Deep Sedation In Children Research Articles

General anesthesia versus deep sedation for dental treatment in children: comparison of parental acceptance, oral health-related quality of life, and treatment efficacy

To compare the parental acceptance of dental treatment under general anesthesia and deep sedation in children and assess the changes in postoperative oral health-related quality of life and treatment efficacy. The parents of 131 children undergoing dental treatment in the Department of Stomatology of Sichuan Provincial People's Hospital from January, 2022 to June, 2022 were surveyed using a questionnaire of children's advanced oral behavior management, and 83 children receiving general anesthesia or deep sedation for dental treatment between January, 2018 and December, 2021 were also investigated for changes in quality of life after the treatment using a questionnaire. The treatment efficacy was assessed at the 1-year follow-up visit in 149 children who received dental treatment under general anesthesia or deep sedation during the same period. The survey of perantal acceptance showed that 62.6% of the parents preferred deep sedation, 29.01% preferred general anesthesia, and 8.4% preferred compulsory treatment. Dental treatments under general anesthesia and deep sedation both significantly improved oral health-related quality of life of the children. While dental surgeries under general anesthesia resulted in the most significant improvement of pain symptoms, deep sedation was associated with both obvious relief of the children's pain symptoms and reduction of the parents' pressure level. No significant difference was found in the efficacy of treatments under general anesthesia and deep sedation at the 1-year follow-up. Dental treatment in children under deep sedation has the highest parental acceptance, followed by treatment under general anesthesia, and the acceptance of compulsory treatment is the lowest. The treatments under general anesthesia and deep sedation significantly improve the quality of life of the children and their parents and both have good treatment efficacy.

Sedation and analgesia during manipulation in children

The article provides an overview of modern methods of sedation and analgesia during therapeutic and diagnostic manipulations in children, indicates indications and contraindications. Special attention is paid to the assessment of sedation and anaesthesia effectiveness, scales used for this purpose in children of different ages are described, criteria of sedation depth are given, equipment and measures necessary to ensure patient safety during manipulation are described. It has been noted that BIS index values correlate with sedation scales in children and adults, but values that determine deep sedation in children are currently not clearly defined, which requires further research. Drugs for sedation, their main characteristics and limitations for use are presented. The differences between sedation and monitored anesthesiology care (MAC), which can be provided only by a qualified anesthesiologist, are described in detail. It has been demonstrated that monitored anesthesiologic care implies deep sedation with control of vital functions, control of breathing and hemodynamics during manipulation, and it is noted that capnography is a mandatory element of monitoring in this type of anesthesiologic care in order to detect apnea as early as possible. Criteria for recovery of consciousness after completion of sedation are specified, which include normal airway, adequate ventilation, stability of hemodynamic, restoration of initial level of consciousness, motor activity and possibility to receive liquids through mouth in absence of vomiting. It is noted that the average time from the end of procedural sedation to the restoration of the original state is about 2 hours.

Validity of bispectral index monitoring during deep sedation in children with spastic cerebral palsy undergoing injection of botulinum toxin.

BackgroundThis prospective study aimed to determine whether the bispectral index (BIS) is a valid objective tool for differentiating adequate from inadequate deep sedation in spontaneously breathing children with cerebral palsy (CP).MethodsPropofol was titrated to increase the level of sedation with a continuous infusion of remifentanil at a rate of 0.05 μg/kg/min while maintaining spontaneous ventilation in 22 children with spastic CP, aged 3–18 years. The depth of sedation was assessed using the University of Michigan Sedation Scale (UMSS) and the Modified Observer’s Assessment of Alertness and Sedation (MOAAS) scale. Receiver operating characteristic curve analysis was performed to determine the cutoff BIS values for deep sedation, defined as a UMSS score of 3–4 and a MOAAS score of 0–1.ResultsThe BIS values significantly changed with the increase in the level of sedation across both the UMSS and MOAAS scores (P < 0.001). The BIS values correlated with the UMSS (r = −0.795, P < 0.001) and MOAAS (r = 0.815, P < 0.001) scores. The cutoff BIS value to detect adequate deep sedation in children with CP was 61.5 (UMSS score: sensitivity 0.860, specificity 0.814; MOAAS score: sensitivity 0.794, specificity 0.811).ConclusionsThe BIS value strongly correlates with the clinical sedation scales, such as the UMSS and MOAAS, during deep sedation in children with CP. Therefore, BIS monitoring can be used as a valid tool for assessing the level of propofol sedation in spontaneously breathing children with CP undergoing a botulinum toxin injection.

