1
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Albert OK, Friedmann K, Jaeger R, Berry-Kravis E. Low Risk Profile of Long-Term Repeated Lumbar Puncture for Intrathecal Delivery of 2-Hydroxypropyl-Beta-Cyclodextrin in Patients With Niemann-Pick Type C. Pediatr Neurol 2023; 144:99-103. [PMID: 37201244 DOI: 10.1016/j.pediatrneurol.2023.04.009] [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: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Intrathecal delivery of 2-hydroxypropyl-beta-cyclodextrin (VTS-270, adrabetadex) by lumbar puncture (LP) has been performed on a biweekly schedule for over nine years for the treatment of Niemann-Pick type C1 (NPC1) at Rush University Medical Center. METHODS Over this time 59 patients with NPC1 have been treated with 2935 infusions, performed with either a 22-G 3-inch Whitacre or a 22-G 2-inch Gertie Marx atraumatic needles, with or without general anesthesia. Adverse events potentially related to the LP infusion were collected from records for all patients treated for NPC. The NPC1 cohort ranged in age from one to 31 years at the initiation of treatment. RESULTS Of the 59 patients treated 33 (55.9%) had no adverse events ever after an LP and 26 (44.1%) had adverse effects at some time. Of the 2935 LPs, adverse events occurred after 3.3% of LPs. Adverse events most observed were headache (1.2% of LPs), nausea (0.3%), vomiting (1.0%), and back pain (1.3%). CONCLUSIONS This study shows that frequent repeated LPs are possible for delivery of intrathecal therapy and can be accomplished with a very low rate of post-LP adverse events.
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Affiliation(s)
- Orsolya K Albert
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Katherine Friedmann
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois; College of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Rebecca Jaeger
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois; Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois; Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois.
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2
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Orman A, Aydın H. Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures? CHILDREN 2023; 10:children10030509. [PMID: 36980067 PMCID: PMC10047216 DOI: 10.3390/children10030509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
Lumbar puncture (LP) is widely employed to evaluate infectious, neurological and metabolic diseases in the newborn. Neonatal LP is a difficult procedure with 45–54% success rates. Although there are studies examining traumatic LP failure, studies on the effects of needle sizes are limited. This study was intended to investigate the effect of needle sizes on LP traumatization. Term and premature babies who underwent LP in the neonatal intensive care unit between 30 November 2017 and 30 July 2019 were included in the study by retrospective file scanning. LP was performed by a pediatric or neonatal specialist using a 22 Gauge pen (G) or 25 G pen spinal needle in all cases, with all patients being placed in the lateral decubitus position. The primary outcome was to evaluate the effect of needle sizes used in LP on traumatization. The secondary outcome was to evaluate traumatization rates and complications. A statistically significant difference was determined in the rate of traumatized LP and desaturation development between needle sizes and CSF microscopic findings (p = 0.031, p = 0.005, and p = 0.006, respectively). The study data show that 25 G pen-tip spinal needles cause less traumatic LP in neonates than 22 G pen-tip spinal needles.
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Affiliation(s)
- Aysen Orman
- Departments of Neonatology, School of Medicine, Mersin University, Mersin 33110, Turkey
- Correspondence: ; Tel.: +90-3242412264
| | - Hilal Aydın
- Departments of Pediatric Neurology, School of Medicine, Balikesir University, Balikesir 10145, Turkey
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3
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Senturk Apiliogulari S, Aktas M. Critical tips and questions on pediatric spinal anaesthesia. J Pediatr Urol 2023:S1477-5131(23)00006-2. [PMID: 36702671 DOI: 10.1016/j.jpurol.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Seza Senturk Apiliogulari
- Canakkale Onsekiz Mart University, School of Medicine, Department of Anesthesia and Intensive Care, 17110, Canakkale, Turkey.
| | - Melih Aktas
- Canakkale Onsekiz Mart University, School of Medicine, Department of Anesthesia and Intensive Care, 17110, Canakkale, Turkey.
