1
|
Yuan I, Garcia-Marcinkiewicz AG, Zhang B, Ulrich AM, Georgostathi G, Missett RM, Lang SS, Bruton JL, Kurth CD. Electroencephalographic Indices for Clinical Endpoints during Propofol Anesthesia in Infants: An Early-phase Propofol Biomarker-finding Study. Anesthesiology 2024; 141:353-364. [PMID: 38718376 DOI: 10.1097/aln.0000000000005043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
BACKGROUND Unlike expired sevoflurane concentration, propofol lacks a biomarker for its brain effect site concentration, leading to dosing imprecision particularly in infants. Electroencephalography monitoring can serve as a biomarker for propofol effect site concentration, yet proprietary electroencephalography indices are not validated in infants. The authors evaluated spectral edge frequency (SEF95) as a propofol anesthesia biomarker in infants. It was hypothesized that the SEF95 targets will vary for different clinical stimuli and an inverse relationship existed between SEF95 and propofol plasma concentration. METHODS This prospective study enrolled infants (3 to 12 months) to determine the SEF95 ranges for three clinical endpoints of anesthesia (consciousness-pacifier placement, pain-electrical nerve stimulation, and intubation-laryngoscopy) and correlation between SEF95 and propofol plasma concentration at steady state. Dixon's up-down method was used to determine target SEF95 for each clinical endpoint. Centered isotonic regression determined the dose-response function of SEF95 where 50% and 90% of infants (ED50 and ED90) did not respond to the clinical endpoint. Linear mixed-effect model determined the association of propofol plasma concentration and SEF95. RESULTS Of 49 enrolled infants, 44 evaluable (90%) showed distinct SEF95 for endpoints: pacifier (ED50, 21.4 Hz; ED90, 19.3 Hz), electrical stimulation (ED50, 12.6 Hz; ED90, 10.4 Hz), and laryngoscopy (ED50, 8.5 Hz; ED90, 5.2 Hz). From propofol 0.5 to 6 μg/ml, a 1-Hz SEF95 increase was linearly correlated to a 0.24 (95% CI, 0.19 to 0.29; P < 0.001) μg/ml decrease in plasma propofol concentration (marginal R2 = 0.55). CONCLUSIONS SEF95 can be a biomarker for propofol anesthesia depth in infants, potentially improving dosing accuracy and utilization of propofol anesthesia in this population. EDITOR’S PERSPECTIVE
Collapse
Affiliation(s)
- Ian Yuan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Annery G Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bingqing Zhang
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allison M Ulrich
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Georgia Georgostathi
- Vagelos Intergrated Program in Energy Research, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard M Missett
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shih-Shan Lang
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James L Bruton
- Small Molecule and Metabolite Laboratory, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - C Dean Kurth
- Departments of Anesthesiology and Critical Care Medicine, Neurology, and Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Oglesby FC, Scholefield BR, Cook TM, Smith JH, Pappachan VJ, Kane AD, Armstrong RA, Kursumovic E, Soar J. Peri-operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:583-592. [PMID: 38369586 DOI: 10.1111/anae.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/20/2024]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri-operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2-3.3 per 10,000). The incidence of peri-operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non-cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri-operative cardiac arrest.
Collapse
Affiliation(s)
- F C Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - B R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
| | - J H Smith
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - V J Pappachan
- Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- National Institute for Health and Care Research Biomedical Research Centre, University of Southampton, Southampton, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- Hull York Medical School, Hull, UK
| | - R A Armstrong
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
3
|
de Graaff JC, Frykholm P, Engelhardt T, Schindler E, Kovesi T, Simic D, Malagon I, Woodman N, Courtman S, Najafi N, Claussen NG, Karlsson J, Bonhomme F, Laffargue A, Vutskits L. Pediatric anesthesia in Europe: Variations within uniformity. Paediatr Anaesth 2024. [PMID: 38415881 DOI: 10.1111/pan.14873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
Organization of healthcare strongly differs between European countries and results in country-specific requirements in postgraduate medical training. Within the European Union (EU), the European Board of Anaesthesiology has set recommendations of training for the Specialty of Anaesthesiology including standards for Postgraduate Medical Specialist training including a description for providing service in pediatric anesthesia. However, these standards are advisory and not mandatory. Here we aimed to review the current state and associated challenges of pediatric anesthesia training in Europe. We report an important country-specific variability both in training and regulations of practice of pediatric anesthesia in the EU and in the United Kingdom. The requirements for training in pediatric anesthesia varies between nothing specified (Belgium) or providing anesthesia with direct supervision to a minimum of 50 cases below 5 years of age (Germany) to 3-6 month clinical practice in a specialized pediatric hospital (France). Likewise, the regulations for providing anesthesia to children varies from no regulations at all (Belgium) to age specific requirements and centralization of all children below 4 years of age to specified centers (United Kingdom). Officially recognized pediatric anesthesia fellowship programs are not available in most countries of Europe. It remains unclear if and how country-specific differences in pediatric anesthesia training are associated with clinical outcomes in pediatric perioperative care. There is converging interest and support for the establishment of a European pediatric anesthesia curriculum.
