Sedation In Infants Research Articles

Medium dose chloral hydrate for sedation of infants and children undergoing CT

The use of chloral hydrate for paediatric sedation before CT was studied systematically in a limited scale and mainly retrospectively. Chloral hydrate in a dose of 50–75 mg/kg (maximum dose 2 g) was administered per os or per rectum to 378 children for 400 CT examinations. All absolute and relative contraindications had been taken into account. A total of 360 CT examinations (90%) were free of motion artifacts, due to successful sedation. A total of 28 examinations (7%) were less optimal, but still diagnostic, so repetition was unnecessary. A total of 12 examinations (3%) had to be repeated with IV anaesthesia. Adverse reactions that occurred were vomiting in 30 examinations (7.5%), diarrhoea in 4 (1.0%), hyperactivity in 2 (0.5%) and respiratory symptoms in 1 (0.3%). Prolonged sedation (> 2 h) was noted in 71 of 245 children (29.0%). No side effect with simultaneous oral or IV contrast agent was observed.

Alfentanil infusion for sedation in infants and small children during cardiac catheterization

We have analyzed several sedation techniques for paediatric cardiac catheterization which offer stable conditions for a few hours investigation, and maintain spontaneous breathing. In the present study, after premedication with oral flunitrazepam 0.1 mg.kg-1, 14 children aged 1-17 mo were sedated with an individually titrated alfentanil infusion. Every patient was sedated to a level which produced no reaction to pain or any discomfort. The induction dose and the maintenance requirement of alfentanil were 24 +/- 8 micrograms.kg-1 and 32 +/- 8 micrograms.kg-1.hr-1 (mean +/- SD), respectively. These doses were less in cyanotic than in acyanotic patients: 21 +/- 6 vs 28 +/- 8 micrograms.kg-1 and 29 +/- 10 vs 34 +/- 3 micrograms.kg-1.hr-1, respectively (P less than 0.05). The mean plasma concentration of alfentanil during maintenance of sedation was 79 +/- 23 ng.ml-1. Ventilation of two children was assisted for a short time after an incremental bolus of alfentanil. It is concluded that an alfentanil infusion technique with close monitoring of breathing is a practical sedation method for paediatric cardiac catheterization.

A Clinical Study of Upper Gastrointestinal Endoscopy in Japanese Children

A total of 370 children who underwent upper gastrointestinal endoscopy (534 procedures) were retrospectively studied. All procedures were performed successfully. Side effects were demonstrated in only one case (0.2%), which was complicated by perioral cyanosis during the procedure. As to pre-endoscopic medication, it was thought that topical pharyngeal anesthesia alone may well be used for school-age children over 7 years of age, general anesthesia with endotracheal intubation for neonates, and intravenous sedation for infants and younger children. Of 370 patients studied, 70.8% had endoscopic diagnoses. The most common diagnosis was gastritis (136 cases), followed by peptic ulcer (75), duodenitis (29), and esophagitis (20). Several conclusions for indications were drawn from the present study. Pediatric upper gastrointestinal endoscopy is a safe and useful method for diagnostic and therapeutic approach, if adequate pre-endoscopic medication is chosen.

Midazolam nose drops for outpatient echocardiography sedation in infants

Midazolam nose drops for outpatient echocardiography sedation in infants

Prolonged Sedation Associated with Secobarbital in Newborn Infants Receiving Ventilatory Support

Newborn infants receiving ventilatory support often require sedation. Secobarbital is commonly used in these patients, but dosage guidelines to avoid prolonged sedation are not available. Seventeen infants (gestational age, 30 to 40 weeks; postnatal age, 0 to 3 days) with hyaline membrane disease or persistent pulmonary hypertension on mechanical ventilation were studied. These patients received secobarbital, 4 to 14 mg/kg/day intravenously for 1 to 10 days to produce sedation. Sedation was considered prolonged if it lasted more than 24 hours after the last dose. Nine of 17 infants experienced prolonged sedation. The mean daily secobarbital dose was 11.2 mg/kg/day in patients with prolonged sedation and 6.9 mg/kg/day in those patients without (p less than 0.05); the cumulative mean dose in the respective groups was 33.3 and 21.3 mg/kg (p less than 0.05). Four infants were sedated for 3 to 4 days after stopping secobarbital; the mean daily and cumulative dose was 13 mg/kg/day and 53 mg/kg in these patients. Duration of sedation was related to both daily and cumulative doses of secobarbital. Based on our results, the daily dose of secobarbital should not exceed 7 mg/kg/day to avoid prolonged sedation in infants. Frequent monitoring appears necessary to ensure efficacy with the lowest cumulative dose of secobarbital in newborn infants.

