Anesthesia Care For Children Research Articles

Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children: Research Letter.

Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children: Research Letter.

Sevoflurane requirements during electroencephalogram (EEG)-guided vs standard anesthesia Care in Children: A randomized controlled trial

Study ObjectivesIntra-operative electroencephalographic (EEG) monitoring utilizing the spectrogram allows visualization of children's brain response during anesthesia and may complement routine cardiorespiratory monitoring to facilitate titration of anesthetic doses. We aimed to determine if EEG-guided anesthesia will result in lower sevoflurane requirements, lower incidence of burst suppression and improved emergence characteristics in children undergoing routine general anesthesia, compared to standard care. DesignRandomized controlled trial. SettingTertiary pediatric hospital. Patients200 children aged 1 to 6 years, ASA 1 or 2, undergoing routine sevoflurane anesthesia for minor surgery lasting 30 to 240 min. InterventionsChildren were randomized to either EEG-guided anesthesia (EEG-G) or standard care (SC). EEG-G group had sevoflurane titrated to maintain continuous slow/delta oscillations on the raw EEG and spectrogram, aiming to avoid burst suppression and, as far as possible, maintain a patient state index (PSI) between 25 and50. SC group received standard anesthesia care and the anesthesia teams were blinded to EEG waveforms. MeasurementsThe primary outcomes were the average end-tidal sevoflurane concentration during induction and maintenance of anesthesia. Secondary outcomes include incidence and duration of intra-operative burst suppression and Pediatric Anesthesia Emergence Delirium (PAED) scores. ResultsThe EEG-G group received lower end-tidal sevoflurane concentrations during induction [4.80% vs 5.67%, −0.88% (−1.45, −0.31) p = 0.003] and maintenance of anesthesia [2.23% vs 2.38%, −0.15% (−0.25, −0.05) p = 0.005], and had a lower incidence of burst suppression [3.1% vs 10.9%, p = 0.044] compared to the SC group. PAED scores were similar between groups. Children <2 years old required higher average end-tidal sevoflurane concentrations, regardless of group. ConclusionsEEG-guided anesthesia care reduces sevoflurane requirements in children undergoing general anesthesia, possibly lowering the incidence of burst suppression, without altering emergence characteristics. EEG monitoring allows direct visualization of brain responses in real time and allows clearer appreciation of varying sevoflurane requirements in children of different ages.

Evaluation of the parental satisfaction of developmentally delayed pediatric patients undergoing dental surgery with the ''pediatric anesthesia parent satisfaction (PAPS)'' survey

Objectives: The aim of the present study was to assess parental satisfaction of developmentally delayed pediatric patients undergoing dental surgery and compare this to satisfaction with anesthesia care for children without developmentally delayed.Methods: Therefore, two different groups were approached and compared to matching controls. ''Pediatric anesthesia parent satisfaction (PAPS)'' survey was used to evaluate parental satisfaction in the present study. The PAPS survey was administered to 50 parents of developmentally delayed pediatric patients (Group I) and 30 parents of children without developmentally delayed (Group II). However, due to the shortcomings in the questionnaires, 5 participants from Group I and 4 from Group II were excluded from the study.Results: In the ''Before anesthesia'', ''After anesthesia'', ''Hospital team'' and ''Anesthesia team'' parts of survey no statistically significant difference was found between the groups. In the ‘‘Before anesthesia’’ part the lowest score was given in response to Q5 item (The anesthesia team explained to me how my child might feel physically and emotionally after anesthesia and surgery). The mean score of Q5 item was 2.73 ± 1.77 in Group I and 2.36 ± 1.40 in Group II.Conclusions: In conclusion, it was found that there is no difference between parental satisfaction of children with developmentally delayed and parental satisfaction of developmentally delayed pediatric patients.

