Therapeutic Procedures In Children Research Articles

Spontaneous Perforation of the Bile Duct in a Toddler: The Role of Endoscopic Retrograde Cholangiopancreatography in Diagnosis and Therapy

Spontaneous Perforation of the Bile Duct in a Toddler: The Role of Endoscopic Retrograde Cholangiopancreatography in Diagnosis and Therapy

Sedation/Analgesia for Diagnostic and Therapeutic Procedures in Children Outside of the Operating Room

Sedation/Analgesia for Diagnostic and Therapeutic Procedures in Children Outside of the Operating Room

Propofol remifentanil deep sedation for gastrointestinal endoscopy in children

INTRODUCTION: Gastrointestinal flexible endoscopy has become an important diagnostic and therapeutic procedure in children. In many medical centers, the use of general anesthesia for upper and lower gastrointestinal endoscopy has been replaced by intravenous sedation (1). Limited data are available on the use of propofol remifentanil sedation in children (2,3). The aim of our study was to evaluate the safety and efficacy of remifentanil propofol combination for deep sedation in children undergoing gastrointestinal endoscopy.

Sedation and Analgesia for Diagnostic and Therapeutic Procedures in Children

Sedation and Analgesia for Diagnostic and Therapeutic Procedures in Children

Sedation/analgesia for diagnostic and therapeutic procedures in children

Sedation/analgesia for diagnostic and therapeutic procedures in children has been associated with life-threatening adverse events. Reports of adverse events and recognition of wide variability in sedation practices has led to the development of guidelines and standards of care to ensure the safety of sedated children. The safety of sedated children can be enhanced by detailed presedation evaluation, careful patient selection, and the use of drugs with a wide margin of safety that are carefully titrated to desired depth of sedation by trained personnel. Once sedative drugs are administered, stringent monitoring, including continuous pulse oximetry and frequent assessment of vital signs and sedation depth, will permit early recognition of untoward drug effects and permit early intervention. Children with underlying medical conditions, such as airway abnormalities, may not be suitable subjects for sedation and may require consideration for general anesthesia to aid their procedure. Although significant strides have been made in recognition of the risks of sedation and in development of guidelines for safe sedation practices, further work must focus on development of newer sedation regimens with shorter-acting drugs and wider margins of safety. © 2000 by American Society of PeriAnesthesia Nurses.

Barbiturates

Sedation remains the most important, and sometimes the most difficult part of diagnostic or therapeutic procedures in children. Today, computed tomography (CT) scan and magnetic resonance imaging, (MRI) are widely used in the evaluation of pediatric disease; and the need for safe and effective sedation practice has grown. Pentobarbital, thiopental, and methohexital are 3 barbiturates that have gained popularity in the pediatric emergency department for sedation Pentobarbital II has been used With great success when sedation is required for unnllainful procedures in the emergency department setting Thiopental was used in the early 1980s but lost popularity in the 1990s. Methohexital because of its ultrashort-acting properties, has gained popularity for use in painful (eg, fracture reduction, laceration repair) and nonpainful procedures (eg, CT scanning, MRI). In this article, each drug is discussed for routes of administration, side effects. contraindications, and overall success rates.

Efficacy of primary and secondary video-assisted thoracic surgery in children

Video-assisted thoracic surgery (VATS) is used commonly for diagnostic and therapeutic procedures in children. The purpose of this study was to determine the accuracy, efficacy, and complications associated with primary and secondary VATS in children. Eighty-seven infants, children, and adolescents underwent 104 VATS procedures between March 1993 and April 1999. There were 47 boys and 40 girls with an age range of 6 months to 19 years. VATS was performed for excision of pulmonary nodule (n = 51), biopsy of infiltrate (n = 14), excision or biopsy mediastinal mass (n = 12), decortication of empyema (n = 16), pleurodesis and bleb excision for pneumothorax (n = 5), pleurolysis for P32 administration (n = 3), esophageal myotomy (n = 2), and thymectomy (n = 1). In 6 children a contralateral thoracic procedure was performed along with VATS (3 VATS, 3 thoracotomies). Secondary VATS was performed in 20 after prior thoracic procedures. VATS was efficacious for diagnostic or therapeutic purposes in 93 cases. Overall, 11 (11%) VATS required conversion to open thoracotomy. Average length of thoracostomy tube drainage (CTD) was 2.2 days, and average length of stay (LOS) was 3.7 days. Complications included prolonged air leak (> 7 days) in 3 (2 empyema, 1 nodule). Two children with malignancy and pulmonary infiltrates died within 30 days of progressive respiratory failure. There were no bleeding complications or deaths related to VATS. VATS is a safe and effective primary and secondary procedure in children resulting in a short length of CTD and LOS. Duration of CTD and LOS are prolonged if empyema is associated with a bronchopleural fistula, and VATS may not be of value in this setting.

