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Khara B, Tobias JD. Perioperative Care of the Pediatric Patient and an Algorithm for the Treatment of Intraoperative Bronchospasm. J Asthma Allergy 2023; 16:649-660. [PMID: 37384067 PMCID: PMC10295469 DOI: 10.2147/jaa.s414026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/17/2023] [Indexed: 06/30/2023] Open
Abstract
Asthma remains a common comorbid condition in patients presenting for anesthetic care. As a chronic inflammatory disease of the airway, asthma is known to increase the risk of intraoperative bronchospasm. As the incidence and severity of asthma and other chronic respiratory conditions that alter airway reactivity is increasing, a greater number of patients at risk for perioperative bronchospasm are presenting for anesthetic care. As bronchospasm remains one of the more common intraoperative adverse events, recognizing and mitigating preoperative risk factors and having a pre-determined treatment algorithm for acute events are essential to ensuring effective resolution of this intraoperative emergency. The following article reviews the perioperative care of pediatric patients with asthma, discusses modifiable risk factors for intraoperative bronchospasm, and outlines the differential diagnosis of intraoperative wheezing. Additionally, a treatment algorithm for intraoperative bronchospasm is suggested.
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Affiliation(s)
- Birva Khara
- Department of Anesthesiology, Shree Krishna Hospital, Pramukhswami Medical College and Bhaikaka University, Karamsad, Gujarat, India
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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Lewis H, Norrington A. Paediatric preoperative assessment. BJA Educ 2023; 23:238-244. [PMID: 37223694 PMCID: PMC10201399 DOI: 10.1016/j.bjae.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/27/2023] [Indexed: 05/25/2023] Open
Affiliation(s)
- H. Lewis
- The Royal London Hospital, London, UK
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Effect of General Anesthesia Maintenance with Propofol or Sevoflurane on Fractional Exhaled Nitric Oxide and Eosinophil Blood Count: A Prospective, Single Blind, Randomized, Clinical Study on Patients Undergoing Thyroidectomy. J Pers Med 2022; 12:jpm12091455. [PMID: 36143240 PMCID: PMC9505258 DOI: 10.3390/jpm12091455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Nitric oxide (NO) is considered a means of detecting airway hyperresponsiveness, since even non-asthmatic patients experiencing bronchospasm intraoperatively or postoperatively display higher levels of exhaled NO. It can also be used as a non-invasive biomarker of lung inflammation and injury. This prospective, single-blind, randomized study aimed to evaluate the impact of two different anesthesia maintenance techniques on fractional exhaled nitric oxide (FeΝO) in patients without respiratory disease undergoing total thyroidectomy under general anesthesia. Methods: Sixty patients without respiratory disease, atopy or known allergies undergoing total thyroidectomy were randomly allocated to receive either inhalational anesthesia maintenance with sevoflurane at a concentration that maintained Bispectral Index (BIS) values between 40 and 50 intraoperatively or intravenous anesthesia maintenance with propofol 1% targeting the same BIS values. FeΝO was measured immediately preoperatively (baseline), postoperatively in the Postanesthesia Care Unit and at 24 h post-extubation with a portable device. Other variables measured were eosinophil blood count preoperatively and postoperatively and respiratory parameters intraoperatively. Results: Patients in both groups presented lower than baseline values of FeΝO measurements postoperatively, which returned to baseline measurements at 24 h post-extubation. In the peripheral blood, a decrease in the percentage of eosinophils was demonstrated, which was significant only in the propofol group. Respiratory lung mechanics were better maintained in the propofol group as compared to the sevoflurane group. None of the patients suffered intraoperative bronchospasm. Conclusions: Both propofol and sevoflurane lead to the temporary inhibition of NO exhalation. They also seem to attenuate systemic hypersensitivity response by reducing the eosinophil count in the peripheral blood, with propofol displaying a more pronounced effect and ensuring a more favorable mechanical ventilation profile as compared to sevoflurane. The attenuation of NO exhalation by both agents may be one of the underlying mechanisms in the reduction in airway hyperreactivity. The clinical significance of this fluctuation remains to be studied in patients with respiratory disease.
