start clinical trials in Europe, says MIT.

Meanwhile, researchers at the Hospital for Special Surgery in New York City are investigating the effectiveness of Smith & Nephew's TruFit plug in treating primary cartilage defects. The plugs are cleared for use to fill some voids or gaps in bone but not for cartilage repair, according to a report in The New York Times. Riley J. Williams III, MD, director of the hospital's Institute for Cartilage Repair, successfully used the plugs to repair knee cartilage in about 250 patients.

"I'm very pleased with the clinical results," he told the Times. "It's a less traumatic surgery and you are not damaging the other areas of the knee" by removing cartilage.

Daniel Cook

An anesthesiologist who pioneered the use of a lipid solution as an antidote for cardiac arrest incidents sparked by local anesthetic toxicity is warning that epinephrine may hinder such rescue efforts, and may impact emergency cardiac care in general.

Guy L. Weinberg, MD, of the University of Illinois at Chicago, has been studying for 5 years the use of lipid emulsion infusion in reversing cardiac events resulting from the rare but potentially fatal complications some patients suffer when administered regional anesthesia or nerve blocks.

In a study to be published in September's issue of the journal Anesthesiology, however, he reports that administering high doses of epinephrine during such an incident has been found to impair the lipid mixture's effectiveness in animal test subjects. In fact, epinephrine's complications present themselves minutes after it is administered and after the patient's blood pressure initially returns.

"These findings suggest that repeated, high doses of epinephrine can impair recovery of cardiac function during resuscitation," says Dr. Weinberg in a press release. "Though our findings are specific to local anesthetic-induced cardiac arrest, the adverse affects of epinephrine should be examined more generally for the drug's overall potential to impede recovery from other causes of cardiac arrest."

David Bernard

Good news: Outpatient Surgery Magazine is extending the deadline for receiving the $100 pre-registration discount for its OR Excellence conference to Aug. 31. "With the recently reduced hotel rates of just $199 per night, and the special airfares that many U.S. airlines are offering, we decided to give our readers additional time to take advantage of these great cost savings," says Stan Herrin, Outpatient Surgery's publisher.

In addition to the discount, those registering by Aug. 31 can also ensure that they'll secure accommodations at the San Francisco Hilton, the center of the conference's activities, and also reserve their spot on our spectacular dinner cruise.

No other meeting provides an ROI quite like OR Excellence. Every course is full of rock-solid, innovative ideas that attendees can put into practice the day they get home. These ideas - on attracting more cases, cutting costs, protecting their facilities from costly liability claims, and much more - can potentially earn or save their centers hundreds of thousands of dollars. With the average total cost of attending OR Excellence at $1,979 until Aug. 31, the benefits far outstrip the expense.

To review the full program and syllabus, as well as a free white paper on justifying the cost of attending the conference, visit the OR Excellence Web site or call 1 (888) YOUR-ORX.

Five months ago, nearly 6 out of 10 readers told us that they blamed the economy for their sagging surgical volumes. What about now? Have things gotten better? Or (gulp) worse? Go to our Web site to take this week's InstaPoll and to view real-time results. We'll report the results in this space next week.

Two-thirds (66%) of the 137 readers who answered last week's InstaPoll on physician ownership of hospitals and ASCs disagreed with the opinion that such ownership creates financial conflicts of interest and leads to over-ordering of tests and procedures.

Dan O'Connor