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Li MY, Fei YD, Zhang XX, Chen TW, Li J, Sun XL, Wang ZY. Application of propofol-remifentanil intravenous general anesthesia combined with regional block in pediatric ophthalmic surgery. BMC Anesthesiol 2024; 24:147. [PMID: 38632505 PMCID: PMC11022467 DOI: 10.1186/s12871-024-02531-8] [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: 01/24/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE The aim of this study is to observe the anesthetic effect and safety of intravenous anesthesia without muscle relaxant with propofol-remifentanil combined with regional block under laryngeal mask airway in pediatric ophthalmologic surgery. METHODS A total of 90 undergoing ophthalmic surgery were anesthetized with general anesthesia using the laryngeal mask airway without muscle relaxant. They were randomly divided into two groups: 45 children who received propofol-remifentanil intravenous anesthesia combined with regional block (LG group), and 45 children who received total intravenous anesthesia (G group). The peri-operative circulatory indicators, awakening time after general anesthesia, postoperative analgesic effect and the incidence of anesthesia-related adverse events were respectively compared between the two groups. RESULTS All the children successfully underwent the surgical procedure. The awakening time after general anesthesia and removal time of laryngeal mask were significantly shorter in the LG group than in the G group (P < 0.05). There was no statistically significant difference in the heart rates in the perioperative period between the two groups (P > 0.05). There was no statistically significant difference in the incidence of intraoperative physical response, respiratory depression, postoperative nausea and vomiting (PONV) and emergence agitation (EA) between the two groups (P > 0.05). The pain score at the postoperative hour 2 was lower in the LG group than in the G group (P < 0.05). CONCLUSION Propofol-remifentanil intravenous anesthesia combined with long-acting local anesthetic regional block anesthesia, combined with laryngeal mask ventilation technology without muscle relaxants, can be safely used in pediatric eye surgery to achieve rapid and smooth recovery from general anesthesia and better postoperative analgesia. This anesthesia scheme can improve the comfort and safety of children in perioperative period, and has a certain clinical popularization value.
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Affiliation(s)
- Ming-Ying Li
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Street, Beijing, 100043, China
| | - Yu-Da Fei
- Department of Anesthesiology, Eye Hospital China Academy of Chinese Medical Sciences, Beijing, 100040, China
| | - Xiao-Xia Zhang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Street, Beijing, 100043, China.
| | - Tian-Wen Chen
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Street, Beijing, 100043, China
| | - Jie Li
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Street, Beijing, 100043, China
| | - Xiao-Li Sun
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Street, Beijing, 100043, China
| | - Zhen-Yuan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Street, Beijing, 100043, China
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Handlogten K. Pediatric regional anesthesiology: a narrative review and update on outcome-based advances. Int Anesthesiol Clin 2024; 62:69-78. [PMID: 38063039 DOI: 10.1097/aia.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Kathryn Handlogten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Pace D, Mack SJ, Sadacharam K, Lang RS, Burke B, Fishlock K, Berman L. Implementation of a quadratus lumborum regional block protocol with assessment of effectiveness for patients with appendicitis: a quality improvement project. Pediatr Surg Int 2023; 39:267. [PMID: 37676327 DOI: 10.1007/s00383-023-05522-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE This study analyzes the implementation of the routine use of quadratus lumborum blocks (QLBs) on postoperative pain and opioid consumption among children undergoing laparoscopic appendectomy compared to those not receiving regional anesthesia. METHODS Children undergoing laparoscopic appendectomy within a multi-hospital children's healthcare system were retrospectively reviewed from 2017 to 2021. Patients were stratified by appendicitis type (uncomplicated vs. complicated). Pain scores and opioid consumption in the post-anesthesia care unit (PACU) and within the first 24 h postoperatively were compared by block status (no block [NB] vs. QLB) and appendicitis type. RESULTS 2033 patients were reviewed, and 610 received a QLB. The frequency of rescue opioid use was reduced in the PACU (uncomplicated: QLB 46.6% vs. NB 54.6%, p = 0.005; complicated: QLB 28.5% vs. NB 39.9%, p = 0.01) and postoperatively (complicated: QLB 33.7% vs. NB 52.9%, p < 0.001) for those who received a QLB. This resulted in reduced opioid consumption as measured by morphine milligram equivalents per kilogram postoperatively. CONCLUSION QLBs can be safely administered in children and provide improvements in opioid consumption postoperatively. QLBs should remain a strongly favored regional anesthetic technique because of their wide applicability for abdominal surgeries to minimize rescue opioid analgesic use. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devon Pace
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, USA.
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 613, Philadelphia, PA, 19107, USA.
| | - Shale J Mack
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kesavan Sadacharam
- Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, DE, USA
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert S Lang
- Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, DE, USA
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian Burke
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Keith Fishlock
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Division of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, USA
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Zheng S, Xu L, Zhou Y, Zhang W, Zhao Y, Hu L, Zheng S, Wang G, Wang T. General anesthesia combined with bilateral 2-level erector spinae plane block may accelerate postoperative gastrointestinal function recovery and rehabilitation process in patients undergoing posterior lumbar surgery: A randomized controlled trial. Surgery 2023; 174:647-653. [PMID: 37429768 DOI: 10.1016/j.surg.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND This randomized controlled trial explored whether bilateral 2-level erector spinae plane block could accelerate postoperative gastrointestinal function and rehabilitation in patients undergoing posterior lumbar surgery. METHODS A total of 80 adult patients undergoing posterior lumbar surgery between March 2021 and August 2021 were randomized to either ultrasound-guided bilateral 2-level erector spinae plane block (group E) or not (group C). General anesthesia was routinely performed. The primary outcome was the time of the first flatus after surgery. We also recorded the first food and liquid intake, first off-bed activity, days of hospital stay, and postoperative complications. Postoperative visual analog scale score and opioid consumption were also recorded. A venous blood sample was taken to measure the serum concentration of lipopolysaccharides, c-reactive protein, tumor necrosis factor-alpha, interleukin-6, and blood glucose before induction of anesthesia, immediately after, and 24 and 48 hours after surgery. RESULTS Seventy-seven patients, 39 in group C and 38 in group E, finished the trial. Patients in group E had a significantly shorter time to first flatus (16.2 ± 3.2 vs 19.7 ± 3.0 hours, P < .05), earlier liquid intake (1.7 ± 0.2 vs 1.9 ± 0.3 hours, P < .05), earlier food intake (1.9 ± 0.2 vs 2.1 ± 0.3 hours, P < .05), and first off-bed activity (27.9 ± 3.2 vs 31.4 ± 3.3 h, P < .05). Patients in group E had shorter postoperative hospital stay (4.6 [4.2-5.5] d vs 5.4 [4.5-6.3], P < .05). We found that patients in group E had less pain and total sufentanil consumption (129 [120-133] vs 138 [132-147] μg, P < .05) within 24 hours after surgery. At 24 hours after surgery, the serum concentrations of lipopolysaccharides, tumor necrosis factor-alpha, interleukin-6, and C-reactive protein in group E were significantly decreased compared to group C (P < .05). CONCLUSION Bilateral 2-level erector spinae plane block can accelerate gastrointestinal function recovery and shorten the length of hospital stay in patients undergoing open posterior lumbar surgery. The potential mechanism may attribute to the opioids-sparing effects and anti-stress-related anti-inflammatory effects of bilateral 2-level erector spinae plane block.
