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Purpose: This is the second of two reviews evaluating the management of patients with selected medical conditions undergoing ambulatory anesthesia and surgery. Conditions highlighted in this review include: diabetes mellitus; morbid obesity; the ex-premature infant; the child with an upper respiratory infection; malignant hyperthermia; and the use of monoamine oxidase inhibitors. Source: Medline search strategies and the framework for the evaluation of clinical evidence are presented in Part I. Principal findings: Diabetes mellitus has not been linked with adverse events following ambulatory surgery. The morbidly obese patient is at an increased risk for minor respiratory complications in the perioperative period but these events do not increase unanticipated admissions. The ex-premature infant may be considered for ambulatory surgery if post-conceptual age is 60 weeks and hematocrit is 30%. The child with a recent upper respiratory tract infection is at an increased risk for perioperative respiratory complications, particularly if endotracheal intubation is required. Patients with malignant hyperthermia may undergo outpatient surgery but require four hours of postoperative temperature monitoring. Sporadic cases of drug interactions have been reported when meperidine and indirectacting catecholamines are administered in the presence of monamine oxidase inhibitors. Ambulatory anesthesia and surgery is safe if these combinations of drugs are avoided. Conclusion: Ambulatory anesthesia can be performed in, and is being offered to, a variety of patients with significant coexistent disease. In many cases there is little evidence documenting the outcomes expected in such patients. Prospective observational and interventional trials are required to better define perioperative management.
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As of early March 2004, from 238 parents with 2 or more children screened via the Internet-based system, data were available on 518 offspring, including 206 sets of affected sib-pairs, 26 sets of sib-trios, and 6 sets of sibsize 4 or more. Of these, 312 60% ; were male. Average age was 12.4 4.5 years median 12.2 ; . The parents report that almost half 44.8% ; of the subjects were considered to have a current or past diagnosis of bipolar disorder and 78% suffered from within-the-day mood cycling. Other diagnoses reported by the parents to have been assigned currently or at some prior time were: ADHD, 55.0%; major depression, 30.8%; oppositional defiant disorder, 29.2%; obsessive- compulsive disorder, 20.7%; generalized anxiety disorder, 17.4%; seasonal affective disorder, 11.6%; conduct disorder, 8.3%; eating disorder, 7.4%; pervasive developmental disorder, 6.6%; Tourette's Syndrome, 5.2%; Asperger's Syndrome, 2.5%; and schizoaffective disorder, 0.8%. Demographic and diagnostic data for this study sample are summarized in Table 1. Co-occurring parent-reported diagnoses were common. BPD and ADHD were recorded jointly in 28.4% of the subjects; BPD and oppositional defiant disorder in 17.2%; BPD and major depression in 15.3%; BPD and generalized anxiety disorder, 10.5%; and BPD and conduct disorder, 4.7%. ADHD, as noted above the most frequently recorded diagnosis and the most frequently co-occurring in combination with BPD, also co-occurred very frequently with other diagnoses, especially with oppositional defiant disorder, 22.2%, and major depression, 17.8%. Multiple occurrences of parent-reported current prior BPD diagnoses in these sibships were frequent. In 76 238 31.9% ; families, BPD was noted as having been diagnosed in 2 or more children. In 10 of the 238 families 4.2% ; , BPD was reported as having been diagnosed in 3 or more children!