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Li M, Cui X, Yue H, Ma C, Li K, Chai L, Ge M, Li H, Ng YL, Zhou Y, Shi J, Duan Y, Cheng Z. The efficacy of short acquisition time using 18F-FDG total-body PET/CT for the identification of pediatric epileptic foci. EJNMMI Res 2024; 14:21. [PMID: 38409511 PMCID: PMC10897067 DOI: 10.1186/s13550-024-01081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND 18F-FDG positron emission tomography (PET) plays a crucial part in the evaluation for pediatric epileptic patients prior to therapy. Short-term scanning holds significant importance, especially for pediatrics epileptic individuals who exhibited involuntary movements. The aim was to evaluate the effects of short acquisition time on image quality and lesion detectability in pediatric epileptic patients using total-body (TB) PET/CT. A total of 25 pediatric patients who underwent TB PET/CT using uEXPLORER scanner with an 18F-FDG administered dose of 3.7 MBq/kg and an acquisition time of 600 s were retrospectively enrolled. Short acquisition times (60 s, 150 and 300 s) were simulated by truncating PET data in list mode to reduce count density. Subjective image quality was scored on a 5-point scale. Regions of interest analysis of suspected epileptogenic zones (EZs), corresponding locations contralateral to EZs, and healthy cerebellar cortex were used to compare the semi-quantitative uptake indices of short-time images and then were compared with 600 s images. The comparison of EZs detectability based on time-dependent PET images was performed. RESULTS Our study demonstrated that a short acquisition time of 150 s is sufficient to maintain subjective image quality and lesion significance. Statistical analysis revealed no significant difference in subjective PET image quality between imaging at 300 s and 150 s (P > 0.05). The overall impression scores of image quality and lesion conspicuity in G60s were both greater than 3 (overall quality, 3.21 ± 0.46; lesion conspicuity, 4.08 ± 0.74). As acquisition time decreased, the changes of SUVmax and SD in the cerebellar cortex gradually increased (P < 0.01). There was no significant difference in asymmetry index (AI) difference between the groups and the AIs of EZs were > 15% in all groups. In 26 EZs of 25 patients, the lesion detection rate was still 100% when the time was reduced to 60 s. CONCLUSIONS This study proposed that TB PET/CT acquisition time could be reduced to 60 s with acceptable lesion detectability. Furthermore, it was suggested that a 150 s acquisition time would be sufficient to achieve diagnostic performance and image quality for children with epilepsy.
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Affiliation(s)
- Min Li
- Postgraduate Department, Shandong First Medical University, Shandong Academy of Medical Sciences), Jinan, China
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiao Cui
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Huixin Yue
- Postgraduate Department, Shandong First Medical University, Shandong Academy of Medical Sciences), Jinan, China
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chao Ma
- Postgraduate Department, Shandong First Medical University, Shandong Academy of Medical Sciences), Jinan, China
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Kun Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Leiying Chai
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Min Ge
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Hui Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yee Ling Ng
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Yun Zhou
- Central Research Institute, United Imaging Healthcare Group Co., Ltd, Shanghai, China
| | - Jianguo Shi
- Department of Epilepsy Center, Children's Hospital Affiliated to Shandong University, Jinan Children's Hospital, Jinan, China.
