Sedation In Pediatric Patients Research Articles

Dexmedetomidine versus propofol on the sedation of pediatric patients during magnetic resonance imaging (MRI) scanning: a meta-analysis of current studies.

Magnetic resonance imaging (MRI) is a widely applied diagnostic approach for detection of pediatric diseases. Sedatives are commonly used to acquire the accurate MRI images. Dexmedetomidine and propofol serve as sole or combined sedatives in pediatric MRI scanning. This meta-analysis aimed to compare the efficacy of dexmedetomidine and propofol in children ubdergoing MRI. Pubmed, Cochrane Library and Web of Science were searched up to June, 2017. Onset of sedation time, recovery time, sedation time, MRI time, MRI quality and emergence delirium were analyzed. 6 studies with 368 subjects were enrolled in this meta-analysis. The pooling data showed that propofol had a shorter onset of sedation time (WMD: 6.05, 95% CI: 3.12 – 8.98, P < 0.0001) and recovery time (WMD: 1.01, 95% CI: 0.36–1.67, P < 0.001) than dexmedetomidine. But for sedation time and MRI scanning time, there were no differences between the two groups (sedation time: P = 0.29; MRI scanning time: P = 0.50). There were no significance between dexmedetomidine and propofol on MRI quality (MRI quality 1: P = 1.00; MRI quality 2: P = 0.68; MRI quality 3: P = 0.45). Two studies using Pediatric Anesthesia Emergence Delirium (PAED) to assess emergence delirium 10 minutes after awakening showed that propofol had a lower PAED than dexmedetomidine (WMD: 2.57, 95% CI: 0.15–5.00, P = 0.04). Thus, propofol should be encouraged in pediatric patients undergoing MRI for its better sedative effects and a low incidence of emergence delirium.

Nurse-driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first-stage palliation surgery: A pilot study.

Few data are available regarding requirements of sedation and analgesia in children during extracorporeal life support. The aim of this study was to evaluate if children with functionally univentricular hearts on extracorporeal life support after first-stage palliation surgery have higher requirement of analgesics and sedatives compared with children without extracorporeal life support using a goal-directed nurse-driven analgesia and sedation protocol. This prospective observational matched case-control pilot study was conducted at a cardiac pediatric intensive care unit of a tertiary referral center. Seventeen patients with functionally univentricular hearts including hypoplastic left heart syndrome who were on extracorporeal life support after first-stage palliation surgery were enrolled from July 2012 to January 2017. Seventeen matched patients served as controls. Doses of morphine, midazolam, clonidine, and muscle relaxants as well as sedation scores (COMFORT behavior scale and the nurse interpretation of sedation scale) were assessed according to a nurse-driven protocol every 8 hours up to 120 hours after first-stage palliation surgery. Sedation scores were equal in the extracorporeal life support group and in the control group at most points in time. There was no significant difference in cumulative doses of morphine and midazolam. However, children of the extracorporeal life support group received higher doses of midazolam and morphine at some points in time. A nurse-driven protocol for analgesia and sedation of children with extracorporeal life support is feasible. Patients with extracorporeal life support do not need deeper sedation levels and have not higher cumulative sedation requirements than children without extracorporeal life support.

Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up-and-down sequential allocation trial.

Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single-dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial. This study was to determine the 50% effective dose and estimate the 95% effective dose of single-dose intranasal dexmedetomidine to induce sedation in pediatric patients with noncyanotic congenital heart disease, and also determine the effect of age on the dose required for sedation. Patients were stratified into three age groups of 1-6months, 7-12months, and 13-36months. Intranasal dexmedetomidine started at a dose of 2μgkg-1 on the first patient. The dose of dexmedetomidine for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.25μgkg-1 . Sedation scale and recovery were assessed by the Modified Observer Assessment of Alertness and Sedation Scale and Modified Aldrete Recovery Score. The 50% effective dose was determined by Dixon's up-and-down method. In addition, both 50% effective dose and 95% effective dose were obtained using a probit regression approach. Other variables included sedation onset time, echocardiography time, wake-up time, discharge time, heart rate, blood pressure, oxygen saturation, respiratory rate, and adverse events such as vomiting, regurgitation, and apnea. The study population was comprised of 70 patients. The 50% effective dose (95% confidence interval) and the 95% effective dose (95% confidence interval) of intranasal dexmedetomidine for sedation were 1.8 (1.58-2.00) μgkg-1 and 2.2 (1.92-5.62) μgkg-1 in patients aged 1-6months, 1.8 (1.61-1.95) μgkg-1 and 2.1 (1.90-2.85) μgkg-1 in patients aged 7-12months, 2.2 (1.92-2.37) μgkg-1 and 2.7 (2.34-6.88) μgkg-1 in patients aged 13-36months, respectively. The 50% effective dose in age group 13-36months was higher than those of age group 1-6months (P=.042) and 7-12months (P=.043). There were no differences in sedation onset time, echocardiography time, wake-up time, and discharge time between groups. None of the patients experienced oxyhemoglobin desaturation, hypotension, or bradycardia during the procedure. No significant adverse events occurred. Single-dose of intranasal dexmedetomidine was an effective agent for patients under the age of 3years requiring sedation for transthoracic echocardiography. The 50% effective dose of intranasal dexmedetomidine for transthoracic echocardiography sedation in children aged 13-36months was higher than in children <13months.

Use of the Pasero Opioid-induced Sedation Scale (POSS) in Pediatric Patients

The Pasero Opioid-induced Sedation Scale (POSS) is a valid, reliable tool used to assess sedation when administering opioid medications to manage pain. The POSS is endorsed by The Joint Commission and the American Society for Pain Management Nursing to help prevent adverse opioid-related respiratory events. Although the POSS is used to assess sedation in pediatric patients at some hospitals, prior to this study, it was not formally evaluated in the pediatric population. This study used a quasi-experimental design with a convenience sample of pediatric patients admitted to a large regional medical center in southeastern North Carolina. The POSS was evaluated from three perspectives. First, the study was designed to compare the documentation of sedation when opioids were administered before (n=25) and after (n=27) implementation of the POSS to assess sedation. Second, the occurrence of respiratory adverse events before and after implementation of the POSS was compared. Third, the appropriateness of using the POSS in the pediatric population was evaluated. When the POSS was used, there was an increase in both the clarity and frequency of documentation when sedation was assessed. There was no incidence of opioid-related adverse respiratory events after implementation of the POSS. Finally, the POSS was found to be appropriate and safe to use in the pediatric population. Through a survey, the majority of registered nurses who cared for the research subjects evaluated the POSS as easy, appropriate and safe to use with pediatric patients. The nurses also noted using the POSS provided standardized communication among staff regarding patients' levels of sedation. No adverse effects, concerns, or objections were reported. Coincidentally, while it was not part of the study, frequency of documentation of assessment of pain also improved with implementation of the POSS.

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

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

Median Effective Dose of Intranasal Dexmedetomidine for Rescue Sedation in Pediatric Patients Undergoing Magnetic Resonance Imaging

The median effective dose (ED50) of intranasal dexmedetomidine after failed chloral hydrate sedation has not been described for children. This study aims to determine the ED50 of intranasal dexmedetomidine for rescue sedation in children aged 1 to 36 months, who were inadequately sedated by chloral hydrate administration during magnetic resonance imaging (MRI). This study was performed on 120 children, who were 1 to 36 months old and underwent MRI scanning. Intranasal dexmedetomidine was administered as a rescue sedative to children not adequately sedated after the initial oral dose of chloral hydrate (50 mg/kg). Children were stratified into four age groups. ED50 values were estimated from the up-and-down method of Dixon and Massey and probit regression. Other variables included induction time, time to wake up, vital signs, oxygen saturation, MRI scanning time, and recovery characteristics. ED50 of intranasal dexmedetomidine for rescue sedation was 0.4 μg/kg (95% CI, 0.34 to 0.50) in children aged 1 to 6 months, 0.5 μg/kg (95% CI, 0.48 to 0.56) in children aged 7 to 12 months, 0.9 μg/kg (95% CI, 0.83 to 0.89) in children aged 13 to 24 months, and 1.0 μg/kg (95% CI, 0.94 to 1.07) in children aged 25 to 36 months. There were no significant differences in sedation induction time or time to wake up between the different age groups. Additionally, no significant adverse hemodynamic or hypoxemic effects were noted. The authors determined the ED50 for rescue sedation using intranasal dexmedetomidine after failed chloral hydrate sedation in children. It was found that ED50 increases with advancing age during the first 3 yr of life.

