I doubt there is a magic set of 20 words. And words alone are not enough.

My pre-op talk is tailored to each patient (based on their level of understanding and anxiety levels) and I think the manner is as important as the words themselves. Being calm, reassuring, and listening to their concerns are all as important as the content of what you say.

My personal practice is to allow solid food up to 4 hours prior to surgery in children, and water (only) up to 2 hours prior to sugery. This seems to be pretty standard where I work. When I did a locum in another hospital (another city and a non-pediatric institution), they seemed a bit alarmed. They insisted on 6 hours for all.

Any thoughts?

Our pre-admission clinic explicitly states to all patients not eat, drink, (even water or tea), chew gum. Parents are reminded to observe children in the pre-operative period to ensure the children are fasted.

This reminder is given verbally and in a printed flyer.

I disagree. The high concentrations during induction are unavoidable and unscavengable.

Once maintenance is achieved, the concentrations are lower, although the flow rates are still high. As long as you allow the bag to vent away from the surgeons and scrub staff's faces, the airconditioning will so rapidly dilute the gas that it cannot be smelled. And sevo is so pungent that we can smell minute quantities of it (try it - even 0.2% is easiliy detectable).

Unless you are of the belief that trace amounts of volatile is dangerous (for which there is no evidence), then scavenging is unnecessary.

How much does it cost (onc-off cost and ongoing disposables)?

As with a lot of new technologies, it often comes down to cost-benefit ratios.

Muscle relaxant work at the neuromuscular junction. The muscle fibre it innervates, however, may extend well below the torniquet. While I have no data about this, I would imagine that once a torniquet is up, extra muscle relaxant may have a small effect on the muscle below the torniquet as long as they are long muscle fibres that extend below the torniquet. I doubt that it would be a significant effect.

Remember the study of awareness where a limb was isolated from the rest of the body by the use of a torniquet. Despite a general anesthetic, some patients could obey verbal commands (lifting hand). Thus the torniquet effectively protected the limb from the relaxant.

I have never seen bronchospam as a result of desflurane use. If anything, a sympathetic stimulation should PROTECT a patient from bronchospasm. Laryngospasm is another matter.  :-\

We had one to play with for week (on loan) and it is every bit as good as it looks. It is a very simple matter to assemble and requires very little change in LMA etchnique. The intubation is still a bit of a fiddle, but with practice, becomes easy.

Well, its a big commitment, not to be taken lightly. For an anesthesiologist, the training is at least 5 years ON TOP OF medical school, with some pretty heavy-duty exams and a heavy time-commitment. I had to put my life on hold for several years while doing my training - exercise/relationships/entertainment all suffered.

On the other hand, now that I am fully qualified, I love my work and the rewards it has brought me is life, financially and professionally.

I suggest meeting a few people in real life, and maybe doing some work experience before to commit.

My college guidelines state that ECG needs to be available for every patinet but not necessarily applied to every patient (unlike pulse oximetry, BP, capnography, gas analysis - all of which must be applied for every GA). Having said that, I must admit I see little harm in using it on almsot everybody.

For purely elective surgery I would postpone any child who has been chewing gum. The act of chewing not only results in large amounts of saliva production (and swallowing) but also gastric fluid secretion by the stomach. Chewing gum increases gastric volume and decreases gastric pH. It increases the risk of dangerous aspiration.

No,I have no evidence for this except basic physiology. However, from a medicolegal point of view, you would be crazy to proceed. Imaging if the child did aspirate (whether or not the chewing gum contributed). How could you defend yourself?

This is a quote from the FDA:

QuoteBurns from Misuse of Forced-Air Warming Devices
FDA Patient Safety News: Show #9, October 2002

Forced-air warming systems are often used to maintain normal body temperatures in patients before, during and after surgery. They're an effective way to keep patients warm and prevent complications from hypothermia. These systems deliver heated air through a hose to an inflatable blanket that covers the patient. With the blanket attached, the heated air is evenly distributed across the patient's body.

But serious burns can occur when the hose isn't attached to the blanket. Without the blanket, the heated air can be extremely hot and concentrated at the hose nozzle, and blow directly onto the patient's skin. Burns can also occur if the patient's skin comes in direct contact with the hose surface.

This practice, where forced-air warming is applied without a blanket, is called "hosing" or "free hosing". Hosing has caused first, second and even third degree burns. The most serious report we've received to date describes a burn that resulted in muscle necrosis so severe that that the patient's leg had to be amputated above the knee.

This kind of injury can occur with any forced-air warming system that's supposed to be used with a blanket - but isn't. There are plenty of warnings about the risks of hosing - in manuals, in printed instructions, and on device labels. ECRI has published a Hazard Report specifically warning about this problem. Yet, despite all these warnings, hosing still occurs.

One manufacturer, Augustine Medical, has begun a campaign to help spread the word about the dangers of hosing. The company has developed a web site called "stophosing.com" where you can get more information on hosing and request educational materials like pamphlets, posters and warning labels for hoses. The web site also gives tips to help prevent hosing, such as storing blankets in a location that's close to where they're going to be used.

But the primary message is clear and simple: always use a blanket with forced-air warming.

Augustine Medical has even made a website to promote the use of a blanket with all hot air warming devices. www.stophosing.com