| | - Yanhua Duan
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Zhaoping Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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Lee D, Yeo H, Lee Y, Park H, Park H. A Survey on Procedural Sedation and Analgesia for Pediatric Facial Laceration Repair in Korea. Arch Plast Surg 2023; 50:30-36. [PMID: 36755661 PMCID: PMC9902079 DOI: 10.1055/s-0042-1759792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/19/2022] [Indexed: 02/08/2023] Open
Abstract
Background Most children with facial lacerations require sedation for primary sutures. However, sedation guidelines for invasive treatment are lacking. This study evaluated the current status of the sedation methods used for pediatric facial laceration repair in Korea. Methods We surveyed one resident in each included plastic surgery training hospital using face-to-face interviews or e-mail correspondence. The health care center types (secondary or tertiary hospitals), sedation drug types, usage, and dosage, procedure sequence, monitoring methods, drug effects, adverse events, and operator and guardian satisfaction were investigated. Results We included 45/67 hospitals (67%) that used a single drug, ketamine in 31 hospitals and chloral hydrate in 14 hospitals. All health care center used similar sedatives. The most used drug administered was 5 mg/kg intramuscular ketamine (10 hospitals; 32%). The most common chloral hydrate administration approach was oral 50 mg/kg (seven hospitals; 50%). Twenty-two hospitals (71%) using ketamine followed this sequence: administration of sedatives, local anesthesia, primary repair, and imaging work-up. The most common sequence used for chloral hydrate (eight hospitals; 57%) was local anesthesia, administration of sedatives, imaging work-up, and primary repair. All hospitals that used ketamine and seven (50%) of those using chloral hydrate monitored oxygen saturation. Median operator satisfaction differed significantly between ketamine and chloral hydrate (4.0 [interquartile range, 4.0-4.0] vs. 3.0 [interquartile range, 3.0-4.0]; p <0.001). Conclusion The hospitals used various procedural sedation methods for children with facial lacerations. Guidelines that consider the patient's condition and drug characteristics are needed for safe and effective sedation.
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Affiliation(s)
- Dongkyu Lee
- Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Hyeonjung Yeo
- Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea,Address for correspondence Hyeonjung Yeo, MD Department of Plastic and Reconstructive SurgeryDaegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu 41199Korea
| | - Yunjae Lee
- Cheongdam Okay Plastic Surgery Clinic, Seoul, Korea
| | - Hyochun Park
- Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Hannara Park
- Department of Plastic and Reconstructive Surgery, Daegu Fatima Hospital, Daegu, Korea
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Ulusoy O, Karakuş OZ, Ateş O, Hakgüder G, Olguner M, Akgür FM. Diagnostic failures in ovarian torsion during childhood: The effect of ovarian cyst size on the diagnostic accuracy of Doppler ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:660-665. [PMID: 35235217 DOI: 10.1002/jcu.23167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
| | | | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University, Izmir, Turkey
- Division of Pediatric Urology, Dokuz Eylul University, Izmir, Turkey
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Molu B, Açıkgöz A. A randomized controlled study: The effect of preprocedurals ınformative animation watch about echocardiography and ıntraprocedural kaleidoscope watch on anxiety in children. Jpn J Nurs Sci 2021; 19:e12468. [PMID: 34939313 DOI: 10.1111/jjns.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/02/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
AIM This study was conducted as a randomized controlled study to investigate the effect of procedural cartoons displayed before echocardiography and kaleidoscope display during the procedure on anxiety in children aged 5-12 years. METHODS The study was completed with 164 children aged 5-12 years who were admitted for echocardiography. The study was conducted with four groups: cartoons group, kaleidoscope group, cartoons + kaleidoscope group, and control group. Data were collected using a follow-up form and the Children's Fear Scale. RESULTS The results showed that the cartoons, kaleidoscope, and cartoons + kaleidoscope groups had lower anxiety scores during the procedure than during the preprocedural period (p < .001). In the control group, there was no significant difference between anxiety scores before the procedure and during the procedure (p > .05). CONCLUSION The present study concluded that cartoon display for preparing children aged 5-12 years or distracting them during the procedure using a kaleidoscope was effective in reducing their anxiety.