Remifentanil and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy.

Flexible fibreoptic bronchoscopy (FOB) has become a useful diagnostic and therapeutic procedure in children. We investigated 26 patients (3-14 years) for FOB using a new sedation strategy. All patients received oral premedication and inhalation of topical anaesthetic. Sedation for bronchoscopy was achieved with a continuous infusion of remifentanil and intermittent boluses of propofol. Propofol injection was repeated if sedation was inadequate. Sedation could be successfully performed in all children without adverse effects. Endtidal CO2 concentration and arterial oxygen saturation remained stable throughout the study. All children were awake 5+/-1.3 min after stopping remifentanil infusion. Sedation with remifentanil/propofol is a new sedation strategy for diagnostic flexible paediatric bronchoscopy in children with spontaneous ventilation.

Efficacy of primary and secondary video-assisted thoracic surgery in children

Background/Purpose: Video-assisted thoracic surgery (VATS) is used commonly for diagnostic and therapeutic procedures in children. The purpose of this study was to determine the accuracy, efficacy, and complications associated with primary and secondary VATS in children. Methods: Eighty-seven infants, children, and adolescents underwent 104 VATS procedures between March 1993 and April 1999. There were 47 boys and 40 girls with an age range of 6 months to 19 years. VATS was performed for excision of pulmonary nodule (n = 51), biopsy of infiltrate (n = 14), excision or biopsy mediastinal mass (n = 12), decortication of empyema (n = 16), pleurodesis and bleb excision for pneumothorax (n = 5), pleurolysis for P32 administration (n = 3), esophageal myotomy (n = 2), and thymectomy (n = 1). In 6 children a contralateral thoracic procedure was performed along with VATS (3 VATS, 3 thoracotomies). Secondary VATS was performed in 20 after prior thoracic procedures. Results: VATS was efficacious for diagnostic or therapeutic purposes in 93 cases. Overall, 11 (11%) VATS required conversion to open thoracotomy. Average length of thoracostomy tube drainage (CTD) was 2.2 days, and average length of stay (LOS) was 3.7 days. Complications included prolonged air leak (>7 days) in 3 (2 empyema, 1 nodule). Two children with malignancy and pulmonary infiltrates died within 30 days of progressive respiratory failure. There were no bleeding complications or deaths related to VATS. Conclusions: VATS is a safe and effective primary and secondary procedure in children resulting in a short length of CTD and LOS. Duration of CTD and LOS are prolonged if empyema is associated with a bronchopleural fistula, and VATS may not be of value in this setting. J Pediatr Surg 35:134-138. Copyright © 2000 by W.B. Saunders Company.

Therapeutic gastrointestinal endoscopy.

