Induction Of Anesthesia In Children Research Articles

Effects of glycopyrrolate and atropine for oral secretions and perioperative hemodynamics in children undergoing tonsillectomy and adenoidectomy: a prospective, single-center, randomized, double-blind, controlled trial.

Glycopyrrolate is commonly researched as a preoperative medication or in conjunction with cholinesterase inhibitors to counteract the lingering muscarinic effects of non-depolarizing muscarinic agents. However, studies have yielded inconsistent results regarding the superiority of glycopyrrolate over other anti-cholinergic drugs, such as atropine, particularly its effect on heart rate, blood pressure (BP), and glandular secretions. This study aimed to evaluate the differences in perioperative oral secretions, hemodynamics, and recovery quality with glycopyrrolate versus those with atropine before anesthesia induction in children undergoing tonsillectomy and adenoidectomy. In this prospective, single-center, randomized, double-blind, controlled trial, a total of 103 children were randomly assigned to group A (n = 51, glycopyrrolate 0.005mg/kg) or B (n = 52, atropine 0.01mg/kg). The follow-up anesthetic induction and maintenance protocols were the same in both groups. Vital signs, duration of surgery, extubation time, degree of wetness around the vocal cords during tracheal intubation, weight of oral secretions, and perioperative complications were recorded. No significant differences were observed in the degree of wetness around the vocal cords during tracheal intubation, as well as in the weight of oral secretions, duration of surgery, or extubation time, between the two groups. The intraoperative and postoperative heart rates were lower in group A than in group B (110.18 ± 10.58 vs. 114.94 ± 11.14, p = 0.028; 96.96 ± 10.81 vs. 103.38 ± 10.09, p = 0.002). The differences observed in the intraoperative and preoperative heart rates were lower in group A than in group B (23.84 ± 9.62 vs. 29.65 ± 8.75, p = 0.002). The differences observed in the postoperative and preoperative heart rates were lower in group A than in group B (10.63 ± 9.97 vs. 18.09 ± 9.39, p = 0.000). Glycopyrrolate showed a smoother change in heart rate than atropine during and after tonsillectomy and adenoidectomy, with no effect on BP or recovery quality, and did not increase oral secretions. The findings indicate that glycopyrrolate can serve as an alternative to atropine to prevent secretions in anesthesia induction for tonsillectomy and adenoidectomy in children. Trial registration: This study was registered with the Chinese Clinical Trial Registry (Registration Number: ChiCTR2200063578; Date of Registration: 12/09/2022).

The effect on perioperative anxiety and emergence delirium of the child or parent's preference for parental accompaniment during anesthesia induction in children undergoing adenotonsillectomy surgery.

Pediatric emergence delirium (ED) occurs in the early postoperative period and is defined as a complex psychiatric disorder. Non-pharmacological methods of treatment, such as perioperative parental presence, have been the focus of many studies, but the impact on preventing ED of which parent accompanies the child during anesthesia induction has not been identified as yet. Therefore, the aim of this study was to determine whether the selection made by children undergoing adenotonsillectomy of which parent will accompany them during anesthesia induction has the effect of reducing postoperative delirium scores and incidence compared to selections made by the parents. The study included 80 children of both genders, aged 5-12 years, who underwent day-case surgery in the otorhinolaryngology clinic. The patients were separated randomly into two groups of 40. In Group 1, the children were asked to choose which of their parents would accompany them during general anesthesia induction, and in Group 2, the parents were asked to decide who would be the accompanying parent. Evaluation of postoperative delirium was made using the Pediatric Anesthesia Emergence Delirium (PAED) scale. The anxiety level of the children was evaluated with the modified Yale Preoperative Anxiety Scale (mYPAS) both in the preoperative waiting area and during the anesthesia induction. The State-Trait Anxiety Inventory (STAI) was used to evaluate the anxiety level of the parents. The mean PAED scores were similar in both groups (mean difference [95% CI]: -0.1 [-2.8 to 0.7]). The incidence of emergence delirium was also similar in both groups (risk ratio 0.9 [0.4 to 1.8]). The mean mYPAS scores during the induction of anesthesia of Group 1 was lower than that of Group 2 (mean difference [95% CI]: -8.4 [-15.2 to -1.6]). The mean mYPAS scores evaluated in the preoperative waiting area were found to be similar in the two groups (mean difference [95% CI]: -1.9 [-7.5 to 3.5]). The mean STAI anxiety scores of the parents were similar in both groups, with higher scores obtained by mothers compared to fathers, at all measurement times. The incidence or severity of ED did not decrease significantly even though lower anxiety scores were obtained during anesthesia induction in children who were allowed to make the decision of accompanying parent. Based on these findings, it can be concluded that postoperative delirium is a more complicated process that can be affected by many other variables rather than just the parent-child general interaction.