Dexmedetomidine for sedation in pediatric patients who received more than 20 sessions of radiation therapy: two cases report.

Dexmedetomidine is a highly selective α2-adrenoceptor agonist that demonstrates anxiolytic and analgesic properties without inducing respiratory compromise, which makes it a suitable agent for procedural sedation and imaging studies. In our current case reports, intravenous dexmedetomidine infusion was used to provide sedation to 2 pediatric patients over more than 20 sessions of radiation therapy. On both occasions, dexmedetomidine provided adequate sedation without respiratory depression. However, the required dosage increased with repeated radiation therapy sessions.

Sedation for magnetic resonance imaging in a child with lingual venolymphatic malformation.

Sir, The number of diagnostic and therapeutic procedures performed outside the operation theatre has increased over the last decade and providing anaesthesia and sedation will be a real challenge to the anaesthetisiologists. Sedation for magnetic resonance imaging (MRI) procedures in children adds a substantial risk in younger children. This is more so in paediatric patients with difficult airway.[1] A 4 years male child weighing 16 kg presented to paediatric department with a huge swelling of tongue since birth. He had undergone resection of the same at 6 months of age which had recurred (size approximately around 6 cm × 4 cm). He had difficulty in speech and feeding, and, of course, cosmetic issue to his family and society. Paediatricians suspected venolymphatic malformation and to confirm the diagnosis child was advised MRI neck. During preanaesthetic evaluation, we noted the profusely enlarged tongue which was protruding out of oral cavity [Figure 1]. The child was unable to protrude his tongue as it was covering the entire oral cavity. Availability of all emergency drugs and difficult airway cart including fibreoptic bronchoscope were confirmed in the MRI suite. Figure 1 (a and b) Profusely enlarged and protruding tongue Parental consent was obtained, and the child was fasted for 6 h for solids and 2 h for clear liquids. Monitoring with pulseoximeter and electrocardiogram (ECG) were initiated, and baseline heart rate (HR), and blood pressure were recorded. Intranasal dexmedetomidine 1 μg/kg and eutectic mixture of lignocaine and prilocaine cream was applied 30 min before securing a 22 gauge intravenous cannula over dorsum of the left hand. Injection glycopyrrolate 10 μg/kg was administered. Oxygen through nasal prongs was delivered at 2 L/min. Injection dexmedetomidine 0.5 ΅g/kg (IV)was administered over 10 min. The sedated child was taken to MRI console (Ramsay sedation score of 5).[2] An MRI compatible monitor was used to monitor HR, ECG and oxygen saturation and respiration through a sidestream capnography continuously and patient remained stable throughout the procedure lasting for 20 min. In the recovery room, the child was made to lie in the left lateral position. Monitoring and oxygen supplementation were continued. The child made an uneventful recovery from sedation. Venolymphatic malformations are slow-flow lesions that are a combination of dilated lymphatic channels filled with proteinaceous fluid and large veins. These can be difficult to separate from other low flow lesions such as lymphatic malformations and haemangiomas on certain imaging, especially ultrasound. The presence at birth favours venolymphatic malformation, although the other two do occur at birth.[3] Computed tomography and MRI are used for volumetric analysis of haemangiomas and vascular malformations. Imaging resources are useful in both diagnostic differentiation and analysis of lesion features with regard to its size, extension and location, as well as for follow-up of lesions treated under a systemic therapy.[4] MRI suite is unlikely to be a favourable place to give sedation or anaesthesia for many reasons. Patient's distance from anaesthesiologist creates problems such as airway management, intravenous access, patient visualisation and monitor attachment.[5] MRI compatible machines and airway instruments are required and patients may suffer due to claustrophobia, noisy unfamiliar environment, hypothermia, and strong magnetic field. Children require moderate to deep sedation during MRI procedures to avoid movement and image distortion. The potential complications of deep sedation include hypoventilation, apnoea, airway obstruction, bradycardia and hypotension. An appropriate drug which causes minimal cardiorespiratory depression has to be used. Dexmedetomidine (a highly selective α2 -adrenoreceptor agonist) as a sedative agent will provide a controllable sedation and analgesia without cardiorespiratory depression.[6] An interesting feature regarding oral use of dexmedetomidine is that after oral administration for paediatric sedation, the absorption is to the extent of 82%.[7] Although dexmedetomidine and propofol provide adequate sedation in children, propofol provides more rapid rates of anaesthetic induction and recovery but dexmedetomidine better preserves mean arterial pressure and respiratory rate.[8] Thus, we conclude that drugs which provide a controlled sedation without cardiorespiratory depression like dexmedetomidine can be very useful for sedation in paediatric patients with difficult airway outside operation theatre. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Comparison of preanesthetic sedation in pediatric patients with oral and intranasal midazolam.