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4
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Långström S, Huurre A, Kari J, Lohi O, Sievänen H, Palmu S. Bioimpedance spinal needle provides high success and low complication rate in lumbar punctures of pediatric patients with acute lymphoblastic leukemia. Sci Rep 2022; 12:6799. [PMID: 35474331 PMCID: PMC9042945 DOI: 10.1038/s41598-022-10915-4] [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: 10/14/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
In this prospective single-arm study of 50 pediatric patients with acute lymphoblastic leukemia (ALL), we evaluated the clinical performance of a novel bioimpedance spinal needle system in 152 intrathecal treatment lumbar punctures (LP) of these patients. The system detects in real-time when the needle tip reaches the cerebrospinal fluid (CSF) in the spinal canal. The success was defined as getting a CSF sample and/or administering the intrathecal treatment with one needle insertion. Incidence of traumatic LP (TLP) was defined as ≥ 10 erythrocytes/µL of CSF. Post-procedural complications were monitored with a one-week diary and one-month register follow-up. The success of the first attempt was 79.5%, with the CSF detection sensitivity of 86.1%. The incidence of TLP was 17.3%. A successful first attempt was associated with a significantly lower incidence of TLP (10% vs 40%, p = 0.0015). During the week after the procedure, the incidence of post-dural puncture headache was 6%. During the follow-up, no major complications were observed. In conclusion, the novel bioimpedance spinal needle system achieved a high success rate and low incidence of TLP and other complications in pediatric patients with ALL in a real-world clinical setting, indicating clinical utility for this system in pediatric hemato-oncology.
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Affiliation(s)
- Satu Långström
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital, New Children's Hospital, Helsinki, Finland
| | - Anu Huurre
- Department of Pediatric Hematology and Oncology, Turku University Hospital, Turku, Finland
| | | | - Olli Lohi
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, and Cancer Center, Tampere University Hospital, Tampere, Finland
| | | | - Sauli Palmu
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, and Cancer Center, Tampere University Hospital, Tampere, Finland.
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5
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Liu J, Chen J, Nguyen PT. Neuraxial anesthesia and pain control for pediatric burn patients receiving excision and split-thickness skin grafts-A retrospective case series. Paediatr Anaesth 2021; 31:1113-1120. [PMID: 34270145 DOI: 10.1111/pan.14256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postoperative pain management in pediatric burn patients requiring excision and split-thickness skin grafts remains largely under-studied. ICU care is often necessary due to the level of sedation and amount of opioids required to achieve adequate pain control. AIMS Our case series aimed to describe a pain management strategy using neuraxial anesthesia intraoperatively. Primary outcomes include pain scores, postoperative opioid consumption, and adverse events. METHODS A retrospective chart review was performed on a total of 61 patients who received intraoperative neuraxial anesthesia for split-thickness skin grafting between January 1st, 2017 and June 1st, 2018. Patient demographics, operating room data, and subsequent hospital course was extracted from their electronic medical record and plotted using R Studio statistical software. RESULTS The overwhelming majority of patients received single-shot spinals with both local anesthetic and either morphine or hydromorphone. Average pain scores were 1 out of 10 with standard deviation of 1.6 in the immediate postoperative period and decreased over the next 72 h. Oral morphine equivalents consumed did not exceed 0.61 ME/kg/day. The most common adverse reaction was pruritus. CONCLUSIONS Spinal anesthesia was most commonly used for split-thickness skin grafting in the pediatric burn population and provides excellent analgesia for patients' immediate postoperative course, including their initial dressing changes, with minimal risk for complications. Pain was well-controlled in all subgroups indicating that this strategy can be used flexibly in a variety of pediatric burn patients.
