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Xu J, Wen J, Mathena RP, Singh S, Boppana SH, Yoon OI, Choi J, Li Q, Zhang P, Mintz CD. Early Postnatal Exposure to Midazolam Causes Lasting Histological and Neurobehavioral Deficits via Activation of the mTOR Pathway. Int J Mol Sci 2024; 25:6743. [PMID: 38928447 PMCID: PMC11203812 DOI: 10.3390/ijms25126743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/11/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Exposure to general anesthetics can adversely affect brain development, but there is little study of sedative agents used in intensive care that act via similar pharmacologic mechanisms. Using quantitative immunohistochemistry and neurobehavioral testing and an established protocol for murine sedation, we tested the hypothesis that lengthy, repetitive exposure to midazolam, a commonly used sedative in pediatric intensive care, interferes with neuronal development and subsequent cognitive function via actions on the mechanistic target of rapamycin (mTOR) pathway. We found that mice in the midazolam sedation group exhibited a chronic, significant increase in the expression of mTOR activity pathway markers in comparison to controls. Furthermore, both neurobehavioral outcomes, deficits in Y-maze and fear-conditioning performance, and neuropathologic effects of midazolam sedation exposure, including disrupted dendritic arborization and synaptogenesis, were ameliorated via treatment with rapamycin, a pharmacologic mTOR pathway inhibitor. We conclude that prolonged, repetitive exposure to midazolam sedation interferes with the development of neural circuitry via a pathologic increase in mTOR pathway signaling during brain development that has lasting consequences for both brain structure and function.
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Affiliation(s)
- Jing Xu
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
- Department of Anesthesiology, The First Affiliated Hospital of Xi’an Jiaotong University School of Medicine, Xi’an 710061, China
| | - Jieqiong Wen
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
- Department of Anesthesiology, The Second Affiliated Hospital of Xi’an Jiaotong University School of Medicine, Xi’an 710000, China;
| | - Reilley Paige Mathena
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
| | - Shreya Singh
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
| | - Sri Harsha Boppana
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
| | - Olivia Insun Yoon
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
| | - Jun Choi
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
| | - Qun Li
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
| | - Pengbo Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi’an Jiaotong University School of Medicine, Xi’an 710000, China;
| | - Cyrus David Mintz
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA; (J.X.); (J.W.); (R.P.M.); (S.S.); (S.H.B.); (J.C.); (Q.L.)
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Garra R, Piersanti A, Del Vicario M, Pizzo CM, Festa R, Tosi F, Sbaraglia F, Spano MM, Della Sala F, Rossi M. Clinical Evaluation of Oral Midazolam Containing Cyclodextrin in Pediatric Magnetic Resonance: A Retrospective Cohort Study. J Pers Med 2024; 14:472. [PMID: 38793054 PMCID: PMC11122387 DOI: 10.3390/jpm14050472] [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: 03/30/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Reducing a child's level of anxiety before magnetic resonance imaging (MRI) procedures allows for better behavioral outcomes. The aim of this retrospective study was to evaluate anxiolytic efficacy of Midazolam/γ-cyclodextrin oral formulation. METHODS We retrospectively reviewed 100 medical charts of children who, between 1 February and 31 July 2022, underwent MRI under general anesthesia with or without premedication with midazolam/γ-cyclodextrin. Primary outcome was comparison of behavior to facemask positioning, while secondary endpoints were degree of drugs acceptance, anxiolytic effect evaluation, child's behavior on separation, and sevoflurane need. RESULTS Facemask positioning was accepted by 58% of the midazolam/γ-cyclodextrin group compared to 22% of children in the control group. The rate of acceptance was >90%. At the moment of separation from parent, none of the premedicated children needed to be restrained compared to 18% in the control group. A lower percentage of sevoflurane was needed for eye-closure at induction of anesthesia and for anesthesia maintenance. At emergence from anesthesia, 46% of children in the premedicated group compared to 66% of children in the control group showed transient agitation. CONCLUSIONS Midazolam/γ-cyclodextrin showed a good profile of acceptance, satisfactory anxiolytic properties, and reduced need for anesthetics when administered to children before MRI under general anesthesia.
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Affiliation(s)
- Rossella Garra
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Alessandra Piersanti
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Miryam Del Vicario
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Cecilia Maria Pizzo
- Department of Anesthesia and Critical Care, Ospedale Pediatrico Bambino Gesù IRCCS, 00146 Rome, Italy;
| | - Rossano Festa
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Federica Tosi
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Fabio Sbaraglia
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Michelangelo Mario Spano
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Filomena Della Sala
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
| | - Marco Rossi
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.P.); (M.D.V.); (R.F.); (F.T.); (F.S.); (M.M.S.); (F.D.S.); (M.R.)
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Jen CK, Lu KC, Chen KW, Lu YR, Huang IT, Huang YC, Huang CJ. Oral Dexmedetomidine Achieves Superior Effects in Mitigating Emergence Agitation and Demonstrates Comparable Sedative Effects to Oral Midazolam for Pediatric Premedication: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Clin Med 2024; 13:1174. [PMID: 38398486 PMCID: PMC10889161 DOI: 10.3390/jcm13041174] [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: 01/18/2024] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence agitation. Oral dexmedetomidine may be effective in providing satisfactory sedation and reduce the incidence of emergence agitation, although the results of different randomized controlled trials are conflicting. Methods: This study enrolled randomized controlled trials (RCTs) examining premedication with oral dexmedetomidine versus oral midazolam in pediatric patients undergoing general anesthesia. PubMed, the Cochrane Library, Embase, and the Web of Science database were searched from their inception until June 2023. The outcomes were the incidence of satisfactory preoperative sedation, satisfactory sedation during separation from parents, satisfactory sedation during anesthesia induction using an anesthesia mask, and the incidence of emergence agitation. Results: A total of 9 RCTs comprising 885 patients were analyzed. Our data revealed comparable effects of dexmedetomidine and midazolam with respect to satisfactory preoperative sedation and a satisfactory incidence of sedation during parental separation and mask acceptance before anesthesia induction. Notably, our data revealed that the rate of emergence agitation was significantly lower in pediatric patients receiving dexmedetomidine (n = 162) than in those receiving midazolam (n = 159) (odds ratio = 0.16; 95% confidence interval: 0.06 to 0.44; p < 0.001; I2 = 35%). Conclusions: Data from this meta-analysis revealed comparable effects for premedication with oral dexmedetomidine or oral midazolam with respect to satisfactory sedation; furthermore, premedication with oral dexmedetomidine more effectively mitigated emergence agitation in pediatric patients receiving general anesthesia compared with oral midazolam.
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Affiliation(s)
- Chun-Kai Jen
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan; (C.-K.J.); (K.-C.L.); (K.-W.C.); (Y.-R.L.)
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Kuo-Ching Lu
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan; (C.-K.J.); (K.-C.L.); (K.-W.C.); (Y.-R.L.)
- Department of Anesthesiology, Binkun Women’s and Children’s Hospital, Taoyuan 324, Taiwan
| | - Kuan-Wen Chen
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan; (C.-K.J.); (K.-C.L.); (K.-W.C.); (Y.-R.L.)
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Yun-Ru Lu
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan; (C.-K.J.); (K.-C.L.); (K.-W.C.); (Y.-R.L.)
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - I-Tao Huang
- Emergency Department, Redcliffe Hospital, Redcliffe, QLD 4020, Australia;
- School of Public Health, Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia
| | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
| | - Chun-Jen Huang
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan; (C.-K.J.); (K.-C.L.); (K.-W.C.); (Y.-R.L.)
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan
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Hailemariam T, Sisay S, Mebratu Y, Belay F, Getinet T, Solomon S, Belina M, Abebe A, Hilawi Tewodros B, Manyazewal T. Effects of sedatives on radiologic enema reduction in children with ileocolic intussusception: A systematic review and meta-analysis. Eur J Radiol 2024; 170:111237. [PMID: 38039783 DOI: 10.1016/j.ejrad.2023.111237] [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: 08/12/2023] [Revised: 11/05/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND In children with ileocolic intussusception, sedatives such as midazolam, ketamine and propofol may facilitate radiologic enema reduction, but studies on their separate and joint effects remain controversial. OBJECTIVES We aimed to systematically analyze studies for the effects of sedatives on the radiologic reduction of ileocolic intussusception in children. METHODS We searched PubMed, EMBASE, CINAHL, Scopus and Web of Science from database inception through March 2023 for articles that enrolled children with ileocolic intussusception who underwent non-operative pneumatic or hydrostatic enema reduction under ultrasound or fluoroscopic guidance with or without the use of sedatives. The primary and secondary outcomes were success rate in radiologic reduction of ileocolic intussusception and risk of perforation, respectively. Effect estimates from the individual studies were extracted and combined using the Hartung-Knapp-Sidik-Jonkman log-odds random-effects model. Heterogeneity between studies was checked using Cochran's Q test and the I2 statistic. RESULTS A total of 17 studies with 2094 participants were included in the final review, of which 15 were included in the meta-analysis. Nine studies reported on the success rate of radiologic reduction performed under sedation in all participants, while six studies compared the success rate in two patient groups undergoing the procedure with or without sedation. The pooled success rate of non-operative reduction under sedation was 87 % (95 % CI: 80-95 %), P = 0.000 with considerable heterogeneity (I2 = 85 %). A higher success rate of 94 % (95 % CI: 88-99 %) and homogeneity (I2 = 12 %) were found in studies with pneumatic enema reduction. Among comparative studies, the odds of success of non-operative reduction were increased when the procedure was performed under sedation, with a pooled odds ratio of 2.41 (95 % CI: 1.27-4.57), P = 0.010 and moderate heterogeneity (I2 = 60 %). In a sensitivity analysis, homogeneity was found between analyzed studies when two outliers were excluded (I2 = 0.73 %). The risk of perforation was not significantly different (OR 1.52, 95 % CI: 0.09-23.34), P = 0.764 indicating small study effects. No publication, bias was detected on visual inspection of the funnel plots or the Begg's and Egger's bias tests. Most studies were categorized as having a low risk of bias using Joanna Briggs Institute checklists. CONCLUSIONS In selected patient groups, sedation can increase the success rate of radiologic enema reduction in children with ileocolic intussusception without evidence of increased risk of perforation. Systematic review protocol registration: PROSPERO CRD42023404887.