Incidence of tolerance in children undergoing repeated administration of propofol for proton radiation therapy: a retrospective study

BackgroundPropofol is an excellent hypnotic drug for use in repeated radiation procedures in young children. To date, tolerance to propofol generally does not develop in pediatric patients undergoing radiation therapy. However, several studies have suggested that there may be potential for development of tolerance to propofol. The aim of this study was to evaluate the development of a tolerance to propofol used for repeated deep sedation in children undergoing proton radiation therapy (PRT).MethodsAll children undergoing PRT at our institution between December 2015 and January 2018 were eligible for inclusion in this study. Sedation was induced by a bolus dose of propofol (2.0 mg.kg− 1) followed by a continuous infusion of 250 μg.kg− 1.min− 1 via an infusion pump to achieve deep sedation. Sedation was maintained with the propofol infusion of 200 μg.kg− 1.min− 1, which was adjusted in 25 μg.kg− 1.min− 1 increments up or down as necessary to ensure deep sedation. The primary outcome was mean doses of propofol over time.ResultsFifty-eight children were analyzed. The mean (SD) age was 4.5 (2.1) years. The mean (SD) number of treatment sessions was 19 (7). Fifteen patients (26%) developed tolerance to propofol. However, there were no significant differences between the children who developed tolerance and the children who did not develop tolerance in mean propofol dose and awakening time over time (p = 0.887 and P = 0.652, respectively). Age, the number of PRT, and attending anesthesiologists was not significantly associated with the incidence of tolerance to propofol.ConclusionRepeated prolonged deep sedation for PRT elicited multiple times over several weeks in young children using propofol did not develop tolerance in 74% of patients. Although the incidence of 26% tolerance to propofol may still be present, the increase in propofol dose was minimal. Therefore, the use of repeated propofol for children was safe.

Moderate and deep sedation for children: a retrospective analysis for failure reasons

Objective The aim of this study was to evaluate the factors of failure in moderate and deep sedation in children and to improve the success rate of sedation in the future. Methods Forty-eight thousand one hundred and fifty-eight patients who failed to cooperate for painless procedures were enrolled. According to the criterion of sedation in shanghai children′s medical center, pediatric outpatients were sedated by chloral hydrate and/or phenobarbital for procedures of echocardiography, CT and MRI (31 076, 7 368 and 9 714), respectively. A retrospective analysis was performed for factors which affected the rates of failure. Results There were 4 164(8.6%) failure cases in the study. For echocardiography, CT and MRI sedation, the failure rates were 7.4%, 9.3% and 12.2% respectively. The failure rate of echocardiography was lower than CT and MRI(P<0.05). The failure rate of sedation had an ascending tendency with prolonged fasting time and increased age(P<0.05). Conclusions Multiple factors might affect the efficacy of sedation. For further improvement of success rate in moderate and deep sedation in pediatric outpatients, we should reasonably adjust and modulate some of these factors. Key words: Pediatric; Sedation

Transperineal Ultrasound as a Tool to Plan Surgical Strategies in Pediatric Urology: Back to the Future?