The optimal induction dose of ciprofol combined with low-dose rocuronium in children undergoing daytime adenotonsillectomy

Adenotonsillectomy is the most common daytime surgery performed on children. Anesthesiologists must select the optimal combination of drugs to ensure effective anesthesia effect and prompt recovery in children. The optimal induction dose of ciprofol in children is unclear. In this study, we aim to investigate the effect of different doses of ciprofol on anesthesia induction in children undergoing daytime adenotonsillectomy and provide a reference for clinical use. 144 children aged 3–12 years, ASA I-II, undergoing daytime adenotonsillectomy, were included in this clinical trial. The children were randomly divided into three groups and given 0.4 mg/kg (C4), 0.6 mg/kg (C6), or 0.8 mg/kg (C8) of ciprofol for anesthesia induction. The primary outcome was intubation conditions. Vital signs and injection pain were also recorded. The rates of unacceptable intubation conditions were 30.6%, 8.7%, and 8.2% in the C4, C6, and C8 groups (P value < 0.0167). The overall incidence of reported injection pain was 3.5%. The heart rate and mean arterial pressure did not differ between the groups at the same time points. We found that combining 0.6 mg/kg of ciprofol with low-dose rocuronium could provide optimal intubation conditions in pediatric daytime adenotonsillectomy patients. This combination resulted in stable circulation and BIS values. This study is registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR2200063144, Date of Registration: 31/08/2022)

Parental presence during induction of anesthesia in children undergoing tonsillectomy and adenoidectomy.

To investigate the effect of parental presence during induction of anesthesia (PPIA) in relieving preoperative anxiety of children undergoing tonsillectomy and adenoidectomy. One hundred and sixty children undergoing tonsillectomy and adenoidectomy were divided into the control group and the trial group. The control group received routine nursing in the operation room, while anesthesia was induced in the trial group children in the presence of their parents as part of the routine nursing. The differences in heart rate and mean dynamic pressure during pre-operative visit and anesthesia induction between the two groups were observed and recorded. The Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Induction Compliance Checklist (ICC) were scored. The anxiety status of the children and their family members in the two groups was scored at different times, and the psychological stress of anesthesiologists during anesthesia induction was scored by a visual analogue scale. The differences in each index between the two groups were compared. Operation time and costs in-hospital were also compared. Compared with the control group, the heart rate and blood pressure scores as well as the ICC in the trial group were lower than those in the control group (P < 0.01). On comparing the scores of m-YPAS between the two groups, we observed that the scores of the children in the trial group were lower than those in the control group before entering the induction room and anesthesia induction (P < 0.01). There was no statistical difference between the scores of the children in the trial group and the control group on the day of operation and on the way to the operating room (P > 0.05). The nursing satisfaction scores of the family members in the trial group were significantly superior to those in the control group (P < 0.01). The scores of the visual analogue scale for psychological pressure of anesthesiologists during anesthesia induction were higher in the trial group than in the control group (P < 0.05). The operation time and costs in study group were both significantly higher than those of control group (P < 0.05). PPIA can significantly reduce preoperative anxiety and surgical physiological stress response in children undergoing tonsillectomy and adenoidectomy, and it is worth being encouraged.