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Affiliation(s)
- Birsel Molu
- Department of Nursing, Selçuk University Akşehir Kadir Yallagöz Health School, Konya, Turkey
| | - Ayfer Açıkgöz
- Department of Pediatric Nursing, School of Health, Eskişehir Osmangazi University, Eskişehir, Turkey
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Gentle Touch: Noninvasive Approaches to Improve Patient Comfort and Cooperation for Pediatric Imaging. Top Magn Reson Imaging 2021; 29:187-195. [PMID: 32541256 DOI: 10.1097/rmr.0000000000000245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pediatric imaging presents unique challenges related to patient anxiety, cooperation, and safety. Techniques to reduce anxiety and patient motion in adults must often be augmented in pediatrics, because it is always mentioned in the field of pediatrics, children are not miniature adults. This article will review methods that can be considered to improve patient experience and cooperation in imaging studies. Such techniques can range from modifications to the scanner suite, different ways of preparing and interacting with children, collaborating with parents for improved patient care, and technical advances such as accelerated acquisition and motion correction to reduce artifact. Special considerations for specific populations including transgender patients, neonates, and pregnant women undergoing fetal imaging will be described. The unique risks of sedation in children will also be briefly reviewed.
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Farr KM, Moffett BS, Jones JL, Rogers AP, Chumpitazi CE. Chloral Hydrate Sedation in a Dexmedetomidine Era. Hosp Pharm 2020; 55:236-239. [PMID: 32742011 DOI: 10.1177/0018578719836639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brief Overview: The use of chloral hydrate as the primary sedation agent has declined across the nation after commercial production of the liquid formulation ceased. Although alternative sedatives have gained popularity, some pharmacies have continued to provide oral chloral hydrate by compounding it from raw ingredients. Thus, oral chloral hydrate use has continued in children despite the availability of alternative effective agents. Objective: The purpose of this investigation was to evaluate institutional chloral hydrate utilization as the primary agent for procedural sedation. Design/Methods: We conducted a retrospective study of patients given chloral hydrate for procedural sedation from October 2010 to December 2016. The hospital pharmacy database of chloral hydrate use at our 2 free-standing children's hospitals was reviewed and matched to procedure billing data. Results: There were 5874 chloral hydrate administrations for procedural sedation during the study period. The highest rates of use occurred in 2014, when there were 1420 chloral hydrate orders within our hospital. The large majority of sedations were for cardiac studies/procedures (n = 4250, 72.4%). Conclusions: Despite significant declines in use of chloral hydrate for procedural sedation across the country, local utilization of oral chloral hydrate remains high. Recent declines may be due to high-use clinical sites transitioning to alternative sedatives such as intranasal dexmedetomidine.
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Gounder S, Strudwick M. Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond) 2020; 27:236-242. [PMID: 32713824 DOI: 10.1016/j.radi.2020.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Ovarian torsion (OT), although rare, can be described as a complete or partial twist of the ovary with impairment of blood flow. Although occurring at any age, it is more common in children and during pregnancy. Presenting symptoms are non-specific but include either persistent or intermittent acute abdominal pain, making early diagnosis difficult. Delayed diagnosis is associated with an increased need for oophorectomy. The aim of this literature review is to establish the safest and most efficacious imaging strategy for OT by comparing and contrasting evidence for current imaging modalities found in the literature. KEY FINDINGS Characteristically, OT can be identified through a combination of findings some of which includes an enlarged ovary, multiple follicles at the periphery and a "whirlpool" sign. Currently, ultrasound is the preferred primary imaging modality; although computed tomography (CT) and magnetic resonance imaging (MRI) may also be used when findings are equivocal; with MRI being the safer option. CONCLUSION Ultimately, while it is true that ovarian torsion is not a common cause of acute abdominal pain in children, it should always be considered in the differential diagnosis. Prior to selecting an imaging modality; the clinical presentation, age group, possible radiation dose and availability of the modality needs to be considered to ensure the appropriate imaging strategy. IMPLICATIONS FOR PRACTICE With new tools such as scoring systems, B-flow imaging (BFI), diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) currently being explored for possible use in the future, early diagnosis of OT may be attainable. Thus, reducing the likelihood of adverse complications and consequently the need for oophorectomy.
