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Introduction: Deep sedation using propofol has become a standard technique in children. This double-blinded randomized clinical trial aims to compare the clinical effects of propofol-mono-sedation vs a combination of propofol and ketamine at induction and a reduced propofol infusion rate for maintenance in children undergoing diagnostic magnetic resonance imaging. Methods: Children aged from 3 months to 10 years scheduled as outpatients for elective magnetic resonance imaging with deep sedation were included. They were randomized into 2 groups, receiving either 1 mg/kg ketamine at induction, then a propofol infusion rate of 5 mg/kg/h or a propofol infusion rate of 10 mg/kg/h without prior ketamine. Time to full recovery (modified Aldrete score = 10) was the primary outcome. Further outcomes were quality of induction, immobilization during image acquisition, recovery, postoperative nausea and vomiting, emergence delirium using the Pediatric Anesthesia Emergence Delirium scale, vital signs and adverse cardiorespiratory events. All patients and parents as well as anesthetists, imaging technicians, and postsedation personnel were blinded. Data are given as median (range). Results: In total, 347 children aged 4.0 (0.25-10.9) years, weighing 15.6 (5.3-54) kg, ASA classification I, II, or III (141/188/18) were included. The ketamine-propofol group showed significantly shorter recovery times (38 (22-65) vs 54 (37-77) minutes; median difference 14 (95% CI: 8, 20) minutes; P < .001), better quality of induction, and higher blood pressure, but higher incidence of movement requiring additional sedative drugs. There were no significant differences in respiratory side effects, cardiovascular compromise, emergence delirium, or postoperative nausea and vomiting. Conclusion: Both sedation concepts proved to be reliable with a low incidence of side effects. Ketamine at induction with a reduced propofol infusion rate leads to faster postanesthetic recovery. [ABSTRACT FROM AUTHOR]

Background: Emergency situations and conditions with impaired gastric emptying enhance the risk of perioperative pulmonary aspiration due to increased residual gastric contents volume (GCV). Gastric ultrasonographic (US) measurement of the gastric antral cross-sectional area (CSA) has been proposed to estimate preanesthetic GCV. However, only few healthy children and fasted pediatric patients have been investigated so far, predicting GCV with considerable imprecision. This study aimed to compare GCV assessed by US in different patient positions for measuring CSA, using magnetic resonance imaging (MRI) as reference, and to evaluate its potential as diagnostic test. Methods: Healthy volunteer children were examined in a crossover design on 2 days. After baseline examination, they received a light breakfast, followed by 7 ml·kg-1 clear fluid after 2 or 4 h. Gastric emptying was examined with MRI over 4 or 6 h, respectively. US was performed immediately after MRI in right lateral decubital (RLD) and supine with upper body elevated (SUBE) positions. Correlation coefficients (Pearson R; 95%CI) between CSA and body weight corrected GCV (GCVw) as determined by MRI volumetry were calculated. Data are presented as median (range). Results: Eighteen children aged 9.8 (6.8-12.2) years had 72 US examinations completed. CSA was 401 (101-1311) mm² and 271 (118-582) mm², and R between CSA and GCVw was 0.76 (0.76-1) and 0.57 (0.41-0.88) for the RLD and SUBE positions, respectively. The corresponding GCVw was 2.1 (0.1-13.8) ml·kg-1. A linear regression model from RLD was similar to one previously derived. Bland-Altman analysis and ROC plots are presented. Conclusion: CSA correlated with GCVw in healthy children over a wide range of gastric filling, with the RLD position clearly superior to the SUBE position, confirming a previously derived formula. Although direct calculation of GCVw is imprecise, this technique has the potential to become a diagnostic risk assessment test. [ABSTRACT FROM AUTHOR]

