This study demonstrates good preservation of upper airway patency and rapid recovery using general anesthetic doses of propofol in children.

The combination of remifentanil and propofol for TIVA may be an effective method of light general anesthesia in pediatric patients undergoing MRI.

Anesthesia for magnetic resonance imaging in children: a survey of Canadian pediatric centres To the Editor: We recently conducted a telephone survey of pediatric anesthesia departments in 11 Canadian university centres. Department chiefs (or designates) were asked to identify current anesthesia practice and concerns for pediatric magnetic resonance imaging (MRI). In all 11 centres, care was provided by pediatric anesthesiologists, with ten centres having MRI compatible machines available. All centres routinely used capnography and pulse oximetry. Eight centres routinely used non-invasive blood pressure monitoring. Five centres routinely used electrocardiogram (ECG) monitoring, and two centres had no MRI compatible ECG available. In seven centres the anesthesiologists were located in the control room during scanning. Staff were more likely to remain in the scanning room if a slave monitor was unavailable in the control room. Six centres predominantly used a propofol total iv anesthesia technique (TIVA), with the other five centres using a volatile technique more frequently or exclusively. Centres predominantly using TIVA were less likely to instrument the airway (Table). Propofol induction and maintenance dose estimates ranged from 2 to 6 mg•kg-1 (mean 3.7) and 100 to 250 µg•kg-1 •min-1 (mean 165) respectively, with one centre using boluses as required rather than an infusion. Three centres routinely using TIVA had no MRI compatible infusion pump available;

Advancing catheters from the lumbar and caudal epidural spaces to the thoracic level has been reported to be an alternative to the direct thoracic approach. However, as children grow, the threading of catheters in the epidural space becomes increasingly difficult. This report describes three cases of thoracic epidural placement using a multiport catheter threaded from the caudal and lumbar spaces using electrical stimulation guidance. In the first case, a multiport catheter was threaded 22 cm from the lumbar space to T8 following a failed attempt with a single-port catheter in a 9-year-old boy scheduled to undergo a right nephrectomy. In the second case, a multiport catheter was threaded 26 cm from the caudal space to T9 in a 3-year-old girl undergoing fundoplication. In the last case, a multiport catheter was inserted at the completion of a fundoplication in a 2-year-old girl after it had been confirmed that the single-port catheter inserted prior to surgery had not advanced to the desired thoracic level. The multiport catheter was threaded 17 cm without resistance from the caudal space to T9. In all cases, electrical stimulation was used to confirm the location of the catheter tip at the time of insertion. The position of the catheters was later confirmed by X-ray. The multiport catheter incorporates a stylet, which extends to a closed distal tip, within a catheter body that ejects fluid from three lateral holes in a direction perpendicular to the advancing catheter. These properties may facilitate the reliable advancement of catheters in the epidural space.