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Affiliation(s)
- Shaoqiang Zheng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Xu
- Department of Anesthesiology, Beijing Jishuitan Hospital, China
| | - Yan Zhou
- Department of Anesthesiology, Beijing Jishuitan Hospital, China
| | - Wenchao Zhang
- Department of Anesthesiology, Beijing Jishuitan Hospital, China
| | - Yaoping Zhao
- Department of Anesthesiology, Beijing Jishuitan Hospital, China
| | - Lin Hu
- Department of Spinal Surgery, Beijing Jishuitan Hospital, China
| | - Shan Zheng
- Department of Spinal Surgery, Beijing Jishuitan Hospital, China
| | - Geng Wang
- Department of Spinal Surgery, Beijing Jishuitan Hospital, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Pace D, Mack SJ, Gong J, Sadacharam K, Lang RS, Burke B, Fishlock K, Berman L. Patient-Reported Outcomes in Pain Management After Ambulatory Pediatric General and Urologic Surgery. J Pediatr Surg 2023; 58:1816-1823. [PMID: 36894445 DOI: 10.1016/j.jpedsurg.2023.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Many studies evaluating opioid stewardship interventions' effects on postoperative pain rely on emergency department (ED) visits or readmissions, but patient-reported pain scores represent a more complete picture of the postoperative experience. This study compares patient-reported pain scores after ambulatory pediatric and urologic procedures and the effect of an opioid stewardship intervention that nearly eliminated the use of outpatient narcotics. METHODS This is a retrospective comparative study including 3173 pediatric patients who underwent ambulatory procedures from 2015 to 2019, during which there was an intervention to reduce narcotic prescriptions. Postoperative day one phone calls assessed pain levels using a four-point scale (no pain, mild pain, moderate pain controlled with medication, or severe pain uncontrolled with medication). We quantified the proportion of patients prescribed opioids pre-versus post-intervention and compared pain scores for patients receiving opioid versus non-opioid regimens. RESULTS Opioid prescription rates demonstrated a 6.5-fold reduction after opioid stewardship efforts. The majority of patients (2838) received non-opioids, with only 335 patients receiving opioids. Opioid patients reported moderate/severe pain slightly more than non-opioid patients (14.1% vs. 10.4%, p = 0.04). On by-procedure analyses, there were no subgroups in which non-opioid patients reported significantly higher pain scores. CONCLUSIONS Non-opioid postoperative pain regimens appear to be effective, with only 10.4% of patients reporting moderate/severe pain after ambulatory procedures. Future studies assessing patient-reported outcomes are necessary to optimize pain control for all patients and to determine whether there is ever an indication for opioid prescription after ambulatory general pediatric or urologic surgery. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devon Pace
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | - Shale J Mack
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia Gong
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Kesavan Sadacharam
- Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert S Lang
- Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian Burke
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Keith Fishlock
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
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Cruz-Suárez GA, Rebellón Sánchez DE, Torres-Salazar D, Arango Sakamoto A, López-Erazo LJ, Quintero-Cifuentes IF, Vélez-Esquivia MA, Jaramillo-Valencia SA, Suguimoto-Erasso AJT. Postoperative Outcomes of Analgesic Management with Erector Spine Plane Block at T5 Level in Pediatric Patients Undergoing Cardiac Surgery with Sternotomy: A Cohort Study. Local Reg Anesth 2023; 16:1-9. [PMID: 36798075 PMCID: PMC9926978 DOI: 10.2147/lra.s392307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/16/2022] [Indexed: 02/11/2023] Open
Abstract
Introduction There is limited evidence on the impact of erector spinae plane block (ESPB) as part of multimodal analgesia in pediatric population undergoing cardiac surgery. Methods A retrospective cohort study was conducted in patients under 18 years of age, who underwent cardiac surgery Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) ≤3 by sternotomy. The study aims to evaluate the effect of ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery compared to conventional analgesia (CA) on relevant clinical outcomes: length of hospital stay, length of ICU stay, opioid consumption, time to extubation, mortality, and postoperative complications. The participants included were treated in a reference hospital in Colombia from July 2019 to June 2022. Results Eighty participants were included, 40 in the ESPB group and 40 in the CA group. There was a significant decrease (Log rank test p = 0.007) in days to length of hospital stay in ESPB group (median 6.5 days (IQR: 4-11)) compared to the CA group (median 10.5 days (IQR: 6-25)). Likewise, there was a higher probability of discharge from the ICU in the ESPB group (HR 1.71 (95% CI: 1.05-2.79)). The ESPB group had lower opioid consumption (p < 0.05). There were no differences in time to extubation, mortality, and postoperative complications. Conclusion ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery is feasible and associated with shorter hospital length of stay, faster ICU discharge and lower opioid consumption.
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Affiliation(s)
- Gustavo A Cruz-Suárez
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia,Correspondence: Gustavo A Cruz-Suárez, Fundación Valle del Lili, Anesthesiology Department, Cra. 98 # 18-49, Cali, 760032, Colombia, Tel +576023319090; Ext 4022, Email
| | - David E Rebellón Sánchez
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Universidad Icesi, Cali, Colombia,Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, 760032, Colombia
| | - Daniela Torres-Salazar
- Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | - Akemi Arango Sakamoto
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, 760032, Colombia
| | - Leidy Jhoanna López-Erazo
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | - Iván F Quintero-Cifuentes
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | - María A Vélez-Esquivia
- Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
| | | | - Antonio J T Suguimoto-Erasso
- Fundación Valle del Lili, Anesthesiology Department, Cali, 760032, Colombia,Universidad Icesi, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Cali, Colombia
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Yan TT, Yang XL, Wang S, Chen JQ, Hu JC, Zhou L, Gao W. Application of Continuous Sacral Block Guided by Ultrasound After Comprehensive Sacral Canal Scanning in Children Undergoing Laparoscopic Surgery: A Prospective, Randomized, Double-Blind Study. J Pain Res 2023; 16:83-92. [PMID: 36647434 PMCID: PMC9840437 DOI: 10.2147/jpr.s391501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose The present study aimed to explore the effects of continuous sacral block on the postoperative pain of children and the satisfaction of the nurses in post-anesthesia care unit (PACU). Also, the influence of the modified protocol of continuous sacral block was investigated. Patients and Methods A total of 60 children undergoing laparoscopic surgery were randomly divided into two groups: GI and GC groups. The general anesthesia was induced with midazolam, propofol, sufentanil and succinylcholine in both groups. In addition, the patients were subjected to continuous sacral block with levobupivacaine in group GC. The modified protocol of continuous sacral block was divided into three steps: comprehensive lumbar and sacral vertebral canal scanning by ultrasound, catheterization and administration. The EVENDOL pain scales and pediatric anesthesia emergence delirium scales of the children were evaluated at 5 min after extubation (T3), 90 min (T4), and 4 h (T5) after the operation. The nurses' satisfaction scores at T3 -T4 and adverse events, such as nausea and vomiting, were also recorded, after the operation. Results After ultrasonic scanning, one patient in group GC was excluded due to the sacral hiatus atresia, which might lead to failure of catheterization. Data of 59 patients were collected for statistical analysis. Compared to the GI group, the EVENDOL scores and the pediatric anesthesia emergence delirium scales were reduced at T3, T4, and T5 (P < 0.05) in group GC. Furthermore, there was a higher rank of PACU nurses' satisfaction in the GC group compared to the GI group (P < 0.05). Conclusion Based on the modified protocol, continuous sacral block provides reliable and safety analgesia for children undergoing laparoscopic surgery, thereby improving the satisfaction of PACU nurses.