Alfentanil and fentanyl sedation in infants and small children during cardiac catheterization

Thirty patients aged 1-23 mth received either alfentanil or fentanyl for the induction and maintenance of IV sedation during cardiac catheterization following oral flunitrazepam premedication (0.1 mg.kg-1). Patients breathed spontaneously 30 per cent oxygen in air. Both alfentanil and fentanyl abolished all reaction to pain and discomfort with minimal haemodynamic and respiratory changes. Induction doses of alfentanil and fentanyl were 20 +/- 6 and 2.5 +/- 1.1 (mean +/- SD) micrograms.kg-1, respectively, and maintenance requirements 30 +/- 12 and 1.5 +/- 0.6 micrograms.kg-1.h-1, respectively. These requirements were comparable among younger and older as well as cyanotic and acyanotic patients. The IV sedation described adds an effective method to the armamentarium of an anaesthetist working in the cardiac laboratory.

The electroretinogram.

The electroretinogram, findings, in response to a flash stimulus, was recorded from a skin electrode placed on the bridge of the nose in 4465 infants and children seen over a 10 year period. The electroretinogram was combined with a flash visual evoked potential. From this total, the electroretinographic findings in 240 patients, aged 1 day to 17 years, without suspected retinal pathology and with a normal visual evoked potential, were used as controls and normal electroretinographic parameters of different age groups defined. There were 332 patients who showed an absent or very reduced amplitude electroretinogram. They were divided into primarily ocular disorders (n = 195), neurodegenerative disorders (n = 94), and various syndromes (n = 43). Fundus examination did not always show any obvious abnormalities. The use of this simple and reliable technique for recording the electroretinogram made it possible to include this investigation as a routine procedure without the need for sedation in infants and uncooperative children. Electroretinographic studies, especially when combined with visual evoked potentials, and in some cases electroencephalography, may aid diagnosis in a wide variety of paediatric conditions, many of which have genetic implications.

The use of midazolam for sedation of infants and children.

The use of midazolam for sedation of infants and childrenMJ Diament and P StanleyAudio Available | Share

Use of Intravenous Sedatives in Infants and Children

Use of Intravenous Sedatives in Infants and Children

Measurement of work of breathing in infancy.

Assessment of lung function in young children is extremely difficult unless sedation is given. If tidal exchange and intrathoracic pressure swings can be recorded, the severity of the respiratory problem can be measured by construction pressure-volume loops and calculating the work of breathing. The system we have used to measure tidal thoracic volumes is that of a soft, rubber, inflatable jacket with pressure-volume characteristics linear from inflation pressure of 2.5 to 7 cm H2O. Oesophageal (intrathoracic) pressures are measured using water-filled nasogastric tubes (FG6). Frequency responses showed that 63% rise times for the jacket and water-filled nasogastric tube assessed together to be 10.5 msec. Recordings were traced onto a computer digitizing tablet and print-outs were obtained with the following information: respiratory rate, tidal thoracic volume, minute thoracic volume, oesophageal pressure, resistive work per min, elastic work per min, and total work per min. Comparisons were made between volumes measured using the respiratory jacket (VJ) and by pneumotachograph and integrator (VInt) in six infants. Hysteresis arising from the jacket produces some change in resistive work of breathing, but the total work of breathing is only increased by a maximum of 10.5%. Studies on healthy newborn babies showed that the jacket system tends to underrecord the resistive work of breathing, but that total work of breathing values are very similar. Reproducibility of analysis showed the following coefficients of variation from the mean: tidal thoracic volume, 1.6%; minute thoracic volume, 1.7%; resistive work, 5%; elastic work, 2%; and total work, 2.5%. The extent of breath-to-breath variation is much larger. This system makes it possible to obtain serial measurements of work of breathing without the need for sedation in infants who may be acutely ill and in respiratory failure.