Collapse
Affiliation(s)
- Jurgen C de Graaff
- Department of Anesthesia, Adrz-Erasmus MC, Goes, The Netherlands
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Peter Frykholm
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Thomas Engelhardt
- Department of Anesthesia, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Tamas Kovesi
- Department of Paediatric Anaesthesia, Department of Anaesthesiology and Intensive Therapy, University of Pecs Medical School, Pécs, Hungary
| | - Dusica Simic
- Medical faculty University of Belgrade, University Children's Hospital, Belgrade, Serbia
| | - Ignacio Malagon
- Department of Anesthesia Radboud UMC, Nijmegen, The Netherlands
| | | | - Simon Courtman
- Department of Anaesthesia, University Hospital Plymouth, Plymouth, UK
| | - Nadia Najafi
- Department of Anesthesiology and Perioperative Medicine, University Hospital of Brussels, Brussels, Belgium
| | - Nicola Groes Claussen
- Pediatric Anesthesia Section, Department of Anesthesia and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jacob Karlsson
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Fanny Bonhomme
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne Laffargue
- Department of Pediatric Anesthesia, University Hospital of Lille, Lille, France
| | - Laszlo Vutskits
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Bolt R, Hyslop MC, Herbert E, Papaioannou DE, Totton N, Wilson MJ, Clarkson J, Evans C, Ireland N, Kettle J, Marshman Z, Norrington AC, Paton RH, Vernazza C, Deery C. The MAGIC trial: a pragmatic, multicentre, parallel, noninferiority, randomised trial of melatonin versus midazolam in the premedication of anxious children attending for elective surgery under general anaesthesia. Br J Anaesth 2024; 132:76-85. [PMID: 37953202 PMCID: PMC10797512 DOI: 10.1016/j.bja.2023.10.011] [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: 06/21/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Child anxiety before general anaesthesia and surgery is common. Midazolam is a commonly used premedication to address this. Melatonin is an alternative anxiolytic, however trials evaluating its efficacy in children have delivered conflicting results. METHODS This multicentre, double-blind randomised trial was performed in 20 UK NHS Trusts. A sample size of 624 was required to declare noninferiority of melatonin. Anxious children, awaiting day case elective surgery under general anaesthesia, were randomly assigned 1:1 to midazolam or melatonin premedication (0.5 mg kg-1, maximum 20 mg) 30 min before transfer to the operating room. The primary outcome was the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes included safety. Results are presented as n (%) and adjusted mean differences with 95% confidence intervals. RESULTS The trial was stopped prematurely (n=110; 55 per group) because of recruitment futility. Participants had a median age of 7 (6-10) yr, and 57 (52%) were female. Intention-to-treat and per-protocol modified Yale Preoperative Anxiety Scale-Short Form analyses showed adjusted mean differences of 13.1 (3.7-22.4) and 12.9 (3.1-22.6), respectively, in favour of midazolam. The upper 95% confidence interval limits exceeded the predefined margin of 4.3 in both cases, whereas the lower 95% confidence interval excluded zero, indicating that melatonin was inferior to midazolam, with a difference considered to be clinically relevant. No serious adverse events were seen in either arm. CONCLUSION Melatonin was less effective than midazolam at reducing preoperative anxiety in children, although the early termination of the trial increases the likelihood of bias. CLINICAL TRIAL REGISTRATION ISRCTN registry: ISRCTN18296119.
