General Anesthesia In Children Research Articles

Paediatric vascular access

### Key points Obtaining reliable vascular access in small children is frequently made challenging by anatomical factors—in particular, small, mobile veins and an excess of subcutaneous fat which make visualization and palpation of veins difficult. Paediatric patients are often less co-operative, and the potential for psychological trauma, especially with repeated procedures in the conscious patient, further complicates matters. Short-term vascular access is frequently required in hospitalized children for the delivery of i.v. fluids, medication, and blood product administration. Longer-term vascular access devices are required for repeated medication delivery (e.g. enzyme replacement therapy in inherited metabolic diseases), chemotherapy, immunotherapy, total parenteral nutrition, and extracorporeal procedures such as plasmapheresis and haemodialysis. In addition, vascular access devices may be needed for repeated blood sampling and invasive haemodynamic monitoring. The choice of vascular access device depends upon the condition and preference of the patient or parent/guardian, the likely duration and frequency of treatment, and the properties of the infusate. Infusates with vesicant properties (drugs with the potential to cause blistering with tissue injury, e.g. calcium solutions and amphotericin B), hypertonic solutions, and those with pH 9 will necessitate central venous access. Vasopressors and inotropes are preferentially administered centrally as they require reliable access and extravasation may cause tissue necrosis. It is important to try to predict future needs for vascular access as poor prospective management …

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre

Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential.

Efficacy of ketamine in prevention of agitation in children undergoing magnetic resonance imaging under face mask sevoflurane: A randomized trial

BackgroundEmergence agitation (EA) is a common distressing problem in children after sevoflurane general anesthesia. The aim of the present study was to test the efficacy of ketamine in prevention of EA after sevoflurane general anesthesia in children undergoing magnetic resonance imaging (MRI) scan. Also, we evaluated the safety and efficacy of the face mask for administration of sevoflurane anesthesia in children.MethodsIn this randomized study, 120 children aged 2–7 years (ASA I or II) of either sex scheduled for elective MRI scan under sevoflurane anesthesia were enrolled in the study protocol. Patients were randomly allocated to one of 3 groups: saline group receiving normal saline (n = 40), ketamine 0.25 group receiving 0.25 mg/kg of ketamine intravenously 10 min prior the end of the procedure (n = 40), and ketamine 1.0 group receiving 1.0 mg/kg of ketamine intravenously before sevoflurane induction, (n = 40). Anesthesia was provided with sevoflurane in 100% oxygen. EA score, pausing of the scan, scan time, discharge time and any reported adverse events were recorded.ResultsNo significant differences as regards age, weight, sex, or ASA score were found among the studied groups. Children in ketamine 1.0 group reported significant lower EA score in comparison with ketamine 0.25 and saline groups (P < 0.05). Ketamine 0.25 group reported significant lower EA score in comparison with saline group (P < 0.05). Children in ketamine 1.0 group reported significant lower incidence of pausing in comparison with ketamine 0.25 and saline groups (P < 0.05). No significant differences as regards nausea, vomiting, desaturation, scan and discharge times among the studied groups (P < 0.05) were found.ConclusionKetamine premedication was effective in reducing EA without delay in recovery and significantly reduced the incidence of pausing of MRI scan.

A clinical evaluation of i-gelTMduring general anesthesia in children

A clinical evaluation of i-gel^TMduring general anesthesia in children

A clinical evaluation of i-gelTMduring general anesthesia in children

A clinical evaluation of i-gelTMduring general anesthesia in children

Survey of comprehensive restorative treatment for children under general anesthesia

