General Anesthesia In Pediatric Patients Research Articles

Efficacy of intratracheal dexmedetomidine on recovery from general anaesthesia in paediatric patients undergoing lower abdominal surgeries: A randomised controlled trial.

This study investigated the effectiveness of intratracheal dexmedetomidine in reducing untoward laryngeal responses in paediatrics undergoing lower abdominal surgeries. This trial included 60 patients divided into two groups scheduled for lower abdominal surgeries. Group D were given intratracheal dexmedetomidine at a dosage of 0.5mg/kg, while Group C received intratracheal saline (0.9%). The cough severity score, the Paediatric Objective Pain Scale for pain assessment, awareness, extubation, emergence agitation score, Ramsay sedation score and adverse effects were recorded. There was a significant difference in the incidence of coughing severity between Groups D and C both at extubation and after five minutes of extubation (p < 0.001). The median scores of the Paediatric Objective Pain Scales and the median agitation scales of Group D were significantly lower over the first four hours (p < 0.050). The mean time to first request rescue analgesia was significantly longer in the D group than in the control group (p < 0.001). The mean total consumption of rescue analgesia in the first 24 hours postoperatively was significantly lower in the dexmedetomidine group (p < 0.050). Awareness and extubation times were comparable in both groups, and none of the subjects reported any adverse effects. In the current study, lower abdominal surgery patients who received intratracheal dexmedetomidine at a dose of 0.5mg/kg 30 minutes before the completion of the procedure experienced smooth extubation and balanced anaesthetic recovery.

Evaluating the Correlation between Ptosis Improvement and Immediate Postoperative Lagophthalmos following Blepharoptosis Surgery under General Anesthesia in Pediatric Patients.

Background: The objective of this study is to establish a potential correlation between postoperative improvement in upper eyelid ptosis, measured by the marginal reflex distance 1 (MRD1), and the immediate postoperative degrees of lagophthalmos (IPDL). The established correlation is then used to assess whether IPDL can be used as a reliable indicator of successful treatment of eyelid ptosis. Methods: This retrospective study involved 19 patients, aged 1 to 11, with a total of 28 eyes affected by ptosis, who underwent surgery under general anesthesia at Seoul National University Bundang Hospital from January 2018 to December 2022. We monitored the MRD1 of the patients for over six months postoperatively and measured the IPDL. Results: After ptosis correction surgery, no statistically significant correlation was observed between the improvement in MRD1 and IPDL. Furthermore, the degree of postoperative eyelid ptosis improvement was found to vary and was not consistently sustained, attributable to a range of factors. Conclusions: Our study did not establish a statistically significant correlation between IPDL and ptosis improvement as measured by MRD1. Further research is needed to draw definitive conclusions about their correlation.

A Single Center's Experience With Spinal Anesthesia for Pediatric Patients Undergoing Surgical Procedures

PurposeTo perform a single institution review of spinal instead of general anesthesia for pediatric patients undergoing surgical procedures. Spinal success rate, intraoperative complications, and postoperative outcomes including unplanned hospital admission and emergency department visits within seven days are reported. MethodsRetrospective chart review of pediatric patients who underwent spinal anesthesia for surgical procedures from 2016 until 2022. Data collected included patient demographics, procedure and anesthetic characteristics, intraoperative complications, unplanned admissions, and emergency department returns. ResultsThe study cohort included 1221 patients. Ninety-two percent of the patients tolerated their surgical procedure without requiring conversion to general anesthesia, and 78% of patients that had spinals placed successfully did not receive any sedation following lumbar puncture. The most common intraoperative event was systolic blood pressure below 60 mm Hg (14%), but no cases required administration of vasoactive agents, and no serious intraoperative adverse events were observed. Post-Anesthesia Care Unit Phase I was bypassed in 72% of cases with a median postoperative length of stay of 84 min. Forty-six patients returned to the emergency department following hospital discharge, but no returns were due to anesthetic concerns. ConclusionsSpinal anesthesia is a viable and versatile option for a diversity of pediatric surgical procedures. We noted a low incidence of intraoperative and postoperative complications. There remain numerous potential advantages of spinal anesthesia over general anesthesia in young pediatric patients particularly in the ambulatory setting. Level of EvidenceIV. Type of StudyRetrospective cohort treatment study.