Collapse
Affiliation(s)
- Robert Bolt
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Marie C Hyslop
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, UK
| | - Esther Herbert
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, UK
| | - Diana E Papaioannou
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, UK
| | - Nikki Totton
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Sheffield, UK
| | - Matthew J Wilson
- Sheffield School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Janet Clarkson
- Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - Christopher Evans
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Ireland
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jennifer Kettle
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | | | | | - Christopher Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| |
Collapse
|
5
|
Kursumovic E, Cook TM, Lucas DN, Davies MT, Martin S, Kane AD, Armstrong RA, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Beecham E, Cordingley J, Dorey J, Finney SJ, Kunst G, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Wain EC, Soar J. The 7th National Audit Project (NAP7) baseline survey of individual anaesthetists: preparedness for and experiences of peri-operative cardiac arrest. Anaesthesia 2023; 78:1453-1464. [PMID: 37920919 DOI: 10.1111/anae.16154] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri-operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In-date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists, respectively. There were 8994 (84%) respondents who were confident in leading a peri-operative cardiac arrest, with males more confident than females, but only 5985 (56%) were confident in leading a debrief and 7340 (68%) communicating with next of kin. In the previous two years, 4806 (46%) respondents had managed at least one peri-operative cardiac arrest, of which 321 (7%) and 189 (4%) of these events involved a child or an obstetric patient, respectively. Respondents estimated the most common causes of peri-operative cardiac arrest to be hypovolaemia, hypoxaemia and cardiac ischaemia, with haemorrhage coming fifth. However, the most common reported causes for the most recently attended peri-operative cardiac arrest were haemorrhage; (927, 20%); anaphylaxis (474, 10%); and cardiac ischaemia (397, 9%). Operating lists or shifts were paused or stopped after 1330 (39%) cardiac arrests and 1693 (38%) respondents attended a debrief, with 'hot' debriefs most common. Informal wellbeing support was relatively common (2458, 56%) and formal support was uncommon (472, 11%). An impact on future care delivery was reported by 196 (4%) anaesthetists, most commonly a negative psychological impact. Management of a peri-operative cardiac arrest during their career was reported by 8654 (85%) respondents. The overall impact on professional life was more often judged positive (2630, 30%) than negative (1961, 23%), but impact on personal life was more often negative.
Collapse
|
6
|
Althubaiti MA, Hanif AA, Alghamdi MK, Tirkistani J, Alobedi AM, Alshareef AF, Alshaikh MG, Saeidi AF, Alazwari NA, Shatla M. Awareness of Epidural Analgesia Among Childbearing Women in Western Region of Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e42618. [PMID: 37641773 PMCID: PMC10460618 DOI: 10.7759/cureus.42618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background Labor pain is one of the most excruciating experiences that women can go through. Epidural anesthesia (EDA) is the most prevalent form of labor analgesia considered as a secure and effective method of pain relief for women during active labor. The EDA works by numbing the nerves that cause pain. To our knowledge, only a few studies have been conducted on the use of EDA in Saudi Arabia. Objectives The purpose of this study was to assess the awareness of EDA among childbearing women in the western region of Saudi Arabia. Methods We carried out a cross-sectional study using a self-administered online questionnaire to measure awareness about EDA. The study targeted the general population of women from the western region of Saudi Arabia who were aged between 18 and 50 years. A total of 1,137 questionnaires were returned and analyzed. Results This study assessed the perspectives of 1,137 women. The results revealed that 52.6% of women who received EDA showed a good level of knowledge of the procedure, while 26.1% of women had not experienced EDA (P = 0.001). Good knowledge of EDA was detected among 39.3% of women aged 36-50 years. This rate was significantly higher than that of women younger than 20 years old, of which 24.3% had good knowledge (P = 0.038). Conclusion This study shows that women in this particular region have a lack of knowledge about EDA. Therefore, it is recommended that more education about EDA be provided during antenatal visits to improve awareness.
Collapse
Affiliation(s)
| | - Azzam A Hanif
- Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Wang J, Li Y, Xiao S, Shi B, Xia Z, Huang C, Xu H, Li N, Tang W. Efficacy and safety of intranasal dexmedetomidine versus oral chloral hydrate as sedatives for pediatric patients: a systematic review and meta-analysis. J Investig Med 2022; 70:1219-1224. [PMID: 35074857 DOI: 10.1136/jim-2021-002038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/03/2022]
Abstract
This study was designed to review published literature to determine the efficacy and safety of intranasal dexmedetomidine versus oral chloral hydrate (CH) for sedation in pediatric patients based on qualified studies. We searched the PubMed, Cochrane, and Embase databases for qualified studies published before March 2021. For each study, we analyzed the relative risk or weighted mean difference combined with a 95% CI. Fourteen studies including 3749 pediatric patients were included in this meta-analysis. Compared with oral CH, intranasal dexmedetomidine significantly increased the success rate of sedation and decreased the duration and latency of sedation, time of recovery from sedation, and total sedation time. Compared with oral CH, intranasal dexmedetomidine significantly decreased the incidence of adverse events, including vomiting, but increased the incidence of bradycardia. In conclusion, intranasal dexmedetomidine provides better sedation than oral CH for pediatric patients with good safety; however, the incidence of bradycardia is increased.