Background and Aims:Preoperative anxiety in children leading to postoperative negative changes and long-term behavioral problems needs better preanesthetic sedation. Across the world, midazolam is the most commonly used premedicant in pediatric patients. The fact that no single route has achieved universal acceptance for its administration suggests that each route has its own merits and demerits. This study compares oral midazolam syrup and intranasal midazolam spray as painless and needleless systems of drug administration for preanesthetic sedation in children.Material and Methods:With randomization, Group O (30 children): Received oral midazolam syrup 0.5 mg/kg and Group IN (30 children): Received intranasal midazolam spray 0.2 mg/kg. Every child was observed for acceptance of drug, response to drug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug. Data were analyzed using Student's t-test, standard error of the difference between two means and Chi-square test.Results:In Group O and IN, 15/30 children (50%) and 7/30 children (23%) accepted drug easily (P < 0.05); 4/22 children (18%) in Group O and 11/20 children (55%) in Group IN cried after drug administration (P < 0.05). In both the groups, sedation at 20 min after premedication (Group O [80%] 24/30 vs. Group IN [77%] 23/30), parental separation and acceptance to mask were comparable (P > 0.05); 12/30 children (40%) in Group IN showed transient nasal irritation.Conclusion:Oral midazolam and intranasal midazolam spray produce similar anxiolysis and sedation, but acceptance of drug and response to drug administration is better with oral route.

Removal of an Embedded Crochet Needle in the Mouth

A 3-year-old child presented to the emergency department with a crochet needle lodged in her posterior oral cavity. To localize the needle and significant surrounding anatomic structures, bedside transcavitary ultrasound was employed. After careful localization, the needle was removed using a modified needle cover technique. A review of barbed foreign object removal techniques, including advance-and-cut, retrograde, string-yank, and needle cover techniques, is presented. Important considerations while planning any procedure include risk, benefit, availability of staff, and availability of equipment. Proper anesthesia is paramount to the success of these procedures, and sedation in pediatric patients may prove necessary. Postprocedure wound care and follow-up must also be arranged. This case demonstrates the importance of adaptation of well-documented techniques to remain flexible for any situation that may present to the emergency department.

Issues in Propofol Sedation for Pediatric Patients Using Target Control Infusion (TCI): Safety in Children 1-3 Years Old Versus Children Older than 3 Years of Age