Timing of general anesthesia for pediatric patients recovering from COVID-19: a prospective cohort study

ObjectiveTo explore the timing of general anesthesia for pediatric patients who have recovered from novel coronavirus infection and summarize anesthesia-related complications.MethodsWe summarized the perioperative management of children under 14 years of age who underwent general anesthesia in our hospital according to national epidemic prevention and control requirements. We compared the incidence of postoperative pulmonary complications within 2 weeks (Group A), 3–4 weeks (Group B), and 5–6 weeks (Group C) after COVID-19 recovery.ResultsThere were differences among the three groups in terms of decreased blood oxygen saturation (< 94%), secretions, and coughing during the PACU period. The risk of low blood oxygen saturation during PACU decreased as the time of COVID-19 recovery extended in the three groups. Compared to Group A, the risk of low blood oxygen saturation was lower in Group B. The presence of respiratory symptoms and a body temperature above 40℃ increased the risk of decreased blood oxygen saturation. The proportion of children aged 11–14 years and children with high fever experiencing decreased blood oxygen saturation during PACU was higher in Groups A and B. Among the three groups, children with respiratory symptoms and longer illness duration had a higher proportion of decreased blood oxygen saturation during PACU.ConclusionPediatric patients who have recovered from COVID-19 for more than 2 weeks have a lower risk of postoperative complications after general anesthesia. For children with respiratory system symptoms or high fever, there is a higher risk of transient blood oxygen saturation decrease during PACU. For older children, those with high fever, respiratory system symptoms, or longer illness duration, it is recommended to appropriately extend the time from COVID-19 recovery to surgery.

The effect of recorded mother voice on emergence delirium after general anesthesia in pediatric patients

The effect of recorded mother voice on emergence delirium after general anesthesia in pediatric patients

Ultrasound-Guided Sciatic Nerve Block vs. Caudal Analgesia in Cerebral Palsy Undergoing Lower Limb Surgeries

Background: Continuous advancements in ultrasound (US)-guided neuraxial and peripheral nerve blocks (PNB) have allowed the safe and successful use of these blocks as adjuvants to general anesthesia in pediatric patients. Objectives: This study was designed to compare the analgesic efficacy of 2 US-guided regional techniques, caudal epidural block (CEB) and subgluteal sciatic nerve block (SNB), in children with cerebral palsy (CP). Methods: The current randomized comparative study was conducted on 30 patients with spastic CP aged 2-12 years who were scheduled for unilateral lower limb multilevel soft tissue corrective surgeries, randomly distributed using a computerized program into 2 equal groups. The CEB group received a US-guided caudal block, and the SNB group received a US subgluteal sciatic nerve block. The time to the first postoperative analgesia requirement (primary outcome), postoperative pain score, total postoperative analgesic consumption, and perioperative complications (secondary outcomes) were assessed in both groups. Results: The duration of postoperative analgesia was significantly longer in patients of the SNB (14.65 ± 3.08 h) than in the CEB group (5.93 ± 1.68 h). The postoperative pain scores recorded at 6th-12th h and the postoperative 24-h rescue analgesic consumption were significantly lower in the SNB compared to the CEB group. Conclusions: Ultrasound-guided subgluteal sciatic nerve block is a safe and effective alternative to US-guided caudal analgesia in pediatric patients with spastic CP scheduled for lower limb surgeries, with longer postoperative analgesia and similar perioperative safety profiles.

Supraclavicular Brachial Plexus Block Guided by Ultrasonography in Pediatric Patient: A Case Report

Background: Supraclavicular brachial plexus block has proven to be very useful in upper limb surgeries in pediatric patients. Supraclavicular brachial plexus block is preferred over general anesthesia for pediatric patients undergoing upper limb surgeries. This study aimed to report a procedure of supraclavicular brachial plexus block guided by ultrasonography in a pediatric patient undergoing orthopedic surgery on the upper extremity, which yielded good results, a high success rate, reduced opioid usage, and aided in faster recovery while minimizing complications.&#x0D; Case presentation: The patient was a 14-year-old child with a diagnosis of malunion in the left distal radius after open reduction internal fixation (ORIF) planned for osteoclasis surgery and ORIF with regional anesthesia through supraclavicular brachial plexus block. The patient was monitored during the surgery, and after the surgery, the patient returned to the ward; the patient was given oral analgesics without opioids for pain management.&#x0D; Conclusion: The efficient regional anesthesia procedure option for upper limb surgeries in pediatric patients is the supraclavicular brachial plexus block. Due to lower risks and fewer side effects, the supraclavicular brachial plexus block procedure is preferred over general anesthesia in pediatric patients.

What is your optimal target of oxygen during general anesthesia in pediatric patients?