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Affiliation(s)
- Ting-ting Yan
- Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Xin-lu Yang
- Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Shan Wang
- Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Jia-qi Chen
- Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Ji-cheng Hu
- Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Ling Zhou
- Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Wei Gao
- Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China,Correspondence: Wei Gao; Ling Zhou, Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China, Tel +86-15605690073; +86-13866702756, Fax +86-551-62283912, Email ;
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Semmelmann A, Loop T. [Anesthetic Management in Pediatric Thoracic Surgery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:550-562. [PMID: 36049739 DOI: 10.1055/a-1690-5620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pediatric thoracic anesthesia is a challenging task. Specific implications arise from the patients' developmental stage, the disease and the intervention. An interdisciplinary management plan includes relevant factors. The main aspects are airway management, analgesic techniques and cardiorespiratory therapeutic strategies adapted to the underlying pathophysiology. Every step should be designed to provide optimal care. This article provides insight to specific airway, respiratory and regional anesthesia management in pediatric patients.
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Lončar-Stojiljković D, Maksimović Ž, Đurić M. Use of an ultrashort-acting selective β1-adrenergic receptor antagonist esmolol in ear, nose and throat surgery. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-37135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background / Aim: The concept of general balanced anaesthesia was devised in order to assure cardiovascular stability and fast post-anaesthesia recovery. This clinical trial was organised in order to investigate the parameters of cardiovascular function and emergence from anaesthesia in elective ear, nose and throat (ENT) surgery patients. Methods: A total of 40 ASA I and II patients of both sexes scheduled for elective ENT surgery were randomly divided into two equal groups. Both groups received a continuous IV infusion of glucose 5 % solution and in the esmolol group this infusion also contained esmolol. Esmolol infusion rate was 0.3 mg/kg/min during the first 5 min and thereafter 0.1 mg/kg/min. In critical phases of anaesthesia and operation (induction, intubation, first incision, surgical manipulations, wound suture, extubation), systolic and diastolic blood pressure were monitored. Recovery after anaesthesia was assessed based on times of eye opening on command, spontaneous eye opening and regaining of full orientation. Increases in cardiovascular parameters by 20 % of the baseline values or more were treated with IV boluses of fentanyl, alone or with droperidol and, if necessary, by adding isoflurane 0.5 % to the inhalational mixture. Consumption of drugs was recorded. Results: Esmolol assured stable values of cardiovascular parameters that were in most critical phases of anaesthesia and operation lower than in the control group. The duration of anaesthesia did not differ between the groups. In the esmolol group, lower consumption of fentanyl, droperidol and sevoflurane was registered. Patients in the esmolol group emerged from anaesthesia faster than patients in the control group. Conclusion: Continuous IV infusion of esmolol assures better cardiovascular stability, necessitates lower consumption of analgesics and anaesthetics and results in faster emergence from general anaesthesia in elective ENT surgery.
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Lin Z, Fang Y, Yan L, Lin Y, Liu M, Zhang B, He Y, Shen Y, Wu D, Zhang L. General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study. BMC Anesthesiol 2021; 21:209. [PMID: 34461833 PMCID: PMC8404309 DOI: 10.1186/s12871-021-01431-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. METHODS A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. RESULTS A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000). CONCLUSION General anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.
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Affiliation(s)
- Zhixiong Lin
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yifan Fang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Lei Yan
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yu Lin
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Mingkun Liu
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Bing Zhang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yuanbing He
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yong Shen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Dianming Wu
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Longxin Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fuzhou, 350001, Fujian, China.
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Evaluation of the effect of lidocaine epidural injection on immunological indices in dogs under total intravenous anesthesia submitted to ovariohysterectomy. PLoS One 2021; 16:e0253731. [PMID: 34181674 PMCID: PMC8238226 DOI: 10.1371/journal.pone.0253731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
This study aimed to evaluate the effects of epidural anaesthesia with lidocaine in combination with general anaesthesia with propofol on some immunologic indices in dogs undergoing ovariohysterectomy. Twelve adult dogs were anesthetized with propofol (induction: 7 mg/kg; maintenance: 0.4 mg/kg/min) and were then allocated into either groups of epidural saline (control) or epidural lidocaine (4 mg/kg; treatment). All the included animals underwent ovariohysterectomy operation. The immune responses, hematologic parameters and cortisol levels were assessed in the predetermined intervals. Evaluation of the innate immunity revealed higher significant levels in the bactericidal, lysozyme and myeloperoxidase activities at 4 hours after surgery in the treatment. In the humoral immunity, the total immunoglobulin level was significantly higher in the treatment. In the assessment of cellular immunity, higher significant values were detected in the delayed skin sensitivity to phytohemagglutinine injection after 48 and 72 hours in the treatment. Moreover, higher significant levels were observed in the number and percentage of lymphocytes as well as an increase in the percentage of monocytes in the treatment at 4 hours after the operation. Notably, the cortisol hormone in the treatment was lower than control at 4 hours of the surgery. In conclusion, epidural anaesthesia with lidocaine when added to general anaesthesia with propofol attenuated the suppression of the innate and cellular immune responses produced by anaesthesia and surgery in the dogs.
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12
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Egbuta C, Mason KP. Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit. J Clin Med 2021; 10:1847. [PMID: 33922824 PMCID: PMC8122992 DOI: 10.3390/jcm10091847] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
Critically ill pediatric patients often require complex medical procedures as well as invasive testing and monitoring which tend to be painful and anxiety-provoking, necessitating the provision of analgesia and sedation to reduce stress response. Achieving the optimal combination of adequate analgesia and appropriate sedation can be quite challenging in a patient population with a wide spectrum of ages, sizes, and developmental stages. The added complexities of critical illness in the pediatric population such as evolving pathophysiology, impaired organ function, as well as altered pharmacodynamics and pharmacokinetics must be considered. Undersedation leaves patients at risk of physical and psychological stress which may have significant long term consequences. Oversedation, on the other hand, leaves the patient at risk of needing prolonged respiratory, specifically mechanical ventilator, support, prolonged ICU stay and hospital admission, and higher risk of untoward effects of analgosedative agents. Both undersedation and oversedation put critically ill pediatric patients at high risk of developing PICU-acquired complications (PACs) like delirium, withdrawal syndrome, neuromuscular atrophy and weakness, post-traumatic stress disorder, and poor rehabilitation. Optimal analgesia and sedation is dependent on continuous patient assessment with appropriately validated tools that help guide the titration of analgosedative agents to effect. Bundled interventions that emphasize minimizing benzodiazepines, screening for delirium frequently, avoiding physical and chemical restraints thereby allowing for greater mobility, and promoting adequate and proper sleep will disrupt the PICU culture of immobility and reduce the incidence of PACs.