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Affiliation(s)
- S Gounder
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia.
| | - M Strudwick
- Centre for Advanced Imaging, University of Queensland, St Lucia, Queensland, Australia
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Nozawa M, Mishina H, Tsuji S, Takayama JI. Low plasma D-dimer predicts absence of intracranial injury and skull fracture. Pediatr Int 2020; 62:22-28. [PMID: 31758836 DOI: 10.1111/ped.14063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/02/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Intracranial injury (ICI) is a leading cause of morbidity in children; however, the use of computed tomography (CT) to evaluate ICI has significant risks in children. A recent study suggests D-dimer is associated with ICI. We surveyed the performance of plasma D-dimer in ruling out ICI or skull fracture (SF) in children with head trauma. METHODS In a cross-sectional study in the Emergency Department (ED) at the National Center for Child Health and Development in Tokyo, Japan we reviewed the medical records of all children age 0-16 years brought to the ED with head trauma from January 2010 to July 2013, who underwent CT based on established clinical criteria and had plasma D-dimer measured. We evaluated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of plasma D-dimer, using abnormal findings on CT (ICI, SF) as the criterion standard. We repeated analysis after stratification by age (<2 years, ≥2 years). RESULTS Among 364 eligible children (112 children <2 year of age), abnormal findings on CT were demonstrated in 33.8% (123/364). With the cut-off set at 0.5 μg/mL, sensitivity was 100.0% (95% confidence interval [CI]: 95.6-100.0%), specificity 34.0% (95%CI: 28.1-40.4%), PPV 43.6% (95%CI: 37.7-49.6%), NPV 100.0% (95%CI: 93.5-100%). After stratification by age (<2 years and ≥2 years), sensitivity (100.0% and 100.0%) and NPV (100.0% and 100.0%) remained high in both age groups. CONCLUSIONS Low plasma D-dimer (≤0.5 μg/mL) is useful to limit the use of CT in children by excluding traumatic ICI or SF.
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Affiliation(s)
- Masahiro Nozawa
- Emergency Service and Transport Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Hiroki Mishina
- Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Satoshi Tsuji
- Emergency Service and Transport Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - John I Takayama
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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Coté CJ, Wilson S. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures. Pediatrics 2019; 143:peds.2019-1000. [PMID: 31138666 DOI: 10.1542/peds.2019-1000] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of appropriately trained staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.
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Abstract
Administration of sedation and/or anaesthesia to patients undergoing painful or uncomfortable procedures at off-site locations is referred to as non-operating room anaesthesia (NORA). Sedating/anaesthetising children in an unfamiliar environment, with the lack of support staff, nonavailability of choice of medication and equipment is often challenging. Studies have shown an increased risk of airway-related adverse events, complications, and even death outside the operating room locations. It is crucial to be familiar with the anatomical and physiological variations in children, well versed with the difficult airway algorithm and call for help early. The most common event in NORA claims was inadequate oxygenation/ventilation, which are preventable with vigilant monitoring. English language articles were searched in Pubmed, Google Scholar, and Academic using 'sedation in children', 'remote location anaesthesia', 'peadiatric sedation', and 'nonoperating room anaesthesia' as the mesh words. Full text of the relevant articles was obtained and this review article was synthesised. The article outlines various safety guidelines, sedation techniques, drugs used for sedation, environmental concerns, procedure-specific risks, and complications associated with NORA in children.
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Affiliation(s)
- Subrahmanyam Maddirala
- Department of Anaesthesiology, Rainbow Children's Hospital, Hyderabad, Telangana, India.,Director, Axon Anaesthesia Associates Pvt. Ltd., Hyderabad, Telangana, India
| | - Annu Theagrajan
- Department of Anaesthesiology, Rainbow Children's Hospital, Hyderabad, Telangana, India
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Chompunud Na Ayudhya C, Granquist EJ, Mupparapu M, Sollecito TP, Stoopler ET. Advanced maxillofacial imaging for temporomandibular disorder in special needs patients. SPECIAL CARE IN DENTISTRY 2018; 38:150-154. [PMID: 29722903 DOI: 10.1111/scd.12289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Temporomandibular disorder (TMD) is prevalent in special needs patients. Clinical examination of the temporomandibular joint (TMJ) complex and imaging in this patient population can be challenging due to patient disposition and cooperation. We report a case of a 29-year-old male with neurologic and behavioral special needs who required advanced maxillofacial imaging for a suspected TMD under general anesthesia, which has not been reported previously. This article intends to serve as a resource for health care providers who may encounter similar clinical situations.