Comparison of I-Gel insertion conditions with two different induction methods in children: a prospective observational study

Aim: Insufficient depth of anesthesia is one of the important causes of laryngospasm in pediatric patients undergoing surgery. Propofol is a widely used anesthetic agent for induction of anesthesia in children. Its use alone in induction may be insufficient to suppress laryngeal reflexes during laryngeal mask insertion and may lead to complications such as cough, hiccups, and laryngospasm. In this study, the effects of fentanyl-ketamine mixture and remifentanil used as co-induction in anesthesia induction in children on I-gel insertion conditions and hemodynamic stability were compared. In addition, the evaluation of propofol injection pain after the use of coinduction agent was made.&#x0D; Material and Method: The study included 60 patients aged 2-10 years, of ASA I-III class, who underwent ambulatory surgery. For anesthesia induction, the KF group (n:30) were administered intravenous (iv) 1 mcg/kg fentanyl + 0.5 mg/kg ketamine followed by 3 mg/kg propofol, and the R group (n:30) were administered iv 0.5 mcg/kg remifentanil followed by 3 mg propofol. The I-gel insertion conditions were evaluated by scoring the six variables of mouth opening, ease of insertion, swallowing, coughing, movement, and laryngospasm. Pain during propofol injection was graded using a four-point scale. &#x0D; Results: No statistically significant difference was determined between the groups in terms of I-gel insertion conditions total score values (p&gt;0.05). The pain of the propofol injection was determined at a significantly higher level in Group R (p

Standardized Anesthesia InductioN Tool (SAINT) - The development and international adoption of an integrated electronic tool for documenting the induction of anesthesia in children.

The induction of anesthesia in children poses a challenge for the anesthesiologist, the parent and child. Anxiety and negative behaviours and strategies that effectively mitigate should be documented accurately and be available for future patient encounters. To address the need for a structured and standardized electronic documentation tool. Our aim was to develop a comprehensive electronic tool to capture and report behaviours during induction of anesthesia. We performed a literature search on existing validated tools for documenting behaviours during anesthesia induction. We used the nominal group technique to achieve agreement on the components to include. We used Agile software development techniques to design and review the integrated electronic tool. Twelve international hospitals informed the development of the tool. We developed an electronic tool, the Standardized Anesthesia InductioN Tool (SAINT). SAINT incorporates validated scales for documenting key stages of the anesthesia induction journey (separation from caregivers, mask acceptance, induction behaviour, parental presence, the use of adjuncts and their effectiveness). In addition, the standardised data elements used in SAINT allow for local reporting, quality metrics and can assist in data across multi-centre trials. To date the tool has been adopted by 133 institutions across four countries and is freely available. We show that collaborative development and rapid adoption of the comprehensive induction tool SAINT has led to its rapid adoption in the routine practice of pediatric anesthesiology across several countries. Further studies on how the SAINT is being used for quality improvement or research are warranted.

Parental presence and intranasal dexmedetomidine for the prevention of anxiety during anesthesia induction in children undergoing tonsillectomy and/or adenoidectomy surgery: A randomized controlled trial.