Purpose: Appropriate sedation is required when performing proton radiation therapy on pediatric patients. A target-controlled infusion (TCI) of propofol has recently been used for this purpose. However, there may be safety issues with the use of TCI in pediatric patients, as the initial bolus dose might be excessive for younger patients. To compare the safety and the incidence of adverse events between patients under and over 3 years of age undergoing sedation with a TCI (Paedfusor) model. Methods: We performed a retrospective observational study by analyzing the medical records of patients who underwent a computer tomography simulation prior to beginning proton radiation therapy between January 2013 and December 2014. Patients were divided into those 1-3 years of age and those > 3 years of age. The incidence of adverse events was tabulated. Results: Fifty-two patients-16 patients 1-3 years of age and 40 patients > 3 years of age-were included in the study. The adverse event incidence was the primary outcome. There was no statistically significant difference in desaturation (p = 0.231), nasopharyngeal airway insertion (p = 0.366), bradycardia (p = 1.000), and hypotension (p = 0.578). Additionally, there was no significant difference in sedation time, recovery time, propofol dose, and target concentration for induction or maintenance of anesthesia. Conclusions: The use of propofol TCI for the induction and maintenance of sedation did not show an increased risk of adverse events in pediatric patients 1-3 years of age versus patients > 3 years of age.

Anesthetic efficacy of propofol used to supplement spinal anesthesia for sedation in pediatric patients undergoing lower abdominal or lower extremity operations

Objective To evaluate the anesthetic efficacy of propofol used to supplement spinal anesthesia for sedation in the pediatric patients undergoing lower abdominal or lower extremity operations. Methods One hundred twenty pediatric patients of both sexes, aged 2-5 yr, weighing 11-21 kg, of ASA physical status Ⅰ or Ⅱ, scheduled for elective lower abdominal or lower extremity operations were randomly divided into 3 groups (n=40 each) using a random number table: general anesthesia group (group G), propofol used to supplement caudal block for sedation group (group PS+ CB), and propofol used to supplement spinal anesthesia for sedation group (group PS+ SA). In group G, after induction of anesthesia, laryngeal mask airway was inserted, the patients were then mechanically ventilated, and anesthesia was maintained with iv infusion of propofol (5-7 mg·kg-1·h-1), remifentanil (20-25 μg·kg-1·h-1) and cisatracurium besylate (0.1 mg·kg-1·h-1). In group PS+ CB, caudal block was performed with the mixture 0.8 ml/kg of 1% lidocaine and 0.25% bupivacaine.In group PS+ SA, spinal anesthesia was performed with isobaric bupivacaine 1.0 mg/age.Propofol was then infused at 3-5 mg·kg-1·h-1 for sedation in PS+ CB and PS+ SA groups.Before anesthesia(baseline, T0) and at 1, 5 and 10 min after emergence from anesthesia (T1-3), heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2) were recorded.The emergence time, time for recovery of orientation, and duration of stay in postanesthesia care unit were recorded.Pain was assessed and scored, and agitation was graded at 5 min after emergence from anesthesia, and the occurrence of intraoperative traction reaction, body movement and nausea and vomiting within 24 h after operation was recorded. Results No intraoperative traction reaction and body movement was found in group PS+ SA, and no patients stayed in postanesthesia care unit in PS+ CB and PS+ SA groups.HR and MAP were significantly higher at T1-3 than at T0 in group G (P<0.05). Compare with group G, the HR, MAP at T1-3, pain scores, agitation scores, incidence of nausea and vomiting were significantly decreased, and the emergence time and time for recovery of orientation were shortened in groups PS+ CB and PS+ SA (P<0.05). Conclusion Propofol used to supplement spinal anesthesia for sedation is effective and provides faster recovery from anesthesia with fewer complications in the pediatric patients undergoing lower abdominal or lower extremity operations. Key words: Anesthesia, spinal; Propofol; Conscious sedation; Child

Comparison of the Safety and Effectiveness of Oral Diazepam and Oral Midazolam for the Conscious Sedation of Pediatric Patients During Dental Treatment

Comparison of the Safety and Effectiveness of Oral Diazepam and Oral Midazolam for the Conscious Sedation of Pediatric Patients During Dental Treatment

Comparative study of safety and efficacy of Fentanyl and Midazolam combination with Ketamine and Midazolam combination for procedural sedation in pediatric patients

