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Scott R Schulman

Publications and source records attributed to Scott R Schulman.

5 recordsLinked to original sources
PubMed2003

Mechanically ventilated pediatric stem cell transplant recipients: effect of cord blood transplant and organ dysfunction on outcome.

OBJECTIVES: To compare survival of pediatric umbilical cord blood and bone marrow transplant recipients requiring admission to a pediatric intensive care unit for mechanical ventilation and to determine the effect of organ dysfunction on outcome. DESIGN: Retrospective chart review. SETTING: Tertiary care referral center for pediatric stem cell transplants. PATIENTS: All children 0-18 yrs old admitted to the pediatric intensive care unit for mechanical ventilation after receiving a stem cell transplant. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were collected from medical records of 86 patients who received a stem cell transplant and were subsequently admitted to the pediatric intensive care unit for mechanical ventilation. Demographic data were collected at the time of intubation, and physiologic data were collected at 6 hrs and 96 hrs after intubation. The pediatric intensive care unit, hospital, and 2-yr survival rates for umbilical cord blood transplant recipients were 37%, 25%, and 19%, respectively. The survival rates for bone marrow transplant recipients were 47%, 32%, and 21% for the same time periods. Umbilical cord blood and bone marrow transplant recipients with hepatic dysfunction had a significantly worse outcome, as did patients admitted for respiratory failure or sepsis. CONCLUSIONS: Pediatric recipients of an umbilical cord blood transplant who subsequently required mechanical ventilation had lower pediatric intensive care unit and hospital survival rates compared with patients receiving bone marrow transplantation. Survival at 2 yrs for umbilical cord blood transplant and bone marrow transplant patients was similar. Predictors of outcome for all stem cell transplant recipients requiring mechanical ventilation included pediatric intensive care unit diagnosis requiring intubation and hepatic function. Predictors of outcome can be identified shortly after intubation in pediatric stem cell transplant recipients and may aid in therapeutic decision making and family counseling.

Bone Marrow Transplantation↗
PubMed2002

Permission and assent for clinical research in pediatric anesthesia.

IMPLICATIONS: This article discusses the process and specific nature of informed consent for clinical research in pediatric anesthesia. For informed consent to be meaningful, permission from the child's proxy must be obtained and the child's assent must be tailored in a manner that is sensitive to the abilities of children.

Anesthesia↗
PubMed2002

Postoperative nausea and vomiting in children and adolescents undergoing radiofrequency catheter ablation: a randomized comparison of propofol- and isoflurane-based anesthetics.

UNLABELLED: In children, radiofrequency catheter ablation (RFCA) is typically performed under general anesthesia. With the use of volatile anesthetics, postoperative nausea and vomiting (PONV) are common, with an incidence of emesis as frequent as 60%. We tested the hypothesis that a propofol (PRO)-based anesthetic would have a less frequent incidence of PONV than an isoflurane (ISO)-based anesthetic. Patients were randomly assigned to receive either an ISO- or PRO-based anesthetic. Prophylactic ondansetron was given to all patients and droperidol was used as a rescue antiemetic postoperatively while PONV was monitored postoperatively for 18 h. The incidence of nausea, vomiting, use of rescue antiemetic drugs, and sedation scores were recorded. The cost for the anesthetic was also calculated. Fifty-six subjects were included in this study. The cumulative incidence of PONV was significantly more frequent in group ISO (63% nausea/55% emesis) compared with group PRO (21% nausea/6% emesis). After the administration of droperidol, further vomiting occurred in 70% of the patients in group ISO versus 0% of the patients in group PRO. We conclude that RFCA using ISO has a high PONV risk and the prophylactic use of ondansetron as well as antiemetic therapy with droperidol are ineffective. In contrast, a PRO-based anesthetic is highly effective in preventing PONV in children undergoing RFCA. IMPLICATIONS: In children undergoing radiofrequency catheter ablation and receiving prophylactic ondansetron, a frequent incidence (60%) of postoperative vomiting was observed under an isoflurane-based anesthetic, whereas the incidence was significantly reduced to a very low level (5%) under a propofol-based anesthetic.

Adolescent↗
PubMed2002

Comparison of electrophysiologic effects of propofol and isoflurane-based anesthetics in children undergoing radiofrequency catheter ablation for supraventricular tachycardia.

BACKGROUND: Radiofrequency catheter ablation (RFCA), which is typically performed with general anesthesia in children, is an interventional therapy for tachyarrhythmia. Although the electrophysiologic (EP) effects of isoflurane- and propofol-based anesthetics have been shown to be similar, a retrospective analysis reported significantly longer RFCA procedural duration with the use of isoflurane. It remains unclear whether the ability to successfully perform RFCA differs between these drugs. METHODS: Patients were randomly assigned to receive either an isoflurane- or propofol-maintained anesthetic. Drug administration was titrated according to the pharmacodynamic endpoint of depth of sedation using bispectral index score. The ability to induce sustained tachycardia (using a scoring system), procedural durations, and effects on cardiac electrophysiologic properties were evaluated and compared between the groups. RESULTS: Sixty subjects were included in this study. Sustained supraventricular tachycardia (SVT) was inducible with the assigned drug in all but four subjects. In three of these four subjects, SVT was also not inducible with the alternative study drug. Ability to induce the first sustained SVT was similar between the groups (P = 0.83). Total procedural durations were similar (isoflurane 224 +/- 84 min vs. propofol 221 +/- 86 min, mean +/- SD, P = 0.88). Atrioventricular nodal conduction was slower with propofol compared with isoflurane, but this result did not appear to be clinically relevant. Finally, ventricular repolarization was prolonged by isoflurane versus propofol, the clinical significance of which was not demonstrated. CONCLUSION: Isoflurane- and propofol-based anesthesia were equally suitable in children and adolescents undergoing RFCA.

Adolescent↗