To demonstrate the usefulness and advantages of transperineal ultrasound (TPUS) on planning the surgical tactics to treat childhood pelviperineal disease (CPPD). A cohort of CPPD is reviewed to provide a pictorial review of TPUS as imaging method variety of CPPD. Other imaging methods are compared with TPUS. TPUS studies of patients showing different conditions on the spectrum of pelviperineal malformation are shown in detail (pictorial review, graphically shown-see figures in the article and as supplementary material), highlighting the advantages of the method and comparing TPUS findings with other imaging techniques. Magnetic resonance imaging, contrast genitograms, voiding cystourethrography, and genital or urologic endoscopy have some important disadvantages, especially radiation exposure, high cost, not easily available equipment, and the need of general anesthesia or deep sedation in children. TPUS is easily available, including in impoverished environments, portable, painless, reproducible, inexpensive, and capable of providing detailed and specific information about pelviperineal malformation with accuracy. Data provided by TPUS are comparable with other imaging techniques (Table1). Its main disadvantage is the dependency on the expertise of the operator to obtain high-quality, well-interpreted images.

The influence of parents' voice on the consumption of propofol for pediatric procedural sedation-a randomized controlled trial.

In pediatric patients, invasive procedures such as the insertion of a central venous catheter or gastroscopy require deep sedation. It is unknown whether listening to parental voice during deep sedation in children can reduce sedative doses. The aim of this prospective study was to determine the effect of listening to a parent's voice during deep sedation on consumption of sedatives in children. Fifty children aged 2-14 years undergoing central line placement or gastroscopy under deep sedation with propofol were randomly assigned to two groups: (A) listening or (B) not listening their parents' recorded voice reading a standardized text by the use of earphones. Depth of sedation was monitored by Comfort Score and by Bispectral Index. Mean sedative dose of propofol in both groups was equal (A 0.25 mg·kg-1 ·min-1 ; B 0.28 mg·kg-1 ·min-1 ; Δ -0.03 mg·kg-1 ·min-1 (CI 95% -0.08 to 0.01); P = 0.089). Furthermore, complication rate (P = 1.0) and recovery time (A 14.5 min; B 16.1 min; Δ = -1.6 min (CI 95% -6.98 to 3.81); P = 0.60) did not differ between the intervention and the control group. Listening to parental voice during deep sedation does not result in a reduction of sedative dose in children undergoing short medical procedures.

Post-Discharge Events Occurring after Dental Treatment under Deep Sedation in Pediatric Patients.

Deep sedation is often required in dentistry for treating children with uncooperative behavior. We assessed immediate post-sedation events during the first 24 hours after dental treatment under deep sedation in children, and examined correlations to a number of variables. Information was collected from medical files for a convenience sample of children between the ages of 1 and 16, who were treated under deep sedation at one clinic (propofol alone or combined with a sedative agent). Parents were interviewed by telephone regarding the first 24 hours following treatment. Among 32 children under age 6 years, 26 (81.3%) had at least one post sedation complication, compared to 19/22 (86.4%) aged 6 and older, p>0.05. According to parent report, 13 (59.1%) of the older children had pain, compared to 6 (18.8%) of the younger ones, p=0.002. For no patient in the younger group compared to 18.2% in the older group was dizziness reported as a complication, p=0.023. Among those who received a sedative agent, 93.3% had one or more complications; 26.7% had nausea or vomiting. The respective rates were 79.5% and 5.1% among those treated only with propofol. Though safe, deep sedation poses complications and adverse events.

Safety of Deep Sedation in Young Children with Sickle Cell Disease: A Retrospective Cohort Study