The optimal oxygen target during general anesthesia remains difficult to define in pediatric and adult patients. Although access to pediatric patients has become difficult owing to a decrease in birth rate, pediatric anesthesia remains an important part of anesthesiology, and oxygenation related to general anesthesia is an essential part of any anesthesiologist. The use of oxygen has increased survival rates in adults and children; however, the side effects related to oxygen use have also increased. This review addresses the considerations of oxygenation in pediatric patients undergoing general anesthesia.

Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis.

Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required. To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety. We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022. We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2-18 years) undergoing MRI. Standardized instruments were used to extract data and assess study quality. Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48-0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51-0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years. There was substantial heterogeneity among nonrandomized studies. Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.

The safety and efficacy of remimazolam tosylate for induction and maintenance of general anesthesia in pediatric patients undergoing elective surgery: Study protocol for a multicenter, randomized, single-blind, positive-controlled clinical trial.

Introduction: Remimazolam is an ultra-short-acting benzodiazepine sedative agent commonly used in general anesthesia, procedural sedation, and intensive care unit (ICU) sedation. This study aimed to explore the efficacy and safety of remimazolam versus propofol for the induction and maintenance of general anesthesia in preschool-age children undergoing elective surgery. Methods and analysis: In this multicenter, randomized, single-blind, positive-controlled non-inferior clinical trial, one hundred ninety-two children aged 3-6years will be randomly allocated as a 3:1 ratio into two groups: Group R with an intravenous dose of remimazolam 0.3mg/kg for the induction of anesthesia followed by a constant infusion rate of remimazolam 1-3mg/kg/h to maintain anesthesia, and Group P with an intravenous dose of propofol 2.5mg/kg for the induction of anesthesia followed by a constant infusion rate of propofol 4-12mg/kg/h to maintain anesthesia. The primary outcome will be the rate of the successful induction and maintenance of anesthesia. The secondary outcomes will include the time to LoC, the Bispectral Index (BIS) value, awakening time, extubation time, post-anesthesia care unit (PACU) discharge time, usage of additional sedative drugs during the induction period, usage of remedial drugs in PACU, emergence delirium, pain in PACU, behavior scores at day 3 after surgery, parental and anesthesiologists' satisfaction, and adverse events. Ethics and dissemination: This study has been approved by the ethics review boards at all participating hospitals. The Ethics Committee of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University (Reference No. LCKY 2020-380, November 13, 2020) is the central ethics committee.

Comparison of parental and practitioner’s acceptance for dental treatment under general anaesthesia in paediatric patients

BackgroundPractitioner’s knowledge and parental perspectives on dental general anaesthesia (GA) have been surveyed separately in the past. But in daily routine both need to collaborate for the benefit of the child. The aim of this paper was to compare parental and practitioner’s acceptance of GA with special focus on identifying factors which influence their differences in decision making.MethodsQuestionnaires were conducted among 142 participants in a specialized paediatric dental clinic in Germany from February 2020 to February 2021. 51 German practitioners from private practices and clinics participated. Data collection included: age, gender, experience with GA, fear of GA, risk evaluation and indications for GA.ResultsThere were no gender related differences in decision making. Emotional factors are present in parents of younger children. Parents are more likely to express fear and uncertainty regarding GA than dentists. Prior experience with GA significantly decreases fears in GA for parents. Both agree that extent of the treatment and low compliance are a suitable indication for GA. Dentists are more likely to accept GA due to a mental disability than parents. Parents were more likely to accept GA than dentists when multiple extractions were needed (regardless of compliance) or acute pain was present.ConclusionsA significant divergence in risk evaluation, acceptance and decision-making could be found in parents compared to dentists. Influencing factors are previous experience, younger age of the child, lack of knowledge and indication for GA.

Intubating Conditions and Efficacy of Rocuronium versus Atracurium in Paediatric Patients undergoing Elective Surgeries under General Anaesthesia: A Randomised Clinical Trial