Background: During the perioperative period of pediatric surgery, it is extremely stressful for children and parents to enter the operating room and receive the anesthesia induction. This study was designed to evaluate the perioperative outcomes with parental presence at induction of anesthesia (PPIA), intranasal dexmedetomidine, and combined use of PPIA and intranasal dexmedetomidine. Methods: In this prospective study, 124 children were randomly divided into four groups: control (no parental presence or intranasal dexmedetomidine), PPIA (parental presence), DEX (intranasal dexmedetomidine (1.0μg/kg)), and PPIA + DEX (parental presence and intranasal dexmedetomidine (1.0μg/kg)). The anxiety of children was mainly evaluated by the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary evaluation methods were, for example, the Induction Compliance Checklist (ICC), the Pediatric Anesthesia Emergence Delirium Scale (PAED), the COMFORT Behavior Scale (COMFORT-B Scale), the State-Trait Anxiety Inventory (STAI), and the Visual Analog Scale (VAS). Results: Children in the PPIA + DEX group exhibited significantly lower mYPAS-SF and ICC scores compared with all three other groups (p < 0.001), and children in that group exhibited significantly lower mYPAS-SF and ICC scores compared with the PPIA and DEX groups (p < 0.05). The children's PAED scores in the PPIA, DEX, and PPIA + DEX groups were significantly lower than the control group (p < 0.001).The STAI-S scores of the PPIA, DEX, and PPIA + DEX groups were significantly lower than the score of the control group (p < 0.001). The VAS scores of the PPIA, DEX, and PPIA + DEX groups were significantly higher than that of the control group (p < 0.001), while the score of the PPIA + DEX group was significantly higher than those of the PPIA and DEX groups (p < 0.05). Conclusion: The combined use of PPIA and intranasal dexmedetomidine is more effective than PPIA or intranasal dexmedetomidine for alleviating the preoperative anxiety of children, improving children's induction compliance and parental satisfaction.

Views, Experiences, and Challenges of Anesthetists and Anesthesia Technologists on Parental Presence During Induction of Anesthesia in Children: A Mixed Method Study.

Parental presence during induction of anesthesia (PPIA) has a potential positive impact on the pediatric patient, parents, and anesthesia staff. Several studies have explored the effectiveness of PPIA. However, there are no recent studies that explore the anesthesia staff's views, experiences, and challenges toward PPIA. The aim of this study was to discover the views, experiences, and challenges of anesthetists and anesthesia technologists regarding PPIA within a hospital in Saudi Arabia. This study followed a mixed-method design with a qualitative descriptive approach. A methodologic triangulation of data collection, comprising phase one, quantitative Likert-scale questionnaires, and phase two, qualitative semi-structured interviews. Thirteen anesthetic practitioners were recruited in the questionnaire phase, and then six anesthetic practitioners participated in the interviews. The quantitative data set was analyzed using Microsoft Excel and results are given using descriptive statistics. The qualitative data set used thematic analysis and results are given using themes and participants' quotes. The data analysis identified representative themes and revealed no major differences in the opinions and experiences of anesthetists and anesthesia technologists on PPIA support. Based on the anesthesia staff's experiences, they believed in PPIA benefits, such as reduction in sedation use, minimizing the child's anxiety, and enhanced level of cooperation with the staff. Several points were raised indicating that there were challenges of PPIA with anxious parents and hospital policy being the main concern. The study provides evidence from anesthetic practitioners that PPIA is seen in a positive light within the Saudi hospital. The study's findings support further research to improve pediatric anesthesia practice, including a review of the hospital guidelines and policy.

Evaluation of Lateral Head Rotation on Eficacy of Face Mask Ventilation during Induction of Anesthesia in Children

Background: The head's position during mask ventilation on the time of anesthesia induction in children may improve the lung ventilation.&#x0D; Aim: Current study was designed to verify whether lateral head rotation improves face mask ventilation efficiency during anesthesia induction in children.&#x0D; Methods: Fifty-six patients aged 1-4 years, candidate for elective surgery, were randomly divided into two equal groups. During induction of general anesthesia, face mask lung ventilation of patients continued with pressure-controlled mode, at a peak pressure level of 10 cmH2O for children 13-24 months and 14cmH20 for children 24-48 month. In patients in the N group, the head position during ventilation was initially in the neutral position for one minute, then the head was axially rotated 45-degree to the right position for one minute and pulmonary ventilation continued in this position, then the head was rotated again to the neutral position and ventilation continued for one minute. In group R patients, mode and time of ventilation was the same, but the order of head placement was first in the lateral rotated to the right, then neutral and then lateral rotated to the right. The primary outcome was the measurement of expiratory tidal volume in each position.&#x0D; Results: Generally, the mean measured expiratory tidal volume did not change in the neutral position compared to laterally rotated head position, 256.6 vs. 233.5 ml: difference -23.1 [95% confidence interval: 10.8 to 39.4 ml]. Also, the change of head position from lateral to neutral position did not show a significant change in the mean expiratory tidal volume, 232.28 vs.247.86 ml: difference -15 .82 (p= 0.4).&#x0D; Conclusion: The rotation of the head to the lateral position during induction of anesthesia in apnoeic children 1-4 years old could not improve the efficiency of mask ventilation relative to the neutral head position.

