Anesthesia In Children Research Articles

Comparison of Remifentanil with or without Spinal Anesthesia for Children Undergoing Open Heart Surgery

Comparison of Remifentanil with or without Spinal Anesthesia for Children Undergoing Open Heart Surgery

The Hypnotic and Analgesic Effects of Oral Clonidine During Sevoflurane Anesthesia in Children: A Dose-Response Study

The Hypnotic and Analgesic Effects of Oral Clonidine During Sevoflurane Anesthesia in Children: A Dose-Response Study

The Incidence of Emergence Agitation Associated With Desflurane Anesthesia in Children Is Reduced by Fentanyl

The Incidence of Emergence Agitation Associated With Desflurane Anesthesia in Children Is Reduced by Fentanyl

A Retrospective Examination of Regional Plus General Anesthesia in Children Undergoing Open Heart Surgery

A Retrospective Examination of Regional Plus General Anesthesia in Children Undergoing Open Heart Surgery

Sedation and General Anaesthesia in Children Undergoing MRI and CT: Adverse Events and Outcomes

Sedation and General Anaesthesia in Children Undergoing MRI and CT: Adverse Events and Outcomes

Comparison of Heart Rate Variability between the Supine and Prone Position during General Anesthesia in Children

Comparison of Heart Rate Variability between the Supine and Prone Position during General Anesthesia in Children

Efficacy of Simulated Epinephrine-Containing Epidural Test Dose After Intravenous Atropine During Isoflurane Anesthesia in Children

Efficacy of Simulated Epinephrine-Containing Epidural Test Dose After Intravenous Atropine During Isoflurane Anesthesia in Children

Room H, 10/17/2000 9: 00 AM - 11: 00 AM (PS) Effects of Isoflurane and Propofol on Somatosensory Evoked Potentials during Remifentanil Anesthesia in Children

<b>Room H, 10/17/2000 9: 00 AM - 11: 00 AM (PS) Effects of Isoflurane and Propofol on Somatosensory Evoked Potentials during Remifentanil Anesthesia in Children</b>

Compare the Efficacy of Different Laryngeal Mask Size Selection Methods in General Anesthesia in Children

Compare the Efficacy of Different Laryngeal Mask Size Selection Methods in General Anesthesia in Children

Hemodynamic Effects of Combination of General and Caudal Anesthesia in Children

Hemodynamic Effects of Combination of General and Caudal Anesthesia in Children

First 300 Cases Of Pediatric Regional Anesthesia In Venezuela (Caudal, Spinal And Peridural)

Until 1997, only general anesthesia was used for pediatric surger Many complications occurred with this method, which could have d a regional anesthetic technique been used. The objectives of th A) To demonstrate that REGIONAL ANESTHESIA has the following char 1. It is useful in children, causing minimal hemodynamic and resp . 2. It is easy to administer, safe, less costly, allows quick reco mobilization of the patient. B) Stimulate the development of regional anesthesia techniques in ery in Venezuela. We present a historic review, the indications, contraindications, sadvantages, technique, complications, methods, including the dos ed for REGIONAL ANESTHESIA IN CHILDREN. Then we present a prospec 300 cases of regional anesthesia administered to children aged 12 of which 208 were males and 92 females; 240 ASA I and 60 ASA II. ia was used in 150, spinal anesthesia in 104, and peridural anest r abdominal and lower limb surgeries. The youngest patient was a f 47 days of age; the oldest was 12 years old. The mean age was 5 lowest weight was 2.4 kg; the highest weight 45 kg, the mean bein imal changes of systolic, diastolic, mean blood pressures, and he bserved. There were no significant fluctuations in respiratory ra had 8.3% rate of technique errors and 6.33% of adverse effects. ic surgeons regarded the anesthetic technique as good.

Respiratory Mechanics During Sevoflurane Anesthesia in Children With and Without Asthma

Respiratory Mechanics During Sevoflurane Anesthesia in Children With and Without Asthma

Respiratory Mechanics During Sevoflurane Anesthesia in Children With and Without Asthma

We studied lung function in children with and without asthma receiving anesthesia with sevoflurane. Fifty-two children had anesthesia induced with sevoflurane (up to 8%) in a mixture of 50% nitrous oxide in oxygen and then maintained at 3% with children breathing spontaneously via face mask and Jackson-Rees modification of the T-piece. Airway opening pressure and flow were then measured. After insertion of an oral endotracheal tube under 5% sevoflurane, measurements were repeated at 3%, as well as after increasing to 4.2%. Respiratory system resistance (Rrs) and compliance during expiration were calculated using multilinear regression analysis of airway opening pressure and flow, assuming a single-compartment model. Data from 44 children were analyzed (22 asthmatics and 22 normal children). The two groups were comparable with respect to age, weight, ventilation variables, and baseline respiratory mechanics. Intubation was associated with a significant increase in Rrs in asthmatics (17% +/- 49%), whereas in normal children, Rrs slightly decreased (-4% +/- 39%). At 4.2%, Rrs decreased slightly in both groups with almost no change in compliance system resistance. We concluded that in children with mild to moderate asthma, endotracheal intubation during sevoflurane anesthesia was associated with increase in Rrs that was not seen in nonasthmatic children. Tracheal intubation using sevoflurane as sole anesthetic is possible and its frequency is increasing. When comparing children with and without asthma, tracheal intubation under sevoflurane was associated with an increase in respiratory system resistance in asthmatic children. However, no apparent clinical adverse event was observed.