Introduction: Atracurium and rocuronium are non depolarising Neuromuscular Blockers (NMBs) with an intermediate duration of action and are used safely in the short and intermediate duration of surgical procedures in paediatric population. Aim: To compare the efficacy and safety of NMBs (rocuronium versus atracurium) at a dose 2 x (ED95) for elective surgeries under general anaesthesia in paediatric patients. Materials and Methods: The present randomised, doubleblinded, clinical trial study was conducted in the Department of Anaesthesiology and Intensive care, Adesh Institute of Medical Science and Research (AIMSR), Bathinda, Punjab, India, from October 2021 to April 2022. Seventy American Society of Anaesthesiologists (ASA) grade I-II patients of both sexes of 1-12 years age, undergoing elective surgeries under general anaesthesia were included in the study. These patients were randomly divided into two groups: patients receiving rocuronium (0.6 mg/kg) (group R, n=35) and patients receiving atracurium (0.5 mg/kg) (group A, n=35) for endotracheal intubation. Assessments were done for timing of intubation, intubation score, interpretation of relaxogram, haemodynamics, adverse events, extubation (normal or delayed) and recovery time. All the data was entered in Microsoft Excel sheet and results were expressed as percentages and mean±Standard Deviation (SD), chi-square test and unpaired t-test. Results: Time of intubation was faster with rocuronium than atracurium (66±20.32 vs 100.29±21.76 seconds). Intubation score was significantly lower in group A (2.14±0.36) than group R (3.74±0.44). Heart Rate (HR) increased significantly after intubation with atracurium. Adverse effects like bronchospasm, hypotension, skin reaction and wheeze were found in patients receiving atracurium but not in rocuronium group. Faster onset and recovery with short clinical duration was found with rocuronium on relaxogram. Delayed extubation was found in 45.7% patients in atracurium group and 5.7% patients in rocuronium group. Conclusion: Rocuronium gives excellent intubating conditions with faster induction time, shorter clinical duration, high recovery index, minimal side-effects and good haemodynamic stability than atracurium in paediatric patients.

Effect of local anesthesia on postoperative pain and hemostasis after dental rehabilitation under general anesthesia in pediatric patients: a randomized control trial

Effect of local anesthesia on postoperative pain and hemostasis after dental rehabilitation under general anesthesia in pediatric patients: a randomized control trial

Choice of the correct size of endotracheal tube in pediatric patients.

Selection and insertion of an endotracheal tube (ETT) of appropriate size for airway management during general anesthesia in pediatric patients is very important. A very small ETT increases the risk of inadequate ventilation, air leakage, and aspiration, whereas a very large ETT may cause serious complications including airway damage, post-intubation croup, and, in severe cases, subglottic stenosis. Although the pediatric larynx is conical, the narrowest part, the rima glottidis, is cylindrical in the anteroposterior dimension, regardless of development, and the cricoid ring is slightly elliptical. A cuffed ETT reduces the number of endotracheal intubation attempts, and if cuff pressure can be maintained within a safe range, the risk of airway damage may not be greater than that of an ETT without cuff. The age-based formula suggested by Cole (age/4 + 4) has long been used to select the appropriate ETT size in children. Because age-based formulas in children are not always accurate, various alternative methods for estimating the ETT size have been examined and suggested. Chest radiography, ultrasound, and a three-dimensional airway model can be used to determine the appropriate ETT size; however, there are several limitations.

Quantity and duration of exposure to general anesthesia for pediatric patients with retinoblastoma

To quantify the duration of anesthesia required for optimal management of retinoblastoma (Rb), stratified by clinical factors. The medical records of Rb patients treated at Phoenix Children's Hospital between January 2011 and January 2022 were reviewed retrospectively. Demographic, tumor, and treatment data were collected. Anesthesia time was recorded for procedures requiring general anesthesia, including intra-arterial chemotherapy (IAC), enucleation, brainstem auditory evoked response testing (BAER), port placement, magnetic resonance imaging (MRI), and examination under anesthesia (EUA). Descriptive statistics were used to summarize patient and clinical characteristics. Total anesthesia time was 48,991 minutes for 610 procedures in 43 patients. The median follow-up time was 36 months (range, 12-114 months). Average anesthetic durations per exposure were 274, 152, 81.8, 62.5, 60.7, and 45 minutes for IAC, enucleation, BAER, port placement, MRI, and EUA, respectively. Patients with bilateral Rb underwent a median of 1,659 minutes of total anesthesia, compared with 397 minutes for those with unilateral disease. In patients with unilateral Rb, median total anesthesia time was 2,651, 1681, 312, 397 minutes for International Classification of Retinoblastoma grades B, C, D, and E tumors, respectively. Patients who received IAC as their primary treatment had the highest median anesthesia duration (2,100 minutes), followed by systemic chemo (654 minutes) and enucleation (289 minutes). Treatment of Rb requires prolonged and repeated exposure to general anesthesia. Future studies are required to determine the potential effects of these childhood anesthetic exposures.