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Affiliation(s)
| | - Keira P. Mason
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA;
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Lončar-Stojiljković D, Maksimović Ž, Đurić M. Esmolol as an adjunct to general balanced anaesthesia in neurosurgery. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-35617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background/Aim: In surgery, and especially in the neurosurgical operations, maintenance of cardiovascular stability during and in the phase of the immediate postoperative recovery is of vital importance. The aim of this study was to investigate the effects of continuous esmolol infusion on the values of cardiovascular parameters and quality of the emergence from anaesthesia in neurosurgical patients. Methods: A total of 40 patients of both sexes scheduled for elective supratentorial surgery were randomly assigned to two groups. Esmolol group received intravenous (iv) infusion of esmolol dissolved in 5 % glucose solution (during the first 5 min at a rate of 0.3 mg/kg/min and thereafter at a rate of 0.1 mg/kg/min), while the ones from the control group received a 5 % glucose solution without esmolol at the same volume and rate. Cardiovascular parameters were registered at critical phases of anaesthesia and operation (induction, intubation, placement of Mayfield frame, craniotomy, skull closure, extubation). Recovery after anaesthesia was assessed based on times of eye opening on command, spontaneous eye opening and regaining of full orientation. Results: Values of systolic blood pressure and heart rate were significantly lower in the esmolol than in the control group of patients. Although the durations of anaesthesia did not differ, patients from the esmolol group required significantly less opioids and isoflurane and recovered after the anaesthesia significantly faster than the patients in the control group. Conclusion: Ultrashort-acting beta-adrenergic receptor antagonist esmolol, administered as a continuous iv infusion, assures better cardiovascular stability and smoother emergence from the balanced inhalation general anaesthesia than the control glucose infusion in elective neurosurgical patients.
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Abdelbaser II, Mageed NA. Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind, controlled study. J Clin Anesth 2020; 67:110002. [DOI: 10.1016/j.jclinane.2020.110002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
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15
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Falciola V, Boretsky K. Quadratus lumborum and rectus sheath blocks in an infant with severe pulmonary hypertension undergoing laparoscopic cholecystectomy. J Clin Anesth 2020; 64:109831. [PMID: 32305786 DOI: 10.1016/j.jclinane.2020.109831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/12/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
- V Falciola
- Département d'Anesthésiologie, Hôpitaux Universitaires de Genève, Geneve, Switzerland; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - K Boretsky
- Département d'Anesthésiologie, Hôpitaux Universitaires de Genève, Geneve, Switzerland; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America.
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Pasma W, Peelen LM, Broek S, Buuren S, Klei WA, Graaff JC. Patient and anesthesia characteristics of children with low pre-incision blood pressure: A retrospective observational study. Acta Anaesthesiol Scand 2020; 64:472-480. [PMID: 31833065 PMCID: PMC7079014 DOI: 10.1111/aas.13520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative blood pressure has been suggested as a key factor for safe pediatric anesthesia. However, there is not much insight into factors that discriminate between children with low and normal pre-incision blood pressure. Our aim was to explore whether children who have a low blood pressure during anesthesia are different than those with normal blood pressure. The focus of the present study was on the pre-incision period. METHODS This retrospective study included pediatric patients undergoing anesthesia for non-cardiac surgery at a tertiary pediatric university hospital, between 2012 and 2016. We analyzed the association between pre-incision blood pressure and patient- and anesthesia characteristics, comparing low with normal pre-incision blood pressure. This association was further explored with a multivariable linear regression. RESULTS In total, 20 962 anesthetic cases were included. Pre-incision blood pressure was associated with age (beta -0.04 SD per year), gender (female -0.11), previous surgery (-0.15), preoperative blood pressure (+0.01 per mm Hg), epilepsy (0.12), bronchial hyperactivity (-0.18), emergency surgery (0.10), loco-regional technique (-0.48), artificial airway device (supraglottic airway device instead of tube 0.07), and sevoflurane concentration (0.03 per sevoflurane %). CONCLUSIONS Children with low pre-incision blood pressure do not differ on clinically relevant factors from children with normal blood pressure. Although the present explorative study shows that pre-incision blood pressure is partly dependent on patient characteristics and partly dependent on anesthetic technique, other unmeasured variables might play a more important role.
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Affiliation(s)
- Wietze Pasma
- Department of Anesthesiology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Linda M. Peelen
- Department of Anesthesiology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Department of Epidemiology Julius Center for Health Sciences and Primary Care Utrecht University Utrecht the Netherlands
| | - Stefanie Broek
- Department of Anesthesiology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Stef Buuren
- Department of Methodology & Statistics, FSS University of Utrecht Utrecht the Netherlands
- Netherlands Organization for Applied Scientific Research TNO Delft the Netherlands
| | - Wilton A. Klei
- Department of Anesthesiology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Jurgen C. Graaff
- Department of Anesthesiology Erasmus MC—Sophia Children's Hospital Rotterdam the Netherlands
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Benka AU, Pandurov M, Galambos IF, Rakić G, Vrsajkov V, Drašković B. [Effects of caudal block in pediatric surgical patients: a randomized clinical trial]. Rev Bras Anestesiol 2020; 70:97-103. [PMID: 32204919 DOI: 10.1016/j.bjan.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. OBJECTIVES The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. METHODS This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient. RESULTS Children who received a caudal block had significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01) and pain scores 3 hours (p = 0.002) and 6 hours (p = 0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group. CONCLUSIONS The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.
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Affiliation(s)
- Anna Uram Benka
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
| | - Marina Pandurov
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia.
| | - Izabella Fabri Galambos
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
| | - Goran Rakić
- Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia; University of Novi Sad, Medical Faculty, Department of Emergency Medicine, Novi Sad, República da Sérvia
| | - Vladimir Vrsajkov
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Clinical Centre of Vojvodina, Clinic of Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
| | - Biljana Drašković
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
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18
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Benka AU, Pandurov M, Galambos IF, Rakić G, Vrsajkov V, Drašković B. Effects of caudal block in pediatric surgical patients: a randomized clinical trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32204919 PMCID: PMC9373225 DOI: 10.1016/j.bjane.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. Objectives The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. Methods This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient. Results Children who received a caudal block had significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01) and pain scores 3 h (p = 0.002) and 6 h (p = 0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group. Conclusions The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.
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Abstract
Regional anesthesia provides effective anesthesia and pain relief in infants with age-specific data attesting to safety and efficacy. Regional anesthesia decreases exposure to opioids and general anesthetic agents and associated adverse drug effects, suppresses the stress response, and provides better hemodynamic stability compared to general anesthesia. Regional anesthesia can prevent long-term behavioral responses to pain. As a result, the overall number and variety of nerve blocks being used in infants is increasing. While neuraxial blocks are the most common blocks performed in infants, the introduction of ultrasound imaging and a better safety profile has advanced the use of peripheral nerve blocks. Infant-specific pharmacokinetic and pharmacodynamic data of local anesthetic medications are reviewed including risk factors for the accumulation of high serum levels of unbound, pharmacologically active drug. Bupivacaine accumulates with continuous infusion and 2-chloroprocaine can be used as an alternative. Local anesthetic systemic toxicity has the highest incidence in infants less than 6 months of age and is associated with bolus dosing and penile nerve blocks. Local anesthetic toxicity is treated by securing the airway, suppression of seizure activity and implementation of cardiopulmonary resuscitation. Administration of intralipid (intravenous lipid emulsion) is initiated at the first sign of toxicity. A high level of expertise in regional anesthesia is needed when treating infants due to their unique development.