Introduction: Study was planned to compare the safety and efficacy of Fentanyl and Midazolam combination with Ketamine and Midazolam combination for “procedural sedation” in pediatric patients. Methodology: Sixty ASA1and 2 pediatric patients satisfying inclusion criteria were included in the study. These patients were enrolled by convenience sampling. They were randomized to receive ketamine or midazolam/fentanyl. Both the groups were comparable with respect to age, sex and body weight and proposed procedures. Hemodynamic and respiratory changes occurring during sedation, surgical procedure and during recovery, after administration of the test drug were studied. Measures used for efficacy of drug, that is quantification of distress, pain, anxiety, sedation and complications were also evaluated. Results: On Comparison of age, gender, weight at different time intervals of cases between both groups were comparable with respect to age and weight of patients. On comparison of Pulse Rate at different time intervals of cases between K/M and F/M groups. The mean value of Pulse Rate in K/M and F/M groups is statistically significant (p<0.05) only at 5 and 10 minutes after sedation. Comparison of Mean Duration of Procedure and Recovery of cases between K/M and F/M groups shows statistically non-significant difference (p<0.05) in duration of procedures, and statistically significant difference (p<0.05) in duration of recovery. Comparison of complication rate of cases between K/M and F/M groups is statistically non-significant (p<0.05). Conclusion: We concluded that both the drugs were safe to use in pediatric patients in the doses used intravenous. Ketamine / Midazolam regimen is more effective than the intravenous Fentanyl / Midazolam regimen for relief of pain and anxiety in children, resulting in lesser distress scores.

Is dexmedetomidine really superior to propofol?

1. Sriganesh K, Reddy M, Jena S, Mittal M, Umamaheswara Rao GS. A comparative study of dexmedetomidine and propofol as sole sedative agents for patients with aneurysmal subarachnoid hemorrhage undergoing diagnostic cerebral angiography. J Anesth. 2014. doi:10.1007/s00540-014-1952-1. To the Editor: We read the article by Sriganesh et al. published ahead of print in your journal [1]. Based on a study conducted in 60 patients, the authors concluded that “dexmedetomidine appears to be superior to propofol as a sole sedative agent for sedation during cerebral angiography in patients with subarachnoid hemorrhage.” We noticed that the sample size calculation by Sriganesh et al. is based on the onset time for sedation in pediatric patients undergoing magnetic resonance imaging. The validity of this extrapolation to cerebral angiography (CA) needs to be confirmed. We feel that the authors should have conducted a pilot study and then calculated the sample size. In an ongoing trial in our center, on a similar patient population with similar intervention drugs, we conducted a pilot study. We calculated the necessary sample size to be as large as 92 patients in each group in order to show significant differences in movement during CA. Sedation for diagnostic CA needs to be evaluated further in patients of different grades of subarachnoid hemorrhage, as the sensorium of the patients will significantly influence the choice of drug and its dosages.

Rectal Thiopental versus Intramuscular Ketamine in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial.

Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df=1, 58; F=6.58; P=0.013) was significantly higher in ketamine group. The findings of the present study show that Although the recovery time from sedation by ketamine is more than sodium thiopental, it's fast-acting function without effecting on the oxygen saturation level causes that ketamine is considered as the better choice for induction of sedation in pediatric patients need laceration repair. In addition, long-term effect of ketamine provides more time for the physician to do the procedure and this issue decreases the need probability to the repeated-dose. However, effectiveness of both drugs to decrease the agitation was equal, based on the Ramsey score.

Ketamine affects the neurogenesis of rat fetal neural stem progenitor cells via the PI3K/Akt-p27 signaling pathway.