Background/purposeGeneral anesthesia provides optimal conditions for treating uncooperative children. The purpose of this retrospective study was to assess all restorative outcomes and evaluate the efficacy of comprehensive dental rehabilitation under general anesthesia in children. Materials and methodsSixty-eight complete records of children who underwent comprehensive dental rehabilitation under general anesthesia in the Kaohsiung Chang Gung Hospital, Kaohsiung, Taiwan between 2012 and 2013 were selected for this study. The clinical and radiographic assessments included determination of the outcomes of anterior versus posterior composite restorations, posterior composite restorations versus stainless steel crown restorations, and vital pulpotomies versus indirect pulp cappings. ResultsPosterior composite restoration had a significantly higher success rate (90.3%) than anterior composite restoration (71.7%, P < 0.001). Full-coverage stainless steel crowns had a significantly higher success rate (99.0%) than posterior composite restorations (P < 0.001). In addition, indirect pulp capping had a 100% success rate, which was higher than that of vital pulpotomy (94.9%). However, the difference was not significant (P > 0.05). ConclusionAlthough general anesthesia provides an optimal condition for treating children with high caries risk, high failure rates of composite restorations were noted. Indirect pulp capping and ferric sulfate pulpotomy followed by stainless steel crown restorations are successful techniques and can be used to treat deep carious lesions.

Quality and Safety of General Anesthesia with Propofol and Sevoflurane in Children Aged 1-14 Based on Laboratory Parameters.

Introduction:Knowledge of anatomic, physiological, biochemical and physical characteristics of children of all age groups, the existing illness and possible pathological response of the organism to the existing situation, require a pediatric anesthesiologist to participate in the preparation of a child for surgical treatment, to choose the best anesthesia technique and medications, and manipulative techniques to enable the scheduled surgical treatment with minimum anesthesia risks. The aim of this clinical study was to prove reliability and quality of propofol or sevoflurane general anesthesia in children in the age group of 1-14 years from the ASA I group and in the elective surgical treatments in duration of 60 minutes, based on preoperative and postoperative levels of laboratory findings (transaminases, blood sugar, urea and creatinine).Materials and methods:the study included 160 patients randomized in two groups based on different approaches: total intravenous anesthesia was used for the propofol group (n=80) (TIVA) and the inhalation technique was used for the sevoflurane group (n=80).Results:statistical evaluation of the obtained results indicates stability of laboratory findings in the immediate postoperative course (after 24 hours) in respect to the preoperative period. Based on the Mann Whitney test (P), preoperative and postoperative blood sugar levels in the sevoflurane vs. propofol group were P=0.152 vs. 0.021; creatinine levels P=0.113 vs. 0.325; urea levels P= 0.016 vs. 0.900; AST levels P=0,031 vs. 0,268 and ALT levels P=0.021 vs. 0.058. Level of significance was P<0.5.Conclusion:Analysis of the examined laboratory parameters show that propofol and sevoflurane provide full security and quality of general anesthesia in children age group 1-14 years, from the ASA I group. All analyzed laboratory levels in the postoperative course remained in their referential values in both groups of participants.

Spinal Anaesthesia in children: Comparative study of isobaric Levobupivacaine 0.5% with or without Clonidine

Background & Objectives: Spinal anaesthesia reduces the incidence of morbidity that follows general anaesthesia in children with good efficacy and safety record. Racemic bupivacaine is the widely used local anaesthetic for paediatric spinal anaesthesia. Local anaesthetic levobupivacaine has an equivalent potency to that of racemic bupivacaine but with a greater safety margin. Limited duration of surgical anaesthesia is however, one of the major deterrents for widespread use of spinal anesthesia in children. Clonidine lengthens spinal anaesthesia in adults and in children. We conducted a prospective, randomized clinical trial to study the effect of the addition of clonidine to 0.5% isobaric levobupivacaine induced spinal anaesthesia in children undergoing infra-umbilical procedures. Methods: Sixty patients between 5 to 10 years, posted for infra-umbilical surgeries were given spinal anaesthesia with either 0.5% plain isobaric levobupivacaine (5-15 kg – 0.4 mg/kg, 15-40 kg – 0.3 mg/kg) or levobupivacaine (5-15 kg – 0.4 mg/kg, 15-40 kg – 0.3 mg/kg) with clonidine (1?g/kg). Blockade characteristics and duration of analgesia were recorded along with mean arterial pressure, heart rate, respiratory rate and SpO2. Results: Satisfactory surgical anaesthesia was achieved in all 60 patients with comparable mean arterial pressure, heart rate, respiratory rate and SpO2. Block extension was 2 segments higher in patients given intrathecal clonidine. Duration of spinal anaesthesia (2 segment regression) increased from (90.3 ± 7.2 min) in the control group to (143.5 ± 8.7 min) in the group receiving clonidine 1?g/kg (p

A study of the effect of caudal epidural block on bispectral index targeted propofol requirement in children: A comparative study.