Premedication with Midazolam Delays Recovery After Ambulatory Sevoflurane Anesthesia in Children

We studied the effect of oral premedication with midazolam on the recovery characteristics of sevoflurane anesthesia in small children.In a randomized, double-blinded study, 60 children (1-3 yr, ASA physical status I or II) undergoing ambulatory adenoidectomy received either midazolam 0.5 mg/kg (Group M) or placebo (Group P) PO approximately 30 min before the induction of anesthesia. All children received atropine 0.01 mg/kg IV and alfentanil 10 [micro sign]g/kg IV before the induction of anesthesia with sevoflurane up to 8 vol% inspired concentration in N2 O 67% in O2. Tracheal intubation was facilitated with mivacurium 0.2 mg/kg. Anesthesia was continued with sevoflurane adjusted to maintain hemodynamic stability. In the postanesthesia care unit, predetermined recovery end points (emergence, recovery, discharge) were recorded. A pain/discomfort scale was used to determine the quality of recovery. A postoperative questionnaire was used to evaluate the well-being of the patient at home 24 h after surgery. Emergence (spontaneous eye opening), recovery (full points on the modified Aldrete scale), and discharge were achieved later in Group M than in Group P (15 +/- 6 vs 11 +/- 3 min [P = 0.002], 25 +/- 17 vs 16 +/- 6 min [P = 0.01], and 80 +/- 23 vs 70 +/- 23 min [P = 0.03]). Side effects, postanesthetic excitement, and analgesic treatment did not differ significantly between groups. At home, more children in Group P (30%) experienced disturbed sleep during the night compared with those in Group M (4%) (P = 0.007). Implications: In this randomized, double-blinded, placebo-controlled study, premedication with midazolam 0.5 mg/kg PO delayed recovery in children 1-3 yr of age after brief (<30 min) sevoflurane anesthesia. Except for more peaceful sleep at home, premedication did not affect the quality of recovery. (Anesth Analg 1999;89:75-9)

Air Embolism during Tunneled Central Catheter Placement Performed without General Anesthesia in Children: A Potentially Serious Complication

Central venous catheters have had an increasingly important role in a variety of patient care situations, including long-term antibiotic therapy, chemotherapy, and nutritional support. The recent past has seen a gradual transition from placement of vascular access catheters by surgeons to placement by interventional radiologists. The interventional radiology service places a majority of the vascular access devices at our children's hospital, including peripherally inserted central catheters, tunneled central venous catheters, temporary and permanent hemodialysis catheters, and subcutaneous ports. Most procedures performed by our interventional radiology service in children can be successfully completed with use of intravenous (i.v.) sedation, and a few require general anesthesia (GA). Key advantages of GA over i.v. sedation include the ability to have positive pressure ventilation (PPV) or controlled apnea during the procedure. We report our experience of venous air embolism in three small children during placement of tunneled central venous catheters when GA was not used.

PARENTAL SATISFACTION WITH PEDIATRIC DAY SURGERY

S293 INTRODUCTION: Patient satisfaction has become an increasingly important measure of quality of service in the current health care environment. Although several patient satisfaction studies have been undertaken in adult ambulatory surgery, few such studies have been conducted in children [1]. Parental satisfaction is used as a surrogate measure in the latter patient population. We assessed satisfaction with our pediatric day surgical services by parental responses to a simple set of questions. METHODS: The quality assurance coordinator (KLM) telephoned the caretakers of 1211 consecutive pediatric day surgery patients within 24-48 h of hospital discharge to inquire about perioperative events. In addition she used a structured questionnaire to ask parents: "1) Please rate your overall satisfaction with your child's experience surrounding surgery on a scale of 1-10, where '1' is totally dissatisfied and '10' is completely satisfied, 2) On that same scale, please rate your satisfaction with your child's anesthesia experience. 3) If we did not rate a score of '10', what could have been done to achieve it?" RESULTS: All 1211 parents responded and 1072 (89%) rated the overall experience with the highest score of 10. Parents expressed varying degrees of dissatisfaction (scores =9) with overall services in 139 (11%) cases and with anesthesia services in 97 (8%) [P<0.01, overall experiences vs. anesthesia services]. The most frequently stated cause of dissatisfaction was a delay of surgery start time past the original schedule, even if it was only 40 min. Other major categories included perceived problems with personnel, facilities and anesthesia services. Personnel issues included poor interactions with hospital staff, miscommunication, and limited nurse and physician availability. Facility issues included parking problems, slow elevators, and lack of privacy in crowded waiting areas. Anesthesia-related causes for dissatisfaction included postoperative vomiting and emergence delirium. Some parents objected to not being present in the OR and PACU. Others felt their children were discharged prematurely and some had even wanted them to stay in hospital overnight. There were no complaints about inadequate postoperative pain control. (Figure 1)Figure 1DISCUSSION: Parental satisfaction was high and easily quantified, but the questions used may have resulted in a positive response bias, a common problem in consumer surveys [2]. Any rating less than the highest must be investigated, as most patients will not complain even when asked [2]. Open-ended questions are essential to determine the most important factors for satisfaction from a parental perspective without introducing examiner bias. The questions used in this survey required little time to complete and did not appear to be intrusive or bothersome to the parents who answered with a 100% response rate, unlike rates for other consumer surveys. This survey demonstrated that process and facility issues were more common causes of dissatisfaction than anesthesia-related complaints, and should be addressed at the institutional rather than the departmental level. We believe this questionnaire will be a useful tool for ongoing assessment of quality of care, but may need to be modified to reduce positive response bias.