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21
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Schindler E, Turner NM. Beyond the spine: Local anesthetic blocks in pediatric cardiac surgery. Paediatr Anaesth 2019; 29:403-404. [PMID: 31099467 DOI: 10.1111/pan.13623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Ehrenfried Schindler
- Department of Paediatric Anaesthesiology, Children´s Hospital Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
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22
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Daaboul DG, DiNardo JA, Nasr VG. Anesthesia for high-risk procedures in the catheterization laboratory. Paediatr Anaesth 2019; 29:491-498. [PMID: 30592354 DOI: 10.1111/pan.13571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/18/2018] [Accepted: 12/24/2018] [Indexed: 12/17/2022]
Abstract
Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus-dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic-related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.
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Affiliation(s)
- Dima G Daaboul
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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23
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Raj N. Regional anesthesia for sternotomy and bypass-Beyond the epidural. Paediatr Anaesth 2019; 29:519-529. [PMID: 30861264 DOI: 10.1111/pan.13626] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 12/18/2022]
Abstract
Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution, and duration of pain in these children have not been studied as extensively as in adults. Currently, there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response while minimizing their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimize opioid-related side effects, but this may not obtund the stress response in all children. The development of chronic pain although rare when compared to adults is still a risk that needs further investigation. Regional anesthetic techniques, by blocking the afferent impulses, have been shown to be advantageous in reducing the stress response to surgery as well as pain and opioid requirements in children up to 24 hours after cardiac surgery. Central neuraxial blockades have not gained wide spread acceptance in these procedures due to the worry of hematoma, although rare, leading to catastrophic neurological outcomes. This review focuses on blocks outside the vertebral column, ie, peripheral nerve blocks, performed either in the front or the back of the chest wall to target the thoracic intercostal nerves. Techniques of ultrasound-guided bilateral single shot paravertebral block and erector spinae block posteriorly and transversus thoracic plane block anteriorly are discussed. In addition, parasternal block and wound infiltration by surgeon as well as continuous local anesthetic infusion via catheters placed at end of procedures are summarized. Current evidence available for use of these techniques in children undergoing cardiac surgery are reviewed. These are based on small studies and case series and further studies are required to evaluate the risks and benefits of local anesthetic blocks in children undergoing cardiac surgery.
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Affiliation(s)
- Naveen Raj
- Jackson Rees Department of Anesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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24
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The Incidence of and Risk Factors for Postoperative Fever after Cleft Repair Surgery in Children. J Pediatr Nurs 2019; 45:e89-e94. [PMID: 30738633 DOI: 10.1016/j.pedn.2019.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE The characteristics of postoperative fever after cleft repair surgery in children are unknown. Thus, the purpose of this study was to determine the incidence of and risk factors for postoperative fever. DESIGN AND METHODS We retrospectively assessed 328 children who underwent cleft surgery at our hospital between March 2016 and April 2017 and were followed up for at least 3 days postoperatively. Fever was defined as a body temperature ≥38.0 °C. RESULTS Seventy-one percent (n = 233) of patients developed fever within 72 h postoperatively, and most cases of postoperative fever were benign. Patients most frequently developed fever within 24 h postoperatively, and the occurrence of fever significantly decreased between 24 and 72 h postoperatively (p < 0.001). The incidence of fever with temperatures between 38.0 °C and 39.0 °C was higher than that of fever with temperatures ≥39.0 °C (p < 0.001). The mean duration of an episode of fever was 4 h. The type of surgery, method of anesthesia, and duration of anesthesia and surgery were found to be correlated with postoperative fever after cleft surgery. CONCLUSIONS Most cases of postoperative fever after cleft surgery were benign occurrences. Postoperative fever after cleft repair surgery was characterized by a low grade, an early onset and a short duration in children. The method of anesthesia, duration of surgery and duration of anesthesia were risk factors for postoperative fever. PRACTICE IMPLICATIONS Our results could help healthcare providers to gain increased knowledge of the risk factors for fever and when and how to treat postoperative fever.
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Cunningham ME, Vogel AM. Analgesia, sedation, and delirium in pediatric surgical critical care. Semin Pediatr Surg 2019; 28:33-42. [PMID: 30824132 DOI: 10.1053/j.sempedsurg.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The alleviation of discomfort and distress is an essential component of the management of critically ill surgical patients. Pain and anxiety have multifocal etiologies that may be related to an underlying disease or surgical procedure, ongoing medical therapy, invasive monitors, an unfamiliar, complex and chaotic environment, as well as fear. Pharmacologic and non-pharmacologic therapies have complex risk benefit profiles. A fundamental understanding of analgesia, sedation, and delirium is essential for optimizing important outcomes in critically ill pediatric surgical patients. There has been a recent emphasis on goal directed, evidence based, and patient-centered management of the physical and psychological needs of these children. The purpose of this article is to review and summarize recent advances and describe current practice of these important subjects in the pediatric surgical intensive care environment.
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Affiliation(s)
- Megan E Cunningham
- Texas Children's Hospital, Division of Pediatric Surgery, Department of Surgery, 6701 Fannin Street, Houston, TX 77030, USA.
| | - Adam M Vogel
- Texas Children's Hospital, Division of Pediatric Surgery, Department of Surgery, 6701 Fannin Street, Houston, TX 77030, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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26
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Regional anesthetic techniques for the thoracic limb and thorax in small animals: A review of the literature and technique description. Vet J 2018; 241:8-19. [DOI: 10.1016/j.tvjl.2018.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
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Retrobulbar Block in Pediatric Vitreoretinal Surgery Eliminates the Need for Intraoperative Fentanyl and Postoperative Analgesia: A Randomized Controlled Study. Reg Anesth Pain Med 2018; 42:521-526. [PMID: 28492439 DOI: 10.1097/aap.0000000000000610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric ophthalmologic surgery is traditionally accomplished by general anesthesia with opioids, but respiratory depression remains a major concern. Our study compared the efficacy of retrobulbar block with systemic fentanyl on pain, hemodynamic, and stress response in pediatric vitreoretinal surgery. METHODS A prospective double-blind, randomized controlled study was performed comparing retrobulbar block with intravenously administered fentanyl in 28 children aged 1 to 6 years undergoing vitreoretinal surgery. After general anesthesia was induced, retrobulbar block with 0.5% ropivacaine was accomplished in group RB (general anesthesia plus retrobulbar block) (n = 13), and normal saline was injected into retrobulbar space in group F (general anesthesia alone) (n = 15). Fentanyl 0.5 μg/kg was administered when signs of inadequate anesthesia were observed. RESULTS Respiratory depression (defined as a persistent respiratory rate <10 breaths/min or persistent oxygen desaturation <92%) was observed in 5 of 15 patients in group F after laryngeal mask airway was removed in the operating room, compared with none in group RB. All children in group F consumed intraoperative fentanyl rescue (average intraoperative fentanyl consumption, 1.3 ± 0.3 μg/kg) compared with none in group RB. Pain scores assessed with Faces, Legs, Activity, Cry and Consolability were significantly lower in group RB than in group F (1 [0, 3.5] vs 5 [3, 7], P = 0.003) immediately after laryngeal mask airway removal. Heart rate in group RB was significantly lower than that in group F before anesthesia induction, at the beginning and end of surgery, respectively. Mean blood pressure in group RB was significantly lower than that in group F at the beginning of surgery. Postoperative tumor necrosis factor α concentration in group RB was significantly lower than that in group F. CONCLUSIONS Retrobulbar block is safe and effective as an alternative to systemic fentanyl and could provide better pain management, hemodynamic suppression, and stress response suppression in pediatric vitreoretinal surgery.