To assess the rates and types of complications associated with deep sedation in children with sickle cell disease (SCD) and to explore potential risk factors. This was a retrospective cohort study of children with SCD and a comparison group of children without SCD who underwent magnetic resonance imaging with deep sedation. The rates of general and SCD-associated sedation complications were calculated, and potential associated clinical and laboratory variables were assessed. A total of 162 sedation records in 94 subjects with SCD and 324 sedation records in 321 subjects without SCD were assessed (mean age, 4.3years in both groups). Pentobarbital, fentanyl, and midazolam were used in the majority of sedation episodes without routine presedation transfusion. Sedation-related complication rates did not differ significantly between the SCD and comparison groups. Within 1month after the sedation procedure, 17 children (10%) experienced a vaso-occlusive pain episode (VOE), and 2 children (1.2%) developed acute chest syndrome. Preprocedure and postprocedure rates of these complications did not differ significantly. Subjects who developed VOE after sedation had a significantly higher VOE rate before sedation, but no other significant clinical or laboratory risk factors were identified. Deep sedation in young children with SCD using a standard protocol is safe, with a sedation-related complication rate comparable to that of the general pediatric population. The observed rate of VOE, although not significantly higher than expected, warrants further investigation.

Anesthesia related Complications in Pediatric GI Endoscopy

Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA). The objective of this study was to describe Anesthesia related complications in children undergoing elective GI endoscopy. Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data , location of GI endoscopy , perioperative vital singe , recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest). 8 patients (0.5%) have transient bradicardia in post operative care Unit. 83 patients (5.9%) have post operative nausea and vomiting controlled by medication. 6 patients (0.4%) have post operative agitation controlled by medication. Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

Anorectal Manometry May Identify Children With Spinal Cord Lesions

We previously showed that approximately 10% of patients with intractable constipation have spinal abnormalities without any other physical findings. Given that spinal magnetic resonance imaging is costly and often requires deep sedation in children, it would be useful to find a screening tool to determine who has a higher likelihood of having a spinal abnormality. The aim of the study was to determine whether anorectal manometry is a useful screening test in predicting which patients will have abnormal spinal MRIs. This is a case-control study comparing the anorectal manometries of 10 children with constipation who had abnormal spinal MRIs (cases) to the manometries of 10 age-matched children with normal MRIs (controls). The maximum relaxation of the sphincter after balloon distention was achieved with a significantly smaller balloon in the cases as compared with the controls (35 ± 20 vs 60 ± 23 mL; P = 0.02). The dose-response curve of sphincter relaxation at different balloon distention was shifted to the left in patients with spinal lesions. Anal spasms after balloon distention were noted in 60% of the patients with abnormal magnetic resonance images compared with 0% of the controls (P < 0.003). There were no other differences. Patients with spinal cord abnormalities may show changes in anorectal manometry. Anal spasms on anorectal manometry are significant predictors of spinal abnormalities. Also, patients with spinal abnormalities have maximum sphincter relaxations with smaller balloon sizes. Further studies are needed to determine the utility of anorectal manometry as a screening test for spinal abnormalities in patients with constipation.

Evaluation of propofol for repeated prolonged deep sedation in children undergoing proton radiation therapy

The aim of this study is to evaluate the safety and sufficiency of a fixed dose rate propofol infusion for repeated prolonged deep sedation in children for proton radiation therapy (PRT). With ERB approval, we recorded anaesthesia monitoring data in children undergoing repeated prolonged propofol sedation for PRT. Sedation was introduced with a single bolus of i.v. midazolam 0.1 mg kg(-1) followed by repeated small boluses of propofol until sufficient depth of sedation was obtained. Sedation was maintained with fixed dose rate propofol infusion of 10 mg kg(-1) h(-1) in all patients up to the end of the radiation procedure. Patient characteristics, number and duration of sedation, propofol induction dose, necessity to alter propofol infusion rate, and heart rate, mean arterial pressure, respiratory rate were noted at the end of the radiation procedure before cessation of the propofol infusion. Data are mean (sd) or range (median) as appropriate. Eighteen children aged from 1.4 to 4.2 yr (2.6 yr) had 27.6 (sd 2.0) (497 in total) radiation procedures within 44.1 (4.0) days lasting 55.7 (8.8) min. Propofol bolus dose for induction, monitoring, and positioning was 3.7 (1.0) mg kg(-1). Propofol bolus requirements were quite stable over the successive weeks of treatment and variability was larger between individuals than over time. In none of the children did propofol infusion rate need to be changed from the pre-set 10 mg kg(-1) h(-1) flow rate because of haemodynamic state, respiratory conditions or inadequate anaesthesia. Repeated prolonged deep sedation over several weeks in very young children using a fixed rate propofol infusion was safe and adequate for all patients.

Comparison of Propofol With Pentobarbital/Midazolam/Fentanyl Sedation for Magnetic Resonance Imaging of the Brain in Children

Propofol and pentobarbital, alone or combined with other agents, are frequently used to induce deep sedation in children for MRI. However, we are unaware of a previous comparison of these 2 agents as part of a randomized, controlled trial. We compared the recovery time of children after deep sedation with single-agent propofol with a pentobarbital-based regimen for MRI and considered additional variables of safety and efficacy. This prospective, randomized trial at a tertiary children's hospital enrolled 60 patients 1 to 17 years old who required intravenous sedation for elective cranial MRI. Patients were assigned randomly to receive a loading dose of propofol followed by continuous intravenous infusion of propofol or to receive sequential doses of midazolam, pentobarbital, and fentanyl until a modified Ramsay score of >4 was attained. A nurse who was blind to group assignment assessed discharge readiness (Aldrete score > 8) and administered a follow-up questionnaire. We compared recovery time, time to induction of sedation, total sedation time, quality of imaging, number of repeat-image sequences, adverse events, caregiver satisfaction, and time to return to presedation functional status. The groups were similar in age, gender, race, American Society of Anesthesiology physical status class, and frequency of cognitive impairment. No sedation failure or significant adverse events were observed. Propofol offered significantly shorter sedation induction time, recovery time, total sedation time, and time to return to baseline functional status. Caregiver satisfaction scores were also significantly higher in the patients in the propofol group. Propofol permits faster onset and recovery than, and comparable efficacy to, a pentobarbital/midazolam/fentanyl regimen for sedation of children for MRI.

Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy

The aim of this study was to evaluate the safety and efficacy of a combination of propofol and remifentanil deep sedation in spontaneously breathing children less than 7 years of age undergoing upper and/or lower gastrointestinal endoscopy. The effect of propofol and remifentanil sedation was prospectively studied in 42 unpremedicated children undergoing gastrointestinal endoscopy. Anesthesia was induced with a combination of sevoflurane, nitrous oxide and oxygen. Anesthesia was maintained with an infusion of propofol (50-80 microg x kg(-1) x min(-1)) and remifentanil (0.1 microg x kg(-1) x min(-1)). Demographic data, heart rate, blood pressure, respiratory rate, and oxygen saturation were recorded every 5 min for each child. In addition, recovery and discharge times were recorded. All 42 procedures were completed with no complications. The combination of propofol and remifentanil resulted in a decrease in heart rate, blood pressure, and respiratory rate. There was no respiratory depression or oxygen desaturation in any child. A bolus of propofol (1 mg x kg(-1)) was necessary in one child for excessive movement. No patient experienced any side effects in the recovery period. The combination of propofol and remifentanil for sedation in children undergoing gastrointestinal endoscopy can be considered safe, effective and acceptable.

Propofol remifentanil deep sedation for gastrointestinal endoscopy in children

INTRODUCTION: Gastrointestinal flexible endoscopy has become an important diagnostic and therapeutic procedure in children. In many medical centers, the use of general anesthesia for upper and lower gastrointestinal endoscopy has been replaced by intravenous sedation (1). Limited data are available on the use of propofol remifentanil sedation in children (2,3). The aim of our study was to evaluate the safety and efficacy of remifentanil propofol combination for deep sedation in children undergoing gastrointestinal endoscopy.

Sedation of children for magnetic resonance imaging

Current British guidelines oppose the use of deep sedation by non-anaesthetists.1 2 but all reflect the needs and experience of adult practice. Despite this, and without reference to paediatric opinion,...

Magnetic resonance imaging in children: Role of the anaesthesiologist

Magnetic resonance imaging in children: Role of the anaesthesiologist