Collapse
Affiliation(s)
- Jun Wang
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Yong Li
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Shuna Xiao
- Liyuan Cardiovascular Center, Tongji Medical College,Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Buyun Shi
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Zhi Xia
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Chengjiao Huang
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Hui Xu
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Na Li
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| |
Collapse
|
8
|
Burton ZA, Lewis R, Bennett T, McLernon DJ, Engelhardt T, Brooks PB, Edwards MR. Prevalence of PErioperAtive CHildhood obesitY in children undergoing general anaesthesia in the UK: a prospective, multicentre, observational cohort study. Br J Anaesth 2021; 127:953-961. [PMID: 34627621 DOI: 10.1016/j.bja.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Childhood obesity has become a serious global healthcare challenge. No UK data currently define its anaesthetic and perioperative implications. We aimed to determine obesity prevalence amongst UK children undergoing general anaesthesia and the incidence of predefined adverse perioperative events, and to compare perioperative obesity rates with National Child Measurement Programme (NCMP) data. METHODS During a site-selected consecutive 7-day study period, all children (2-16 yr) undergoing general anaesthesia were included. Anonymised hospital, surgical, and procedural details; demographic data; and adverse perioperative events were collected prospectively by Paediatric Anaesthesia Trainee Research Network (PATRN) collaborators. RESULTS For this study, 102 UK hospitals participated and 4232 cases were included in the final analysis; 76% of hospitals did not routinely calculate BMI. In addition, 3030 (71.6%; 95% confidence interval [CI]: 70.2-73.0%) children of healthy weight were compared with 537 (12.7%; 11.7-13.7%) children who were overweight and 478 (11.3%; 10.3-12.2%) children with obesity. Children with obesity (n=71; 14.9%) more commonly underwent (adeno)tonsillectomy than children of healthy weight (n=282; 9.3%; P<0.001; odds ratio [OR] 2.15; 95% CI: 1.58-2.92). Fewer children with obesity (n=365; 77% vs n=2552; 85%) were anaesthetised by consultant anaesthetists (OR 0.62; 95% CI: 0.48-0.79). Mask ventilation was difficult for 3.7% of children with obesity vs 0.6% of children of healthy weight (difference 3.0%; 95% CI: 1.3-4.7%; P<0.001). Comparison with NCMP data demonstrated an over-representation of obesity amongst the paediatric surgical population. CONCLUSIONS This large multicentre cohort study suggests a concerning prevalence of children with obesity presenting for anaesthesia. These results should be used to inform optimal provision of care for this population and support perioperative healthcare initiatives to address the burden of childhood obesity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03994419.
Collapse
Affiliation(s)
- Zoë A Burton
- Department of Anaesthesia, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
| | - Rosie Lewis
- Department of Anaesthesia, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Tom Bennett
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Thomas Engelhardt
- McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada
| | - Peter B Brooks
- Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Mark R Edwards
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
9
|
Shah F, Orchard A, Shakib K. Analysis of performed paediatric oral and maxillofacial procedures under general anaesthesia over a two-year period in a North London NHS Trust. Br J Oral Maxillofac Surg 2020; 59:912-920. [PMID: 34325943 DOI: 10.1016/j.bjoms.2020.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
Dental treatment remains one of the most common reasons for paediatric patients to undergo a general anaesthetic (GA). In addition to a wider scope of practice, oral and maxillofacial (OMF) surgeons are affiliated with this well-reported dentoalveolar surgical burden. Thus far much of the research has shown that the majority of these paediatric GAs are for the treatment of decayed teeth. The aim of this study was to evaluate reasons children in a North London region undergo GA procedures in an OMF department and this population's associated demographic factors. Patients treated by this OMF unit from 2016 to 2017 aged 0-16 were included. Retrospective data was obtained; including age, gender, and ASA physical status. Deprivation was calculated from postcodes using the Index of Multiple Deprivation. Chi squared statistical tests were applied. Data from 600 children undergoing 790 procedures were analysed. A similar number of males and females were treated. The most common age group were the 13-16-year-olds. A total of 89.5% of the patients were ASA I. The greatest surgical burden was simple orthodontic extractions, accounting for 24.4% of all OMF paediatric GA procedures. Deprivation impacted the prevalence of the extraction of carious teeth, soft tissue trauma, and orthodontic-related surgery. In the region studied, more paediatric patients are undergoing GA for orthodontic-related surgery than for the extraction of decayed teeth. The type of facial trauma experienced changes with the age of the child.
Collapse
Affiliation(s)
- F Shah
- Cardiff and Vale University Health Board, Cardiff.
