was similar in smokers who quit less than two or two to fourweeks before surgery (risk ratio [RR] 1.20; 95% confidence interval [CI] 0.96to 1.50 vs RR 1.14; CI 0.90 to 1.45, respectively). Smokers who quit more thanfour and more than eight weeks before surgery had lower risks of respiratorycomplications than current smokers (RR 0.77; 95% CI 0.61 to 0.96 and RR 0.53;95% CI 0.37 to 0.76, respectively). For wound-healing complications, the riskwas less in smokers who quit more than three to four weeks before surgery thanin current smokers (RR 0.69; 95% CI 0.56 to 0.84). Few studies reportedcardiovascular complications and there were few deaths.Conclusion At leastfour weeks of abstinence from smoking reduces respiratory complications, andabstinence of at least three to four weeks reduces wound-healing complications.Short-term (less than four weeks) smoking cessation does not appear to increaseor reduce the risk of postoperative respiratory complications.________________________________________________________________________Postoperative intravenous morphine titrationhttp://bja.oxfordjournals.org/content/108/2/193.fullF.Aubrun1,*, J.-X. Mazoit2 and B. Riou3SummaryRelief ofacute pain during the immediate postoperative period is an important task foranaesthetists. Morphine is widely used to control moderate-to-severepostoperative pain and the use of small i.v. boluses of morphine in thepost-anaesthesia care unit allows a rapid titration of the dose needed foradequate pain relief. The essential principle of a titration regimen must be toadapt the morphine dose to the pain level. Although morphine would not appearto be the most appropriate choice for achieving rapid pain relief, this is thesole opioid assessed in many studies of immediate postoperative pain managementusing titration. More than 90% of the patients have pain relief using aprotocol of morphine titration and the mean dose required to obtain pain reliefis 12 (7) mg, after a median of four boluses. Sedation is frequent during i.v.morphine titration and should be considered as a morphine-related adverse eventand not evidence of pain relief. The incidence of ventilatory depression isvery low when the criteria to limit the dose of i.v. morphine are enforced.Morphine titration can be used with caution in elderly patients, in children, orin obese patients. In practice, i.v. morphine titration allows the physician tomeet the needs of individual patients rapidly and limits the risk of overdosemaking this method the first step in postoperative pain management.________________________________________________________________________Case Scenario: Perianesthetic Management ofLaryngospasm in ChildrenOrliaguet,Gilles A. M.D., Ph.D.*; Gall, Olivier M.D., Ph.D.; Savoldelli, Georges L.M.D., M.Ed.; Couloigner, Vincent M.D., Ph.D.http://journals.lww.com/anesthesiology/Fulltext/2012/02000/Case_Scenario___Perianesthetic_Management_of.31.aspxSummaryPERIOPERATIVElaryngospasm is an anesthetic emergency that is still responsible forsignificant morbidity and mortality in pediatric patients.1 It is a relativelyfrequent complication that occurs with varying frequency dependent on multiplefactors.25 Once the diagnosis has been made, the main goals are identifyingand removing the offending stimulus, applying airway maneuvers to open the airway,and administering anesthetic agents if the obstruction is not relieved. Thepurpose of this case scenario is to highlight key points essential for theprevention, diagnosis, and treatment of laryngospasm occurring duringanesthesia.________________________________________________________________________Practice Guidelines for Acute Pain Managementin the Perioperative Setting: An Updated Report by the American Society ofAnesthesiologists Task Force on Acute Pain Managementhttp://journals.lww.com/anesthesiology/Fulltext/2012/02000/Practice_Guidelines_for_Acute_Pain_Management_in.10.aspxSummaryPRACTICEGuidelines are systematically developed recommendations that assist thepractitioner and patient in making decisions about health care. Theserecommendations may be adopted, modified, or rejected according to clinicalneeds and constraints and are not intended to replace