Caudal epidural block is one of the most commonly performed neuraxial block techniques with reliable peri-operative and post-operative analgesia in pediatric patients. In our randomized, prospective, double-blinded, open level, parallel group study, we have established the effect of caudal epidural block on maintenance requirement of intravenous (IV) propofol in targeted bispectral (BIS) monitored patients.Context:Neuraxial anesthesia exhibits sedative properties that may reduce the requirement for general anesthesia. TIVA with propofol has been administered as an established method of maintaining general anesthesia in children. Caudal analgesia being a type of neuraxial block, also seems to reduce the requirement of sedative hypnotics in pediatric patients. Numerous studies show that for patients, administered with caudal epidural block, they require reduced intra-operative volatile inhalation anesthetics. In the present study, we have established the anesthetic sparing effect of Caudal Epidural Analgesia in children undergoing infra-umbilical surgical procedure and calculated the efficacy of propofol-infusion in maintaining adequate depth of anesthesia.Aims:(1) To study and compare the dose requirements of propofol using caudal epidural analgesia. (2) To calculate the efficacy of propofol as maintenance anesthetic agent in both groups and to compare hemodynamic stability of patients in both the techniques.Settings and Design:In our study, after administering general anesthesia to pediatric patients, we have administered caudal analgesia and IV analgesia to monitor the requirement of intra-operative propofol infusion using BIS monitor with a target value of 40-60 in both groups.Materials and Methods:82 patients (aged between 3 and 6 years) have been selected undergoing infra-umbilical surgery and randomly allocated into two groups containing 41 patients in each group. Both the groups group B and group A then intubated with glycopyrrolate, 2 mg/kg injection fentanyl, propofol till loss of verbal contact and atracurium at the rate of 0.5 mg/kg and group B has been administered caudal epidural blockade with 1 ml/kg 0.2% ropivacaine. Propofol infusion at the rate of 10 mg/kg/h is given as maintenance. BIS value has been recorded throughout and propofol requirement at the end of surgery has been calculated.Statistical Analysis Used:Numerical variables between groups have been analyzed using the Student's t-test and the Mann-Whitney U-test as applicable. Categorical variables have been analyzed using the Pearson's Chi-square test. P < 0.05 is considered statistically significant.Results:Consumption of propofol at the start of operation in the group A is 2.9 ± 0.17 and group B is 2.91 ± 0.17, which is not statistically significant (P > 0.05), whereas at the end of the operation in the group A is 11.33 ± 0.17 and group B is 7.83 ± 0.63, which is statistically significant (P < 0.05). Incidence of adverse effects is statistically insignificant between the two groups. The time for administration of rescue analgesic is 2.1 ± 0.88 in group A and 6.5 ± 0.17 in group B, which is statistically significant due to caudal analgesia.Conclusions:We conclude that in BIS-monitored patients (3-6 years) with infra-umbilical surgeries have shown a reduction in consumption of IV propofol due to caudal epidural blockade.

Eyelid gangrene and endophthalmitis after Chalazion surgery: About a case

A chalazion is caused by an obstruction of excretion channel of the meibomian gland due to the accumulation of its own secretions. It can be ovoid, lobed, but most often it is a round nodule, variable in size, usually painless. Conservative treatment is the rule. When this fails, surgery is the only alternative, especially for nodules located far from the inner canthus due to the risk of seeing the section of lacrimal organs. This surgery is simple, with local anesthesia in adults and sometimes general anesthesia in children. It is exceptionally the cause of complications that can compromise the visual and/or vital prognosis. We have only found three cases in the literature, one apex orbital syndrome, an eyelid necrosis and one severe orbital bleeding. This observation reports a case of an eyelid gangrene associated with endophthalmitis due to Pseudomonas aeruginosa, which occurred after surgery for Chalazion in a healthy patient.