Combined Xenon and Epidural Anesthesia During Surgical Correction of Joint Deformities in the Lower Extremities of Children with Cerebral Palsy

Objectives. The objective of this study is to compare different methods of combination general and regional anesthesia based on xenon.Materials and methods. Xenon anesthesia combined with epidural block was performed in 50 children with cerebral palsy aged 3–17 years. In 30 patients xenon was used to maintain anesthesia, in 20 children xenon was combined with sevoflurane. We compared the process of anesthesia, the intraoperative hemodynamic parameters and cognitive status before surgery and after it.Results. The use of xenon in all studied anesthesia methods increased the cardiac performance and was associated with a stable hemodynamic profile at all stages of anesthesia despite the depressive effect of epidural blockade on hemodynamics. Psychological testing revealed that xenon anesthesia has no negative effect on cognitive functions in children with cerebral palsy.Conclusion. Xenon anesthesia is a promising trend in anesthesia care for children with cerebral palsy. Xenon can compensate the hemodynamic depression caused by epidural anesthesia due to its cardiac stimulant property, with no neurotoxicity being a significant benefit for children with initial damage of CNS. However, anesthesia with xenon turned out to have some disadvantages. In our study, xenon showed insufficient analgesic properties, had emetic properties and was associated with spirometric abnormalities. It was more difficult to maintain normal ventilation parameters in young children when using xenon. Several adverse events were noted in the recovery period. These disadvantages can be partially reduced by using a combination of xenon and sevoflurane.

An investment in knowledge: Research in global pediatric surgery for the 21st century

The body of literature addressing surgical and anesthesia care for children in low- and middle-income countries (LMICs) is small. This lack of research hinders full understanding of the nature of many surgical conditions in LMICs and compromises potential efforts to alleviate the significant health, welfare and economic burdens surgical conditions impose on children, families and countries. This article will evaluate the need for improved global pediatric surgery research by (1) presenting the current state of surgical research for children in LMICs and (2) discussing methods and opportunities for improvement within the political context of current global health priorities.

Kinderanästhesie - Der schwierige Venenzugang

Venipunctures in children are difficult. Some factors can hardly be influenced, for example, a well-developed subcutaneous fat tissue. Technical devices may help to identify invisible veins. With the help of ultrasound deep peripheral veins on the wrists and ankles can be presented and punctured. Stiff resistance of a child thwarts any successful puncture. Children should therefore be adequately sedated, if cannot be induced by mask. Missing practice venipuncture and inadequate knowledge of appropriate puncture sites can be met easily by practicing and reading.The possibility of intraosseous puncture today is standard of anesthesia care for children. Within in a few seconds, a secure access to the vein system can be created.

Invited Lectures Related to Patient-centered Outcomes Research

The third PANDA symposium on Anesthesia and Neurodevelopment in Children included a session on Patient Centered Outcomes Research. Three speakers were invited to discuss SmartTots, a private-public partnership between IARS and FDA, Wake Up Safe, a patient safety organization and lastly, NICHD/NIH funding for training in research. The session provided information related to ongoing efforts to improve outcome and safety of anesthesia care in children and introduced potential sources and mechanisms of federal and non-federal funding for research related to anesthetic neurotoxicity in the developing brain.

Dexmedetomidine as Part of Balanced Anesthesia Care in Children With Malignant Hyperthermia Risk and Egg Allergy

Malignant hyperthermia is an acute hypermetabolic crisis triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When anesthesia care is provided to malignant hyperthermia-susceptible patients, a total intravenous anesthesia technique with propofol is frequently chosen. However, coexisting allergies to egg and soybeans may contraindicate the use of propofol. We present our experience with the use of dexmedetomidine as part of the anesthesia regimen in 3 patients with family histories of malignant hyperthermia and personal histories of egg or soybean allergies. In 2 patients, dexmedetomidine was used as part of a general anesthesia regimen and for sedation during spinal anesthesia in the third patient. Previous reports of the use of dexmedetomidine in patients susceptible to malignant hyperthermia are reviewed, and its benefits in such patients are discussed.

Thirteenth Annual Meeting of the Society for Pediatric Anesthesia, Dallas, Texas, October 8, 1999

Thirteenth Annual Meeting of the Society for Pediatric Anesthesia, Dallas, Texas, October 8, 1999