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Is spinal anaesthesia in young infants really safer and better than general anaesthesia? Curr Opin Anaesthesiol 2018; 31:302-307. [DOI: 10.1097/aco.0000000000000578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Semmelmann A, Kaltofen H, Loop T. Anesthesia of thoracic surgery in children. Paediatr Anaesth 2018; 28:326-331. [PMID: 29484775 DOI: 10.1111/pan.13350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 02/06/2023]
Abstract
Providing anesthesia in children with thoracic disease is a challenging task. The effects of the underlying disease, the surgical interventions, and preexisting condition of the patient need to be considered when planning perioperative care. The perioperative care for children undergoing thoracic surgery requires specific techniques adapted to the pediatric physiology and anatomy. This review is focused on anesthetic strategies for thoracic surgery with an emphasis on perioperative analgesia including neuraxial techniques.
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Affiliation(s)
- Axel Semmelmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Heike Kaltofen
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
| | - Torsten Loop
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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Fizzano KM, Claude AK, Kuo LH, Eells JB, Hinz SB, Thames BE, Ross MK, Linford RL, Wills RW, Olivier AK, Archer TM. Evaluation of a modified infraorbital approach for a maxillary nerve block for rhinoscopy with nasal biopsy of dogs. Am J Vet Res 2017; 78:1025-1035. [PMID: 28836847 DOI: 10.2460/ajvr.78.9.1025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether a maxillary nerve block via a modified infraorbital approach, applied before rhinoscopy and nasal biopsy of dogs, would decrease procedural nociception, minimize cardiorespiratory anesthetic effects, and improve recovery quality. ANIMALS 8 healthy adult hound-type dogs PROCEDURES In a crossover study, dogs received 0.5% bupivacaine (0.1 mL/kg) or an equivalent volume of saline (0.9% NaCl) solution as a maxillary nerve block via a modified infraorbital approach. A 5-cm, 20-gauge over-the-needle catheter was placed retrograde within each infraorbital canal, and bupivacaine or saline solution was administered into each pterygopalatine region. Rhinoscopy and nasal biopsy were performed. Variables monitored included heart rate, systolic arterial blood pressure (SAP), mean arterial blood pressure (MAP), diastolic arterial blood pressure (DAP), plasma cortisol and norepinephrine concentrations, purposeful movement, and pain scores. After a 14-day washout period, the other treatment was administered on the contralateral side, and rhinoscopy and nasal biopsy were repeated. RESULTS SAP, MAP, and DAP were significantly higher for the saline solution treatment than for the bupivacaine treatment, irrespective of the time point. Plasma cortisol concentrations after saline solution treatment were significantly higher 5 minutes after nasal biopsy than at biopsy. Heart rate, norepinephrine concentration, purposeful movement, and pain score were not significantly different between treatments. CONCLUSIONS AND CLINICAL RELEVANCE Maxillary nerve block via a modified infraorbital approach prior to rhinoscopy and nasal biopsy reduced procedural nociception as determined on the basis of blood pressures and plasma cortisol concentrations during anesthesia. These findings warrant further evaluation in dogs with nasal disease.
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ŞAVLUK ÖF, KUŞÇU MA, GÜZELMERİÇ F, GÜRCÜ ME, ERKILINÇ A, ÇEVİRME D, OĞUŞ H, KOÇAK T. Do preoperative oral carbohydrates improve postoperative outcomesin patients undergoing coronary artery bypass grafts? Turk J Med Sci 2017; 47:1681-1686. [DOI: 10.3906/sag-1703-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Yuki K, Matsunami E, Tazawa K, Wang W, DiNardo JA, Koutsogiannaki S. Pediatric Perioperative Stress Responses and Anesthesia. TRANSLATIONAL PERIOPERATIVE AND PAIN MEDICINE 2017; 2:1-12. [PMID: 28217718 PMCID: PMC5310630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Surgical stress responses cause an array of endocrinological, metabolic and immunological changes in patients. The landmark studies in the 1980s showed that adequate anesthesia dramatically improved the outcomes of pediatric surgical patients by attenuating stress hormonal responses, pointing out the harm of 'inadequate' anesthesia. Subsequent studies questioned the role of administering very high-dose anesthetics to further attenuate stress responses. Here we review the feature of surgical stress responses in pediatric patients including their difference from those in adult patients. Overall, pediatric patients show minimal or no resting energy expenditure change postoperatively. In adult patients, increased resting energy expenditure has been described. Pediatric patients demonstrated robust cortisol and catecholamine responses than adult patients. However, the duration of these surges is often short-lived. Systemic proinflammatory and anti-inflammatory cytokine levels have been measured. Pediatric patients showed less proinflammatory cytokine elevation, but had similar anti-antiinflamatory responses. We also review in detail the immunological changes in response to surgical stress. Based on our current knowledge, we attempted to understand the underlying mechanism how adequate anesthesia dramatically improved the outcome of patients. Although more work is needed to be done, understanding how pediatric patients respond to perioperative stress, and its mechanism and consequence will allow us to direct us into a better, perioperative management in this population.
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Affiliation(s)
- Koichi Yuki
- Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children’s Hospital, Boston, USA,Harvard Medical School, Boston, USA
| | - Erika Matsunami
- Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children’s Hospital, Boston, USA,Harvard Medical School, Boston, USA
| | - Kazumasa Tazawa
- Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children’s Hospital, Boston, USA,Harvard Medical School, Boston, USA
| | - Wei Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children’s Hospital, Boston, USA,Harvard Medical School, Boston, USA
| | - James A. DiNardo
- Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children’s Hospital, Boston, USA,Harvard Medical School, Boston, USA
| | - Sophia Koutsogiannaki
- Department of Anesthesiology, Perioperative and Pain Medicine, Cardiac Anesthesia Division, Boston Children’s Hospital, Boston, USA,Harvard Medical School, Boston, USA
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Çeliksular MC, Saraçoğlu A, Yentür E. The Influence of Oral Carbohydrate Solution Intake on Stress Response before Total Hip Replacement Surgery during Epidural and General Anaesthesia. Turk J Anaesthesiol Reanim 2016; 44:117-23. [PMID: 27366573 DOI: 10.5152/tjar.2016.65265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 02/11/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The effects of oral carbohydrate solutions, ingested 2 h prior to operation, on stress response were studied in patients undergoing general or epidural anaesthesia. METHODS The study was performed on 80 ASA I-II adult patients undergoing elective total hip replacement, which were randomized to four groups (n=20). Group G patients undergoing general anaesthesia fasted for 8 h preoperatively; Group GN patients undergoing general anaesthesia drank oral carbohydrate solutions preoperatively; Group E patients undergoing epidural anaesthesia fasted for 8 h and Group EN patients undergoing epidural anaesthesia drank oral carbohydrate solutions preoperatively. Groups GN and EN drank 800 mL of 12.5% oral carbohydrate solution at 24:00 preoperatively and 400 mL 2 h before the operation. Blood samples were taken for measurements of glucose, insulin, cortisol and IL-6 levels. RESULTS The effect of preoperative oral carbohydrate ingestion on blood glucose levels was not significant. Insulin levels 24 h prior to surgery were similar; however, insulin levels measured just before surgery were 2-3 times higher in groups GN and EN than in groups G and E. Insulin levels at the 24(th) postoperative hour in epidural groups were increased compared to those at basal levels, although general anaesthesia groups showed a decrease. From these measurements, only the change in Group EN was statistically significant (p<0.05). Plasma cortisol levels at the 2(nd) peroperative hour were higher in epidural groups than in general anaesthesia groups. Both anaesthesia techniques did not have an effect on IL-6 levels. CONCLUSION We concluded that epidural anaesthesia suppressed stress response, although preoperative oral carbohydrate nutrition did not reveal a significant effect on surgical stress response.