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Affiliation(s)
- John Liu
- Shriners Hospitals for Children Northern California, Sacramento, California, USA
| | - Joy Chen
- University of California Davis School of Medicine, Davis, California, USA
| | - Phat-Tan Nguyen
- University of California Davis School of Medicine, Davis, California, USA
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6
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Armstrong SA, Nguyen HTN, Rebsamen SL, Iskandar B, Stadler JA. Epidural Fibrin Sealant Injection for the Management of Cerebrospinal Fluid Leak Following Dural Puncture in Children. Cureus 2020; 12:e6940. [PMID: 32190492 PMCID: PMC7067364 DOI: 10.7759/cureus.6940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cerebrospinal fluid (CSF) leak, intracranial hypotension, and postdural puncture headaches are common following dural punctures. Management usually consists of conservative treatments with medications (e.g. caffeine, nonsteroidal anti-inflammatory drugs, steroids, opioids), increased fluid intake, and bed rest. In more severe and persistent cases, epidural blood patches (EBPs) are indicated. When multiple EBPs fail, epidural injection of fibrin sealant has been successful in a few reported adult cases. The authors describe the first reported clinical experiences of epidural fibrin patch in children for repair of CSF leak and resolution of intracranial hypotension. This technique was used in three cases where serial EBPs failed to resolve symptoms related to intracranial hypotension following dural puncture. Following the procedure, each patient had resolution of their presenting clinical symptoms and radiographic abnormalities, and there were no noted complications. Epidural fibrin sealant injection is a reasonable option for relieving intracranial hypotension due to CSF leak following dural puncture in children.
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Affiliation(s)
- Stephanie A Armstrong
- Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Huy Tram N Nguyen
- Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Susan L Rebsamen
- Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Bermans Iskandar
- Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - James A Stadler
- Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
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7
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Celik D, Onal O, Apiliogullari S, Kara I, Celik JB. Estimating the Lumbar Puncture Needle Depth in Children. J INVEST SURG 2019; 34:157-163. [DOI: 10.1080/08941939.2019.1614698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Derya Celik
- Department of Anesthesiology and Intensive Care, Medical Faculty, Selcuk University, Konya, Turkey
| | - Ozkan Onal
- Department of Anesthesiology and Intensive Care, Medical Faculty, Selcuk University, Konya, Turkey
| | - Seza Apiliogullari
- Department of Anesthesiology and Intensive Care, Medical Faculty, Selcuk University, Konya, Turkey
| | - Inci Kara
- Department of Anesthesiology and Intensive Care, Medical Faculty, Selcuk University, Konya, Turkey
| | - Jale Bengi Celik
- Department of Anesthesiology and Intensive Care, Medical Faculty, Selcuk University, Konya, Turkey
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8
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Comparative cyto-histological study of needle tip aspirates and entry sites after intravitreal injection using different needle types. PLoS One 2017; 12:e0174467. [PMID: 28692684 PMCID: PMC5503168 DOI: 10.1371/journal.pone.0174467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 03/09/2017] [Indexed: 12/12/2022] Open
Abstract
A comparison of the cellular content of needle tip aspirates and entry sites after transconjunctival intravitreal injection (IVI) using different needle types was performed. White outbred rats and human cadaver eyes were used for IVI by hypodermic 27 gauge (G) and 30G needles, and spinal anesthesia Pencan 27G needles. Aspiration of vitreous for quantitative morphological and cell cultivation analysis, as well as cyto-histological analysis of aspirates and entry sites were carried out. The most common cells in the aspirates from all needle types were conjunctival epithelial-, ciliary body non-pigmented epithelial- and sclerocyte-like cells and granular proteins. Crystallized vitreous specimens were present in each aspirate. The entry sites of hypodermic needles showed marked trauma in all wall layers of rat and human eyes accompanied by cellular destruction and hemorrhages. Pencan 27G needle caused less tissue trauma with partial reposition of sclerocytes. Transconjunctival IVIs with hypodermic 27G and 30G, and Pencan 27G needles result in trauma of all layers of the eyeball. The possible consequences of cellular content being cut and injected into the eye, as well as the entry site wound shape deserve future consideration and improvements.