Risk factors of anxiety during anesthesia induction in children undergoing eye and ear-nose-throat surgery

Objective: To explore the risk factors of anxiety during anesthesia induction in children undergoing eye and ear-nose-throat (ENT) surgeries. Methods: The clinical data of 930 children who underwent eye and ENT surgeries in the Eye & ENT Hospital of Fudan University from January to December 2019 were collected. The outcome variable was the degree of anxiety during anesthesia induction. Demographic information about the children and their family members, anxiety scores and the usage of preoperative sedative drugs were collected as the exposure factors. The risk factors of anxiety during anesthesia induction were determined by logistic regression analysis. Results: A total of 930 children were included in the study, of which 56(6.0%) cases developed anxiety during the induction period. Univariate logistic regression analysis showed that age (OR=0.72, 95%CI:0.61-0.86, P<0.001), anxiety grading of children by medical evaluation method (mild as the reference, moderate OR=5.42, 95%CI:2.92-10.07, P<0.001; severe OR=7.53, 95%CI: 2.54-22.29, P<0.001), Modified Yale Preoperative Anxiety Scale (mYPAS) score at arrival in the preoperative waiting room (OR=1.05, 95%CI:1.02-1.07, P<0.001) and sedation score (OR=0.48, 95%CI: 0.30-0.76, P<0.001) were risk factors for the development of anxiety during the induction period. Multivariate logistic regression analysis revealed that anxiety grading of children by medical evaluation method was a risk factor for affecting anxiety in the induction period (mild as the reference, moderate OR=4.08, 95%CI:1.81-9.18, P<0.01; severe OR=4.95, 95%CI:1.26-19.44, P=0.022). Conclusion: Anxiety grading of children by medical evaluation method is an essential risk factor for predicting anxiety during induction period.

Effect of a game-based intervention on preoperative pain and anxiety in children: A systematic review and meta-analysis.

Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological. To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients. A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication. 26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded. Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients. In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients' emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.

Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries.

Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction. Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time. Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p < 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p < 0.001). Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.

Anesthetic considerations in children with asthma.

Due to the high prevalence of asthma and general airway reactivity, anesthesiologists frequently encounter children with asthma or asthma-like symptoms. This review focuses on the epidemiology, the underlying pathophysiology, and perioperative management of children with airway reactivity, including controlled and uncontrolled asthma. It spans from preoperative optimization to optimized intraoperative management, airway management, and ventilation strategies. There are three leading causes for bronchospasm (1) mechanical (eg, airway manipulation), (2) non-immunological anaphylaxis (anaphylactoid reaction), and (3) immunological anaphylaxis. Children with increased airway reactivity may benefit from a premedication with beta-2 agonists, non-invasive airway management, and deep removal of airway devices. While desflurane should be avoided in pediatric anesthesia due to an increased risk of bronchospasm, other volatile agents are potent bronchodilators. Propofol is superior in blunting airway reflexes and, therefore, well suited for anesthesia induction in children with increased airway reactivity.

LncRNA Riken Attenuated Sevoflurane-Induced Neuroinflammation by Regulating the MicroRNA-101a/MKP-1/JNK Pathway.