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Affiliation(s)
- M Cem Çeliksular
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ayten Saraçoğlu
- Department of Anaesthesiology Aad Reanimation, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ercüment Yentür
- Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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Romano M, Portela DA, Breghi G, Otero PE. Stress-related biomarkers in dogs administered regional anaesthesia or fentanyl for analgesia during stifle surgery. Vet Anaesth Analg 2016; 43:44-54. [DOI: 10.1111/vaa.12275] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 01/28/2015] [Indexed: 01/30/2023]
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Wajekar A. Screening for inpatient hyperglycaemia in surgical patients under 40 years at the time of securing intravenous access on the operative table. Indian J Anaesth 2016; 60:135-7. [PMID: 27013754 PMCID: PMC4787126 DOI: 10.4103/0019-5049.176272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Tedore T, Weinberg R, Witkin L, Giambrone GP, Faggiani SL, Fleischut PM. Acute Pain Management/Regional Anesthesia. Anesthesiol Clin 2015; 33:739-751. [PMID: 26610627 DOI: 10.1016/j.anclin.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Effective and efficient acute pain management strategies have the potential to improve medical outcomes, enhance patient satisfaction, and reduce costs. Pain management records are having an increasing influence on patient choice of health care providers and will affect future financial reimbursement. Dedicated acute pain and regional anesthesia services are invaluable in improving acute pain management. In addition, nonpharmacologic and alternative therapies, as well as information technology, should be viewed as complimentary to traditional pharmacologic treatments commonly used in the management of acute pain. The use of innovative technologies to improve acute pain management may be worthwhile for health care institutions.
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Affiliation(s)
- Tiffany Tedore
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Roniel Weinberg
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Lisa Witkin
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Gregory P Giambrone
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Susan L Faggiani
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Peter M Fleischut
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA.
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Tedore T. Regional anaesthesia and analgesia: relationship to cancer recurrence and survival. Br J Anaesth 2015; 115 Suppl 2:ii34-45. [DOI: 10.1093/bja/aev375] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Onal O, Apiliogullari S, Gunduz E, Celik JB, Senaran H. Spinal anaesthesia for orthopaedic surgery in children with cerebral palsy: Analysis of 36 patients. Pak J Med Sci 2015; 31:189-93. [PMID: 25878641 PMCID: PMC4386184 DOI: 10.12669/pjms.311.5709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 05/28/2014] [Accepted: 10/05/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cerebral palsy is one of the most common childhood neuromuscular diseases in the world. Spinal anaesthesia in children is an evolving technique with many advantages in perioperative management. The aim of this retrospective study was to provide first-hand reports of children with cerebral palsy who underwent orthopaedic surgery under spinal anaesthesia. METHODS Records of the children with cerebral palsy who underwent orthopaedic surgery under spinal anaesthesia between May 2012 and June 2013 at Selcuk University Hospital were investigated. In all patients, lumbar puncture was performed in lateral decubitus position with mask sevoflurane-nitrous oxide anaesthesia. In patients who were calm prior the spinal block, inhalation anaesthesia was terminated. In patients who were restless before the spinal block, anaesthesia was combined with light sevoflurane anaesthesia and a laryngeal mask. From anaesthesia records, the number of attempts required to complete the lumbar puncture, and the success rates of spinal anaesthesia and perioperative complications were noted. Data were expressed as numbers and percentages. RESULTS The study included 36 patients (20 girls and 16 boys). The mean age was 71 months. The rate of reaching subarachnoid space on first attempt was 86%. In all patients, spinal anaesthesia was considered successful. In 26 patients, laryngeal mask and light sevoflurane anaesthesia were required to maintain ideal surgical conditions. No major perioperative complications were observed. CONCLUSION Spinal anaesthesia alone or combined with light sevoflurane anaesthesia is a reliable technique with high success rates in children with cerebral palsy undergoing orthopaedic surgery.
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Affiliation(s)
- Ozkan Onal
- Ozkan Onal, Department of Anaesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
| | - Seza Apiliogullari
- Seza Apiliogullari, Department of Anaesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
| | - Ergun Gunduz
- Ergun Gunduz, Department of Anaesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
| | - Jale Bengi Celik
- Jale Bengi Celik, Department of Anaesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey
| | - Hakan Senaran
- Hakan Senaran, Department of Orthopaedics and Traumatology, Selcuk University Medical Faculty, Konya, Turkey
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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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Milosavljevic SB, Pavlovic AP, Trpkovic SV, Ilić AN, Sekulic AD. Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients. Med Sci Monit 2014; 20:1833-40. [PMID: 25284266 PMCID: PMC4199462 DOI: 10.12659/msm.890981] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the study was to determine the significance of spinal anesthesia in the suppression of the metabolic, hormonal, and hemodynamic response to surgical stress in elective surgical patients compared to general anesthesia. Material/Methods The study was clinical, prospective, and controlled and it involved 2 groups of patients (the spinal and the general anesthesia group) who underwent the same surgery. We monitored the metabolic and hormonal response to perioperative stress based on serum cortisol level and glycemia. We also examined how the different techniques of anesthesia affect these hemodynamic parameters: systolic arterial pressure (AP), diastolic AP, heart rate (HR), and arterial oxygen saturation (SpO2). These parameters were measured before induction on anesthesia (T1), 30 min after the surgical incisions (T2), 1 h postoperatively (T3) and 24 h after surgery (T4). Results Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). Glycemia was significantly higher in the general anesthesia group (p<0.05). There was a statistically significant, positive correlation between serum cortisol levels and glycemia at all times observed (p<0.01). Systolic and diastolic AP did not differ significantly between the groups (p=0.191, p=0.101). The HR was significantly higher in the general anesthesia group (p<0.01). SpO2 values did not differ significantly between the groups (p=0.081). Conclusions Based on metabolic, hormonal, and hemodynamic responses, spinal anesthesia proved more effective than general anesthesia in suppressing stress response in elective surgical patients.
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Affiliation(s)
| | - Aleksandar P Pavlovic
- Department of Surgery, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Sladjana V Trpkovic
- Department of Surgery, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Aleksandra N Ilić
- Department of Preventive Medicine, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Ana D Sekulic
- Department of Anesthesiology, CHC "Bezanijska Kosa", Belgrade, Serbia
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MARHOFER P, LÖNNQVIST PA. The use of ultrasound-guided regional anaesthetic techniques in neonates and young infants. Acta Anaesthesiol Scand 2014; 58:1049-60. [PMID: 25059918 DOI: 10.1111/aas.12372] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 12/14/2022]
Abstract
Optimal pain therapy during the perioperative period or at the neonatal intensive care unit and subsequent reduced use of opioids and various sedative drugs is an important factor for patients care. The use of various regional anaesthetic techniques in experienced hands provides excellent pain relief and has the potency to reduce the requirement for perioperative mechanical ventilation. Most of regional anaesthesia techniques are applicable also in neonates and young infants and can be used in an effective and safe manner. Ultrasound guidance should be used for all regional anaesthetic techniques to increase efficacy and safety. The spectrum of indications for ultrasound-guided regional anaesthesia in babies and infants are surgery, selective pain therapy and sympathicolysis. This review reflects an expert-based description of the most recent developments in ultrasound-guided regional anaesthetic techniques in babies and infants.