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Petroze RT, Puligandla PS. Preoperative cardiopulmonary evaluation in specific neonatal surgery. Semin Pediatr Surg 2019; 28:3-10. [PMID: 30824131 DOI: 10.1053/j.sempedsurg.2019.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Preoperative assessment of surgical neonates often relates to issues of prematurity, low birth weight, or associated malformations. This review explores the preoperative cardiopulmonary evaluation in specific newborn surgical populations, the role of echocardiography in congenital diaphragmatic hernia perioperative management, the impact of bronchopulmonary dysplasia in the ex-preterm surgical neonate and a brief discussion on the risk of general anesthesia and specific anesthetic considerations for any surgical neonate. Newborns with congenital anomalies requiring early general surgical intervention should have an assessment for congenital heart disease. In the asymptomatic neonate, a thorough physical exam may be sufficient preoperatively. Neonates born with esophageal atresia or anorectal malformations should have a full evaluation for VACTERL associations. Initial echocardiography in congenital diaphragmatic hernia is used to evaluate anatomy, but there is emerging evidence to suggest the use of echocardiography in the ongoing surveillance of CDH to influence the timing of surgical intervention. Bronchopulmonary dysplasia is present in up to 40% of ex-premature neonates and increases the risk of postoperative apneas and need for ventilatory support. However, all surgical neonates have an increased risk of post-operative apneas, and the need for surgical intervention should be balanced with the risk of general anesthesia.
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Affiliation(s)
- Robin T Petroze
- Division of Pediatric Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Pramod S Puligandla
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, 1001 Decarie Blvd, Room B04.2318, Montreal, QC, Canada.
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Altit G, Lee HC, Hintz S, Tacy TA, Feinstein JA, Bhombal S. Practices surrounding pulmonary hypertension and bronchopulmonary dysplasia amongst neonatologists caring for premature infants. J Perinatol 2018; 38:361-367. [PMID: 29234146 DOI: 10.1038/s41372-017-0025-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Pulmonary hypertension (PH) is associated with bronchopulmonary dysplasia (BPD). Screening strategies, a thorough investigation of co-morbidities, and multidisciplinary involvement prior to anti-PH medications have been advocated by recent guidelines. We sought to evaluate current practices of neonatologists caring for premature infants with PH. DESIGN Electronic survey of American Academy of Pediatrics neonatology members. RESULTS Among 306 neonatologist respondents, 38% had an institutional screening protocol for patients with BPD; 83% screened at 36 weeks for premature neonates on oxygen/mechanical ventilation. In those practicing more than 5 years, 54% noted increasing numbers of premature infants diagnosed with PH. Evaluation for PH in BPD patients included evaluations for micro-aspiration (41%), airways anomalies (29%), and catheterization (10%). Some degree of acquired pulmonary vein stenosis was encountered in 47%. A majority (90%) utilized anti-PH medications during the neonatal hospitalization. CONCLUSIONS Screening for PH in BPD, and subsequent evaluation and management is highly variable.