The induction of anesthesia in children makes its safety one of the most important global health problems. Neuroinflammation contributes to anesthesia-induced neurotoxicity in young individuals. However, the mechanisms underlying anesthesia-induced neurotoxicity have not been established. In this study, the level of interleukin (IL)-6 in the hippocampus of mice and N2A cells treated with sevoflurane was increased, and long noncoding RNA (LncRNA) Riken was sufficient to decrease sevoflurane-induced neurotoxicity, and the level of inflammatory cytokine IL-6. The RNA pull-down assay verified that miR-101a was bound to lncRNA Riken in N2A cells. In addition, miR-101a blocked the protective effect of lncRNA Riken on anesthesia-induced neuroinflammation. These data suggest that lncRNA Riken attenuated anesthesia-induced neuroinflammation by interacting with microRNA-101a. Finally, we also demonstrated that MAPK phosphatase 1 (MKP-1) was a downstream target of miR-101a, and lncRNA Riken can regulate the expression of MKP-1; the JNK signal transduction pathway has been implicated in sevoflurane-induced IL-6 secretion. Our findings demonstrated that lncRNA Riken alleviated the sevoflurane-induced neurotoxic effects, and the lncRNA Riken/miR-101a/MKP-1/JNK axis plays an important role in the cognitive disorder.

Difficult tracheal intubation and perioperative outcomes in patients with congenital heart disease: A retrospective study

Background and objectiveManagement of difficult tracheal intubation during induction of anesthesia in children with congenital heart disease is challenging. The aim of this study is to evaluate the incidence of difficult tracheal intubation in patients with congenital heart disease and compare the incidence of perioperative complications and outcomes in patients with and without difficult tracheal intubation. DesignRetrospective cohort study. SettingTertiary Children's Hospital. Participants6858 patient-encounters including cardiac diagnostic, interventional or surgical procedures from 2012 to 2018 were reviewed. Exclusion criteria: age > 18 years, endotracheal tube or tracheostomy in-situ. Methods/interventionsPatients' demographics, number and methods of intubation, peri-intubation hemodynamics, intensive care unit and postoperative hospital length of stay were recorded. Multivariable mixed-effects median, logistic, ordinal, and multinomial regression modeling were implemented to analyze outcomes in the matched sets. ResultsOf the 6014 encounters examined in the study, the incidence of DTI was 0.96% and all 58 difficult tracheal intubations (DTI) were matched using 1:2 propensity score matching to 116 non-DTI encounters. Number of intubation attempts was significantly higher among patients with difficult tracheal intubation (ordinal logistic regression odds ratio = 2; 95% CI; 1.3, 2.7; P < 0.001). No significant differences in peri-intubation hemodynamic stability were noted. Patients with difficult tracheal intubation had longer postoperative hospital length of stay (median = 12.1 vs 7.9 days, coef. = 4; 95% CI: 1.3, 6.8; P = 0.004) than patients without. ConclusionDespite a higher number of intubation attempts, our study shows no major differences in the peri-intubation hemodynamics in patients with and without difficult tracheal intubation. This risk can be mitigated by a good understanding of cardiac physiology, management of hemodynamics, and early use of an indirect intubation technique to maximize first attempt success.

Effect of parental presence on anxiety during induction of anaesthesia in children undergoing elective day case surgery