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Affiliation(s)
- Chalatip Chompunud Na Ayudhya
- Senior Resident, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Eric J Granquist
- Assistant Professor, Department of Oral and Maxillofacial Surgery/Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Mel Mupparapu
- Professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Thomas P Sollecito
- Professor and Chairman, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Eric T Stoopler
- Associate Professor, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
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Barton K, Nickerson JP, Higgins T, Williams RK. Pediatric anesthesia and neurotoxicity: what the radiologist needs to know. Pediatr Radiol 2018; 48:31-36. [PMID: 28470388 DOI: 10.1007/s00247-017-3871-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/07/2017] [Accepted: 04/19/2017] [Indexed: 11/24/2022]
Abstract
The use of cross-sectional imaging in the pediatric population continues to rise, particularly the use of MRI. Limiting motion artifact requires cooperative subjects who do not move during imaging, so there has been an increase in the need for pediatric sedation or anesthesia. Over the last decade, concern has increased that exposure to anesthesia might be associated with long-term cognitive deficits. In this review we report current understanding of the effects of anesthesia on the pediatric population, with special focus on long-term developmental and cognitive outcomes, and suggest how radiologists can use new technologies or imaging strategies to mitigate or minimize these potential risks.
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Affiliation(s)
- Katherine Barton
- Department of Radiology, The University of Vermont College of Medicine, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Joshua P Nickerson
- Department of Radiology, The University of Vermont College of Medicine, 111 Colchester Ave, Burlington, VT, 05401, USA.
| | - Timothy Higgins
- Department of Radiology, The University of Vermont College of Medicine, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Robert K Williams
- Department of Anesthesiology, The University of Vermont College of Medicine, Burlington, VT, USA
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Tamada I, Mori T, Inoue N, Shido H, Aoki M, Nakamura Y, Kamogawa R. An Algorithmic Approach Using Ultrasonography in the Diagnosis of Pediatric Nasal Bone Fracture. J Craniofac Surg 2017; 28:84-87. [PMID: 27906845 DOI: 10.1097/scs.0000000000003217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ultrasonography (US) was recently reported as a reliable modality for diagnosing nasal bone fractures. However, whether US is reliable as a screening tool in the pediatric emergency department (ED) remains unknown. This prospective cohort study had a 2-fold aim: to assess the utility of US in the diagnosis of pediatric nasal bone fracture, and to evaluate the validity of our protocol for managing pediatric nasal bone fractures (Fuchu-Kids algorithm). PATIENTS AND METHODS Among the patients who presented at the ED with facial trauma, those with a suspected nasal bone fracture were enrolled in the study. Patients were treated according to Fuchu-Kids algorithm, and the validity of the protocol using US imaging was evaluated. RESULTS Among 81 patients who were enrolled during the 1-year study period, 63 patients were able to complete the process described in our protocol for further examination. The diagnostic power of the Fuchu-Kids algorithm had a sensitivity of 91.7%, a specificity of 92.3%, a positive predictive value (PPV) of 88%, and a negative predictive value (NPV) of 94.7%. However, when the performance of US was assessed as a single examination, its sensitivity, specificity, PPV, and NPV were 75%, 92.3%, 85.7%, and 85.7%, respectively. CONCLUSION Using our algorithm, the majority of patients with nasal bone fracture were successfully diagnosed and screened out successfully. Repeated US imaging is effective when clinical symptoms persist even if the first US imaging was negative for nasal bone fracture. However, a detailed medical interview and clinical examination are mandatory, regardless of the use of US.