| | - A Orchard
- Royal Berkshire Hospital NHS Foundation Trust, Reading
| | - K Shakib
- Oral and Maxillofacial Surgery Department, Royal Free London NHS Foundation Trust, London
| |
Collapse
|
10
|
Lian X, Lin Y, Luo T, Yuan H, Chen Y. Comparison of dexmedetomidine with chloral hydrate as sedatives for pediatric patients: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21008. [PMID: 32756086 PMCID: PMC7402776 DOI: 10.1097/md.0000000000021008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dexmedetomidine (Dex) and chloral hydrate (CH) are the most frequently used sedative agents in pediatric patients. We aimed to systematically review the literature comparing the efficacy and safety of Dex and CH for sedation in pediatric patients. METHODS Seven electronic databases and 3 clinical trial registry platforms were searched for articles published prior to October 2019. Randomized controlled trials (RCTs) evaluating the efficacy and safety of Dex versus CH for sedation in children were examined by 2 reviewers. The extracted information included the success rate of sedation, sedation latency, sedation duration, sedation recovery time, and adverse events. Moreover, the extracted data included 5 subgroups: the effects of 1, 1.5, 2, 2.5, and 3 μg/kg doses of Dex were compared with the effect of CH on the success rate of sedation. We also formed separate subgroups for different types of adverse events (incidence of vomiting, hypotension, bradycardia, etc). The outcomes were analyzed by Review Manager 5.3 software and are expressed as relative risks (RR) or the mean difference (MD) with the 95% confidence interval (CI). Heterogeneity was assessed with I-squared (I) statistics. RESULTS A total of 15 RCTs involving 2128 children with Dex versus CH for sedation were included in the meta-analysis. The dose range of Dex ranged from 1 to 3 μg/kg. Compared with CH, the Dex group had a significantly higher success rate of sedation (RR = 1.14, 95% CI [1.05, 1.25], I = 79%, P = .003). Additionally, subgroup analysis revealed that there was no significant difference in the success rate of sedation between the CH group and the 1, 1.5, 2.5, and 3 μg/kg Dex groups; only the 2 μg/kg Dex group had a significantly higher success rate than the CH group (RR = 1.15, 95% CI [1.03, 1.29], I = 80%, P = .02). There was no significant difference in the number of subjects who required 2 doses or the duration of sedation between the CH and Dex groups. Furthermore, compared with the Dex group, the CH group had a significantly longer sedation latency (MD = -3.54, 95% CI [-5.94, -1.15], I = 95%, P = .004), sedation recovery time (MD = -30.08, 95% CI [-46.77, -13.39], I = 99%, P = .0004), and total time from sedative administration to discharge (MD = -12.73, 95% CI [-15.48, -9.97], I = 0%, P < .05), as well as a higher number of adverse events in total (RR = 0.25, 95% CI [0.11, 0.61], I = 89%, P = .002). Moreover, the subgroup analysis of adverse events revealed that CH was associated with higher risks of vomiting (RR = 0.07, 95% CI [0.03, 0.17], I = 0%, P < .0001), crying or resisting (RR = 0.22, 95% CI [0.07, 0.71], I = 60%, P = .01), and cough (RR = 0.15, 95% CI [0.05, 0.44], I = 0%, P = .0006); there was no significant difference in the risk of hypotension, supplemental oxygen, or respiratory events between CH and Dex. However, Dex was associated with a higher risk of bradycardia (RR = 4.08, 95% CI [1.63, 10.21], I = 0%, P = .003). CONCLUSIONS Dex is an appropriate effective alternative to CH for sedation in pediatrics. However, considering the possibility of bradycardia, Dex should be used with caution.
Collapse
Affiliation(s)
- Xianghong Lian
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yunzhu Lin
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Ting Luo
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Hongbo Yuan
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| | - Yuan Chen
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, People's Republic of China
| |
Collapse
|
11
|
Shrimpton AJ, Gill H. Airway management for dental clearance in a preschool child: A UK survey. Paediatr Anaesth 2020; 30:716-719. [PMID: 32297693 DOI: 10.1111/pan.13882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/21/2023]
Affiliation(s)
| | -
- Paediatric Anaesthesia Trainee Research Network, Sub-committee of the APAGBI Scientific Committee
| | - Hannah Gill
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, UK.,Bristol Anaesthesia, Pain & Critical Care Sciences, Translational Health Sciences, Bristol Medical School, Bristol, UK.,Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
| |
Collapse
|
12
|
Abstract
Dexmedetomidine is an α2 adrenoreceptor agonist that may be administered by the intranasal route as a sole sedative agent in children. It is odourless, colourless and tasteless and is formulated in a concentration of 100µg.ml-1. We performed a review of published randomised controlled trials in order to determine the efficacy of intranasal dexmedetomidine for sedation in children. Fourteen trials were eligible for inclusion in the review and contained a total of 1809 patients ranging in age from one month to 14 years. Intranasal dexmedetomidine was administered in a dose range of 1-4µg.kg-1 and was compared with various other sedatives. Dexmedetomidine was administered by either drops or a mucosal atomiser device. The procedures ranged from non-painful examinations such as magnetic resonance imaging scans and transthoracic echocardiography to painful procedures such as dentistry and venous cannulation. Administration of 2µg.kg-1 appears to be the optimal dose.
Collapse
Affiliation(s)
- J Lewis
- KCL School of Medicine, London, UK
| | - C R Bailey
- Department of Anaesthetics, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
13
|
Chin JW, Macrae JL, Sury MR. Paediatric pre-operative anaesthetic clinic: A survey of consultant-led caseload and outcomes. J Paediatr Child Health 2020; 56:432-438. [PMID: 31614066 DOI: 10.1111/jpc.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
AIM The role of pre-operative anaesthetic clinics (POAC) in adult practice is well-established and is developing in paediatric hospitals in the UK. METHODS We carried out a retrospective survey of all patients assessed in our POAC by a consultant, determining the pre-operative problems and the perioperative anaesthetic interventions and outcomes. RESULTS In 2016, 537 patients were seen by a consultant: the median age was 5.5 years (interquartile range 2.2-10.2) and median weight was 18.7 kg (interquartile range 12-28.7). 77% were ASA3 and 4% were ASA4. Seventy-five percent of patients referred for consultant assessment had a problem with at least one of the following four major body systems: cardiac (37%), respiratory (26%), airway (18%) and neurodevelopment (14%), Fifteen percent of these patients had two of these systems affected, and 3% had three or more. The rate of cancellation due to significant risk was 2.6% (n = 14): nine had significant cardiac risk and five had respiratory reasons. The rate of serious perioperative problems was 2.8% (n = 15): six were cardiac, six were respiratory, two neurological and one coagulation. Cardiac and airway problems occurred during anaesthesia, whereas problems relating to respiratory and neurological disease were post-operative. Of the 15 patients with three or more body system problems, 5 were cancelled or had a perioperative complication causing deterioration, 5 had a major complication but recovered fully and 5 proceeded to general anaesthesia (GA) without serious event. There were no deaths during GA or within 30 days. CONCLUSION In the POAC, consultants identified a wide range of GA-related potential problems enabling patients to be investigated, informed and prepared (or cancelled because of excess risk), and for appropriate resources to be allocated to achieve efficient and safe perioperative care.
Collapse
Affiliation(s)
- Joel We Chin
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jenny L Macrae
- Department of Anaesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Rj Sury
- Department of Anaesthesia, Great Ormond Street Hospital for Sick Children, London, United Kingdom
| |
Collapse
|
14
|
Ali Alahmari SS, ALmetrek M, Alzillaee AY, Hassan WJ, Ali Alamry SM. Knowledge, attitude, and practice of childbearing women toward epidural anesthesia during normal vaginal delivery in Alsanayeah Primary Health Care in Khamis Mushait. J Family Med Prim Care 2020; 9:99-104. [PMID: 32110573 PMCID: PMC7014839 DOI: 10.4103/jfmpc.jfmpc_530_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/22/2019] [Accepted: 12/04/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Labor pain is a severe form of agony that females experience while giving birth. A lot of pregnant women prefer epidural anesthesia (EA) to avoid labor pain. OBJECTIVE This study focuses on women's general awareness about EA during the childbearing age. METHODS A cross-sectional, hospital-based study was conducted using a self-administered questionnaire. The study included all females of childbearing age getting routine antenatal care. The survey was designed to measure their awareness toward EA. A total of 328 females participated in the study. Of these, 205 (62.5%) women showed a low level of knowledge toward EA. Data were analyzed using the Chi-square test and Independent Samples t-test. RESULTS Participants in our study included 328 women of childbearing age. Most women (172 [52.4%]) participating in the study were aged between 30 and 40 years. In terms of education, 204 (62.2%) women had university-level education. Two hundred and ninety (88.4%) women were multipara. The majority of women (205 [62.5%]) had a low-level knowledge about EA with a significant relationship between the level of perception and primary education, as well as postgraduation with P < 0.023 and P < 0.001, respectively. Also, previous EA with pregnancy significantly related to the level of knowledge with P < 0.001. Through past pregnancies, 106 (32.3%) women had experience with EA. Of these, EA caused complications in only 13 (12.3%) women and side effects in 29 (27.4%) women. CONCLUSION The majority of women of childbearing age had limited knowledge about the benefits and complications associated with EA. During the antenatal visit, it is essential to educate all women about EA. This could be done by the obstetrician, anesthesiologist, or midwives and/or through flyers and brochures.
