Mark D Twite

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OBJECTIVE The COMFORT scale is a commonly used observational scoring system to assess the level of sedation in ventilated children in pediatric intensive care units (PICUs). The bispectral index (BIS) monitor is a processed electroencephalographic parameter that noninvasively measures the hypnotic effect of anesthetic and sedative drugs on the brain. The(More)
OBJECTIVE To survey current sedation, analgesia, and neuromuscular blockade practices in pediatric critical care fellowship training programs in the United States. DESIGN Questionnaire survey sent by all program directors. The survey could be submitted either via a Web site, fax, or mail. SETTING University school of medicine. SUBJECTS Fifty-nine(More)
BACKGROUND Handoff protocols from the cardiovascular operating room (CVOR) to the cardiac intensive care unit (CICU) can improve patient outcomes and delivery of care beyond the immediate postoperative period. In a prospective quality improvement study, a structured CVOR-to-CICU handoff protocol was implemented at a university-affiliated children's(More)
PURPOSE OF REVIEW This review is a survey of the recent literature concerning issues and trends in the rapidly changing field of pediatric sedation. RECENT FINDINGS Clinical guidelines for the safe provision of sedation to children continue to be developed and revised. Systems for providing sedation are evolving, and the most successful models emerging(More)
ALK-negative CD30-negative peripheral T-cell lymphoma (PTCL) is an exceedingly rare neoplasm in children. Equally rare is the finding of cardiac involvement from lymphoma at presentation. The authors present a pediatric patient with PTCL involving the heart. The patient had orthopnea and an abnormal echocardiogram on presentation. After three doses of(More)
BACKGROUND Dexmedetomidine, an α-2 receptor agonist, is widely used in children with cardiac disease. Significant hemodynamic responses, including systemic and pulmonary vasoconstriction, have been reported after dexmedetomidine administration. Our primary goal of this prospective, observational study was to quantify the effects of dexmedetomidine initial(More)
Children need cardiac catheterization to establish the diagnosis and monitor the response to treatment when undergoing drug therapy for the treatment of pulmonary arterial hypertension (PAH). Children with PAH receiving general anesthesia for cardiac catheterization procedures are at significantly increased risk of perioperative complications in comparison(More)
INTRODUCTION Mediastinitis is an infrequent, but significant complication of median sternotomy. Perioperative hyperglycemia is associated with increased morbidity, including infection in pediatric and adult cardiac surgical patients. We hypothesized that perioperative blood glucose levels would be higher in patients who later developed mediastinitis. (More)
BACKGROUND Emergence agitation (EA) and negative postoperative behavioral changes (NPOBC) are common in children, although the etiology remains unclear. We investigated whether longer times under deep hypnosis as measured by Bispectral Index (BIS) monitoring would positively correlate with a greater incidence of EA in the PACU and a greater occurrence of(More)
Tetralogy of Fallot (TOF) is a common congenital heart defect in children. Perioperative considerations include preoperative preparation for surgery, intraoperative anesthetic management, and common postoperative issues in the intensive care unit. Surgical debates have shifted away from 2-stage versus single-stage repairs to debates of how surgery to limit(More)