Supplemental intraoperative crystalloids for pediatric postoperative nausea and vomiting-A systematic review and meta-analysis.

Postoperative nausea and/or vomiting is a relatively frequent occurrence after general anesthesia in pediatric patients. Supplemental perioperative crystalloid fluid administration has been shown to have a positive effect on the incidence of nausea and/or vomiting in adults undergoing surgery. The question arises whether supplemental intraoperative intravenous fluids in pediatric patients offers beneficial results with regards to pediatric postoperative nausea and/or vomiting. Pubmed, EMBASE, Google Scholar, and Web of Science were searched up to March 2022 to perform a systematic review with meta-analysis of randomized controlled trials involving patients ≤18 years undergoing elective surgery under general anesthesia, with one group receiving conventional intraoperative fluids therapy and the other group receiving supplemental intraoperative fluid therapy, with intravenous crystalloids. The outcomes included incidence of postoperative vomiting, postoperative nausea and vomiting, the need for rescue anti-emetics, postoperative thirst, and adverse events attributed to supplemental intravenous fluid therapy. Relative risk (RR) with 95% confidence intervals (CIs) were reported for the outcomes using a random or fixed effects model. Seven randomized controlled trials (864 patients) were included in the final analysis. Supplemental intraoperative crystalloids reduce postoperative vomiting (RR 0.56, 95% CI 0.39-0.80; p=.001), postoperative nausea and vomiting (RR 0.52, 95% CI 0.37-0.74; p=.0003), postoperative thirst (RR 0.21, 95% CI 0.13,0.34; p < .01), and the need for rescue anti-emetics postoperatively (RR 0.60, 95% CI 0.49-0.74; p=.00001). Supplemental intraoperative intravenous crystalloids significantly reduce several PONV outcomes in healthy children undergoing relatively simple and superficial surgeries under volatile agent-based general anesthesia.

Efficacy and safety of intranasal ketamine compared with intranasal dexmedetomidine as a premedication before general anesthesia in pediatric patients: a systematic review and meta-analysis of randomized controlled trials.

To compare the efficacy and safety of intranasal ketamine with intranasal dexmedetomidine as a premedication in pediatric patients undergoing general anesthesia for elective surgery or other procedures. We conducted a systematic literature search in PubMed, PubMed Central, Scopus, LILACS, Google Scholar, the Cochrane Database of Systematic Reviews, and trial registries for randomized controlled trials (RCTs) comparing intranasal ketamine with intranasal dexmedetomidine as preanesthetic medication in elective surgery or other procedures in pediatric patients. We used Review Manager software version 5.4.1 for statistical analysis and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed the methodological quality of the included studies with the RoB 2 risk of bias tool. All outcomes were pooled using the Mantle-Haenszel method and a random-effects model. The quality of evidence was assessed using the GRADE approach. Out of 2,445 full texts assessed, we included ten RCTs in the analysis. The efficacy outcomes did not fulfill the comparability criteria between intranasal ketamine and intranasal dexmedetomidine for sedation at parental separation (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.79 to 1.04; I2 = 89%; GRADE evidence, low), mask acceptance (RR, 0.86; 95% CI, 0.66 to 1.13; I2 = 50%; GRADE evidence, low), and iv canulation (RR, 1.16; 95% CI, 0.79 to 1.69; I2 = 69%; GRADE evidence, very low). Intranasal ketamine-treated patients showed a higher incidence of nausea and vomiting (RR, 2.47; 95% CI, 1.24 to 4.91; I2 = 0; GRADE evidence, moderate). Significantly more bradycardia was observed in the intranasal dexmedetomidine group (RR, 0.16; 95% CI, 0.04 to 0.70; I2 = 40%; GRADE evidence, moderate) than in the ketamine group. The low to very low-quality evidence in this systematic review and meta-analysis of RCTs neither confirmed nor refuted comparable premedication efficacy of intranasal ketamine and dexmedetomidine in terms of parental separation, mask acceptance, and iv cannulation in a pediatric population. Clinical decision-making is likely to be influenced by differences in gastrointestinal and cardiovascular safety profiles. PROSPERO (CRD42021262516); registered 22 July 2021.

Wildfire Smoke Exposure Is Associated with Adverse Respiratory Events under General Anesthesia in At-risk Pediatric Patients.