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Affiliation(s)
- Gabriel Altit
- Neonatology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada. .,Pediatric Cardiology and Neonatal and Developmental Medicine at Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | - Henry C Lee
- Neonatal and Developmental Medicine, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Susan Hintz
- Obstetrics and Gynecology, Neonatologist, Professor in Neonatal and Developmental Medicine, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Theresa A Tacy
- Echocardiography Laboratory, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Jeffrey A Feinstein
- Bioengineering, Pediatric Cardiologist, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Shazia Bhombal
- Neonatal and Developmental Medicine, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA, USA
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Adler AC, Leung S, Lee BH, Dubow SR. Preparing Your Pediatric Patients and Their Families for the Operating Room: Reducing Fear of the Unknown. Pediatr Rev 2018; 39:13-26. [PMID: 29292283 DOI: 10.1542/pir.2017-0011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine and.,Baylor College of Medicine, Houston, TX
| | - Stephanie Leung
- Department of Child Life, Texas Children's Hospital, Houston, TX
| | - Benjamin H Lee
- Department of Anesthesiology, Perioperative and Pain Medicine and.,Baylor College of Medicine, Houston, TX
| | - Scott R Dubow
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kou K, Omae T, Wakabayashi S, Sakuraba S. A case in which a capnometer was useful for diagnosing laryngospasm following administration of sugammadex. JA Clin Rep 2017; 3:41. [PMID: 29457085 PMCID: PMC5804625 DOI: 10.1186/s40981-017-0111-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Sugammadex has been reported to cause upper-airway obstruction, such as laryngospasm or bronchospasm. These two conditions are treated using different approaches, but the differential diagnosis is difficult. Case presentation We describe a case in which general anesthesia was administered via endotracheal intubation, in combination with brachial-plexus block, for arthroscopic surgical treatment of a rotator-cuff tear caused by recurrent shoulder dislocation. The total dose of rocuronium administered was 90 mg, and the last dose of 10 mg was given 15 min before the end of the surgery. Sugammadex was intravenously administered at 100 mg to reverse the effect of rocuronium after the operation ended. After extubation in this case, we placed a mask firmly around the patient's mouth, and thus, there was no air leakage around the mask. We detected upper-airway obstruction that was presumably attributable to administration of sugammadex. The end-tidal carbon dioxide (EtCO2) concentration was undetectable on a capnometer. Although 100% oxygen was administered at 10 L/min via a facemask, oxygen saturation (SpO2) decreased to approximately 70%. With suspected onset of laryngospasm, continuous positive airway pressure with 100% oxygen at 10 L/min was started at 30 cm H2O. The patient's airway obstruction resolved after a short time. Conclusion The use of a capnometer facilitated the diagnosis of laryngospasm and allowed us to administer appropriate treatment after administration of sugammadex.
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Affiliation(s)
- Keito Kou
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
| | - Takeshi Omae
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
| | - Saiko Wakabayashi
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
| | - Sonoko Sakuraba
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka hospital, 1129 Izunokuni, Shizuoka, Japan
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Armoni Domany K, Gut G, Yakir BE, Sivan Y. Variability in anesthesiologists' approach to the preoperative management of asthmatic children. J Clin Anesth 2016; 35:62-69. [PMID: 27871597 DOI: 10.1016/j.jclinane.2016.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/19/2016] [Accepted: 07/05/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE No consensus guidelines exist for the preoperative treatment of asthmatic children referred for elective surgery. We investigated the attitude of pediatric anesthesiologists to this issue. DESIGN A questionnaire survey was conducted. SETTING National survey. SUBJECTS Certified Israeli pediatric anesthesiologists from all 24 general hospitals in Israel. MEASUREMENT Twenty-one questions regarding the approach to preoperative management of asthmatic children including 6 case scenarios with a variety of clinical situations and treatments of asthmatic children. The results were compared with the attitude of pediatric pulmonologists recently published using a similar methodology. MAIN RESULTS Forty-four pediatric anesthesiologists from all 24 general hospitals in Israel responded. Twenty-five percent of pediatric anesthesiologists answered that, in addition to pediatric anesthesiologists, the primary pediatrician should be consulted, and 70% believed that a pediatric pulmonologists should also be consulted. Overall, results showed a wide variability between responders especially for preschool children and unstable school-aged asthmatic children for both disciplines. The variability referred to the use of any treatment, bronchodilators, inhaled corticosteroids and their combination, addition of systemic corticosteroids, and the length of preoperative treatment. Compared with pediatric pulmonologists, a better within-discipline agreement was observed by the pediatric anesthesiologists for stable school-aged asthmatic children with a lower inclination to augment preoperative treatment (P< .001). No difference was observed for the preschool children with asthma and for the unstable school-aged asthmatic child. CONCLUSIONS A wide variability exists in pediatric anesthesiologists' approach to the preoperative management of asthmatic children for most common case scenarios. This is probably explained by the heterogeneity of asthma, the type of surgery, the lack of guidelines, and the paucity of data. Similarities as well as differences exist between pediatric anesthesiologists and pulmonologists. Further studies and implementation of consensus guidelines are needed.