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9
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Bishop KM. Progress and promise of antisense oligonucleotide therapeutics for central nervous system diseases. Neuropharmacology 2016; 120:56-62. [PMID: 27998711 DOI: 10.1016/j.neuropharm.2016.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 12/14/2022]
Abstract
Antisense oligonucleotide (ASO) drugs are an emerging class of therapeutics that have recently demonstrated progress and promise to treat diseases of the central nervous system (CNS). ASOs for a variety of targets and mechanisms are currently being investigated in clinical trials and pre-clinically for a number of CNS diseases. This review examines the available data regarding central ASO delivery, distribution, pharmacokinetics, pharmacodynamics and therapeutic opportunities. This article is part of the Special Issue entitled "Beyond small molecules for neurological disorders".
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10
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Haché M, Swoboda KJ, Sethna N, Farrow-Gillespie A, Khandji A, Xia S, Bishop KM. Intrathecal Injections in Children With Spinal Muscular Atrophy: Nusinersen Clinical Trial Experience. J Child Neurol 2016; 31:899-906. [PMID: 26823478 PMCID: PMC4871174 DOI: 10.1177/0883073815627882] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/20/2015] [Indexed: 12/22/2022]
Abstract
Nusinersen (ISIS-SMNRx or ISIS 396443) is an antisense oligonucleotide drug administered intrathecally to treat spinal muscular atrophy. We summarize lumbar puncture experience in children with spinal muscular atrophy during a phase 1 open-label study of nusinersen and its extension. During the studies, 73 lumbar punctures were performed in 28 patients 2 to 14 years of age with type 2/3 spinal muscular atrophy. No complications occurred in 50 (68%) lumbar punctures; in 23 (32%) procedures, adverse events were attributed to lumbar puncture. Most common adverse events were headache (n = 9), back pain (n = 9), and post-lumbar puncture syndrome (n = 8). In a subgroup analysis, adverse events were more frequent in older children, children with type 3 spinal muscular atrophy, and with a 21- or 22-gauge needle compared to a 24-gauge needle or smaller. Lumbar punctures were successfully performed in children with spinal muscular atrophy; lumbar puncture-related adverse event frequency was similar to that previously reported in children.
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Affiliation(s)
- Manon Haché
- Division of Pediatric Anesthesia, Columbia University Medical Center, New York, NY, USA
| | - Kathryn J Swoboda
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Navil Sethna
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Alan Farrow-Gillespie
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Shuting Xia
- Ionis Pharmaceuticals, Inc., Carlsbad, CA, USA
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11
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Eizaga Rebollar R, García Palacios MV, Morales Guerrero J, Torres Morera LM. [Central blockades in Pediatrics: A review of current literature]. ACTA ACUST UNITED AC 2015; 63:91-100. [PMID: 25866132 DOI: 10.1016/j.redar.2015.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
Pediatric neuraxial anesthesia is an effective tool that can be used as a supplement or alternative to general anesthesia. However, there have always been doubts about its usefulness and risk-benefit ratio. The purpose of this review is to describe the current role of central blockades in pediatric patients, upgrade practical and safety aspects, and review the latest technological advances applied to this procedure.
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Affiliation(s)
- R Eizaga Rebollar
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - M V García Palacios
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Puerta del Mar, Cádiz, España
| | - J Morales Guerrero
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta del Mar, Cádiz, España
| | - L M Torres Morera
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta del Mar, Cádiz, España
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12
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Rusch R, Schulta C, Hughes L, Withycombe JS. Evidence-Based Practice Recommendations to Prevent/Manage Post-Lumbar Puncture Headaches in Pediatric Patients Receiving Intrathecal Chemotherapy. J Pediatr Oncol Nurs 2014; 31:230-238. [PMID: 24928757 PMCID: PMC5685494 DOI: 10.1177/1043454214532026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Post-lumbar puncture headaches (PLPHs) are a known complication of lumbar puncture procedures. Children undergoing treatment for cancer often undergo multiple lumbar punctures, placing them at increased risk for PLPHs. There are currently no guidelines for the prevention or management of PLPHs in children. A team was therefore assembled to conduct a systematic review of the evidence in relationship to PLPHs in the pediatric population. Clinical questions were developed and used to guide the literature review. Twenty-four articles were deemed appropriate for use and were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Based on the review of evidence, strong recommendations are made for the use of smaller needle sizes and for the use of pencil point needles during lumbar puncture procedures. Weak recommendations are made for needle orientation and positioning following the procedure as well as for interventions used to treat PLPHs once they occur. There is a need for additional, pediatric-specific studies to further examine the issue of PLPH prevention and treatment.
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Affiliation(s)
- Rebecca Rusch
- Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Laura Hughes
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
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13
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Abstract
Even after a vast safety record, the role of spinal anesthesia (SA) as a primary anesthetic technique in children remains contentious and is mainly limited to specialized pediatric centers. It is usually practiced on moribund former preterm infants (<60 weeks post-conception) to reduce the incidence of post-operative apnea when compared to general anesthesia (GA). However, there is ample literature to suggest its safety and efficacy for suitable procedures in older children as well. SA in children has many advantages as in adults with an added advantage of minimal cardio-respiratory disturbance. Recently, several reports from animal studies have raised serious concerns regarding the harmful effects of GA on young developing brain. This may further increase the utility of SA in children as it provides all components of balanced anesthesia technique. Also, SA can be an economical option for countries with finite resources. Limited duration of surgical anesthesia in children is one of the major deterrents for its widespread use in them. To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates. But, the developing spinal cord may also be vulnerable to drug-related toxicity, though this has not been systematically evaluated in children. So, adjuvants and drugs with widest therapeutic index should be preferred in children. Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA. Literature yields encouraging results regarding its safety and efficacy. Technical skills and constant vigilance of experienced anesthesia providers is indispensable to achieve good results with this technique.
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Affiliation(s)
- Anju Gupta
- Department of Anesthesiology and Intensive Care, Delhi State Cancer Hospital, Dilshad Garden, New Delhi, India
| | - Usha Saha
- LHMC and Associated Hospitals, New Delhi, India
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14
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Postdural puncture headache: a neglected complication after lumbar puncture and intrathecal chemotherapy in children with acute lymphoblastic leukemia. Int J Clin Oncol 2013; 19:769-70. [PMID: 23942836 DOI: 10.1007/s10147-013-0608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
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15
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Diaz Herrera W, Osorio Zambrano HF, Sandoval Cabrera MF. Reporte de caso: anestesia espinal multimodal en paciente pediátrico con vía aérea difícil. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rca.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Case report: Multimodal spinal anesthesia in a pediatric patient with a difficult airway. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Abstract
Children comprise approximately one-quarter of all visits to most emergency departments. Children are generally healthier than adults, yet there are similar priorities in assessment and management of pediatric patients. The initial approach to airway, breathing, and circulation still applies and is first and foremost in the evaluation of young infants and children. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during their evaluation and treatment. In this review, we present and discuss an evidence-based approach to high-yield procedures necessary for all emergency physicians taking care of children.
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Affiliation(s)
- Fernando Soto
- Pediatric Emergency Medicine Section, University of Puerto Rico School of Medicine, PO Box 29207, San Juan, PR 00929, USA.