Collapse
Affiliation(s)
| | - Meterk ALmetrek
- Department of Clinical Health Education, General Directorate of Health Affairs in Aseer Region, Saudi Arabia
| | | | | | | |
Collapse
|
15
|
Miskovic A, Johnson M, Frost L, Fernandez E, Pistorio A, Disma N. A prospective observational cohort study on the incidence of postoperative sore throat in the pediatric population. Paediatr Anaesth 2019; 29:1179-1185. [PMID: 31610063 DOI: 10.1111/pan.13757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postoperative sore throat is common after general anesthesia. The incidence in pediatric anesthesia is variable, and the etiology unclear. Establishing risk factors would enable prevention and could improve quality of care. AIMS We performed a prospective single-center cohort study aiming to establish the incidence of postoperative sore throat in children undergoing GA with an endotracheal tube or laryngeal mask airway. Secondary aims were to identify independent risk factors for sore throat and the incidence of other postoperative complications including stridor, laryngospasm, nausea and vomiting, and delayed oral intake. METHODS Between November 2017 and April 2018, perioperative data were collected from children aged 5-16 years undergoing general, plastic, urology, renal, and orthopedic surgery. Patients completed a postoperative questionnaire within 24 hours of surgery. RESULTS We screened 334 children for inclusion at a tertiary pediatric hospital in the United Kingdom. One hundred and ninety-seven patients were included in the final analysis. The frequency of postoperative sore throat was 36.5%. Stridor occurred in 1.5%, laryngospasm 1.0%, postoperative nausea 59.4%, vomiting in recovery 4.6%, and delayed oral intake due to postoperative sore throat 30%. Nausea, vomiting, thirst, and pain were associated with a sore throat. Univariate analysis showed anesthesia longer than 2 hours, and use of an endotracheal tube was statistically associated with higher risk of sore throat. Over 50% of children with an endotracheal tube cuff pressure <20 cmH2 O had a postoperative sore throat. CONCLUSION Postoperative sore throat is common in children. Endotracheal intubation is associated with a greater incidence than laryngeal mask airway use. A high rate of postoperative sore throat in children with endotracheal tube cuff pressures within the recommended range suggests multifactorial etiology. To confirm validity of the identified risk factors, we would recommend a larger prospective multi-center study.
Collapse
Affiliation(s)
- Alice Miskovic
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - Mae Johnson
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - Louise Frost
- Department of Anaesthesia, St George's University Hospital, London, UK
| | - Elena Fernandez
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - Angela Pistorio
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Disma
- Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
16
|
Long-term neurocognitive impairment after general anaesthesia in childhood: Is obstructive sleep apnoea to blame? Eur J Anaesthesiol 2019; 36:719-720. [PMID: 31483343 DOI: 10.1097/eja.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children. Anesthesiology 2019; 131:164-185. [DOI: 10.1097/aln.0000000000002657] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
Propofol administered in conjunction with an opioid such as remifentanil is used to provide total intravenous anesthesia for children. Drugs can be given as infusion controlled manually by the physician or as automated target-controlled infusion that targets plasma or effect site. Smart pumps programmed with pharmacokinetic parameter estimates administer drugs to a preset plasma concentration. A linking rate constant parameter (keo) allows estimation of effect site concentration. There are two parameter sets, named after the first author describing them, that are commonly used in pediatric target-controlled infusion for propofol (Absalom and Kataria) and one for remifentanil (Minto). Propofol validation studies suggest that these parameter estimates are satisfactory for the majority of children. Recommended target concentrations for both propofol and remifentanil depend on the type of surgery, the degree of surgical stimulation, the use of local anesthetic blocks, and the ventilatory status of the patient. The use of processed electroencephalographic monitoring is helpful in pediatric total intravenous anesthesia and target-controlled infusion anesthesia, particularly in the presence of neuromuscular blockade.
Collapse
|
18
|
Engelhardt T, Ayansina D, Bell GT, Oshan V, Rutherford JS, Morton NS. Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study). Anaesthesia 2018; 74:300-311. [PMID: 30536369 DOI: 10.1111/anae.14520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 12/20/2022]
Abstract
The anaesthesia practice in children observational trial of 31,127 patients in 261 European hospitals revealed a high (5.2%) incidence of severe critical events in the peri-operative period and wide variability in practice. A sub-analysis of the UK data was undertaken to investigate differences compared with the non-UK cohort in the incidence and nature of peri-operative severe critical events and to attempt to identify areas for quality improvement. In the UK cohort of 7040 paediatric patients from 43 hospitals, the overall incidence of peri-operative severe critical events was lower than in the non-UK cohort (3.3%, 95%CI: 2.9-3.8 vs. 5.8%, 95%CI: 5.5-6.1, RR 0.57, p < 0.001). There was a lower rate of bronchospasm (RR 0.22, 95%CI: 0.14-0.33; p < 0.001), stridor (RR 0.42, 95%CI: 0.28-0.65; p < 0.001) and cardiovascular instability (RR 0.69, 95%CI: 0.55-0.86; p = 0.001) than in the non-UK cohort. The proportion of sicker patients where less experienced teams were managing care was lower in the UK than in the non-UK cohort (10.4% vs. 20.4% of the ASA physical status 3 and 9% vs. 12.9% of the ASA physical status 4 patients). Differences in work-load between centres did not affect the incidence and outcomes of severe critical events when stratified for age and ASA physical status. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk patients in the UK. Areas for quality improvement include: standardisation of serious critical event definitions; increased reporting; development of evidence-based protocols for management of serious critical events; development and rational use of paediatric peri-operative risk assessment scores; implementation of current best practice in provision of competent paediatric anaesthesia services in Europe; development of specific training in the management of severe peri-operative critical events; and implementation of systems for ensuring maintenance of skills.
Collapse
Affiliation(s)
- T Engelhardt
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, UK.,Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - D Ayansina
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - G T Bell
- Department of Anaesthesia, Royal Hospital for Children, Glasgow, Scotland, UK
| | - V Oshan
- Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - J S Rutherford
- Designated Paediatric Anaesthetist, Dumfries and Galloway Royal Infirmary, Dumfries, Scotland, UK
| | - N S Morton
- Department of Paediatric Anaesthesia and Pain Management, University of Glasgow, Glasgow, Scotland, UK
| | | |
Collapse
|
19
|
Stuart GM, Sury MRJ. Dexmedetomidine sedation service for MRI in a UK paediatric teaching hospital. Anaesthesia 2018; 71:1115-6. [PMID: 27523061 DOI: 10.1111/anae.13612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- G M Stuart
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - M R J Sury
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
20
|
Cross-sectional study of perioperative drug and allergen exposure in UK practice in 2016: the 6th National Audit Project (NAP6) Allergen Survey. Br J Anaesth 2018; 121:146-158. [DOI: 10.1016/j.bja.2018.04.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/01/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022] Open
|
21
|
Perrott C, Lee CA, Griffiths S, Sury MRJ. Perioperative experiences of anesthesia reported by children and parents. Paediatr Anaesth 2018; 28:149-156. [PMID: 29266767 DOI: 10.1111/pan.13300] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Sprint National Anaesthesia Project reported feedback from adults but not from children. We developed questionnaires for children and parents, and conducted a survey of perioperative anesthetic experiences in a large pediatric hospital. METHODS Patients undergoing elective general anesthesia were selected randomly each weekday over 10 weeks. Parents and children were approached within 4 hours after awakening, and were asked to complete a short questionnaire. Personal or patient identifiable data were not collected. Questionnaires were processed by optical mark reading technology and descriptive data analysis was performed. RESULTS Seven hundred and forty parents and 250 children completed questionnaires. The most common symptoms reported by parents were thirst and hunger (76%), drowsiness (75%), sore throat (41%), and pain of the surgery (38%). Sixty-four percent of children felt worried or scared about something before the procedure: common worries were about the "anesthetic," "procedure," or "needles/cannula." Fifty-five percent reported postoperative pain. Thirty-nine children (15.6%) remembered something between going to sleep and waking up although distress was not reported; of these, the most common experiences remembered included hearing voices (34%), feeling sore (20%), and being worried (14%). Twenty-two parents (2.9%) had any complaint and most were about fasting instructions. Only 3 parents would not recommend the anesthetic service. CONCLUSION This study shows that the experiences of children and their parents are similar to those of adults reported by the Sprint National Anaesthesia Project. Thirst (and hunger), anxiety, and pain continue to be common problems for many children. This feedback may help direct interventions and research to improve the pediatric patient and parent experience with anesthesia.
Collapse
Affiliation(s)
| | - Clover-Ann Lee
- Department of Anaesthesia, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sian Griffiths
- Department of Anaesthesia, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Michael R J Sury
- Department of Anaesthesia, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Portex Unit of Anaesthesia, Great Ormond Street Institute of Child Health, University College London, London, UK
| |
Collapse
|
22
|
Factors associated with use of general anaesthesia for dental procedures among British children. Br Dent J 2017; 223:339-345. [DOI: 10.1038/sj.bdj.2017.763] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/08/2022]
|
23
|
Jöhr M. Inhalative und intravenöse Anästhesie bei Kindern. Anaesthesist 2016; 65:415-22. [DOI: 10.1007/s00101-016-0181-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Abstract
This educational review explores the current understanding of accidental awareness during general anesthesia (AAGA) in children. Estimates of incidence in children vary between 1 in 135 (determined by direct questioning) and 1 in 51,500 (determined from spontaneous reporting). The lessons from the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland show that the characteristics of spontaneous reports of AAGA are extremely variable and relate to the type of procedure and anesthetic technique rather than age group: approximately 50% of experiences were distressing; most lasted less than 5 min; neuromuscular blockade (NMB) combined with pain caused the most distress; most cases (approximately 70%) occur at induction or emergence. The value of depth of anesthesia monitoring in preventing AAGA is uncertain but is probably useful in patients having total intravenous anesthesia and NMB. Reports of AAGA by children should be received sympathetically and a generic protocol for managing distressed patients is presented.
Collapse
Affiliation(s)
- Michael R J Sury
- Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Portex Unit of Anaesthesia, Institute of Child Health, University College London, London, UK
| |
Collapse
|
25
|
Affiliation(s)
- C. R. Bailey
- Evelina London Children's Hospital; Guy's and St. Thomas' NHS Foundation Trust; London UK
| |
Collapse
|