Validation of measures of parents' preoperative anxiety and anesthesia knowledge.

Parents' anxiety about their children's anesthesia may adversely affect the children's outcomes and compromise the quality of informed consent. Studies of these issues have been limited by the lack of validated measures of parental anxiety and knowledge surrounding anesthesia. In the present study, we evaluated psychometric properties of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Standard Anesthesia Learning Test (SALT) among 85 parents who participated in an evaluation of the effects of a videotape about pediatric anesthesia. The results supported the internal consistency, test-retest reliability, and concurrent validity of both instruments and documented the equivalence of two forms of the SALT. Factor analysis supported the previously demonstrated factor structure of the APAIS, further confirming its construct validity. We conclude that the APAIS and SALT are reliable and valid measures of parental anxiety and knowledge of pediatric anesthesia that can be used for clinical and research purposes. This study verified the reliability and validity of two questionnaires for measuring parents' knowledge and anxiety about pediatric anesthesia. These questionnaires can be used in further research on factors affecting parental anxiety and knowledge before their children's surgery.

A Comparison of Recovery from Mivacurium during Enflurane or Propofol Anesthesia in Children

A Comparison of Recovery from Mivacurium during Enflurane or Propofol Anesthesia in Children

Decreased Mivacurium Requirements and Delayed Neuromuscular Recovery During Sevoflurane Anesthesia in Children and Adults

The purpose of this study was to compare the mivacurium infusion requirements and neuromuscular recovery in adults and children during propofol/opioid and sevoflurane anesthesia.Seventy-five adult and 75 pediatric patients were randomized to receive propofol/opioid 0.5 or 1.0 minimum alveolar anesthetic concentration (MAC) (age-related) sevoflurane anesthesia. Plasma cholinesterase (PChE) activity was measured. Neuromuscular blockade was monitored by train-of-four (TOF) stimulation every 10 s and adductor pollicis electromyography. A bolus of 2 x the 95% effective dose of mivacurium (0.25 mg/kg) was followed by an infusion titrated to maintain 90%-95% blockade. Mivacurium doses were recorded every 5 min. At the end of surgery, the infusion was stopped, and recovery from mivacurium was monitored until TOF >or=to0.7. PChE concentrations were within the normal range (adults 4-12 KU/L, children 6-16 KU/L) and correlated with mivacurium dose. Mivacurium infusion rates were higher in children than in adults: at 30 min, the rates in children were 13.1 +/- 6.4, 8.1 +/- 4.7, and 5.2 +/- 2.9 [micro sign]g [center dot] kg-1 [center dot] min-1 at 0, 0.5, and 1.0 MAC sevoflurane, respectively; the corresponding rates in adults were 5.9 +/- 3.1, 4.3 +/- 1.7, and 2.9 +/- 0.7 [micro sign]g [center dot] kg-1. min-1 (P < 0.01). Sevoflurane decreased mivacurium requirements, maximal decreases at 45 min in children and 10 min in adults, and delayed neuromuscular function recovery. Children recovered twice as quickly as adults, achieving TOF >or=to 0.7 at 9.8 +/- 2.5, 11.4 +/- 2.8, and 19.6 +/- 6.3 min compared with 19.9 +/- 5.4, 26.4 +/- 8.3, and 32.9 +/- 9.8 min in adults (P < 0.0001). In conclusion, mivacurium requirements were correlated with PChE, were greater in children than in adults, and were reduced by sevoflurane. Neuromuscular recovery occurred more rapidly in children and was delayed by sevoflurane. Implications: The mivacurium infusion requirement to maintain constant 90%-95% neuromuscular block during anesthesia is correlated with plasma cholinesterase activity. It is increased in children and reduced by the inhaled anesthetic sevoflurane. Despite the larger dose administered to children, recovery from block occurred more rapidly in children than in adults and was delayed by sevoflurane. (Anesth Analg 1998;87:772-8)

Remifentanil versus Regional Anaesthesia in Children Anaesthetised with Isoflurane/Nitrous Oxide - A Comparison of Anaesthetic Techniques

Remifentanil versus Regional Anaesthesia in Children Anaesthetised with Isoflurane/Nitrous Oxide - A Comparison of Anaesthetic Techniques