The safety, efficacy and utility of various therapeutic gastrointestinal (GI) endoscopic procedures performed on children (January 1992 to July 1995) at a tertiary referral centre in India were studied. A total of 1,030 sessions (upper GI 972 and lower GI 58) of therapeutic GI endoscopy were performed in 162 children (mean age 7.4 +/- 4 years; upper GI 115, lower GI 47). Various upper GI endoscopic procedures done were injection sclerotherapy (EIS), endoscopic variceal ligation (EVL), bougie dilatation of oesophageal strictures, balloon dilatations of oesophageal stricture/pyloric obstruction and retrieval of foreign bodies in 75%, 6%, 9%, 4% and 12% of children respectively. Therapy for bleeding from oesophageal varices constituted the major group (75%). Repeated EIS (sessions total--876, mean 8, range 5-15) performed on 86 children resulted in control of bleeding in all and eradication of oesophageal varices in 85% of cases. Minor complications (oesophageal ulcers and oesophageal strictures) due to EIS were observed in 9% of children. EVL (10 sessions in 7 children) was effective in controlling bleeding and substantial decrease of varices in all without any complication. Oesophageal dilation either by bougie (61 sessions in 10 children) or balloon (6 sessions in 3 children) were performed for benign strictures. Balloon dilatation of pyloric obstruction was successfully done in 2 children. Foreign bodies (retained or sharp) were retrieved from upper GI tract in 14 children. No complications were observed with stricture dilatation/foreign body retrieval. Therapeutic lower GI endoscopies were performed in 47 children (colonoscopic polypectomy in 92%, anal dilatation and piles banding in 4% each). One child with juvenile polyposis coli developed sigmoid colon performation following colonoscopic polypectomy which required surgical correction. We conclude that upper and lower GI endoscopic therapeutic procedures in children are highly effective and safe. The risk of major complication is very small in experienced hands and occasional minor complications, can be managed conservatively.

Sedation in pediatric patients.

Sedation is being used increasingly in children to allay anxiety and discomfort. Sedation can also increase the efficiency of performing both diagnostic and therapeutic procedures in children. There are a wide array of available sedation methods that are used by radiologists, gastroenterologists, hematologists/oncologists and emergency room physicians everyday. Indiscriminate use of sedatives has led to seizures, respiratory arrests and death in a variety of practice settings. With improved monitoring capability, more potent drugs and better understanding of the pharmacokinetics in children, it is possible to provide batter care.

Diagnostico y tratamiento del pólipo juvenil del colon

In a five year period 75 colonoscopies were carried out in 66 children with rectal bleeding. Five patients presented with severe anemia. Their age ranged from 2 to 16 years (mean 6.6). Most of the procedures were performed on an outpatient basis (87%) and under oral sedative premedication (78%). At least the splenic flexure was reached in each case. We found 59 polyps in 47 children (71%). All polyps were snared and removed during the same procedure. There were no serious complications. Colonoscopy is a most usefull diagnostic and therapeutic procedure in children with rectal bleeding, where there is a high probability that a juvenile polyp can be found which can be safely treated during the same session.

Comparison of Enflurane, Halothane, and Isoflurane for Diagnostic and Therapeutic Procedures in Children with Malignancies

The authors performed a randomized, prospective trial comparing enflurane, halothane, and isoflurane (each administered with nitrous oxide) to establish which inhaled anesthetic produced the fewest complications and the most rapid induction of anesthesia for children undergoing general anesthesia fo

Comparison of Enflurane, Halothane, and Isoflurane for Diagnostic and Therapeutic Procedures in Children with Malignancies

Comparison of Enflurane, Halothane, and Isoflurane for Diagnostic and Therapeutic Procedures in Children with Malignancies

Renal transplantation in children. First year experience

14 children, 5 to 14 years old, received cadaveric renal kidneys during 1973. Donors were 2 to 41 years old. Kidney size was greater than normal for the recipient in 9 cases, less in 3 cases, and equivalent in 2 cases. When too large to be placed in the pelvis, the kidney was placed in a paravertebral position. Uretero-ureteral anastomosis was performed in most cases. Treatment was Azathioprine and corticotherapy. High doses of Furosemide (10 mg/kg) during operation prevented ischemia acute renal failure, despite cold ischemia as long 23 hours. One child died after 1 week from intracerebral hemorrhage due to severe hypertension. A second died after 5 weeks from a diffuse hemorrhagic syndrome. Primary thrombosis of the kidney vessels led to transplantectomy in 1 case. Kidney function is normal in 9 cases, chronic rejection is present in 2. Ho urologic complications were observed. Hypertension developped in half of the children. One case was associated with renal artery stenosis, another with chronic rejection. Hypertension was more frequent in those who had severe hypertension, leading to binephrectomy, before transplantation. No correlation was found between occurence of hypertension and kidney size. Although follow-up is too short, growth appears possible in prepubertal children, when steroid doses are low. Rehabilitation was total within 3 months in 10 cases. Cadaveric kidney transplantation seems to be a valuable therapeutic procedure in children with chronic renal failure.