BackgroundSurgical operation and anaesthesia induction are fearful events which may interfere with the smooth conduct of anaesthesia and postoperative recovery in children. Indeed, the fear of needles, syringes and unknown hospital environment often compound their anxiety. Various modalities such as use of clowns, music, low intensity light in the induction room, pharmacological agents and parental presence during induction of anaesthesia have been utilized with the aim of gaining the cooperation of the children during induction. However, their use has yielded conflicting results. This prospective study was conducted among children whose ages were between 2 and 15 years. They were randomized into parental presence and parental absence (un-accompanied) or control groups. The anxiety levels of children and parents in both groups were compared at baseline, separation and during induction of anaesthesia.ResultsThe ages of the children ranged between 2 and 15 years with a mean age of 6.78 ± 2.50 years. The mean age of patients in the parental presence at induction (PPIA) was 7.14 ± 3.68 years while in the control group was 6.42 ± 3.31 years. The difference was not statistically significant, p < 0.05. The mean anxiety score of patients in the PPIA at reception, separation and induction of anaesthesia were 26.6 ± 9.2, 38.4 ± 18.3 and 54.1 ± 22.8 compared to 27.3 ± 8.04, 41.4 ± 21.7 and 58.6 ± 23.1 in the control group respectively, p < 0.05. The mean anxiety score of parents in the PPIA at reception, separation and induction of anaesthesia were 52.2 ± 6.7, 51.7 ± 7.8 and 51.9 ± 7.9 compared to 53.0 ± 6.5, 52.4 ± 6.2 and 52.9 ± 7.9 in the control group respectively, p < 0.05. Among the cohort of preschool age group, children in the control group were more anxious at induction compared to the PPIA group, p = 0.01. As the age increases, the anxiety state of the children decreases, t = − 0.398, p < 0.001. The mean score of parental satisfaction in the PPIA and the control groups were comparable, 8.1 ± 7.1 vs 7.3 ± 1.1 respectively, p = 0.395.ConclusionThe presence of parents during induction of anaesthesia did not influence the anxiety states of children in our study. Anxiety at induction tends to reduce as the age of patients increases.

A concept mobility device with multi-positional configurations and child-kind restraint for safe perioperative transfer and induction of anaesthesia in children with autistic spectrum disorder \u2013 a cross sectional study

BackgroundTransfer into the operating room, onto the operating table and mask induction of anaesthesia are major challenges faced by children with Autistic Spectrum Disorder (ASD). In a pilot study, parents observed that perioperative transfer becomes unsafe and difficult when children with ASD becomes uncooperative.MethodA CHILD-KIND CONCEPT mobility system comprising of multi-positioning seat configurations and restraining module was developed with inputs from multi-disciplinary healthcare professionals and parents with children with ASD. To appeal to children and motivate child-machine interaction, the seat configurations and restraining module are designed to take the form of child-friendly, non-threatening, fun and familiar items. The sitting configuration, sitting to supine transformation, the restraint modules resemble racing-car seat, reclining motion of a home massage chair, safety restraints found in airplanes and amusement rides respectively. Healthcare professionals (HCPs) involved in the perioperative patient care, parents of ASD children and children (neurotypical and ASD) experience the use of the system in a non-clinical environment and participated in a survey study. The acceptance of its functionality (HCPs, parents) for perioperative transfer and induction of anaesthesia, rating of the user experience and likes and dislikes of (parents and children) were obtained.ResultsThirty-two HCPs, 30 parents and 23 children participated. Majority of parents and HCPs opined the use of the system enables improvement in the management of perioperative movement (90.0% parents, 100% HCPs), safe perioperative movement (86.7% parents, 96.9% HCPs) and promotes ease of anaesthesia induction (76.7% parents, 90.6% HCPs) for uncooperative combative ASD children. Overall, 93.8% HCPs and 86.7% parents would recommend its frequent use in their own practice and their ASD children respectively. Attractiveness and multi-functionality are attributes endorsed by parents and children. Children endorse its use for induction of anaesthesia (73.9%), dental chair (82.6%), intra-hospital transfer (95.7%).ConclusionA child-kind mobility device that integrates appeal with functionality of restraint and multi-positional transformation has a potential to promote safe perioperative movement and ease of induction of anaesthesia in anxious uncooperative ASD children.

Incidence of post-induction hypoxemia in children and the effect of induction gas composition.

