BackgroundCigarette smoking carries a threat both to the expecting mother and her newborn. Data on the prevalence and predictors of smoking during pregnancy is limited in Canada. Canadian studies are mainly representative of specific cities and/or provinces. Therefore, the study aims to assess the prevalence of smoking during pregnancy and its associated risk factors throughout the Canadian provinces and territories.MethodsThe analysis was based on the Maternity Experience Survey targeting women aged ≥15 years who had singleton live births during 2005/06 in the Canadian provinces and territories. The outcome was ever smoking during the thirst trimester of pregnancy. Socio-economic factors, demographic factors, maternal characteristics, and pregnancy related factors that proved to be significant at the bivariate level were considered for a logistic regression analysis. Bootstrapping was performed to account for the complex sampling design.ResultsThe sample size was 6,421 weighted to represent 76,508 Canadian women. The prevalence of smoking during pregnancy was 10.5%, whereby smoking mothers consumed on average 7 cigarettes a day (95% Confidence interval - CI: 6.5-7.4; SD = 5.7). Regression analysis revealed that mothers who smoked during pregnancy were more likely to be of low socio-economic status, non-immigrant, single and passive smokers during pregnancy. Not attending prenatal classes and experiencing stressful events before/during pregnancy also increased the mothers' odds of smoking during pregnancy. While the age of the mother's first pregnancy was negatively associated with smoking during pregnancy, the mother's current age was positively associated with it.ConclusionSmoking during pregnancy is still prevalent among Canadian women. The findings may be useful to enhance smoking prevention programs and integrated health promotion strategies to promote positive health behaviors among disadvantaged pregnancies.

Propofol anesthesia is effective in achieving patient comfort and amnesia, while optimizing conditions for elective oncology procedures in children. Although transient hypotension and respiratory depression may occur, propofol anesthesia seems to be safe to use for these procedures in the PICU setting. Recovery from anesthesia was rapid and total stay was brief. Under the proper conditions, propofol anesthesia delivered by pediatric intensivists in the PICU is a reasonable option available to facilitate invasive oncology procedures in children.

ABSTRACT. Objectives. To describe our experience with propofol anesthesia to facilitate invasive procedures for ambulatory and hospitalized children in the pediatric intensive care unit (PICU) setting.Methods. We retrospectively reviewed the hospital records of 115 children who underwent 251 invasive procedures with propofol anesthesia in our multidisciplinary, university-affiliated PICU during a 20-month period. All patients underwent a medical evaluation and were required to fast before anesthesia. Continuous monitoring of the patient's cardiorespiratory and neurologic status was performed by a pediatric intensivist, who also administered propofol in intermittent boluses to obtain the desired level of anesthesia, and by a PICU nurse, who provided written documentation. Data on patient demographics, procedures performed, doses of propofol used, the occurrence of side effects, induction time, recovery time, and length of stay in the PICU were obtained.Results. Propofol anesthesia was performed successfully in all children (mean age, 6.4 years; range, 10 days to 20.8 years) who had a variety of underlying medical conditions, including oncologic, infectious, neurologic, cardiac, and gastrointestinal disorders. Procedures performed included lumbar puncture with intrathecal chemotherapy administration, bone marrow aspiration and biopsy, central venous catheter placement, endoscopy, and transesophageal echocardiogram. The mean dose of propofol used for induction of anesthesia was 1.8 mg/kg, and the total mean dose of propofol used was 8.8 mg/kg. In 13% of cases, midazolam also was administered but did not affect the doses of propofol used. The mean anesthesia induction time was 3.9 minutes, and the mean recovery time from anesthesia was 28.8 minutes for all patients. The mean PICU stay for ambulatory and ward patients was 140 minutes. Hypotension occurred in 50% of cases, with a mean decrease in systolic blood pressure of 25%. The development of hypotension was not associated with propofol doses, the concomitant use of midazolam, or the duration of anesthesia, but was associated with older patient age. Hypotension was transient and not associated with altered perfusion. Intravenous fluid was administered in 61% of the cases in which hypotension was present. Respiratory depression requiring transient bag-valve-mask ventilation occurred in 6% of cases and was not associated with patient age, propofol doses, concomitant use of midazolam, or the duration of anesthesia. Transient myoclonus was observed in 3.6% of cases. Ninety-eight percent of procedures were completed successfully, and no procedure failures were considered secondary to the anesthesia. Patients, parents, and health care providers were satisfied with the results of propofol anesthesia.Conclusions. Propofol anesthesia can safely facilitate a variety of invasive procedures in ambulatory and hospitalized children when performed in the PICU and is associated with short induction and recovery times and PICU length of stay. Hypotension, although usually transien...

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