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Affiliation(s)
- Ikkei Tamada
- *Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Children's Medical Center †Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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Wandalsen GF, Lanza FDC, Nogueira MCP, Solé D. Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 27449074 PMCID: PMC5176059 DOI: 10.1016/j.rppede.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. Methods: All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described. Results: The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14-182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications. Conclusions: The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.
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Takamiya M, Niitsu H, Saigusa K, Dewa K. Pediatric autopsy case of asphyxia due to salmon egg (ikura) aspiration. Pediatr Int 2016; 58:899-901. [PMID: 27389419 DOI: 10.1111/ped.12993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/27/2016] [Accepted: 03/18/2016] [Indexed: 11/30/2022]
Abstract
Here we report an autopsy case of asphyxia due to aspiration of a salmon egg (ikura) into the airway. The patient was a 19-month-old girl. During breakfast, she put salmon eggs into her mouth, and began to walk. She slipped, fell down, and collapsed. She was pronounced dead following 2 h of resuscitation. The body was autopsied 28 h after death. The gastric contents consisted of rice, orange sections, and white salmon eggs. The lungs were deeply congested and over-inflated. In the right lung, areas of atelectasis in the upper and middle lobes were seen. A yellow salmon egg (8 mm in diameter) was found in the trachea. Although fish eggs are consumed throughout the world, reports of this sort are limited. The aspiration of fish eggs is under-acknowledged and underreported. The importance of preventive measures needs to be emphasized to parents and caregivers.
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Affiliation(s)
- Masataka Takamiya
- Department of Forensic Medicine, Iwate Medical University, Iwate, Japan.
| | - Hisae Niitsu
- Department of Forensic Medicine, Iwate Medical University, Iwate, Japan
| | - Kiyoshi Saigusa
- Department of Biology, Iwate Medical University Center For Liberal Arts And Sciences, Iwate, Japan
| | - Koji Dewa
- Department of Forensic Medicine, Iwate Medical University, Iwate, Japan
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Wandalsen GF, Lanza FDC, Nogueira MCP, Solé D. Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. REVISTA PAULISTA DE PEDIATRIA 2016; 34:408-411. [PMID: 27449074 DOI: 10.1016/j.rpped.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/03/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. METHODS All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described. RESULTS The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14 to 182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications. CONCLUSIONS The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.
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Affiliation(s)
- Gustavo Falbo Wandalsen
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
| | - Fernanda de Cordoba Lanza
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil; Universidade Nove de Julho, São Paulo, SP, Brasil
| | - Márcia Cristina Pires Nogueira
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Dirceu Solé
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Coté CJ, Wilson S. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016. Pediatrics 2016; 138:peds.2016-1212. [PMID: 27354454 DOI: 10.1542/peds.2016-1212] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.
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Callahan P, Pinto SJ, Kurland G, Cain JG, Motoyama EK, Weiner DJ. Dexmedetomidine for infant pulmonary function testing. Pediatr Pulmonol 2015; 50:150-4. [PMID: 25187360 DOI: 10.1002/ppul.23100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/20/2014] [Indexed: 11/11/2022]
Abstract
For the last thirty years, oral chloral hydrate has been used for sedation of infants for lung function testing. Recently, however, availability of chloral hydrate became severely limited in the United States after two manufacturers discontinued manufacturing in 2012. Due to these limitations and the recent and ongoing shortage of chloral hydrate, other medications have been proposed for lung function testing, including midazolam and propofol. Herein, we describe our limited experience using intravenous dexmedetomedine (DMED), a medication thus far described as having minimal effect on pulmonary function or respiratory drive.