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Affiliation(s)
- Keren Armoni Domany
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Israel.
| | - Guy Gut
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Israel
| | - Bat-El Yakir
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Israel
| | - Yakov Sivan
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University Sackler Faculty of Medicine, Israel
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Najafi N, Veyckemans F, Van de Velde A, Poelaert J. Usability of dexmedetomidine for deep sedation in infants and small children with respiratory morbidities. Acta Anaesthesiol Scand 2016; 60:865-73. [PMID: 26940080 DOI: 10.1111/aas.12715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/17/2016] [Accepted: 01/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Children with respiratory morbidities are at increased risk of developing adverse respiratory events while undergoing deep sedation. Dexmedetomidine possesses sedative properties with minimal respiratory depression. This report aimed to determine the usability of dexmedetomidine in children with significant respiratory morbidities who require deep sedation. METHODS Medical records of children with ASA classification III who had at least three characteristics of respiratory morbidities and who received dexmedetomidine sedation for magnetic resonance imaging (MRI) between January 2014 and May 2015 were retrospectively reviewed. Dexmedetomidine was administered as a bolus of 1 μg/kg over 10 min followed by 1 μg/kg/h infusion. If necessary, an additional bolus dose was given and the infusion rate was increased to 2 μg/kg/h. Respiratory morbidities, haemodynamic parameters, total dexmedetomidine dose, adverse cardiorespiratory events and sedation characteristics were analysed. RESULTS Nineteen out of 642 children who underwent MRI were eligible for evaluation. Seventeen children (89%) had at least four characteristics of respiratory morbidities. The median [IQR] age was 9 months [3.5-14]. All patients completed MRI scans while breathing spontaneously via the native airway. No episodes of adverse respiratory events or haemodynamic instability were observed. Children who were administered a lower dexmedetomidine dose and had a shorter sedation time were more likely to be younger than 1 year of age. CONCLUSION These data demonstrate that dexmedetomidine deep sedation was well-tolerated in children with significant respiratory morbidities. Moreover, children younger than 1 year of age were administered lower dexmedetomidine dose than children older than 1 year of age for the same sedation level. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02555605.
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Affiliation(s)
- N. Najafi
- Department of Anaesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel (UZBrussel); Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - F. Veyckemans
- Department of Anaesthesiology; Cliniques universitaires Saint Luc (UCL); Brussels Belgium
| | - A. Van de Velde
- Department of Anaesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel (UZBrussel); Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - J. Poelaert
- Department of Anaesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel (UZBrussel); Vrije Universiteit Brussel (VUB); Brussels Belgium
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Rajesh MC. Anaesthesia for children with bronchial asthma and respiratory infections. Indian J Anaesth 2015; 59:584-8. [PMID: 26556917 PMCID: PMC4613405 DOI: 10.4103/0019-5049.165853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Asthma represents one of the most common chronic diseases in children with an increasing incidence reported worldwide. The key to successful anaesthetic outcome involves thorough pre-operative assessment and optimisation of the child's pulmonary status. Judicious application of proper anti-inflammatory and bronchodilatory regimes should be instituted as part of pre-operative preparation. Bronchospasm triggering agents should be carefully probed and meticulously avoided. A calm and properly sedated child at the time of induction is ideal, so also is extubation in a deep plane with an unobstructed airway. Wherever possible, regional anaesthesia should be employed. This will avoid airway manipulations, with additional benefit of excellent peri-operative analgesia. Agents with a potential for histamine release and techniques that can increase airway resistance should be diligently avoided. Emphasis must be given to proper post-operative care including respiratory monitoring, analgesia and breathing exercises.