Pediatric preoxygenation and inhalation induction of anesthesia can include a mixture of gases. In children, the clinical impact on oxygenation while using other gases with oxygen during an inhalation induction is unknown. We aimed to determine the impact of oxygen, nitrous oxide, and air concentrations added to the volatile agent by recording the incidence of hypoxemia following an inhalation gaseous induction in children. Records from an Automated Information Management System were used to find the incidence of hypoxemia following an inhalation induction of anesthesia. Episodes of hypoxemia (SaO2 <90% sustained for at least 120s) were recorded in the 10min after the 3-min induction period. Nitrous oxide and oxygen concentrations were recorded and nitrogen concentration was deduced. We also considered patient sex, age, and ASA status as covariates. A total of 27258 cases were included in the analysis. The overall incidence of hypoxemia following an inhalation induction of anesthesia was 5.08% (95% CI 4.83 5.35). Hypoxemia was more common in younger patients and those with higher ASA scores. Controlling for those factors and sex, the incidence of hypoxemia increased 1.2-fold when inspired oxygen concentration was less than 60% and hypoxemia was 2.37 times greater than the overall incidence when the inspired oxygen concentration was less than 40%. There was no clear effect of different concentrations of nitrous oxide or nitrogen when those were factored into the model. The risk of hypoxemia following an inhalation induction of anesthesia in children is minimized when the inspired concentration of oxygen is greater than 60%.

Impact of Music Therapy on Preoperative Anxiety and Degree of Cooperation With Anesthesia Induction in Children With Simple Congenital Heart Disease

PurposeTo evaluate the impact of music therapy (MT) on preoperative anxiety and degree of cooperation with anesthesia induction in children with simple congenital heart disease (CHD). DesignA randomized controlled clinical study. MethodsNinety children were randomly assigned to the MT and control groups. The MT groups underwent a preoperative 30-minute session of MT, whereas the control group did not listen to any music and had the same amount of quiet time. The modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) was used to evaluate the patients' preoperative anxiety on entering the anesthesia waiting area (T1), 10 minutes after entering the waiting area (T2), and during the initiation of anesthesia induction (T3); the degree of cooperation with anesthesia induction was assessed using the Induction Compliance Checklist. The mean arterial blood pressure (MAP) and heart rate (HR) at T1, T2, T3, and T4 (the time of successful anesthesia) were also recorded. FindingsOne child was excluded from the MT group, and one was excluded from the control group. No difference was found in the mYPAS-SF score, MAP, or HR between the two groups at T1. The mYPAS-SF scores of the MT group were significantly lower than those of the control group at T2 and T3. At T2, T3, and T4, the MAP and HR of the MT group were lower than those of the control group. A statistically significant difference was found in the Induction Compliance Checklist score between the two groups. ConclusionsMT can reduce preoperative anxiety and improve the degree of cooperation with anesthesia induction.

STATE OF SYSTEMIC HEMODYNAMICS FOR CHILDREN WITH CONGENITAL SURGICAL PATHOLOGY IN DIFFERENT COMBINED ANESTHESIA TYPES

General anesthesia for a surgical correction of congenital malformations in children is accompanied, in particular, by the disorders of systemic hemodynamics. In order to assess the impact of different types of combined anesthesia on the state of systemic hemodynamics in surgical correction of congenital malformations, a retrospective study of the treatment of 150 newborns and infants was conducted. These were children with various congenital malformations, but the most common were intestinal obstruction and abdominal tumors. Three groups of patients were formed depending on the type of combined anesthesia during surgical correction of abnormalities: I − inhalation (sevorane) + regional anesthesia; II − inhalation (sevorane) + intravenous anesthesia (fentanyl); III − total intravenous anesthesia with two drugs: analgesic (fentanyl) and drug sleep on the background of intravenous injection of hypnotics (20 % sodium oxybutyrate). There were preformed the surgeries: thoracic, urological, abdominal. The study was retrospectively evaluated in five stages. The analysis of systemic hemodynamics showed a tendency to reduce diastolic blood pressure in children treated with anesthesia with two intravenous drugs (hypnotic and fentanyl), during all observation stages and a significant decrease in this index at the most painful and traumatic period. At the time of induction of anesthesia in children there was a decrease in heart rate. According to the research results, it is concluded that when using the pre−hypnotics as part of combined anesthesia in children with congenital malformations during surgery there is a risk of complications from central hemodynamics in the form of vasodilation, which leads to a drop in blood pressure and increases compensatively the heart contractions. Key words: infants, congenital malformations, anesthesia, hemodynamics.