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Affiliation(s)
- Tesfahunegn Hailemariam
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia; Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia.
| | - Samuel Sisay
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia.
| | - Yonas Mebratu
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fekadu Belay
- Wachemo University, College of Medicine and Health Sciences, Department of Pediatrics and Child Health, Hossana, Ethiopia
| | - Tewodros Getinet
- St. Paul's Hospital Millennium Medical College, School of Public Health, Addis Ababa, Ethiopia
| | - Samrawit Solomon
- St. Paul's Hospital Millennium Medical College, School of Public Health, Addis Ababa, Ethiopia.
| | - Merga Belina
- Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Abel Abebe
- Detroit Medical Center/Wayne State University, Sinai Grace Hospital, Detroit, MI, USA
| | | | - Tsegahun Manyazewal
- Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
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Jerez Molina C, Lahuerta Valls L, Fernandez Villegas V, Santos Ruiz S. Evaluación enfermera de la ansiedad prequirúrgica pediátrica: estudio cualitativo. Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6230.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Resumen Objetivo: explorar y describir cómo las enfermeras perioperatorias evalúan e interpretan el comportamiento del niño antes de entrar a quirófano, identificando las estrategias que utilizan para minimizar la ansiedad y las propuestas de mejora. Método: estudio cualitativo descriptivo mediante entrevistas semiestructuradas y observación participante de las rutinas diarias. Análisis temático de los datos. El estudio sigue las recomendaciones de criterios para la publicación de artículos de metodología cualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: cuatro temas surgieron de los datos: a) evaluación de la ansiedad o comunicación estrecha con el niño y su familia; b) valorando lo observado; c) manejando la ansiedad y d) mejorando la evaluación o propuestas de mejora para la práctica diaria. Conclusión: enfermeras evalúan la ansiedad en su práctica diaria de forma observacional utilizando el juicio clínico. La experiencia de la enfermera es determinante en la adecuada evaluación de la ansiedad prequirúrgica del niño. La falta de tiempo entre la espera y el momento de entrar a quirófano, la mala información que tiene el niño y los padres sobre el proceso quirúrgico y la ansiedad de los padres dificultan la evaluación y el manejo correcto de la ansiedad.
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Yeniay D, Tamdo An L, Yucak Ozdemir A, Ak An LO, Kay R SU. Effects of Videos and Therapeutic Music on Preoperative Anxiety and Postoperative Anxiety and Pain Levels in Boys Who Undergo Circumcision. J Perianesth Nurs 2023; 38:918-924. [PMID: 37589631 DOI: 10.1016/j.jopan.2023.04.007] [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: 08/28/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This purpose of this study was to investigate the effects of having boys aged 5 to 10 years who will undergo circumcision surgery watch informative videos and listen to therapeutic music on preoperative anxiety, and postoperative anxiety, pain, and nausea and vomiting. DESIGN This was a prospective and ranomized controlled study. MATERIALS AND METHODS The sample consisted of 90 boys aged 5 to 10 years who underwent circumcision surgery. The boys included in the study were randomly divided into 3 groups of 30 using a computer program. The first group (group V) watched the video; the second group (group M) listened to the music, and the third group (group C) was the control group with usual care. Boys and their parents were not blinded to the grouping. FINDINGS Heart rate.ßvalues were found to be statistically significantly lower compared to the control group at the 1st minute after local anesthesia in group V (P.ß=.ß.029), at the 5th minute after local anesthesia in group M (P.ß=.ß.030), and at the 10th minute after local anesthesia and after the surgery in both group V and group M (P.ß=.ß.001 and P.ß=.ß.010, respectively). Wong-Baker Faces Pain Rating Scale.ßscores of the control group measured at the 2nd postoperative hour were found to be significantly higher than those of group V (P.ß=.ß.018). Children's Fear Scale.ßscores of group V measured at the time of admission to the postoperative service were found to be significantly higher than those of group M and group C (P.ß<.ß.001). There was no significant difference between the groups in terms of additional analgesic use, nausea and vomiting percentages, and time to discharge. CONCLUSIONS The results of this study revealed that having boys aged 5 to 10 years who will undergo circumcision surgery watch informative videos and listen to therapeutic music did not have any significant effect on their postoperative pain, fear, and anxiety levels. Further large-scale studies, which will also include children who will not undergo circumcision surgery, are needed to generalize this study's results to larger populations.
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Affiliation(s)
- Dilek Yeniay
- Department of Anesthesiology and Reanimation, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey.
| | - Lke Tamdo An
- Department of Anesthesiology and Reanimation, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey
| | - Aysel Yucak Ozdemir
- Department of Pediatric Surgery, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey
| | - Lknur Okur Ak An
- Department of Radiology, Giresun Maternity and Child Health Training and Research Hospital, Giresun, Turkey
| | - Sel Uk Kay R
- Department of Anesthesiology and Reanimation, Hitit University, ..orum, Turkey
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Jerez Molina C, Lahuerta Valls L, Fernandez Villegas V, Santos Ruiz S. Avaliação de enfermagem da ansiedade pré-operatória pediátrica: um estudo qualitativo? Rev Lat Am Enfermagem 2023. [DOI: 10.1590/1518-8345.6230.3739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Resumo Objetivo: explorar e descrever como as enfermeiras perioperatórias avaliam e interpretam o comportamento da criança antes de entrar na sala de cirurgia, identificando as estratégias que utilizam para minimizar a ansiedade e as propostas de melhoria. Método: estudo qualitativo descritivo utilizando entrevistas semiestruturadas e observação participante das rotinas diárias. Análise temática dos dados. O estudo segue os critérios recomendados para publicação de artigos da metodologia qualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: quatro temas emergiram dos dados: a) avaliação da ansiedade ou comunicação próxima com a criança e sua família; b) analisando o que foi observado; c) controlando a ansiedade e d) melhorando a avaliação ou propostas de melhoria na prática diária. Conclusão: as enfermeiras avaliam a ansiedade em sua prática diária por meio da observação e usando julgamento clínico. A experiência da enfermeira é decisiva na avaliação adequada da ansiedade pré-operatória da criança. A falta de tempo entre a espera e o momento de entrar na sala de cirurgia, a escassez de informação que a criança e os pais têm sobre o processo cirúrgico e a ansiedade dos pais, dificultam a avaliação e o controle adequado da ansiedade.
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Zhang MQ, Xu MZ, He Y, Su YW, Ma J, Zuo YX. Comparison of S-ketamine and midazolam for intravenous preoperative sedative and anxiolytic effects in preschool children: study protocol for a randomized controlled clinical trial. Trials 2023; 24:724. [PMID: 37957769 PMCID: PMC10644481 DOI: 10.1186/s13063-023-07767-2] [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: 05/31/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Preoperative anxiety management is gaining particular attention in paediatric anaesthesia. Pharmacological and non-pharmacological resorts can be implemented to address this special issue. Despite the various approaches currently used for preoperative sedation in children, the different sedative and anti-anxiety effects between the newly marketed anaesthetic, S-ketamine, and the traditional sedative, midazolam, are still unclear. METHODS This is a patient- and assessor-blinded randomized controlled clinical trial. Participants (n = 110) will receive S-ketamine (0.5 mg/kg) or midazolam (0.08 mg/kg) intravenously administrated at a ratio of 1:1 in the anaesthesia holding area. The primary outcome of this study is the sedative effect evaluated via the change in the modified Yale preoperative anxiety scale. It will be performed at two timepoints: in the pre-anaesthetic holding area before premedication (baseline, marked as T0) and about 5 min after premedication in the operating room without the existence of their guardians (marked as T1). Our secondary objectives include the parent separation anxiety score, postoperative agitation, caregivers' and anaesthesia care providers' satisfaction, and mask compliance. DISCUSSION This randomized controlled trial is the first study to compare the anti-anxiety effect of intravenous S-ketamine and midazolam. We will provide a new approach for the clinical management of preoperative anxiety in preschool children posted for elective surgery. TRIAL REGISTRATION ChiCTR2300069998. Registered on 30 March 2023.
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Affiliation(s)
- Meng-Qiu Zhang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ming-Zhe Xu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi He
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yong-Wei Su
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jun Ma
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yun-Xia Zuo
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Farlie KH, Austin TM, Gonzalez SN, Edwards CM, Gravenstein N, Dooley FC. The Effect of Computer Tablets on the Need for Medical Anxiolysis in Children in an Ambulatory Surgical Center. Cureus 2023; 15:e42553. [PMID: 37637603 PMCID: PMC10460165 DOI: 10.7759/cureus.42553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Background Preoperative anxiety is common in children undergoing surgery. When anxiety is identified or suspected, there are several strategies typically used to manage it. Perhaps the most common is anxiolytic premedication or parental presence at induction. Medications such as midazolam have been associated with adverse effects, such as a slower wakeup, and require timing of administration, while parental presence can be disturbing to the parent and divert the attention of the operating room team. A more recent option is distraction via electronic tablets. The purpose of this study was to retrospectively investigate and quantify any change in the use of midazolam, the most common anxiolytic approach at our institution, and any change in the length of time in the post-anesthesia care unit (PACU) following the introduction of tablet computers to a pediatric ambulatory surgical center. Methods We conducted an IRB-approved retrospective chart review of 13,790 pediatric patients ages one to 18 undergoing outpatient elective surgeries at the University of Florida (UF) Children's Surgical Center over a five-year period. A univariate analysis was conducted using the Fisher's Exact test and interrupted time series analysis to determine differences between midazolam administration and PACU times, with interruption occurring at tablet implementation. A multivariable analysis and sensitivity analyses were performed to confirm the findings of the univariate analysis. Results On univariate analysis, tablet availability was associated with both a decreased preoperative oral midazolam administration (odds ratio (OR) 0.158, 95% confidence interval (CI): 0.140 to 0.179, P-value <0.001) and a decreased PACU length of stay (-17.4 min, 95% CI: -19.6 to -15.3 min, P-value <0.001). The association with decreased preoperative midazolam administration held after multivariable analysis (adjusted OR 0.207, 95% CI: 0.154 to 0.278, P-value <0.001), but PACU length of stay was not statistically significant (-9.1 min, 95% CI: -20.6 to 2.4, P-value = 0.12). These results were confirmed on sensitivity analysis, with tablet availability continuing to be associated with decreased preoperative oral midazolam administration but not with reduced PACU length of stay. Conclusion Our results demonstrate that computer tablets were associated with a significant decrease in the frequency of midazolam administration and consequently may reduce preoperative pediatric anxiety. We did not find an associated change in PACU length of stay following the introduction of tablets. Tablets present a unique distraction alternative to chemical anxiolysis for institutions seeking to reduce medication use in pediatric patients.