Purpose The aim of this article is to examine the mutual associations between patients' and partners' depression and quality of life (QOL) in couples facing cancer with respect to potential resources (sense of coherence and relationship quality (RQ)) and stressors (physical complaints). Patients and Methods Questionnaires rating depression, QOL, sense of coherence, RQ, and physical complaints were completed by 207 couples facing different cancer types and stages. Multiple regression models were used to assess the mutual associations between patient and partner variables. Results In female patients, 40.7% of the variance in depression score was explained by male partners' stressors and resources, whereas only 3.5% of the variance in male patients' depression was explained by female partners' stressors and resources. In male and female partners, respectively, the patients' stressors and resources explained 34.9% versus just 15.8% of the variance in depression. Regarding QOL in female patients, 30.1% of the variance was explained by the partners' stressors and resources, versus only 3.7% in male patients. Meanwhile, in male and female partners, respectively, the patients' stressors and resources explained 25.6% and 12.9% of the variance in QOL. Conclusions These findings support a couples-centered approach to psycho-oncological counseling and treatment. Particularly in depressed couples with low RQ, couples therapy or counseling should be considered because of the mutual adverse association between depression and QOL in these couples. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim A rating scale for thirst and hunger was evaluated as a noninvasive, simple and commonly available tool to estimate preanesthetic gastric volume, a surrogate parameter for the risk of perioperative pulmonary aspiration, in healthy volunteer school age children. Method Numeric scales with scores from 0 to 10 combined with smileys to rate thirst and hunger were analyzed and compared with residual gastric volumes as measured by magnetic resonance imaging and fasting times in three settings: before and for 2 h after drinking clear fluid (group A, 7 ml/kg), before and for 4 vs 6 h after a light breakfast followed by clear fluid (7 ml/kg) after 2 vs 4 h (crossover, group B), and before and for 1 h after drinking clear fluid (crossover, group C, 7 vs 3 ml/kg). Results In 30 children aged 6.4-12.8 (median 9.8) years, participating on 1-5 (median two) study days, 496 sets of scores and gastric volumes were determined. Large inter- and intra-individual variations were seen at baseline and in response to fluid and food intake. Significant correlations were found between hunger and thirst ratings in all groups, with children generally being more hungry than thirsty. Correlations between scores and duration of fasting or gastric residual volumes were poor to moderate. Receiver operating characteristic ( ROC) analysis revealed that thirst and hunger rating scales cannot predict gastric content. Conclusion Hunger and thirst scores vary considerably inter- and intra-individually and cannot predict gastric volume, nor do they correlate with fasting times in school age children. [ABSTRACT FROM AUTHOR]

Summary Background: Cross-sectional gastric antral area (GAA) measurements by ultrasonography (US) have been proposed for preoperative assessment of gastric volume in adults but not been validated in children. This study investigates whether in children gastric volumes can be predicted by US performed in different patient positions. Method: Gastric fluid and air volumes were examined by magnetic resonance imaging before or up to 120 min after ingestion of 7 ml·kg−1 diluted raspberry syrup in healthy volunteers who had fasted overnight. GAA was measured with US three times each in supine (SUP), elevated 45° degree supine (E45) and right decubital (RDC) position using imaging planes defined by vascular landmarks. Correlation coefficients (Pearson) between GAA and gastric volumes were calculated and Bland-Altman analysis performed. Results: Sixteen children aged from 6.4 to 12.8 (9.2) years were included in 23 examinations: 6 after overnight fasting, 3 directly after, and 14 with a delay of 74 ± 35 min after fluid intake. GAA was 221 ± 116, 218 ± 112, and 347 ± 188 mm2 for SUP, E45, and RDC position, respectively. The best correlation between body weight corrected total gastric/gastric fluid volume (TGVw/GFVw) with GAA was found for RDC position ( R = 0.79; P < 0.01/ R = 0.78; P < 0.01). Bias and precision of calculated and measured GFVw was 0 ± 2.8 ml·kg−1. Conclusion: Correlations between GAA and TGVw or GFVw in children are best in the RDC position, but not sufficient to predict GFVw with a given GAA. Interpretation of isolated GAA values may be misleading. [ABSTRACT FROM AUTHOR]

Objectives. Lung recipients undergo a complex psychological process, including organ integration and processing of attitudes towards the organ donor. Design. Seventy-six lung recipients were asked to participate in a cross-sectional questionnaire study on the psychological processing of lung transplants. Methods. The questionnaire consisted of statements describing aspects of organ integration and the patient's relationship with the donor. Furthermore, chronic stress/psychological distress (Screening Scale of the Trier Inventory; Symptom Checklist SCL-K-9) and the emotional effects of transplantation/immunosuppression (Transplant Effects Questionnaire; Medication Experience Scale for immunosuppressants) were assessed. Results. In general, lung recipients perceive the transplant as part of themselves (97.4%) and not as a foreign object (90%). One-third of patients still have frequent thoughts about the donor, whilst the majority (80.3%) do not believe that they have adopted the donor's characteristic traits. Factor analysis reveals the two-dimensional structure of the questionnaire items 'organ integration' (factor 1) and 'relationship to the donor' (factor 2). Poor organ integration predicts low adherence, low disclosure and high feelings of guilt, whilst a close donor relationship predicts chronic stress and psychological distress. Conclusions. Poor organ integration and a close relationship to the donor should be borne in mind in psychosocial treatment regarding the patient's adherence behaviour and psychological distress. [ABSTRACT FROM AUTHOR]

Presents a study that explored the comorbidity of obsessive-compulsive disorders (OCD) and eating disorders (ED). Relationship between OCD comorbidity and the duration of ED; Examination of the prevalence rate for OCD; Comparison on the prevalence of OCD in patients with anorexia nervosa and those with bulimia nervosa.