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Affiliation(s)
- Patrick Callahan
- Departments of Anesthesiology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Evaluation of Acute Abdominal Pain in the Emergency Setting Using Computed Tomography Without Oral Contrast in Patients With Body Mass Index Greater Than 25. J Comput Assist Tomogr 2015; 39:681-6. [DOI: 10.1097/rct.0000000000000277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Scheduling for anesthesia at geographic locations remote from the operating room. Curr Opin Anaesthesiol 2014; 27:426-30. [DOI: 10.1097/aco.0000000000000085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lim SH, Kim MJ, Lee MJ. Use of animated cartoons with children's songs to increase compliance with ultrasonography in young children. Yonsei Med J 2013; 54:1533-7. [PMID: 24142662 PMCID: PMC3809887 DOI: 10.3349/ymj.2013.54.6.1533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the effect of animated cartoons with children's songs to increase compliance with ultrasonography (US) examination in young children. MATERIALS AND METHODS Animated cartoons with children's songs viewed on a cell phone were played just before the start of US examination when pediatric patients were agitated or irritable. The effect of this method was evaluated for initial responses and sustained responses (grade 0, no response; 1, partial response; and 2, good response). Site of US examination, scan duration, and the helpfulness of this method (0, useless; 1, partially helpful; and 2, very helpful) were also recorded. RESULTS Among 464 pediatric patients who underwent US during the study period, 88 children (19%) needed to be calmed (67 abdominal and 21 other parts of the body). All subjects were less than five years of age (mean 1.5 years), except for four patients with mental retardation. Scan duration was less than 5 minutes in almost all examinations. Five children refused to watch the cartoon. Initial responses were good in 75 and partial in eight children. Sustained responses were good in 70 and partial in 12 children. The cartoons were very helpful in 73 (83%) and partially helpful in nine (10%) children. The effect of watching the cartoon did not change with sex, age (less or more than one year), or site of examination. CONCLUSION Animated cartoons with children's songs viewed on a cell phone were helpful (93%) in increasing compliance with US examination in young children of both the abdomen and other parts.
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Affiliation(s)
- Sok Hwan Lim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Sandberg KL, Poole SD, Sundell HW. Cardio-respiratory response to moderate chloral hydrate sedation in young lambs. Acta Paediatr 2013; 102:391-6. [PMID: 23289633 DOI: 10.1111/apa.12151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/02/2012] [Accepted: 12/28/2012] [Indexed: 12/27/2022]
Abstract
AIM Chloral hydrate (CH) is the most commonly used sedative for medical procedures and lung function tests in infancy. The aim was to determine whether moderate CH sedation affects airway function, lung volume and ventilation. METHODS Thirteen chronically instrumented 7- to 8-week-old lambs were studied both before and after CH sedation (50 mg/kg as intravenous bolus followed by 25 mg/kg/hour as continuous infusion). Nitrogen washout technique and lung mechanics analysis were used to assess functional residual capacity (FRC) and airway function. Moment analysis and lung clearance index were calculated as measures of gas mixing efficiency in distal airways. Respiratory rate, tidal volume, minute ventilation and indices of inspiratory drive were determined together with heart rate, blood pressure and oxygenation. RESULTS No significant CH-induced changes were found for gas mixing efficiency, FRC or lung mechanics. Minute ventilation decreased slightly, but significantly, while indices of inspiratory drive remained unchanged. Heart rate increased significantly, but mean arterial blood pressure was unaffected. CONCLUSION Moderate CH sedation did not significantly affect airway function or FRC. Although indices of inspiratory drive were not affected, minute ventilation decreased slightly. These findings indicate that reliable results can be obtained from lung function testing when CH is used for sedation.
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Affiliation(s)
- Kenneth L. Sandberg
- Department of Paediatrics; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Stanley D. Poole
- Department of Pediatrics; Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee USA
| | - Håkan W. Sundell
- Department of Pediatrics; Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt; Nashville Tennessee USA
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Saxena AK, Ruttenstock EM, Singer G. Pediatric bilateral Morgagni-Larrey diaphragmatic hernia: is diagnosis with computed tomography required in the era of laparoscopic approach? Hernia 2012; 16:373-4. [PMID: 22392594 DOI: 10.1007/s10029-012-0907-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 02/20/2012] [Indexed: 11/26/2022]
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