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Spontaneous Ventilation using Total Intravenous Anesthesia for Endoscopy in Children
The anesthetic management for removal of foreign bodies in children is challenging. The literature is divided as to the most appropriate anesthetic technique for this procedure. Most standard texts emphasize the desirability of maintaining spontaneous ventilation during retrieval of the foreign body, but some authors specifically recommend the use of muscle relaxants and light inhalation anesthesia.

The aims of this study are three fold: 

1. to conduct a retrospective review on current clinical practice for airway endoscopy
2. to formulate clinical guidelines for anesthetic management of endoscopy
3. to assess the efficacy and safety of using TIVA with propofol and remifentanil to perform this procedure in spontaneously breathing patients.

Optimal Dose of Remifentanil for Endotracheal Intubation in Infants and Children
Many Children will require intubation to help with their breathing while they are asleep. Medicines are routinely given through an intravenous (IV) cannula to allow placement of the breathing tube (intubation) by relaxing the muscles of the throat. The traditional medications given to relax the muscles of the throat are drugs which temporarily cause muscle paralysis. These drugs have a number of unwanted side effects, but an alternative to their use has not existed.

The introduction of an anesthetic drug, propofol, and an ultra short acting pain medicine, remifentanil, may provide an alternative to the use of muscle relaxant drugs. Propofol and remifentanil have been used for more than ten years, but like most medicines, the majority of experience has been gained with adults. We have limited published information, particularly in small children, on what the optimum dose combination for intubation is, although we know from our daily practice that the combination of propofol and remifentanil provide conditions that allow safe intubation.

Sometimes, as the breathing tube is inserted, the child may cough. This is especially the case in small children due to their altered break-down of drugs. The purpose of this study is to find the dose of remifentanil when combined with propofol which provides the best conditions for intubation without cough in infants and small children.

Our group of investigators, led by Dr. Malherbe, has the skills and dedication to complete this study to ensure that all infants and small children will have the safest health care possible.