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Affiliation(s)
- Kerry H Farlie
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Thomas M Austin
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | - Sandra N Gonzalez
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
| | | | | | - Fred C Dooley
- Anesthesiology, University of Florida College of Medicine, Gainesville, USA
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10
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Jerez Molina C, Lahuerta Valls L, Fernandez Villegas V, Santos Ruiz S. Nursing evaluation of pediatric preoperative anxiety: a qualitative study. Rev Lat Am Enfermagem 2023; 31:e3738. [PMID: 36888788 PMCID: PMC9991007 DOI: 10.1590/1518-8345.6230.3738] [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: 05/21/2022] [Accepted: 07/15/2022] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE to explore and describe how perioperative nurses assess and interpret the child's behavior before entering the operating room, identifying the strategies they use to reduce anxiety and the proposals for improvements. METHOD descriptive qualitative study using semi-structured interviews and participant observation of daily routines. Thematic analysis of data. This study follows the recommended criteria for publication of articles of the qualitative methodology Consolidated Criteria for Reporting Qualitative Research. RESULTS four topics emerged from the data: a) assessment of anxiety or close communication with the child and their family; b) evaluating what was observed; c) managing anxiety and d) improving the assessment or proposals for improvements in daily practice. CONCLUSION nurses assess anxiety in their daily practice through observation using their clinical judgment. The nurse's experience is decisive for the appropriate assessment of the preoperative anxiety in child. Insufficient time between waiting and entering the operating room, lack of information from child and their parents about the surgical procedure, and parental anxiety make it difficult to assess and properly manage anxiety.
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Affiliation(s)
- Carmen Jerez Molina
- Campus Docent Sant Joan de Déu, School of Nursing, Barcelona, Spain.,Hospital Sant Joan de Déu, Nursing Department, Ambulatory Surgery, Barcelona, Spain
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11
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Lang B, Wang H, Fu Y, Zeng L, Huang L, Zhang Q, Chen S, Jia ZJ, Zhang L. Efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2022; 22:399. [PMID: 36550437 PMCID: PMC9773574 DOI: 10.1186/s12871-022-01892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intranasal midazolam and ketamine have been widely used as sedative premedication in children. It is difficult to determine which one yields better sedative effects for clinical practice. We conducted the present meta-analysis by summarizing the evidences to evaluate the efficacy and safety of intranasal midazolam versus intranasal ketamine as sedative premedication in pediatric patients. METHODS We searched PubMed, Embase, and Cochrane Library from inception to April 2022. All randomized controlled trials (RCTs) used intranasal midazolam and ketamine as sedatives in children were enrolled. The risk of bias in RCTs was assessed by Cochrane risk of bias tool. Condition of parental separation, anesthesia induction or facemask acceptance, sedation level, different hemodynamic parameters and adverse events were considered as the outcomes in our study. RESULTS A total of 16 studies with 1066 patients were enrolled. Compared with midazolam, administration of intranasal ketamine might be associated with severer changes in hemodynamics parameters including mean blood pressure (SMD = -0.53, with 95% CI [-0.93, -0.13]) and heart rate (HR) (SMD = -1.39, with 95% CI [-2.84, 0.06]). Meanwhile, administration of intranasal midazolam was associated with more satisfactory sedation level (61.76% vs 40.74%, RR = 1.53, with 95%CI [1.28, 1.83]), more rapid onset of sedation (SMD = -0.59, with 95%CI [-0.90, -0.28]) and more rapid recovery (SMD = -1.06, with 95%CI [-1.83, -0.28]). Current evidences also indicated that the differences of various adverse effects between two groups were not significant. CONCLUSIONS Given that administration of midazolam via intranasal route provides more satisfactory sedative level with less fluctuation of hemodynamics parameters and more rapid onset and recovery, it might be considered as the preferred sedative premedication for pediatric patients compared to ketamine. However, the widespread evidences with low or moderate quality indicated that superiority of intranasal midazolam in pediatric sedation needs to be confirmed by more studies with high quality and large sample size in future. TRIAL REGISTRATION The protocol of present study was registered with PROSPERO (CRD42022321348).
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Affiliation(s)
- Bingchen Lang
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Huiqing Wang
- grid.461863.e0000 0004 1757 9397Medical Simulation Centre, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuzhi Fu
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Linan Zeng
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Liang Huang
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
| | - Qianqian Zhang
- grid.489962.80000 0004 7868 473XDepartment of Anesthesiology, Chengdu Women’s and Children’s Central Hospital, Chengdu, China
| | - Shouming Chen
- grid.461863.e0000 0004 1757 9397Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhi-jun Jia
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China ,grid.13291.380000 0001 0807 1581Department of Biopharmaceutics, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lingli Zhang
- grid.461863.e0000 0004 1757 9397Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China ,grid.461863.e0000 0004 1757 9397Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, China ,National Medical Products Administration (NMPA) Key Laboratory for Technical Research On Drug Products In Vitro and In Vivo Correlation, Chengdu, China
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12
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Tesoro S, Gamba P, Bertozzi M, Borgogni R, Caramelli F, Cobellis G, Cortese G, Esposito C, Gargano T, Garra R, Mantovani G, Marchesini L, Mencherini S, Messina M, Neba GR, Pelizzo G, Pizzi S, Riccipetitoni G, Simonini A, Tognon C, Lima M. Pediatric robotic surgery: issues in management-expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP). Surg Endosc 2022; 36:7877-7897. [PMID: 36121503 PMCID: PMC9613560 DOI: 10.1007/s00464-022-09577-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. METHODS A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. RESULTS During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. CONCLUSION Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.
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Affiliation(s)
- Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy.
| | - Mirko Bertozzi
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Rachele Borgogni
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Fabio Caramelli
- Anesthesia and Intensive Care Unit, IRCCS Sant'Orsola Polyclinic, Bologna, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Polytechnical University of Marche, Ancona, Italy
| | - Giuseppe Cortese
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Tommaso Gargano
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
| | - Rossella Garra
- Institute of Anesthesia and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giulia Mantovani
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Laura Marchesini
- Division of Anesthesia, Analgesia, and Intensive Care, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Simonetta Mencherini
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS San Matteo Polyclinic, Pavia, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Santa Maria Alle Scotte Polyclinic, University of Siena, Siena, Italy
| | - Gerald Rogan Neba
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Vittore Buzzi' Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Simone Pizzi
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Giovanna Riccipetitoni
- Department of Pediatric Surgery, IRCCS San Matteo Polyclinic, University of Pavia, Pavia, Italy
| | - Alessandro Simonini
- Department of Pediatric Anesthesia and Intensive Care, Salesi Children's Hospital, Ancona, Italy
| | - Costanza Tognon
- Pediatric Anesthesia, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Mario Lima
- Pediatric Surgery Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Bologna, Italy
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13
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ADV6209 for Premedication in Pediatric Anesthesia: A Double-Blinded, Randomized Controlled Trial. Pharmaceutics 2022; 14:pharmaceutics14102062. [DOI: 10.3390/pharmaceutics14102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
ADV6209, a new formulation of midazolam with the addition of γ-cyclodextrin for oral use, has recently been licensed as the first pediatric sedative in the European Union. We compared the clinical efficacy of ADV6209 to the standard formulation of midazolam in premedication to reduce anxiety in children before anesthesia induction in a randomized, double-blinded controlled trial. Eighty children (ASA I/II; age: 2–8 years) scheduled for elective surgery were randomized to receive 0.25 mg kg−1 of either conventional midazolam or ADV6209. Assessment tools included the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) as well as scores for oral acceptance of the premedication and facemask acceptance during inhalational anesthesia induction. Mann–Whitney U and Pearson’s chi-square tests were used for comparisons of outcome parameters. The primary outcome parameter of the study (mYPAS-SF anxiety score 30 min after the drug administration) did not reveal any significant intergroup difference between the ADV6209 group and the conventional midazolam group. Both drugs revealed their efficacy in reducing anxiety and in providing adequate sedation. The premedication dose was accepted by all children in the ADV6209 but rejected by 15% in the conventional midazolam group (p = 0.037). Acceptance of facemask placement was not found to differ significantly. No adverse events related to the study medications were noted. ADV6209 was better orally accepted than the conventional midazolam preparation and proved its efficacy in reducing preoperative anxiety. This clinically interesting preparation may alleviate the premedication process of 2−8 year-old children and obviates off-label drug use.
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14
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Giacalone M, Pierantoni L, Selvi V, Morabito A, Baldazzi M, Lima M, Lanari M, Masi S, Incerti F, Fierro F, Basile M, Lo Piccolo R, Catania VD, Bettini I, Parri N. Midazolam premedication in ileocolic intussusception: a retrospective multicenter study. Eur J Pediatr 2022; 181:3531-3536. [PMID: 35732982 DOI: 10.1007/s00431-022-04524-6] [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] [Received: 12/01/2021] [Revised: 04/15/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Abstract
UNLABELLED Ileocolic intussusception is a common cause of bowel obstruction. When spontaneous reduction does not occur, non-operative management through enema reduction is necessary. Despite the evidence indicating that sedatives favor success in the reduction, their use is still not a common practice. To determine if midazolam (MDZ) before enema improves the rate of procedure success, we retrospectively reviewed charts of patients admitted to two Italian pediatric emergency departments. Outcome measures were the success rate of the enema, recurrence, and need for surgery. Patients were grouped according to the use of MDZ or not, before hydrostatic reduction attempt. We included 69 and 37 patients in the MDZ and non-MDZ groups, respectively. The two groups did not differ in demographics, clinical characteristics, and ultrasound findings. Intussusception reduction after the first enema attempt occurred in 75% (MDZ group) and 32.4% (non-MDZ group) of patients (P < .001); 27.9% (MDZ group) and 77.8% (non-MDZ group) of patients underwent surgery (P < .001). Among them, spontaneous reduction of intussusception during the induction of general anesthesia occurred in 31.6% and 42.9% of patients, respectively (P .43). Multivariate logistic regression analysis showed that only MDZ had a positive effect on the result of the enema (OR 7.602, 95%CI 2.669-21.652, P < .001). CONCLUSION Procedural sedation with MDZ for enema reduction of intussusception can increase the success rate and lead to a better management of patients. WHAT IS KNOWN • Despite the evidence of the usefulness of sedatives in the reduction of intussusception, their use is still not a common practice. WHAT IS NEW • Midazolam during enema reduction of intussusception can increase the success rate and consequently lead to better management of patients.
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Affiliation(s)
- Martina Giacalone
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy.
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Valeria Selvi
- Department of Experimental and Clinical Biomedical Sciences Radiodiagnostic Unit 2, University of Florence, Careggi University Hospital, Florence, Italy.,Radiology Department, Meyer University Children's Hospital, Florence, Italy
| | - Antonino Morabito
- Department of Emergency, Critical Area and Pediatric Surgery, Meyer University Children's Hospital, University of Florence, Florence, Italy
| | | | - Mario Lima
- Pediatric Surgery, S. Orsola University Hospital, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Stefano Masi
- Department of Emergency Medicine, Meyer University Children's Hospital, Florence, Italy
| | - Filippo Incerti
- Department of Emergency, Critical Area and Pediatric Surgery, Meyer University Children's Hospital, University of Florence, Florence, Italy
| | - Francesca Fierro
- Radiology Department, Meyer University Children's Hospital, Florence, Italy
| | - Massimo Basile
- Radiology Department, Meyer University Children's Hospital, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Emergency, Critical Area and Pediatric Surgery, Meyer University Children's Hospital, University of Florence, Florence, Italy
| | | | - Irene Bettini
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
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15
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Efficacy of tranexamic acid (TXA) for post-tonsillectomy hemorrhage. Am J Otolaryngol 2022; 43:103582. [DOI: 10.1016/j.amjoto.2022.103582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022]
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16
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Lööf G, Lönnqvist P. Role of information and preparation for improvement of pediatric perioperative care. Paediatr Anaesth 2022; 32:600-608. [PMID: 35167154 PMCID: PMC9311830 DOI: 10.1111/pan.14419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/25/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
Abstract
The perioperative period is a significant and stressful experience that may cause negative consequences in children, both in a short-term and long-term perspective. Despite a wide base of evidence stating the importance of adequate preparation to reduce anxiety, improve coping, cooperation and enhance recovery, many children continue to report that they feel unprepared for their perioperative experience. To secure children's right to request and need for preparation, the content, format, and availability of existing programs need to be scrutinized. Preparation programs in perioperative care must change from simply providing information to embracing the importance of children's need to process the information provided in order to learn and understand. Interactive web-based technology can function as a significant resource for preparation of children for perioperative procedures. By changing perspective from children's need for information to their need for learning and by developing preparation programs including adequate educational principles, web-based technology can be used to its fullest advantage as a healthcare learning and preparation resource.
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Affiliation(s)
- Gunilla Lööf
- Paediatric Perioperative Medicine and Intensive CareKarolinska University HospitalStockholmSweden,Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
| | - Per‐Arne Lönnqvist
- Paediatric Perioperative Medicine and Intensive CareKarolinska University HospitalStockholmSweden,Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
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17
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Singariya G, Malhotra N, Kamal M, Jaju R, Aggarwal S, Bihani P. Comparison of nebulized dexmedetomidine and ketamine for premedication in pediatric patients undergoing hernia repair surgery: a randomized comparative trial. Anesth Pain Med (Seoul) 2022; 17:173-181. [PMID: 35378572 PMCID: PMC9091671 DOI: 10.17085/apm.21081] [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: 07/21/2021] [Accepted: 01/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Allaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia. Methods Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study's primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events. Results The median Ramsay sedation scale at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients.
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Affiliation(s)
- Geeta Singariya
- Department of Anesthesiology & Critical Care, Dr S N Medical College, Jodhpur, India
- Corresponding Author Geeta Singariya, M.D. Department of Anesthesiology & Critical Care, Dr S N Medical College, Jodhpur 123, Vaishali Avenue, Jhanwar Road, Jodhpur 342008, Rajasthan, India E-mail: Tel: 91-0291-2705705, Fax: 91-0291-2434376
| | - Namita Malhotra
- Department of Anesthesiology & Critical Care, Dr S N Medical College, Jodhpur, India
| | - Manoj Kamal
- Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | - Rishabh Jaju
- Department of Anesthesiology & Critical Care, Andaman Nicobar Island Institute of Medical Sciences, Port Blair, India
| | - Shruti Aggarwal
- Department of Anesthesiology & Critical Care, Dr S N Medical College, Jodhpur, India
| | - Pooja Bihani
- Department of Anesthesiology & Critical Care, Dr S N Medical College, Jodhpur, India
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18
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Lu X, Tang L, Lan H, Li C, Lin H. A Comparison of Intranasal Dexmedetomidine, Esketamine or a Dexmedetomidine-Esketamine Combination for Induction of Anaesthesia in Children: A Randomized Controlled Double-Blind Trial. Front Pharmacol 2022; 12:808930. [PMID: 35185548 PMCID: PMC8848099 DOI: 10.3389/fphar.2021.808930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To compare the efficacy of dexmedetomidine, esketamine or combined intranasal administration on the induction of inhalation anaesthesia in children.Methods: Ninety children aged 1–6 years were randomly allocated into three equal groups to be premedicated with either intranasal dexmedetomidine 2 μg/kg (Group D), esketamine 1 mg/kg (Group S), or dexmedetomidine 1 μg/kg combined with esketamine 0.5 mg/kg (Group DS). The primary endpoint was the Induction Compliance Checklist (ICC) Scale. Secondary outcomes included the sedation success rate; the modified Yale Preoperative Anxiety Scale score; the time of reaching up to two points on the University of Michigan Sedation Scale (UMSS); Parental Separation Anxiety Scale; anaesthesiologist satisfaction with induction based on the visual analogue scale; emergence agitation scale score; and adverse effects.Results: The children in the DS group showed a high degree of cooperation with inhalation anaesthesia induction, and their ICC score was significantly lower than that of the D and S groups (p = 0.001), but there was no difference between the D and S groups. The success rate of sedation was higher in Group DS (90%) than in Group D (70%) and Group S (53.3%) (p = 0.007). Anaesthesiologist satisfaction with induction was significantly higher in Group DS than in Groups D and S (p = 0.001). The incidence of emergence agitation and the Paediatric Anaesthesia Emergence Delirium (PAED) score in the DS group were lower than those in the D and S groups.Conclusions: Preoperative intranasal administration of dexmedetomidine combined with esketamine can significantly improve the cooperation of children with inhalation anaesthesia masks. It is a sedation method that has a high success rate and reduces the incidence and degree of emergence agitation.
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Affiliation(s)
- Xinlei Lu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Anesthesia, Hangzhou Hospital Affiliated with Zhejiang University School of Medicine, Hangzhou First People’s Hospital, Hangzhou, China
| | - Ling Tang
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiyan Lan
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chunli Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Han Lin
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Han Lin,
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Lin J, Wu C, Zhao D, Du X, Zhang W, Fang J. The Sedative Effects of Inhaled Nebulized Dexmedetomidine on Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:865107. [PMID: 35669400 PMCID: PMC9163573 DOI: 10.3389/fped.2022.865107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Children that need surgery and medical examinations are often uncooperative, and preoperative sedation is necessary. We aimed to assess the safety and efficacy of inhaled nebulized dexmedetomidine in children for sedation that underwent medical examinations or surgery. METHODS We systematically searched PubMed, Web of science, Embase, and Cochrane library, for randomized controlled trials of Intranasal dexmedetomidine using a spray or a mucosal atomization device in children undergoing examination or elective surgery. We included all studies that analyzed the sedation efficiency of intranasal dexmedetomidine in children. RESULTS Ten studies with 1,233pediatric patients were included. Compared to other sedation treatments, inhaled nebulized dexmedetomidine showed similar sedation satisfaction [risk ratio RR: 1.02; 95% confidence interval (CI): 0.87-1.18; P = 0.83; I2 = 72%]. there was also no statistical difference in the success rate of separation from parents (RR: 0.96; 95% CI: 0.82-1.12; P = 0.58; I2 = 67%), and mask acceptability (RR: 1; 95% CI: 0.83-1.20; P = 0.99; I2 = 35%). But it is worth mentioning that nebulized dexmedetomidine combined with ketamine provided better sedation satisfaction (RR: 0.69; 95% CI: 0.49-0.96; I2 = 49%) and more satisfactory separation from parents (RR: 0.85; 95% CI: 0.74-0.97; I2 = 0%). Moreover, nebulized dexmedetomidine reduced the occurrences of nausea and vomiting (RR: 0.28; 95% CI: 0.15-0.51; P < 0.01; I2 = 10%) and emergence agitation (RR: 0.30; 95% CI: 0.18-0.49; P < 0.01; I2 = 0%). There are no hypotension or arrhythmia reported that required intervention in all articles. CONCLUSION Compared to other premedication treatments, inhaled nebulized dexmedetomidine provided equivalent sedation satisfaction for the examination or preoperative sedation of children, but it reduced the occurrences of emergence agitation and postoperative nausea and vomiting.
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Affiliation(s)
- Jun Lin
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chujun Wu
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dizhou Zhao
- Department of Anesthesiology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xuhang Du
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wangzhi Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieyu Fang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Andersson L, Almerud Österberg S, Årestedt K, Johansson P. Nurse anesthetist attitudes towards parental presence during anesthesia induction- a nationwide survey. J Adv Nurs 2021; 78:1020-1030. [PMID: 34462946 DOI: 10.1111/jan.15031] [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: 01/22/2021] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
AIMS To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors. DESIGN A cross-sectional design. METHODS Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis. RESULTS Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude. CONCLUSION This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly. IMPACT Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child-centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.
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Affiliation(s)
- Lisbet Andersson
- Faculty of Health and Caring Science, Linnaeus University, Växjö, Sweden
| | - Sofia Almerud Österberg
- Faculty of Health and Caring Science, Linnaeus University, Växjö, Sweden.,Department of Anesthesiology, Kronoberg County Council, Växjö, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Caring Science, Linnaeus University, Växjö, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Pauline Johansson
- Faculty of Health and Caring Science, Linnaeus University, Växjö, Sweden
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Sakızcı Uyar B, Polat R, Bolat M, Donmez A. Which is good for pre-operative anxiety? Midazolam, video games or teaching with cartoons: A randomised trial. Eur J Anaesthesiol 2021; 38:744-750. [PMID: 33186304 DOI: 10.1097/eja.0000000000001384] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pre-operative anxiety in children has been associated with adverse clinical outcomes such as difficulty in anaesthesia induction, emergence delirium and negative postoperative behavioural changes. Therefore, pre-operative anxiety should be alleviated in both children and clinicians. OBJECTIVE We investigated the effect on pre-operative anxiety of premedication with midazolam, playing video games or watching a cartoon about anaesthesia. DESIGN A prospective randomised trial. SETTING Single-centre study performed between August 2018 and June 2019. PATIENTS We enrolled 138 patients aged 5 to 8 years undergoing elective surgery. INTERVENTIONS After evaluating baseline (T0) anxiety levels using the modified Yale Pre-operative Anxiety Scale (mYPAS) in the pre-operative holding area, 0.5 mg kg-1 oral midazolam was given to Group M, a tablet with videogame applications was given to Group T, and Group S watched the cartoon 'Şüko Is Being Operated'. mYPAS values were recorded a further three times: 20 min after the intervention (T1), while entering the operating room (T2), and during mask induction of anaesthesia (T3). MAIN OUTCOME MEASURES The primary endpoint was the change in children's anxiety levels from baseline. The secondary endpoint was cooperation during mask induction. RESULTS The baseline mYPAS scores were comparable (40.7, 42.6 and 40.7 in groups M, S and T respectively). The mean mYPAS scores at T1 were 32.6, 34.7, 26.8 and at T2 were 38.6, 42.7, 35 in groups M, S and T, respectively. There were significant differences between groups S and T at T1 and T2 (P < 0.001, P = 0.010). A significant decrease was found in Group T compared with both groups M and S from T0 to T1 (P = 0.002). mYPAS values at T3 were 38.3, 43.7, 39.5 in groups M, S and T, respectively, with no difference between the groups (P = 0.224). Mask acceptance scores were similar in all groups (P = 0.912). CONCLUSIONS The passive teaching technique of watching a video for reducing anxiety levels was not effective. However, active distraction with videogames was found to be a valuable method to reduce pre-operative anxiety. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03530670.
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Affiliation(s)
- Bahar Sakızcı Uyar
- From the Department of Anesthesiology and Reanimation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Altındağ, Ankara, Turkey (BSU, RP, MB, AD)
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Wingler D, Liston D, Joseph A, Wang Y, Feng H, Martin L. Perioperative anxiety in pediatric surgery: Induction room vs. operating room. Paediatr Anaesth 2021; 31:465-473. [PMID: 33278852 DOI: 10.1111/pan.14098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perioperative anxiety can have a profound and lasting effect on children and their parents, with up to 70 percent of children undergoing outpatient surgery experiencing significant physiologic and/or psychological manifestations of anxiety throughout the ambulatory surgical process. The physical healthcare environment itself can contribute to these feelings, substantially impacting the level of anxiety experienced by both the child and their parent. OBJECTIVE This study sought to examine whether a difference exists between utilization of an induction room vs. the operating room on child and parent perioperative anxiety for parent present induction. METHODS A single institution multi-site prospective observational study was conducted with a cohort of 51 healthy children aged 6-12 years, receiving an outpatient tonsillectomy and/or adenoidectomy and their parent. The methodological approach utilized for this study was Ecological Momentary Assessment. Two psychological measures of anxiety, (i) momentary and (ii) environmental, and one physiologic measure of anxiety (i) electrodermal activity were used. Data were captured separately for child and parent. RESULTS For children who underwent anesthetic induction in the induction room, all three anxiety responses were significantly lower and exhibited a large positive effect [momentary (P = .0002, d = 1.984, induction room = 3.76, operating room = 7.07), environmental (P = .018, d = 1.160, induction room = 1.72, operating room = 0.85), and electrodermal activity (P = .039, d = 1.007, induction room = 0.76, operating room = 1.51)], as compared to children who were induced in the operating room. Electrodermal activity was also statistically significantly lower, with a large positive effect, in the postoperative environment (P = .004, d = 1.454, induction room = 0.21, operating room = 0.60) for Children who were induced in the induction room, as compared to the operating room cohort. No significant differences were found between parents for momentary and environmental anxiety, and electrodermal anxiety. CONCLUSIONS The nonpharmacological strategy of using an induction room for anesthetic induction of children may be clinically effective in reducing anxiety as compared to an operating room.
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Affiliation(s)
- Deborah Wingler
- The Center for Health Facilities Design and Testing, Clemson University, Clemson, SC, USA
| | - David Liston
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Anjali Joseph
- The Center for Health Facilities Design and Testing, Clemson University, Clemson, SC, USA
| | - Yifan Wang
- Seattle Children's Hospital, Seattle, WA, USA
| | - Haotian Feng
- Statistics and Mathematics Consulting Center, Clemson University, Clemson, SC, USA
| | - Lynn Martin
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Mtubu T, Rajah C, Bishop DG, Rodseth RN. A retrospective evaluation of the efficacy of midazolam and ketamine as premedication for paediatric patients undergoing elective surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.3.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- T Mtubu
- Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal,
South Africa
| | - C Rajah
- Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal,
South Africa
| | - DG Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal,
South Africa
| | - RN Rodseth
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal,
South Africa
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Behavioral and Emotional Disorders in Children and Their Anesthetic Implications. CHILDREN-BASEL 2020; 7:children7120253. [PMID: 33255535 PMCID: PMC7759846 DOI: 10.3390/children7120253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022]
Abstract
While most children have anxiety and fears in the hospital environment, especially prior to having surgery, there are several common behavioral and emotional disorders in children that can pose a challenge in the perioperative setting. These include anxiety, depression, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, post-traumatic stress disorder, and autism spectrum disorder. The aim of this review article is to provide a brief overview of each disorder, explore the impact on anesthesia and perioperative care, and highlight some management techniques that can be used to facilitate a smooth perioperative course.
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Schmid W, Marhofer P, Ohmann S, Kimberger O, Marhofer D, Triffterer L. Psychology versus medication for preanesthesia preparation of children: a randomized controlled trial. Minerva Anestesiol 2020; 86:627-635. [DOI: 10.23736/s0375-9393.20.14082-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Exploring Non-Pharmacological Management among Anesthesia Providers to Reduce Preoperative Distress in Children. J Pediatr Nurs 2020; 50:105-112. [PMID: 31805493 DOI: 10.1016/j.pedn.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022]
Abstract
Preparation for surgery with the induction of general anesthesia is one of the most stressful events that a child can experience. It produces several threats to the child, including physical harm, parent separation, and fear of the unknown. Anesthesia providers utilize non-pharmacological and pharmacological interventions to decrease this preoperatively. However, little is known about the non-pharmacological interventions utilized by anesthesia providers in practice. The purpose of this study was to explore non-pharmacological interventions utilized by anesthesia providers before and during the induction of general anesthesia to reduce preoperative distress in children ages one to six years old. A qualitative descriptive approach was used in this study. Twenty anesthesia providers, fourteen registered nurse anesthetists and six anesthesiologists, participated in face to face, in-depth interviews in South Florida. Content analysis was used to identify and define the major themes that emerged from the interviews. A total of seven main themes were identified. Only the three themes directly related to parent-provider-child relationship are discussed in this paper: (I) Communication, (II) Observational Skills, and (III) Parental Presence. The anesthesia providers who participated in this study offered an opportunity to better understand the non-pharmacological interventions used to impact the management of preoperative distress among children. Study findings provide evidence about non-pharmacological anesthesia providers' clinical work not found elsewhere in the literature. Non-pharmacological interventions are effective in reducing preoperative distress in children.
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Manso MA, Guittet C, Vandenhende F, Granier L. Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review. Paediatr Anaesth 2019; 29:1094-1106. [PMID: 31538393 PMCID: PMC6900062 DOI: 10.1111/pan.13747] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/27/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Abstract
One of the most widely used options for minimal/moderate sedation in pediatric patients is oral midazolam, as it presents an alternative to less well-accepted routes of administration (eg, intravenous or intranasal) of this well-known efficacious and well-tolerated short-acting benzodiazepine. A systematic review of the literature was conducted in order to identify clinical studies evaluating the effectiveness of oral midazolam for sedation in pediatric patients in the context of premedication before anesthesia or during diagnostic/treatment procedures. The percentage of responders (response rate) after single administration of oral midazolam was evaluated and compared versus placebo in a subset of placebo-controlled studies. The range of oral midazolam doses providing effective sedation in the different pediatric age subsets was analyzed in order to assess optimum dosing strategies. A total of 25 pediatric clinical studies, utilizing a variety of measures of sedation effectiveness, were selected. These studies included a total of 1472 patients (aged 4 months-18 years) treated with midazolam (0.25-1.5 mg/kg) and 138 patients treated with placebo. The response rates [95% confidence interval] with oral midazolam ranged from 36.7% [21.6%, 54.9%] to 97.8% [86.1%, 99.7%], while with placebo response rates ranged from 4.0% [0.6%, 23.5%] to 41.0% [29.4%, 53.6%]. When considering the 4 placebo-controlled studies, the odds ratios [95% confidence interval] for the comparison of midazolam vs. placebo ranged from 13.4 [5.0, 36.0] to 25.9 [6.7, 100.6]. The analysis of subgroups by context of sedation showed response rates [95% confidence interval] with oral midazolam ranging from 36.7% [21.6%, 54.9%] to 97.0% [94.8%, 98.3%] for anesthetic premedication and from 56.1% [43.1%, 68.4] to 97.8% [86.1%, 99.7%] for medical procedures. The efficacy of midazolam for pediatric minimal/moderate sedation from a dose of 0.25 mg/kg and above was demonstrated. The probability of occurrence of adverse events and over-sedation increases with increasing doses.
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Park JW, Min BH, Park SJ, Kim BY, Bae SI, Han SH, Hwang JW, Kim JH. Midazolam Premedication Facilitates Mask Ventilation During Induction of General Anesthesia. Anesth Analg 2019; 129:500-506. [DOI: 10.1213/ane.0000000000003707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Park SH, Park S, Lee S, Choi JI, Bae HB, You Y, Jeong S. Effect of transportation method on preoperative anxiety in children: a randomized controlled trial. Korean J Anesthesiol 2019; 73:51-57. [PMID: 31304694 PMCID: PMC7000284 DOI: 10.4097/kja.19191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was performed to evaluate the effect of a wagon as a transport vehicle instead of the standard stretcher car to reduce children's anxiety of separation from parents. The secondary goal was to evaluate whether this anxiolytic effect was related to age. METHODS We divided 80 children (age 2-7 years) into two groups. The stretcher group was transferred to the operating room on a conventional stretcher car, whereas the wagon group was transferred using a wagon. The level of anxiety was evaluated three times using the Modified Yale Preoperative Anxiety Scale (mYPAS): in the waiting area (T0), in the hallway to the operating room (T1), and before induction of anesthesia (T2). RESULTS The mYPAS score was significantly lower in the wagon group (36.7 [31.7, 51.7]) than in the stretcher group (51.7 [36.7, 83.3]) at T1 (P = 0.007). However, there was no difference in the mYPAS score between the two groups at T2 (46.7 [32.5, 54.2] vs. 51.7 [36.7, 75.0], respectively, P = 0.057). The baseline anxiety tended to be lower with increasing age (r = -0.248, P = 0.031). During transportation to the operating room, the increase in the mYPAS score (T1-T0) was greater as the age of children decreased in the stretcher group (r = -0.340, P = 0.034). However, no correlation was observed in the wagon group (r = -0.053, P = 0.756). CONCLUSION The wagon method decreased preoperative anxiety, suggesting that it may be a good alternative for reducing preoperative anxiety in children.
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Affiliation(s)
- Sun-Hong Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Sanghee Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seongheon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jeong Il Choi
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Youngwook You
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seongtae Jeong
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Abstract
Perioperative anxiety has been associated with adverse clinical outcomes such as emergence delirium, increased analgesic requirements and negative postoperative behavioural changes such as sleep disturbance, separation anxiety, eating problems and new-onset enuresis. Predictors of preoperative anxiety have been identified, and these include, among other factors, the age and temperament of the child. Any plan for anaesthetic induction in a child must take into account these factors. The anaesthetic plan must be individualised for special situations, for example, the child with behavioural disorder or at risk of aspiration. This article details the pharmacological and nonpharmacological methods to minimise preoperative anxiety and the techniques of anaesthetic induction in infants and children undergoing surgery. The benefits and limitations of inhalational and intravenous induction and the current status of rapid sequence induction in children are discussed. MEDLINE database was searched for this narrative review using the keywords including preoperative anxiety, child, premedication, paediatric and anaesthetic induction. Search was restricted to articles in English, but without any publication date restrictions.
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Affiliation(s)
- Nandini Malay Dave
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Hussain A, Khan FA. Effect of Two Techniques of Parental Interaction on Children's Anxiety at Induction of General Anaesthesia-A Randomized Trial. Turk J Anaesthesiol Reanim 2018; 46:305-310. [PMID: 30140538 DOI: 10.5152/tjar.2018.66750] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 03/03/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Several non-pharmacological techniques, such as parental presence and behavioral preparation, are used to decrease children's anxiety at anaesthesia induction. We compared the mean anxiety score in children at the time of anaesthesia induction with two different physical techniques of parental interaction and a control group with no parent present. The secondary objective was to determine the face mask acceptance during induction. Methods This study recruited 123 ASA I & II children, aged 1 to 8 years, undergoing day care surgery, who were randomly allocated to three groups. Children either went to the operating room (OR) alone (Gp C), or one parent sat next to the child at induction (Gp PS), or the child sat in parent's lap (Gp PH). The anxiety score on the modified Yale Preoperative Anxiety Scale (mYPAS) was recorded in the preinduction area of OR and at the induction of anaesthesia before the face mask application. A cut-off value of less than 30 indicated low anxiety. The face mask acceptance was also rated. Results All patients had the mYPAS scores higher than 30 in the preinduction area with no significant difference between groups. Prior to induction, the Gp C score was significantly high as compared to Gp PS (p=0.016) and Gp PH (p=0.001), but it was not different between the Gp PS and PH (p=1.00). The face mask acceptance was easy in 4.9 % patients in Gp C, 26.8% in Gp PS, and 56% in Gp PH. Conclusion Parental presence during induction did not prevent children's anxiety, but it reduced it, irrespective of the physical technique used. The face mask acceptance was better in Gp PH.
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Affiliation(s)
- Alia Hussain
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Fauzia Anis Khan
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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Preoperative Anxiety in Greek Children and Their Parents When Presenting for Routine Surgery. Anesthesiol Res Pract 2018; 2018:5135203. [PMID: 30065758 PMCID: PMC6051335 DOI: 10.1155/2018/5135203] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/22/2018] [Indexed: 12/27/2022] Open
Abstract
Background A surgical operation in pediatric patients is a rather stressful experience for both children and their parents. The aim of this study was to assess the effect of specific demographic characteristics in parent's and children's preoperative anxiety. Methods The sample was composed of 128 Greek-speaking children (1–14 years of age) who had to undergo minor surgery in a University General Hospital. Before surgical operation, the Spielberger State-Trait Anxiety Inventory (STAI) questionnaire and a questionnaire for the social-demographic characteristics were completed by the parents. Children's preoperative anxiety was evaluated using the Modified Yale Preoperative Anxiety Scale (m-YPAS). Results The independent predictors of increased anxiety levels in parents are child's age (p=0.024) and gender (girls: p=0.008), living in rural areas (parents: p < 0.001; children: p=0.009), being a mother (p=0.046), high or low education level (p=0.031), a no premedicated child (p=0.007), and high baseline parental anxiety (p=0.003). Previous hospitalization (p=0.019), high situational parental anxiety (p < 0.001), no premedication (p=0.014), and being the only child in the family (p=0.045) are found to be the main determinants of preoperative anxiety control in children. Conclusions This study identifies possible risk factors of preoperative anxiety in parents and their children, which are high parental anxiety, child's age, no premedication, being the only child in the family, living in rural areas, education level, and previous hospitalization.
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Cohen B, Thévenin A, Mille-Zemmoura B, Moënne-Loccoz J, Remérand F, Laffon M. Anxiety during inhalation induction in paediatrics: Sitting versus supine position, a randomised trial. Anaesth Crit Care Pain Med 2018; 37:435-438. [PMID: 29476940 DOI: 10.1016/j.accpm.2018.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 01/19/2018] [Accepted: 02/19/2018] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE We evaluated if the sitting or supine positions affect anxiety levels induced by the application of a facemask in children. DESIGN Prospective, randomised study. SETTING Paediatric hospital, operating room. PATIENTS Two to twelve years old children, 1-3 ASA status, undergoing inhalation anaesthesia for elective surgery. INTERVENTION Children were randomly assigned to a sitting or supine position. After monitoring equipment was established, inhalation was inducted by the application of the mask. MEASUREMENTS Child anxiety was then assessed with the modified Yale Preoperative Anxiety Scale (mYPAS) before the application of the facemask and following mask application. MAIN RESULTS Overall, 99 children in the sitting group and 103 in the supine group were analysed. The mYPAS score was not different in both groups before the application of facemask (40 [28-51] versus 40 [28-53]; P=0.99). It increased (P=0.005) to a similar extent in both groups following mask application without difference between groups (48 [38-60] versus 48 [35-63]; P=0.95). Side effects were not different between both groups. CONCLUSION In children undergoing inhalation induction, sitting or supine positions did not modify anxiety induced by the application of a facemask, nor adverse effects; therefore, children should be allowed to choose their preferred position.
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Affiliation(s)
- Benjamin Cohen
- Department of Anaesthesiology and Critical care, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Aude Thévenin
- Department of Paediatric Anaesthesia, CHRU, 37000 Tours, France
| | | | | | - Francis Remérand
- Department of Anaesthesiology and Critical care, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - Marc Laffon
- Department of Paediatric Anaesthesia, CHRU, 37000 Tours, France
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Di M, Yang Z, Qi D, Lai H, Wu J, Liu H, Ye X, ShangGuan W, Lian Q, Li J. Intravenous dexmedetomidine pre-medication reduces the required minimum alveolar concentration of sevoflurane for smooth tracheal extubation in anesthetized children: a randomized clinical trial. BMC Anesthesiol 2018; 18:9. [PMID: 29343232 PMCID: PMC5773144 DOI: 10.1186/s12871-018-0469-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background It has been known that Dexmedetomidine pre-medication enhances the effects of volatile anesthetics, reduces the need of sevoflurane, and facilitates smooth extubation in anesthetized children. This present study was designed to determine the effects of different doses of intravenous dexmedetomidine pre-medication on minimum alveolar concentration of sevoflurane for smooth tracheal extubation (MACEX) in anesthetized children. Methods A total of seventy-five pediatric patients, aged 3–7 years, ASA physical status I and II, and undergoing tonsillectomy were randomized to receive intravenous saline (Group D0), dexmedetomidine 1 μg∙kg−1 (Group D1), or dexmedetomidine 2 μg∙kg−1 (Group D2) approximately 10 min before anesthesia start. Sevoflurane was used for anesthesia induction and anesthesia maintenance. At the end of surgery, the initial concentration of sevoflurane for smooth tracheal extubation was determined according to the modified Dixon’s “up-and-down” method. The starting sevoflurane for the first patient was 1.5% in Group D0, 1.0% in Group D1, and 0.8% in Group D2, with subsequent 0.1% up or down in next patient based on whether smooth extubation had been achieved or not in current patient. The endotreacheal tube was removed after the predetermined concentration had been maintained constant for ten minutes. All responses (“smooth” or “not smooth”) to tracheal extubation and respiratory complications were assessed. Results MACEX values of sevoflurane in Group D2 (0.51 ± 0.13%) was significantly lower than in Group D1 (0.83 ± 0.10%; P < 0.001), the latter being significantly lower than in Group D0 (1.40 ± 0.12%; P < 0.001). EC95 values of sevoflurane were 0.83%, 1.07%, and 1.73% in Group D2, Group D1, and Group D0, respectively. No patient in the current study had laryngospasm. Conclusion Dexmedetomidine decreased the required MACEX values of sevoflurane to achieve smooth extubation in a dose-dependent manner. Intravenous dexmedetomidine 1 μg∙kg−1 and 2 μg∙kg−1 pre-medication decreased MACEX by 41% and 64%, respectively. Trial registration Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOD-17011601, date of registration: 09 Jun 2017, retrospectively registered.
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Affiliation(s)
- Meiqin Di
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Zhuqing Yang
- Department of Anesthesiology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, N1 Shangcheng Road, Yiwu, Zhejiang Province, People's Republic of China
| | - Dansi Qi
- Department of Pathology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, 109 Xueyuan Western Road, Wenzhou, Zhejiang Province, People's Republic of China
| | - Hongyan Lai
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Junzheng Wu
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Huacheng Liu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Xuefei Ye
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Wangning ShangGuan
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Qingquan Lian
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China
| | - Jun Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of WenZhou Medical University, No. 109 Xueyuan Western Road, Wenzhou, 325027, China.
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Carlsson RNE, Henningsson RN. Visiting the Operating Theatre Before Surgery Did Not Reduce the Anxiety in Children and Their Attendant Parent. J Pediatr Nurs 2018; 38:e24-e29. [PMID: 28939000 DOI: 10.1016/j.pedn.2017.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The induction of anesthesia is known to be the most stressful part of the day of surgery for the child. Non-pharmacologic intervention is a field of great interest. The aims of this prospective randomized study were to evaluate if (1). A preoperative visit to the operating theatre would attenuate the anxiety of the child on the day of surgery. (2). A preoperative visit to the operating theatre would attenuate the anxiety of the parent on the day of surgery. DESIGN AND METHODS Children aged 3-12years and their parents were randomly assigned to the intervention group visiting the operating theatre before surgery and the control group, which never visited there. Anxiety of the children in the preoperative period was measured by using the Swedish version of the modified Yale Preoperative Anxiety Scale (m-YPAS). Parent anxiety was measured by the State-Trait Anxiety Inventory (STAI) instrument. RESULTS Both the children and their parents showed an increase in anxiety during the day of surgery up to the induction of anesthesia. Children in the intervention group showed no reduction in anxiety compared to the control group. There were no differences in anxiety between the parents in the intervention and the control groups. CONCLUSIONS Though a preoperative visit to the surgery department and extensive information and therapeutic play does not seem to decrease the anxiety of the children scheduled for surgery and their parents it might be very important as information is highly wanted. Non-pharmacological interventions still need investigation in larger studies.