Ketamine is widely used as an anesthetic, analgesic, or sedative in pediatric patients. We reported that ketamine alters the normal neurogenesis of rat fetal neural stem progenitor cells (NSPCs) in the developing brain, but the underlying mechanisms remain unknown. The PI3K-PKB/Akt (phosphatidylinositide 3-kinase/protein kinase B) signaling pathway plays many important roles in cell survival, apoptosis, and proliferation. We hypothesized that PI3K-PKB/Akt signaling may be involved in ketamine-altered neurogenesis of cultured NSPCs in vitro. NSPCs were isolated from Sprague-Dawley rat fetuses on gestational day 17. 5-bromo-2'-deoxyuridine (BrdU) incorporation, Ki67 staining, and differentiation tests were utilized to identify primary cultured NSPCs. Immunofluorescent staining was used to detect Akt expression, whereas Western blots measured phosphorylated Akt and p27 expression in NSPCs exposed to different treatments. We report that cultured NSPCs had properties of neurogenesis: proliferation and neural differentiation. PKB/Akt was expressed in cultured rat fetal cortical NSPCs. Ketamine inhibited the phosphorylation of Akt and further enhanced p27 expression in cultured NSPCs. All ketamine-induced PI3K/Akt signaling changes could be recovered by N-methyl-d-aspartate (NMDA) receptor agonist, NMDA. These data suggest that the inhibition of PI3K/Akt-p27 signaling may be involved in ketamine-induced neurotoxicity in the developing brain, whereas excitatory NMDA receptor activation may reverse these effects.

Feasibility of using administration of intranasal dexmedetomidine for preoperative sedation in pediatric patients with congenital heart disease

Objective To evaluate the efficacy and safety of administration of intranasal dexmedetomidine for preoperative sedation in the pediatric patients with congenital heart disease.Methods Sixty pediatric patients of both sexes,aged 2-5 yr,weighing 10-30 kg,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅰ-Ⅲ),scheduled for elective radical operation for congenital heart disease under general anesthesia,were randomly divided into 2groups (n =30 each) using a random number table:dexmedetomidine administered intranasally group (group IN) and dexmedetomidine administered intravenously group (group Ⅳ).After admission to a room for preoperative preparation,dexmedetomidine 2μg/kg was administered intranasally in group IN and dexmedetomidine 0.5 μg/kg (in 15,ml normal saline) was injected intravenously over 20 min in group Ⅳ.After admission to the operating room at 20 min after administration,oxygen was inhaled through a face mask and induction of anesthesia was performed.The patient acceptance of modes of administration,sedation degree at 20 min after administration,score of mood state of the children when they were separated from their parents,and degree of patient acceptance of oxygen inhalation via a face mask were recorded.Bradycardia,hypotension,hypertension and hyoxemia were recorded from administration to induction of anesthesia.Results Compared with IN group,the rate of patient acceptance of modes of administration was significantly decreased,and no significant changes were found in sedation degree at 20 min after administration,score of mood state of the children when they were separated from their parents,and degree of patient acceptance of oxygen inhalation via a face mask in group Ⅳ.No adverse reactions such as bradycardia,hypotension,hypertension or hyoxemia developed from administration to induction of anesthesia in the two groups.Conclusion Dexmedetomidine 2μg/kg administered intranasally can be safely and effectively used for preoperative sedation in the pediatric patients with congenital heart disease. Key words: Dexmedetomidine; Administration, intranasal ; Premedication; Conscious sedation

Current status of monitoring the depth of procedural sedation for pediatric patients outside the operating room

Background The demand for pediatric sedation service outside the operating room increased rapidly in recent years.Anesthesiologists have to concern about how to provide safe and effective sedation and monitoring for these children.Objective To summarize advantages and disadvantages of depth monitoring of pediatric procedural sedation outside the operating room,and to provide current status for clinical anesthesiologists.Content Traditional scoring system makes the depth of sedation quantificationally,but it has its limitations.Bispectral index (BIS) monitoring can be safely and effectively used in assessing the sedation depth outside the operating room.BIS values decreased significantly when the level of sedation deepened.However,for small infants younger than 6 months and patients with ketamine and opioids use,the readings may not be reliable.Trend It is rare in domestic study of pediatric sedation depth monitoring.The BIS application is expected to make this procedure easier and safer for anesthesiologists. Key words: Sedation monitoring; Pediatric; Bispectral index

Technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry

Dental fear is a common problem in pediatric dentistry. Therefore, sedation for pediatric patients is an essential tool for anxiety management. Nitrous oxide/oxygen inhalation sedation is a safe, convenient, effective way to calm children. The review is about the technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry.