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Sumida W, Tainaka T, Shirota C, Yokota K, Makita S, Okamoto M, Takimoto A, Yasui A, Takada S, Nakagawa Y, Kato D, Yokoyama S, Ishizu Y, Amano H, Guo Y, Hinoki A, Uchida H. Biochemical markers to predict the development of gastrointestinal bleeding and esophageal varices after portoenterostomy in biliary atresia. Pediatr Surg Int 2022; 38:1799-1805. [PMID: 36114864 DOI: 10.1007/s00383-022-05243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Gastrointestinal bleeding (GIB) due to esophageal varices (EV) is one of the factors that negatively impact native liver survival of patients with biliary atresia (BA). Gastrointestinal fibroscopy (GIF) is usually used to determine the presence of EVs; however, it requires general anesthesia. The aim of this study is to search for markers in blood tests obtained during routine check-ups that can predict the development of GIB. METHODS Data of patients with BA who underwent portoenterostomy at our hospital from 2014 to 2020 were retrospectively reviewed. The patients' data were assigned to three groups according to specific time points: Group B, which included data at GIB; Group NB-T, which included data at GIF and EV treatment; and Group NB-NT, which included data at GIF without treatment. The data in Group B were compared to those of other groups. RESULTS In our study, GIB occurred in 11 patients, and 12 cases and 8 cases were classified into Groups NB-NT and NB-T, respectively. Compared with the other groups, only ChE and M2BPGi in Group B showed statistically significant differences. CONCLUSIONS ChE and M2BPGi are useful for predicting GIB.
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Affiliation(s)
- Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Toho University Omori Hospital, Tokyo, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuki Yokota
- Department of Gastrointestinal and Pediatric Surgery, Mie University, Tsu, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yaohui Guo
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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El-Mowafy A, Yarascavitch C, Haji H, Quiñonez C, Haas DA. Mortality and Morbidity in Office-Based General Anesthesia for Dentistry in Ontario. Anesth Prog 2020; 66:141-150. [PMID: 31545669 DOI: 10.2344/anpr-66-02-07] [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] [Indexed: 11/11/2022] Open
Abstract
Our objective was to estimate the prevalence of mortality and serious morbidity for office-based deep sedation and general anesthesia (DS/GA) for dentistry in Ontario from 1996 to 2015. Data were collected retrospectively in 2 phases. Phase I involved the review of incidents, and phase II involved a survey of DS/GA providers. In phase I, cases involving serious injury or death for dentistry under DS/GA, sourced from the Office of the Chief Coroner of Ontario and from the Royal College of Dental Surgeons of Ontario (RCDSO), were reviewed. Phase II involved a survey of all RCDSO-registered providers of DS/GA in which they were asked to estimate the number of DS/GAs administered in 2015 and the number of years in practice since 1996. Clinician data were pooled to establish an overall number of DS/GAs administered in dental offices in Ontario from 1996 to 2015. Prevalence was calculated using phase I (numerator) and phase II (denominator) findings. The estimated prevalence of mortality in the 20-year period from 1996 to 2015 was 3 deaths in 3,742,068 cases, with an adjusted mortality rate of 0.8 deaths per 1 million cases. The estimated prevalence of serious morbidity was 1 injury in 3,742,068 cases, which adjusts to a serious morbidity rate of 0.25 per 1 million cases. The mortality rate found in this study was slightly lower than those published by earlier studies conducted in Ontario. The risk of serious morbidity was found to be low and similar to other studies investigating morbidity in office-based dental anesthesia.
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Affiliation(s)
- Alia El-Mowafy
- Clinical Instructor, Dental Anesthesia, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Carilynne Yarascavitch
- Assistant Professor, Dental Anesthesia, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Hussein Haji
- DDS Student, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Quiñonez
- Associate Professor, Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel A Haas
- Professor and Dean, Dental Anesthesia, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Scheiermann P, Herzog F, Siebenhofer A, Strametz R, Weberschock T. Intravenous versus inhalational anesthesia for pediatric inpatient surgery - A systematic review and meta-analysis. J Clin Anesth 2018; 49:19-25. [PMID: 29860223 DOI: 10.1016/j.jclinane.2018.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/09/2018] [Accepted: 05/18/2018] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVE General anesthesia is commonly used in pediatric inpatient surgery. It can be induced and maintained by either intravenous or volatile anesthetic agents. We aimed to elucidate whether intravenous or volatile anesthetic agents are superior with regards to preventing anesthesia-related complications. DESIGN Using a predefined standardized study protocol we conducted a systematic review of randomized controlled trials (RCTs) with meta-analysis where appropriate searching the following data bases: CENTRAL, MEDLINE, EMBASE, metaRegister of Controlled Trials (until June 2016). SETTING AND PATIENTS We included any RCT comparing the adverse effects of intravenous or volatile anesthetic agents in pediatric inpatients. More specifically, primary endpoints were the appearance of cardiopulmonary complications or postoperative nausea and vomiting (PONV) or any cognitive dysfunction within 24 h following general anesthesia. Secondary endpoints were any other complication besides the aforementioned primary endpoints. MEASUREMENTS AND MAIN RESULTS In total, nine RCTs (762 children) were analyzed. Regarding primary endpoints, the use of propofol during strabismus surgery significantly increased the relative risk (RR) of oculocardiac reflex (RR 4.96, 95% confidence interval [CI]: 3.13-7.87, p < 0.00001; two studies, 257 children). PONV was significantly less frequent after general anesthesia with intravenous than with volatile anesthetic agents (RR 0.68, 95% CI: 0.48-0.98, p = 0.04; five studies, 563 children). We did not find identify any further difference with regards to the predefined primary or secondary endpoints due to clinical or statistical heterogeneity. CONCLUSIONS Taken together, propofol increased the risk of oculocardiac reflex whereas PONV was less frequent following intravenous anesthetics compared to volatile anesthetics. The study results may help tailoring the use of either intravenous of volatile anesthetics onto the needs of pediatric inpatients. Given the clinical or statistical heterogeneity among the studies, we call for a scientific effort to increase the body of evidence on anesthetic agents in pediatric general anesthesia.
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Affiliation(s)
- Patrick Scheiermann
- Department of Anesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | - Friederike Herzog
- Institute for General Practice, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Andrea Siebenhofer
- Institute for General Practice, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany; Evidence-based medicine working group, Institute for General Medicine and Evidence-based Health Services Research, Medical University of Graz, Auenbruggerplatz 2/9, 8036 Graz, Austria.
| | - Reinhard Strametz
- Wiesbaden Business School of RheinMain University of Applied Sciences, Bleichstr. 44, 65183 Wiesbaden, Germany.
| | - Tobias Weberschock
- Institute for General Practice, Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany; Department for Dermatology, University Hospital Goethe University Frankfurt/Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
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Morbimortalidade perioperatória no primeiro ano de idade: revisão sistemática (1997‐2012). Rev Bras Anestesiol 2015; 65:384-94. [DOI: 10.1016/j.bjan.2013.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/20/2013] [Indexed: 11/18/2022] Open
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Catré D, Lopes MF, Viana JS, Cabrita AS. Perioperative morbidity and mortality in the first year of life: a systematic review (1997-2012). Braz J Anesthesiol 2015; 65:384-94. [PMID: 26323738 DOI: 10.1016/j.bjane.2013.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/20/2013] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although many recognize that the first year of life and specifically the neonatal period are associated with increased risk of anesthetic morbidity and mortality, there are no studies directed to these pediatric subpopulations. This systematic review of the scientific literature including the last 15 years aimed to analyze the epidemiology of morbidity and mortality associated with general anesthesia and surgery in the first year of life and particularly in the neonatal (first month) period. CONTENT The review was conducted by searching publications in Medline/PubMed databases, and the following outcomes were evaluated: early mortality in the first year of life (<1 year) and in subgroups of different vulnerability in this age group (0-30 days and 1-12 months) and the prevalence of cardiac arrest and perioperative critical/adverse events of various types in the same subgroups. CONCLUSIONS The current literature indicates great variability in mortality and morbidity in the age group under consideration and in its subgroups. However, despite the obvious methodological heterogeneity and absence of specific studies, epidemiological profiles of morbidity and mortality related to anesthesia in children in the first year of life show higher frequency of morbidity and mortality in this age group, with the highest peaks of incidence in the neonates' anesthesia.
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Affiliation(s)
- Dora Catré
- Centro Hospitalar Tondela-Viseu, Viseu, Portugal; Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.
| | - Maria Francelina Lopes
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal; Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joaquim Silva Viana
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
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The safety of general anaesthesia in paediatric patients undergoing the application of Biobrane® for small scalds. Burns 2015; 41:1221-6. [PMID: 25724104 DOI: 10.1016/j.burns.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Each year more than 5000 children present to English and Welsh hospitals for the management of scalds; 60% of these are small scalds of less than 10% body surface area. There are no agreed UK care pathways for this injury. One method of management is to use a biosynthetic wound dressing after thorough wound cleaning. In children, this usually utilises general anaesthesia. This study investigates the incidence of adverse events during anaesthesia for the application of biosynthetic dressings in children with small-area scalds. METHODS The medical records of 500 consecutive admissions to a tertiary care paediatric burn centre between July 1st 2007 and June 30th 2012 were analysed. The primary outcome was any patient-related adverse event incurred as a result of the general anaesthesia. Secondary outcomes included delays in discharge and any recovery sequelae to the adverse events. RESULTS There were 21 (4.2%) documented adverse events associated with 500 episodes of anaesthesia. Of these, the majority (52%) were documented as self-resolving laryngospasm. All episodes were temporary with no recovery sequelae and did not delay discharge from the post-anaesthetic recovery area. CONCLUSIONS The use of general anaesthesia in this setting for the application of biosynthetic dressings in children with small-area scalds has a low incidence of anaesthesia-related complications with no associated long-term sequelae. This incidence is similar to that quoted for adverse events related to anaesthesia for other procedures and is lower than that reported for procedures using sedation.
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Ariza F, Montilla-Coral D, Franco O, González LF, Lozano LC, Torres AM, Jordán J, Blanco LF, Suárez L, Cruz G, Cepeda M. Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study). ACTA ACUST UNITED AC 2014; 61:362-8. [PMID: 24661725 DOI: 10.1016/j.redar.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/20/2013] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case. METHODS We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs. RESULTS GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05). CONCLUSIONS AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.
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Affiliation(s)
- F Ariza
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia.
| | - D Montilla-Coral
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - O Franco
- Department of Pediatric Surgery, Fundación Valle del Lili, Cali, Colombia
| | - L F González
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L C Lozano
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - A M Torres
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - J Jordán
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L F Blanco
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - L Suárez
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - G Cruz
- Department of Anesthesia and Perioperative Medicine, Fundación Valle del Lili, Cali, Colombia
| | - M Cepeda
- Clinical Research Unit, Fundación Valle del Lili, Cali, Colombia
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Abstract
We will discuss a new initiative of the American College of Surgeons and the American Pediatric Surgical Association to prospectively define optimal resource standards for children's surgical care.
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Early life exposure to sevoflurane impairs adulthood spatial memory in the rat. Neurotoxicology 2013; 39:45-56. [PMID: 23994303 DOI: 10.1016/j.neuro.2013.08.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 12/25/2022]
Abstract
Sevoflurane is a general anesthetic commonly used in the pediatric setting because it is sweet-smelling, nonflammable, fast acting and has a very short recovery time. Although recent clinical data suggest that early anesthesia exposure is associated with subsequent learning and memory problems, it is difficult to determine the exact scope of developmental neurotoxicity associated with exposure to specific anesthetics such as sevoflurane. This is largely due to inconsistencies in the literature. Thus, in the present studies we evaluated the effect of early life exposure to sevoflurane (1%, 2%, 3% or 4%) on adulthood memory impairment in Sprague-Dawley rats. Animals were exposed to different regimens of sevoflurane anesthesia on postnatal days (PNDs) 3, 7, or 14 or at 7 weeks (P7W) of age and spatial memory performance was assessed in adulthood using the Morris Water Maze (MWM). Rats exposed to sevoflurane exhibited significant memory impairment which was concentration and exposure duration dependent. Disruption of MWM performance was more severe in animals exposed on both PNDs 3 and 7 than in animals exposed on both PNDs 3 and 14. The younger the animal's age at the time of exposure, the more significant the effect on later MWM performance. Compared to the neonates, animals exposed at P7W were relatively insensitive to sevoflurane: memory was impaired in this group only after repeated exposures to low doses or single exposures to high doses. Early life exposure to sevoflurane can result in spatial memory impairments in adulthood and the shorter the interval between exposures, the greater the deficit.
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