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18
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Schievink WI, Maya MM. Ventral spinal cerebrospinal fluid leak as the cause of persistent post-dural puncture headache in children. J Neurosurg Pediatr 2013; 11:48-51. [PMID: 23140214 DOI: 10.3171/2012.10.peds12353] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Headache occurs after dural puncture in about 1%-25% of children who undergo the procedure-a rate similar to that seen in adults. Persistence of post-dural puncture headache in spite of bed rest, increased fluid intake, and epidural blood patch treatment, however, is rare. The authors reviewed the medical records and imaging studies of all patients 19 years of age or younger who they evaluated between 2001 and 2010 for intracranial hypotension, and they identified 8 children who had persistent post-dural puncture headache despite maximal medical treatment and placement of epidural blood patches. A CSF leak could be demonstrated radiologically and treated surgically in 3 of these patients, and the authors report these 3 cases. The patients were 2 girls (ages 14 and 16 years) who had undergone lumbar puncture for evaluation of headache and fever and 1 boy (age 13 years) who had undergone placement of a lumboperitoneal shunt using a Tuohy needle for treatment of pseudotumor cerebri. The boy also had undergone a laminectomy and exploration of the posterior dural sac, but no CSF leak could be identified. All 3 patients presented with new-onset orthostatic headaches, and in all 3 cases MRI demonstrated a large ventral lumbar or thoracolumbar CSF collection. Conventional myelography or digital subtraction myelography revealed a ventral dural defect at L2-3 requiring surgical repair. Through a posterior transdural approach, the dural defect was repaired using 6-0 Prolene sutures and a dural substitute. Postoperative recovery was uneventful, with complete resolution of orthostatic headache and of the ventral cerebrospinal fluid leak on MRI. The authors conclude that persistent postdural puncture headache requiring surgical repair is rare in children. They note that the CSF leak may be located ventrally and may require conventional or digital subtraction myelography for exact localization and that transdural repair is safe and effective in eliminating the headaches.
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Affiliation(s)
- Wouter I Schievink
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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19
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Apiliogullari S, Varoglu AO, Celik JB. Postdural puncture headache: Do not forget the children. Cephalalgia 2012; 33:143. [PMID: 23162044 DOI: 10.1177/0333102412468678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Kara I, Ciftci I, Apiliogullari S, Arun O, Duman A, Celik JB. Management of postdural puncture headache with epidural saline patch in a 10-year-old child after inguinal hernia repair: a case report. J Pediatr Surg 2012; 47:e55-7. [PMID: 23084234 DOI: 10.1016/j.jpedsurg.2012.07.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/02/2012] [Accepted: 07/20/2012] [Indexed: 10/27/2022]
Abstract
Spinal anesthesia (SA) is becoming increasingly popular among pediatric anesthetists. Postdural puncture headache (PDPH) has been reported in children. PDPH generally spontaneously resolves within a few days with bed rest and nonopioid analgesics, but it may last for several days. If the symptoms persist, an epidural blood patch is considered as an effective treatment. We describe the successful use of an epidural saline patch in a 10 year-old child with PDPH who did not respond to conservative treatment.
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Affiliation(s)
- Inci Kara
- Department of Anesthesiology and Intensive Care, Selcuk University, Selcuklu Medical Faculty, Konya, Turkey
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21
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Post-Dural Puncture Headache: Haunts the Anaesthetist. Anesth Pain Med 2012. [DOI: 10.5812/aapm.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Apiliogullari S, Celik JB. Post-dural puncture headache: haunts the anaesthetist. Anesth Pain Med 2012; 1:198. [PMID: 24904794 PMCID: PMC4018687 DOI: 10.5812/kowsar.22287523.2849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 11/02/2011] [Accepted: 11/11/2011] [Indexed: 12/01/2022] Open
Affiliation(s)
- Seza Apiliogullari
- Department of Anesthesia and Intensive Care, Selcuk University, Selcuklu Medical Faculty, Konya, Turkey
- Corresponding author: Seza Apiliogullari, Department of Anesthesia and Intensive Care, Selcuk University, Selcuklu Medical Faculty, Konya, Turkey. Tel:+90-5054887014, Fax: +90-3322415000, E-mail:
| | - Jale Bengi Celik
- Department of Anesthesia and Intensive Care, Selcuk University, Selcuklu Medical Faculty, Konya, Turkey
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Eizaga Rebollar R, Tuduri Limousin I, García Palacios MV, Torres Morera LM. [Postdural puncture headache after pediatric inguinal herniotomy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:396-397. [PMID: 21797095 DOI: 10.1016/s0034-9356(11)70095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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