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Affiliation(s)
- Robert N E Carlsson
- Department of Anesthesiology, Central Hospital of Karlstad, Karlstad, Sweden
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Jerez-Molina C, Lázaro-Alcay JJ, Ullán-de la Fuente AM. Transcultural adaptation into Spanish of the Induction Compliance Checklist for assessing children's behaviour during induction of anaesthesia. ENFERMERIA CLINICA 2017; 28:S1130-8621(17)30142-0. [PMID: 29054560 DOI: 10.1016/j.enfcli.2017.08.006] [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: 12/09/2015] [Revised: 07/26/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Cross-cultural adaptation into Spanish of the Induction Compliance Checklist (ICC) for assessing children's behaviour during induction of anaesthesia. METHOD A descriptive cross-sectional observational study was conducted on a sample of 81 children aged 2 to 12 years operated in an ambulatory surgery unit of a paediatric hospital in Barcelona. Adaptation by translation-back translation of the tool and analysis of the scale's validity and reliability. RESULTS Face validity of the tool was guaranteed through a discussion group and inter-observer reliability was evaluated, obtaining an intraclass correlation index of r = 0.956. CONCLUSIONS The ICC scale validated for the Spanish population can be an effective tool for the presurgical evaluation of activities carried out to minimise children's anxiety. The ICC is an easy-to-use scale completed by operating room staff in one minute and would provide important information about children's behaviour, specifically during induction.
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Affiliation(s)
- Carmen Jerez-Molina
- Departamento de Enfermería, Unidad de Cirugía Ambulatoria, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España.
| | - Juan J Lázaro-Alcay
- Departamento de Anestesiología y Reanimación, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat (Barcelona), España
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Buehler PK, Spielmann N, Buehrer S, Schmidt AR, Weiss M, Schmitz A. Intraoperative music application in children and adolescents - a pilot study. Acta Anaesthesiol Scand 2017; 61:895-903. [PMID: 28685824 DOI: 10.1111/aas.12935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/29/2017] [Accepted: 06/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalization, surgery and anaesthesia may lead to new-onset maladaptive behaviour, emotional distress and trauma. This pilot study aims to investigate the influence of intraoperatively applied music on post-operative behaviour in children and adolescents. METHODS Children with an ASA physical state classification of I or II, aged from 4 to 16 years and scheduled for elective circumcision or inguinal hernia repair under combined general and caudal anaesthesia were included. The children were randomized into two groups. They wore headphones during surgery, and were either exposed to music or not. All involved staff were blinded. Post-operative behaviour was documented by parents on day 7, 14 and 28 after surgery, using a questionnaire adapted from the "Post Hospitalization Behavioural Questionnaire" (PHBQ). Overall occurrence of at least one item indicating maladaptive behaviour was the primary outcome. Data are presented as median (interquartile range). RESULTS In total, 135 children aged 6.6 (5.3-8.5) years, weighing 22 (19-29) kg, were included, with 112 completed questionnaires returned. Overall occurrence of at least one maladaptive item was lower in the music group, with a significantly lower incidence on day 7 (51% vs. 77% in controls; P < 0.01). CONCLUSION Intraoperative music application in children undergoing minor surgical procedures may reduce the incidence of post-operative maladaptive behaviour within the first week.
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Affiliation(s)
- P. K. Buehler
- Department of Anaesthesiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Zurich Switzerland
| | - N. Spielmann
- Department of Anaesthesiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Zurich Switzerland
| | - S. Buehrer
- Clinic of Psychiatry and Psychotherapy; University Hospital Zurich; Zurich Switzerland
| | - A. R. Schmidt
- Department of Anaesthesiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Zurich Switzerland
| | - M. Weiss
- Department of Anaesthesiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Zurich Switzerland
| | - A. Schmitz
- Department of Anaesthesiology; University Children's Hospital Zurich; Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Zurich Switzerland
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Sola C, Lefauconnier A, Bringuier S, Raux O, Capdevila X, Dadure C. Childhood preoperative anxiolysis: Is sedation and distraction better than either alone? A prospective randomized study. Paediatr Anaesth 2017. [PMID: 28620924 DOI: 10.1111/pan.13180] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preoperative anxiety management receives special attention in pediatric anesthesia. Different pharmacological and nonpharmacological techniques can be employed. This study was designed to assess three different strategies for childhood preoperative anxiolysis: midazolam premedication, midazolam in combination with portable Digital Video-Disk player, or video distraction strategy alone. METHODS In this prospective randomized study, children aged 2-12 years were assigned to one of the three study groups. The primary outcome was a change in preoperative children's anxiety, from baseline (before transfer to the preanesthetic holding area) to separation from parents, assessed by the Modified Yale Preoperative Anxiety Scale (mYPAS) and the Visual Analog Anxiety Scale (VAS-Anxiety). Delirium emergence, postoperative pain, and parental satisfaction were also collected. RESULTS One hundred and thirty-five patients were enrolled. The three preventive strategies allowed control of preoperative distress. Within the three study groups, no significant change was objectified in the anxiety level from baseline to separation from parents (mean change in mYPAS midazolam group: 2.4 95% CI [-1.7 to 6.3]; midazolam+Digital Video-Disk group: -1.0 95% CI [-5.9 to 3]; and Digital Video-Disk group: 1.4 95% CI [-4 to 6.7]). Comparison of change in preoperative children's anxiety between the groups did not show any difference. Emergence delirium, postoperative pain scores, and analgesic consumption were similar between the groups and parents' satisfaction was excellent. CONCLUSION Both pharmacological premedication and video distraction are effective strategies for controlling preoperative childhood anxiety. The combination of midazolam and Digital Video-Disk player was not better than either alone.
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Affiliation(s)
- Chrystelle Sola
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Audrey Lefauconnier
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Sophie Bringuier
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Olivier Raux
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Xavier Capdevila
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Christophe Dadure
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France
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Variation in caries treatment proposals among dentists in Norway: the best interest of the child. Eur Arch Paediatr Dent 2017; 18:345-353. [DOI: 10.1007/s40368-017-0298-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
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Lööf G, Liljeberg C, Eksborg S, Lönnqvist PA. Interactive web-based format vs conventional brochure material for information transfer to children and parents: a randomized controlled trial regarding preoperative information. Paediatr Anaesth 2017; 27:657-664. [PMID: 28393428 DOI: 10.1111/pan.13142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information transfer to patients is an integral part of modern medicine. Internet-based alternatives represent a new and attractive way for information transfer. METHODS The study used a prospective observer-blinded design. Children (3-12 years) and parents were instructed to get further preoperative information either through an interactive web-based platform, the Anaesthesia-Web, or conventional brochure material until day of outpatient surgery. On the day of surgery, children and parents were separately asked six different questions. The primary end-point was to compare the total question score in children between the two information options (maximum score = 36). Secondary aims were the total question score for parents and the influence of age, sex, and time between the preoperative visit and day of surgery. RESULTS A total of 125 children were recruited, of which 103 were included in the final analysis (the Anaesthesia-Web group, n = 49; the brochure material group, n = 54). At the predetermined interim analysis, the total question score in children was found to be substantially higher in the Anaesthesia-Web group than in the brochure material group (median score: 27; IQR: 16.5-33 and median score: 19.5; IQR: 11.25-27.75, respectively, P = 0.0076). The median difference in score was 6; 95% CI: 0-9. The total question score in parents was also higher in the Anaesthesia-Web group than in the brochure material group. Increasing child age was associated with a higher total question score in both groups. Sex did not influence the total question score in the Anaesthesia-Web group, whereas girls scored better than boys in the brochure material group. CONCLUSIONS Children in the age range 3-12 years of age as well as their parents do better attain preoperative information from an interactive web-based platform compared to conventional brochure material.
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Affiliation(s)
- Gunilla Lööf
- Department of Paediatric Anaesthesia and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Liljeberg
- Department of Paediatric Anaesthesia and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Eksborg
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.,Division of Paediatrics, Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Per-Arne Lönnqvist
- Department of Paediatric Anaesthesia and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Abstract
Emergence delirium (ED) is a complex of perceptual disturbances and psychomotor agitation that occurs most commonly in preschool-aged children in the early postanesthetic period. The incidence of ED varies between 10 and 80% in children and is perceived as a troublesome clinical situation by 42% of pediatric anesthesiologists. Although these events are often short lived, they increase the risk of self-injury and delayed discharge, require additional nursing staff and can increase medical care costs, all of which are causes for concern. The prevalence of ED has increased with the introduction and growing use of sevoflurane and desflurane, two low-solubility inhalational anesthetics. These agents promote early arousal post anesthetic, which contributes to ED. Physiological factors, pharmacological factors, the type of procedure, the anesthetic agent administered, painful stimuli, and various patient factors can all contribute to ED and thus need to be considered. Recent literature debates the cause-effect relationship between ED and pain, suggesting that they often occur concurrently but are sometimes independent findings. The consistent relation between ED and sevoflurane-based anesthesia has guided many studies to investigate its incidence compared with using other anesthetic techniques or various adjuncts. The risk of ED is lowest when propofol is used as a single-agent anesthetic compared with sevoflurane-based anesthetics. Adjunctive agents can be rated in the following order of most effective to least effective interventions: dexmedetomidine, fentanyl, ketamine, clonidine, and propofol bolus at the end of sevoflurane-based anesthesia. This review summarizes the factors that may predict ED and provides an intervention algorithm to guide effective prevention and treatment.
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Affiliation(s)
- Arthura D Moore
- Department of Pediatric Medicine, Division of Anesthesiology, MS 130, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Doralina L Anghelescu
- Department of Pediatric Medicine, Division of Anesthesiology, MS 130, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
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Dionigi A, Gremigni P. A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children. J Clin Nurs 2016; 26:632-640. [DOI: 10.1111/jocn.13578] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Paola Gremigni
- Department of Psychology; University of Bologna; Bologna Italy
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Spinelli G, Vargas M, Aprea G, Cortese G, Servillo G. Pediatric anesthesia for minimally invasive surgery in pediatric urology. Transl Pediatr 2016; 5:214-221. [PMID: 27867842 PMCID: PMC5107376 DOI: 10.21037/tp.2016.09.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Laparoscopic or robotic minimally invasive approaches have become the standard of care for many urological pediatric surgical procedures. Anesthetic concerns for conventional and robotic laparoscopy are similar since they both require insufflations of CO2 to allow visualization of surgical field and perform surgery. Even if required insufflation pressures and volumes are lower in pediatric patients (given the small size of the abdomen and laxity of the abdominal walls), the associated increase of intra-abdominal pressure, along with absorption of CO2 and surgical positioning requirement, may result in neurendocrine and mechanical impact capable to mine cardiopulmonary function. Moreover, laparoscopic approach may require specific positioning. A correct positioning is essential to allow the surgical team to optimally and safely access to the patient. The knowledge of patient's health status, along with the multiple physiologic changes that can occur and specific potential complications, allow the anesthesiologist to provide a safer an aesthesia.