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Affiliation(s)
- M C Rajesh
- Department of Anaesthesiology, Baby Memorial Hospital, Kozhikode, Kerala, India
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Diagnosis and Management of Respiratory Adverse Events in the Operating Room. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0103-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Özkan M, Kırkıl G, Dilektaşlı AG, Söğüt A, Sertoğullarından B, Çetinkaya E, Coşkun F, Ulubay G, Yüksel H, Sezer M, Özbudak Ö, Ulaşlı SS, Arslan S, Kovan T. Summary of Consensus Report on Preoperative Evaluation. Turk Thorac J 2015; 16:43-52. [PMID: 29404077 PMCID: PMC5783046 DOI: 10.5152/ttd.2014.4505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/04/2014] [Indexed: 12/31/2022]
Affiliation(s)
| | - Gamze Kırkıl
- Department of Chest Diseases, Fırat University Faculty of Medicine, Elazığ, Turkey
| | | | - Ayhan Söğüt
- Division of Pediatric Allergy and Immunology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | | | - Erdoğan Çetinkaya
- Department of Chest Diseases, Karabük University Faculty of Medicine, Karabük, Turkey
| | - Funda Coşkun
- Department of Chest Diseases, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Gaye Ulubay
- Department of Chest Diseases, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Hasan Yüksel
- Division of Pediatric Chest Diseases, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Murat Sezer
- Department of Chest Diseases, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey
| | - Ömer Özbudak
- Department of Chest Diseases, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Sevinç Sarınç Ulaşlı
- Department of Chest Diseases, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Sulhattin Arslan
- Department of Chest Diseases, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Tezay Kovan
- Clinic of Chest Diseases, Beyşehir State Hospital, Konya, Turkey
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Armoni-Domany K, Gut G, Soferman R, Sivan Y. Pediatric pulmonologists approach to the pre-operative management of the asthmatic child. J Asthma 2014; 52:391-7. [PMID: 25405359 DOI: 10.3109/02770903.2014.986742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE No consensus guidelines exist for the respiratory treatment of asthmatic children referred for elective surgery. The aim of this study was to evaluate the attitude of pediatric pulmonologists regarding the pre-operative management of these children. METHODS A survey of pre-operative management of asthmatic children was conducted. All 48 certified pediatric pulmonologists in Israel completed a questionnaire that comprised 20 questions regarding their approach to pre-operative management including six case scenarios with a variety of clinical situations and treatments of children with asthma. RESULTS Response rate was 100%. All believed that pre-operative treatment should be considered in all asthmatic children. Almost 50% suggested that a pediatric pulmonologist should be consulted in all pre-operative assessments. 50% recommended consultation only in individual cases. Overall, results showed a very wide variability between responders especially in pre-school and poorly controlled school children. The variability referred to the use of bronchodilators, inhaled corticosteroids and their combination during the pre-operative days, the addition of systemic CS and the length of pre-operative treatment. Almost all participants suggested either the initiation or augmentation of pre-operative treatment in high risk situations. CONCLUSIONS This data demonstrate an important variability among pediatric pulmonologists in Israel regarding the practice of pre-operative treatment of infants and children with asthma especially for the less controlled and high risk children. This is most probably explained by the paucity of evidence-based data and the lack of established guidelines. Consensus guidelines for the pre-operative management of asthmatic children are needed.
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Affiliation(s)
- Keren Armoni-Domany
- Sackler Faculty of Medicine, Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv , Israel
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Hemmings H, Rosenberg A, Mahajan R, Webster N. The 2012 BJA /PGA supplement: a selection of seven educational reviews. Br J Anaesth 2012; 109 Suppl 1:i1-i2. [DOI: 10.1093/bja/aes428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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