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Affiliation(s)
- P. MARHOFER
- Department of Anaesthesia and Intensive Care Medicine; Medical University Vienna; Vienna Austria
| | - P.-A. LÖNNQVIST
- Section of Anaesthesiology and Intensive Care; Department of Physiology and Pharmacology; The Karolinska Institute; Stockholm Sweden
- Paediatric Anaesthesia, Intensive Care and ECMO Services; Karolinska University Hospital-Solna; Stockholm Sweden
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Xiang K, Cai H, Song Z. Comparison of Analgesic Effects of Remifentanil and Fentanyl NCA after Pediatric Cardiac Surgery. J INVEST SURG 2014; 27:214-8. [DOI: 10.3109/08941939.2013.879968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Salman N, Durukan AB, Gurbuz HA, Yamalı H, Guler L, Ucar HI, Yorgancioglu C. Comparison of effects of epidural bupivacaine and intravenous meperidine analgesia on patient recovery following elective abdominal aortic surgery. Med Sci Monit 2013; 19:347-52. [PMID: 23666275 PMCID: PMC3659110 DOI: 10.12659/msm.889005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The efficacy of epidural anesthesia and analgesia in management of perioperative stress has been established. Perioperative pain management strategies decrease surgical complications and aid recovery. In this study, we aimed to document and compare the efficacy of epidural bupivacaine and intravenous meperidine on recovery of patients with elective abdominal aortic surgery performed under general anesthesia. Material/Methods Patients undergoing elective abdominal aortic surgery between February 2009 and November 2011 were studied prospectively. Patients were randomized into epidural bupivacaine (n=40) and intravenous meperidine (n=40) groups regarding postoperative analgesia strategy. The preoperative demographic characteristics, perioperative outcomes, postoperative adverse effects of analgesia strategy, time to initiate oral intake, sedation scores, visual analogue scale results, and mobility scores were compared. Results The mean ages of the patients were 61.7±8.1 in the epidural group and 59.4±9.7 in the intravenous group (p>0.05). The preoperative demographic characteristics of the patients were comparable between the groups. There were no statistically significant differences between groups regarding anesthesia times, intubation times, intensive care unit stay, hospital length of stay, postoperative vomiting, and postoperative cardiac, renal, and cerebral complications. Postoperative nausea was more prevalent in the meperidine group (p<0.05). In the epidural group, time to begin oral intake was shorter, sedation scores and visual analogue scale results were lower, and mobility scores were higher (p<0.05 each). Conclusions Epidural analgesia allowed earlier recovery compared to intravenous analgesia in patients undergoing elective abdominal aortic surgery, but did not affect postoperative outcomes and complications.
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Affiliation(s)
- Nevriye Salman
- Department of Anesthesia, Medicana International Ankara Hospital, Ankara, Turkey
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Chloropoulou P, Iatrou C, Vogiatzaki T, Kotsianidis I, Trypsianis G, Tsigalou C, Paschalidou E, Kazakos K, Touloupidis S, Simopoulos K. Epidural anesthesia followed by epidural analgesia produces less inflammatory response than spinal anesthesia followed by intravenous morphine analgesia in patients with total knee arthroplasty. Med Sci Monit 2013; 19:73-80. [PMID: 23353589 PMCID: PMC3628992 DOI: 10.12659/msm.883749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Anesthesia and inflammatory response have been studied in major abdominal and thoracic surgical procedures, but not in major orthopaedic reconstructive procedures such as total knee arthroplasty. Most studies have compared general anesthesia with epidural anesthesia, but none has compared epidural with spinal. Material/Methods In a prospective randomized study, 2 groups of patients scheduled for total knee arthroplasty for osteoarthritis were evaluated regarding the inflammatory response to 2 types of regional anesthesia. In 30 patients (Group A) with spinal anesthesia followed by intravenous morphine analgesia, and in 26 patients (Group B) with epidural anesthesia followed by epidural analgesia, the inflammatory response was assessed through the calculation of leucocyte concentration (WBC), C-reactive protein (CRP), monocyte chemotactic protein 1 (MCP-1), interleukins (IL-1, IL-6, IL-10, IL-18), TNF-a, and leucocyte activation molecules CD11b and CD62l, in 3 blood samples (immediately before induction to anesthesia, immediately after closure of the operative wound, and at 24 hours post-operatively). Results The MCP-1 values showed a statistically significant increase (p<0.02) in the group of patients with spinal anesthesia. Of the leucocyte activation molecules, a high statistically significant increase was noticed in the expression of CD11b on monocytes in the sample taken 24 hours post-operatively in the patients of group A. Similarly, CD62l expression on neutrophils showed a high statistically significant reduction in the sample taken 24 hours post-operatively in the group of patients with spinal anesthesia compared to the group of patients with epidural anesthesia. Conclusions Our results show that epidural anesthesia followed by epidural analgesia produced less inflammatory response compared with spinal anesthesia followed by intravenous morphine analgesia in patients operated on with total knee arthroplasty, and that the most sensitive markers of those investigated were the CD11b and CD62l leucocyte activation molecules.
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Affiliation(s)
- Pelagia Chloropoulou
- Department of Anaesthesiology, Democritus University of Thrace, and Department of Biopathology, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
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Current world literature. Curr Opin Anaesthesiol 2012; 25:629-38. [PMID: 22955173 DOI: 10.1097/aco.0b013e328358c68a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Over the last 25 years, pediatric care has changed dramatically with increased survival after premature birth, more complex care, better outcomes, and reduced mortality. There is a better understanding of how pain pathways and receptor systems develop and also how to assess pain at different stages of development. The myth that children do not feel pain has been comprehensively dispelled. Safe analgesic dose regimens for neonates, infants, and children have been developed based upon a better understanding of developmental pharmacokinetics and pharmacodynamics. It is a myth that pain in children cannot be prevented or treated safely and effectively because of the risks of adverse effects and addiction. Large-scale prospective audits have clarified the safety profile and risk-benefit balance for different techniques. There is now a substantial evidence base supporting many techniques of postoperative and procedural pain management for all age-groups of children. Guidelines based upon systematic review of this evidence have been published and updated, but the real challenge is in implementation of accurate pain assessment and safe, effective pain management comprehensively to all children whatever the procedure, clinical setting, developmental stage of the child, or comorbidities. In developed countries, these are core topics in the education of all doctors and nurses who care for children, and they are integrated into clinical practice by acute pediatric pain teams for most hospitals. However, it is disappointing that many country's healthcare systems do not give pediatric pain management a priority and in many parts of the world there are no analgesics available. So pain-free healthcare is sadly lacking in many hospitals. My hope is that the current knowledge can be used more effectively to relieve the unnecessary suffering of children in the 21st century.
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Affiliation(s)
- Neil S Morton
- Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, UK.
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