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Affiliation(s)
- Gianmario Spinelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Gianfranco Aprea
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Cortese
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Erhaze EK, Dowling M, Devane D. Parental presence at anaesthesia induction: A systematic review. Int J Nurs Pract 2016; 22:397-407. [PMID: 27272603 DOI: 10.1111/ijn.12449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 04/01/2016] [Accepted: 04/10/2016] [Indexed: 02/02/2023]
Abstract
This systematic review assessed the effectiveness of parental presence for children undergoing surgical or diagnostic procedures under general anaesthesia (such as bronchoscopy, laryngoscopy and laparoscopy). Randomized and quasi randomized trials with healthy children scheduled for elective diagnostic and surgical procedures under general anaesthesia (age range 0-16 years) where the intervention was parental presence at anaesthesia induction were included. A comprehensive literature search was conducted using electronic databases and the reference lists of included studies. The Cochrane collaboration's tool for assessing risk of bias was used for assessment of risk of bias. The Review Manager software was used to analyse and synthesize data. A random-effect meta-analysis was used when there was evidence of clinical and/or statistical heterogeneity. Of the 102 citations identified, nine trials involving 1021 children were eligible for inclusion. Only four were sufficient to be included in the meta-analysis. There was no statistically significant difference on average in the level of anxiety in children and their parents either at separation or at induction between children allocated to parental presence and those allocated to no presence, premedication or parental presence plus premedication groups. Significant debate still surrounds this issue, and future trials should focus on the use of reliable and validated tools in assessing outcome measures.
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Affiliation(s)
| | - Maura Dowling
- School of Nursing and Midwifery, Aras Moyola, National University of Ireland Galway, Ireland
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Jerez C, Ullán AM, Lázaro JJ. Reliability and validity of the Spanish version of the modified Yale Preoperative Anxiety Scale. ACTA ACUST UNITED AC 2015; 63:320-6. [PMID: 26633606 DOI: 10.1016/j.redar.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE To minimise preoperative stress and increase child cooperation during induction of anaesthesia is one of the most important perioperative objectives. The modified Yale Preoperative Anxiety Scale was developed to evaluate anxiety. The aim of this study was to translate into Spanish, and validate the psychometric properties of the Spanish version of this scale. MATERIAL AND METHODS The Spanish translation of the scale was performed following the World Health Organisation guidelines. During induction of anaesthesia, 81 children aged 2 to 12 years were recorded. Two observers evaluated the recordings independently. Content validity index of modified Yale Preoperative Anxiety Scale Spanish version was assessed. Weighted Kappa was calculated to measure interobserver agreement, and the Pearson correlation between the Induction Compliance Checklist and the modified Yale Preoperative Anxiety Scale was determined. RESULTS The Spanish version obtained high content validity (0.91 to 0.98). Reliability analysis using weighted Kappa statistics revealed that interobserver agreement ranged from 0.54 to 0.75. Concurrent validity was high (r=0.94; P<.001). CONCLUSIONS Validated assessment tools are needed to evaluate interventions to reduce child preoperative anxiety. The Spanish version of the modified Yale Preoperative Anxiety Scale evaluated in this study has shown good psychometric properties of reliability and validity.
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Affiliation(s)
- C Jerez
- Unidad de Cirugía Ambulatoria, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - A M Ullán
- Facultad de Ciencias Sociales, Universidad de Salamanca, Campus Miguel de Unamuno, Salamanca, España
| | - J J Lázaro
- Departamento de Anestesiología y Reanimación, Hospital Materno-Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Güleç E, Özcengiz D. Preoperative Psychological Preparation of Children. Turk J Anaesthesiol Reanim 2015; 43:344-6. [PMID: 27366525 DOI: 10.5152/tjar.2015.16768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022] Open
Abstract
Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed.
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Affiliation(s)
- Ersel Güleç
- Department of Anaesthesiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Dilek Özcengiz
- Department of Anaesthesiology, Çukurova University Faculty of Medicine, Adana, Turkey
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Faritus SZ, Khazaee-Koohpar M, Ziyaeifard M, Mehrabanian MJ. Oral Dexmedetomidine Versus Midazolam as Anesthetic Premedication in Children Undergoing Congenital Heart Surgery. Anesth Pain Med 2015; 5:e25032. [PMID: 26161325 PMCID: PMC4493729 DOI: 10.5812/aapm.5(3)2015.25032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/07/2014] [Accepted: 12/24/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Premedication is required for reducing anxiety and child’s struggling against mask acceptance on anesthesia in pediatric surgery for congenital heart disease. Midazolam has been widely used for this purpose, but because of its side effects, finding an effective replacement with less complication is necessary. Objectives: In the present study, we compared the efficacy of oral midazolam versus dexmedetomidine in terms of anxiolysis and mask acceptance behavior. Patients and Methods: Sixty children aged between 2 and 12 years, and scheduled for on-pump surgery due to a congenital heart disease were randomly assigned into two groups. Oral midazolam (0.5 mg/kg up to 15 mg per patient) and dexmedetomidine (2 µg/kg) were administered 45 minutes pre-anesthesia. Children’s anxiety, mask acceptance behavior, hemodynamic measures, and cardiopulmonary outcomes were recorded and compared. Results: The mean age of patients was 3.96 ± 2.04 years. Twenty-eight (46.7%) patients were females. Two drugs have similar effects on cardiopulmonary outcomes and hemodynamic measures (P > 0.05). They equally relieved the children’s anxiety (mean sedation score 1.93 ± 0.63 and 2.0 ± 0.63 for midazolam and dexmedetomidine groups, respectively; P > 0.05), while dexmedetomidine showed a better effect on improving the mask acceptance behavior (mean mask acceptance score 2.58 ± 0.6 and 1.6 ± 0.67 for midazolam and dexmedetomidine, respectively; P < 0.05). Conclusions: It appears reasonable to apply oral premedication with dexmedetomidine 45 minutes before transferring the patient to the operating room when he or she is more prone to resist inhalation anesthesia induction.
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Affiliation(s)
- Seyedeh Zahra Faritus
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Khazaee-Koohpar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Ziyaeifard
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Mohsen Ziyaeifard, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2122043921, Fax: +98-2122042026, E-mail:
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Autism spectrum disorder 101: A primer for pediatric otolaryngologists. Int J Pediatr Otorhinolaryngol 2015; 79:798-802. [PMID: 25912683 DOI: 10.1016/j.ijporl.2015.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/03/2015] [Accepted: 04/04/2015] [Indexed: 11/22/2022]
Abstract
Based on a comprehensive review of the literature as well as personal experiences at a tertiary children's hospital, we present an encompassing guide of the management of children with autism spectrum disorder (ASD) in the otolaryngology practice. ASD is a disorder involving persistent deficits in social communication and interaction across multiple contexts with restricted and repetitive patterns of behavior, which presents early in age and causes significant impairment in function. With the increasing prevalence of autism, the otolaryngologist's understanding of the disease and how it affects the management of patients is of paramount importance in order to provide a safe medical and surgical environment. Special considerations in the outpatient visit and peri-operative setting in the management of ASD patients can enhance the patient-provider relationship and improve the quality of care delivered. We discuss several strategies, such as utilization of communication devices and use of pre-medication prior to surgery, to facilitate the clinical experience.
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Yao Y, Qian B, Lin Y, Wu W, Ye H, Chen Y. Intranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion and emergence delirium in children: a prospective, randomized, double-blind, placebo-controlled trial. Paediatr Anaesth 2015; 25:492-8. [PMID: 25487567 DOI: 10.1111/pan.12574] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND We conducted a prospective, randomized, double-blind, placebo-controlled study to verify the hypothesis that intranasal dexmedetomidine premedication can reduce the minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion in children. METHODS Ninety American Society of Anesthesiologists (ASA) physical status I subjects, aged 3-7 years, were randomized to three equal groups to receive saline (Group S), dexmedetomidine 1 μg · kg(-1) (Group D1 ), or dexmedetomidine 2 μg · kg(-1) (Group D2 ) approximately 45 min before anesthesia. The minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane was determined according to the Dixon's up-and-down method. Emergence delirium was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scale in the postanesthesia care unit (PACU). RESULTS Dexmedetomidine premedication of 1 and 2 μg · kg(-1) was associated with reduction in sevoflurane from 1.92% to 1.53% and 1.23%, corresponding to decrease of 20% and 36%, respectively. The peak PAED scores (median [IQR]) were 9 [8-11.5], 5 [3-5.3], and 3 [2-4] in Group S, Group D1, and Group D2 , respectively. The incidence of emergence delirium (defined as peak PAED score ≥ 10) was significantly lower in Groups D1 and D2 than in Group S (P < 0.001). Simultaneously, the induction qualities and the parent's satisfaction scores were significantly higher in Groups D1 and D2 than in Group S (P < 0.001). CONCLUSION Intranasal dexmedetomidine premedication produces a dose-dependent decrease in the minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane and emergence delirium in the PACU.
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Affiliation(s)
- Yusheng Yao
- Department of Anesthesiology, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China
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Kalibatienė L, Kalibatas V, Macas A, Trepenaitis D. An evaluation of the effectiveness and safety of midazolam in children undergoing dental surgery. MEDICINA-LITHUANIA 2015; 51:180-186. [PMID: 28705481 DOI: 10.1016/j.medici.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 04/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness and safety of oral midazolam in children undergoing dental surgery. MATERIALS AND METHODS A prospective, randomized, controlled trial was conducted to assess the effectiveness and safety of midazolam in children. Patients aged 2-9 years who underwent dental surgery under general anesthesia were randomly allocated into one of the four groups: midazolam 0.2mg/kg dose group (n=30); midazolam 0.21-0.4mg/kg dose group (n=15); midazolam more than 0.41mg/kg dose group (n=15) or the placebo group (n=31). The effectiveness of midazolam on sedation was assessed by the evaluation of vital signs, such as the respiratory and heart rate, oxygen saturation and the patients' reactive behaviors, in comparison with the placebo. RESULTS The scores of the ratings for sleep, movement and crying, as well as patients' reactions at the moment of separation from their parents and their collaboration with the staff were statistically significantly better among patients who received oral midazolam compared with the placebo. There were statistically significant direct correlations between the doses of midazolam and higher sleep, movement, crying and reaction scores 30min after premedication as well as higher scores of patients upon separation from their parents. There were only a few clinically insignificant side effects. CONCLUSIONS Oral midazolam, at a single dose from 0.2 to 0.6mg/kg, is effective and safe, and provides the expected sedative effects in children required by premedication for dental surgery.
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Affiliation(s)
- Lina Kalibatienė
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Vytenis Kalibatas
- Department of Health Management, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Andrius Macas
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Darius Trepenaitis
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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