Comparison of the effects of sufentanil and fentanyl on hemodynamics and stress response to anesthesia in-duction in children

Objective To compare the effects of sufentanil and fentanyl on hemodynamics and stress to induction of general anesthesia in children.Methods According to the digital table,78 children undergoing selective operations were randomly divided into sufentanil group（S group） and fentanyl group（F group）,39 cases in each group.Anesthesia was induced with sufentanil 0.3μg/kg or with fentanyl 3μg/kg.Mean arterial pressure（MAP）, heart rate（HR） and the values of norepinephrine （NE）,epinephrine（E）,cortisol（Cor） were detected at five time points：2 minutes before anesthesia（T0）,the time of tracheal intubation（T1）,1 min after intubation（T2）,3 min after intubation（T3） and 5 min after intubation（T3）.Results The values of MAP,HR were higher at any time point after intubation in both groups（all P〈0.05）,and they were significantly higher in F group than those in S group（all P〈0.05）.The concentrations of NE,E,Cor have a significant increasing after endotracheal intubation in F group than those in S group（all P〈0.05）.There were no significant differences in NE,E,Cor concentrations at different time points in S group（all P〉0.05）.Conclusion Sufentanil has more inhibitory effect on stress response and provides more stable hemodynamic than fentanyl to induction of general anesthesia in children. Key words: Anesthesia; General Sufentanil Fentanyl Hemodynamics Child

Dentistry under general anesthesia in children

Dentistry under general anesthesia in children

Progress in emergence agitation following general anesthesia in children

With the rapid development of general anesthesia technology and the occurrence of new types of inhalation and intravenous anesthetics,safety and comfort requirements of general anesthesia become increas-ingly higher. Therefore,emergence agitation and its adverse consequences gradually receive more and more atten-tion . Thus the etiology and prevention of emergence agitation is an important issue in pediatric anesthesia at pres-ent. In recent years, some achievement has been made in emergence agitation following general anesthesia in children. This article will summarize the related factors,possible mechanisms and prevention strategics of pediat-ric emergence agitation. Key words: General anesthesia; Emergence agitation; Children

English

AIM: Aim of our study to compare the spinal anaesthesia and general anaesthesia in children undergoing surgeries below umbilicus. OBJECTIVE: to assess the patient comfort in pt. with GA and pt. with spinal anaesthesia, the adequate surgical condition, assess the hemodynamic change, assess the post op analgesia and to assess the post op complication. MATERIAL AND METHOD: 60 ASA grade I & II children of either sex, aged 5-12 yrs undergoing elective surgeries for the lower abdominal, perineal and lower limb surgeries were taken. After taking a detailed history, thorough general physical examination, all pertinent investigation were carried out to exclude any systemic disease. Patients were classified randomly into 2 groups (30 patients in each group). Group A: General anesthesia was given. Group P: subarachnoid block was given. Intraoperative monitoring consisted of SPO2, PR, NIBP, RR and assessment of duration of post-operative analgesia. P-value <0.05 consider significant. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery In SAB since less general anaesthetic drug including parental opioid are used the risk and postoperative respiratory depression is minimal. The stress response to surgery is also limited and recovery is fast. Postoperatively complications like sore throat, laryngeal irritation, cough etc. was also less associated with it. CONCLUSION pediatric spinal anesthesia is not only a safe alternative to general anesthesia but often the anesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and flexibility is broken and is now found to be even more cost effective. It is much preferred technique special for common day case surgeries generally performed in the pediatric age group.

Visual fMRI under General Anaesthesia in Children with Therapy Refractory Epilepsies

Introduction: Assessment of the visual field is an integral part of the clinical neurological examination of children with therapy refractory epilepsies. Especially in the field of epilepsy surgery, the evaluation of any preoperatively existing visual field defects is important with regards to surgical planning and the risk estimation of additional postoperative deficits. However, performing a formal perimetry or a clinical visual field examination using confrontation techniques is often not possible in children with therapy refractory epilepsies due to young age of the patients, cognitive impairment, or lack of cooperation. We report first experience with visual functional magnetic resonance imaging (fMRI) examinations under general anesthesia.