Increasing wildfire activity worldwide has led to exposure to poor air quality and numerous detrimental health impacts. This study hypothesized an association between exposure to poor air quality from wildfire smoke and adverse respiratory events under general anesthesia in pediatric patients. This was a single-center retrospective double-cohort study examining two significant wildfire events in Northern California. Pediatric patients presenting for elective surgery during periods of unhealthy air quality were compared with those during periods of healthy air quality. The primary exposure, unhealthy air, was determined using local air quality sensors. The primary outcome was the occurrence of an adverse respiratory event under anesthesia. Secondary analysis included association with other known risk factors for adverse respiratory events. A total of 625 patients were included in the analysis. The overall risk of a respiratory complication was 42.4% (265 of 625). In children without a history of reactive airway disease, the risk of adverse respiratory events did not change during unhealthy air periods (102 of 253, 40.3%) compared with healthy air periods (95 of 226, 42.0%; relative risk 0.96 [0.77 to 1.19], P = 0.703). In children with a history of reactive airway disease, the risk of adverse respiratory events increased from 36.8% (25 of 68) during healthy air periods to 55.1% (43 of 78) during periods with unhealthy air (1.50 [1.04 to 2.17], P = 0.032). The effect of air quality on adverse respiratory events was significantly modified by reactive airways disease status (1.56 [1.02 to 2.40], P = 0.041). Pediatric patients with underlying risk factors for respiratory complications under general anesthesia had a greater incidence of adverse respiratory events during periods of unhealthy air quality caused by wildfire smoke. In this vulnerable patient population, postponing elective anesthetics should be considered when air quality is poor.

Comparative study: evaluation of the effect of sevoflurane versus isoflurane in general anesthesia for pediatric patients undergoing cardiac catheterization

ABSTRACT Background Anesthesiologists have had a difficult time managing infants with congenital heart disease, particularly at cardiac catheterization. Aim and objectives The investigation goal was to examine hemodynamic parameters and recovery profiles using Sevoflurane or isoflurane for anaesthesia in children scheduled for elective cardiac catheterization. Setting University educational hospital. Design A single-center, prospective clinical trial Materials and Methods Sixty juvenile patients having optional cardiac catheterization were randomised and assigned to one of two groups: isoflurane (group I) or sevoflurane (group S). Midazolam 0.5 mg/kg was given orally to all patients, 30 minutes prior to the surgical procedure. The initiation of anaesthesia was initiated with 5 mg/kg intramuscular ketamine in both groups. Maintenance of anaesthesia throughout the procedure was either by One MAC 2 ug/kg was given to all patients to provide analgesia and 1% xylocaine infiltration at the site of catheter insertion. Isoflurane (1.2%) (Group I) or sevoflurane (2%) (Group S) in an oxygen-air mixture of 1:1. All drugs were given by anaesthesiologists not involved in the study. Results Hemodynamic changes at and after the procedure: Mean arterial blood pressure (MAP), O2 saturation, ejection fraction (EF), and fraction shortening (FS) showed statistically substantial differences (P 0.05). The S group had a considerably greater steward score (recovery score) than the I group. Conclusion Sevoflurane in paediatric patients having cardiac catheterization provides good preservation of hemodynamic stability, rapid recovery, better sedation, and minimal side effects.

Dental procedures and operating time under day-care general anesthesia among medically compromised and uncooperative pediatric patients.

To analyze dental procedures and operating time provided to medically compromised and uncooperative pediatric patients under general anesthesia (GA). This cross-sectional retrospective study reviewed hospital records of pediatric patients treated under day-care GA at a Malaysian university hospital between January 2013 and December 2019. Dental procedures were categorized into preventive, restorative, pulp therapy, extraction, and surgical procedures. Age groups were categorized into < 6 years (primary), 6 to 12 years (mixed) and > 12 years old (permanent), to represent different dentitions. The treatment and operating times under GA were compared between age groups, sex, and medical conditions. A total of 595 patients (455 uncooperative healthy and 140 medically compromised) were included in the study. The mean age of the patients was 5.7 years. Male patients (58.3%) outnumbered female patients (41.7%). The most frequently performed procedure was primary tooth extraction. A higher number of surgical procedures were performed on children aged > 12 years compared to younger age groups (P = .001). Children with medical problems had more preventive (mean 3.85 ± 3.65) than restorative treatments (mean 2.66 ± 2.80) and the results were reversed for healthy children. The mean operating time was 64.71 ± 27.89 minutes. Regardless of health status, children > 12 years old had longer operating times, and the mixed dentition group had the shortest treatment durations. Different types of dental treatment modalities are provided under GA for pediatric patients and operating time was associated with age group. Findings will be useful to improve efficiency of management of pediatric dental cases under day-care GA.