General anesthesia in the pediatric population.

This article reviews the pertinent perioperative, intraoperative, and short- and long-term postoperative risks associated with general anesthesia in children undergoing ocular surgery. Animal studies suggest an association between general anesthesia and neurodevelopmental delay; however, animal pharmacodynamics and pharmacokinetics do not directly correlate with human metrics. Retrospective human studies present conflicting data. Further, prospective studies in humans are underway, with projected results available within the next 3-5 years. All surgeons should be aware of current practices in pediatric anesthetic care, as well as the immediate- and long-term risks of general anesthesia. Ophthalmologists with pediatric patients should be aware of the potentially life-threatening conditions associated with general anesthesia. Additionally, the relative lifelong risks and benefits of general anesthetic exposure should be considered when recommending surgery, especially in light of the child's age, health status, and necessity of multiple anesthetic events.

Induction characteristic of general anaesthesia in children- a comparative study between sevoflurane and halothane

Background Inhalational induction of anaesthesia remains of fundamental technique in paediatric anaesthesia. Halothane used most frequently for inhalational induction in children. Halothane is not an ideal induction agent because of its potential to cause bradycardia, hypotension and ventricular ectopy. The pleasant nonpungent order of sevoflurane, faster induction of anaesthesia and stable vital signs during induction suggest that it may be a suitable alternative to halothane for use in paediatric anaesthesia. Objectives The aim of study is to compare the induction time and haemodynamic response during induction of sevoflurane and halothane. Methods A total number of 60 patients, age within 1-12 years (ASA grade I &amp; II) were selected randomly into two groups, thirty in each group. Group A induction was done by halothane and Group B induction was done by sevoflurane. Anaesthesia was induced with 60% N2O and 40% O2 and starting inspired concentration of halothane was 1% or sevoflurane was 2% followed by stepwise increases in the inspired concentrations of either sevoflurane (1.5-2% increments) or halothane (0.5-1% increments) every three to four breath until the patients no longer blinked in response to touching the eye lashes. Arterial pressure, heart rate, oxygen saturation (SPO2) were recorded every minute for 3 minutes during induction and induction time was recorded. Results Induction time was significantly shorter in the sevoflurane group compared to the halothane group (P &lt; 0.001). In haemodynamic profile heart rate and mean arterial pressure were significantly reduced in halothane group while no significant changes were observed in sevoflurane group during induction period (P &lt; 0.001). Conclusion The study concludes that induction of anaesthesia was faster with sevoflurane than halothane. Vital signs were stable with sevoflurane during induction period. DOI: http://dx.doi.org/10.3329/jbsa.v24i1.19794 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(1): 13-17

The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis.

The purpose of this meta-analysis was to determine the efficacy of lidocaine in preventing laryngospasm during general anaesthesia in children. An electronic search of six databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to. We included randomised controlled trials reporting the effects of intravenous and/or topical lidocaine on the incidence of laryngospasm during general anaesthesia. Nine studies including 787 patients were analysed. The combined results demonstrated that lidocaine is effective in preventing laryngospasm (risk ratio (RR) 0.39, 95% CI 0.24-0.66; I(2) =0). Subgroup analysis revealed that both intravenous lidocaine (RR 0.34, 95% CI 0.14-0.82) and topical lidocaine (RR 0.42, 95% CI 0.22-0.80) lidocaine are effective in preventing laryngospasm. The results were not affected by studies with a high risk of bias. We conclude that, both topical and intravenous lidocaine are effective for preventing laryngospasm in children.

Effect of lidocaine on preventing laryngospasm during general anaesthesia in children: a systematic review and meta-analysis

1Kanagawa Children’s Medical Center, Dept of Anaesthesiology, Yokohama, Japan, 2Yokohama City University, Dept of Anaesthesiology & Intensive Care, Yokohama, Japan

Prevention of emergence agitation by melatonin premedication after general anesthesia in children: meta-analysis of randomized controlled studies

Prevention of emergence agitation by melatonin premedication after general anesthesia in children: meta-analysis of randomized controlled studies