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Zhu J, Zhou S, Wang L, Zhao Y, Wang J, Zhao T, Li T, Shao F. Characterization of Pediatric Rectal Absorption, Drug Disposition, and Sedation Level for Midazolam Gel Using Physiologically Based Pharmacokinetic/Pharmacodynamic Modeling. Mol Pharm 2024; 21:2187-2197. [PMID: 38551309 DOI: 10.1021/acs.molpharmaceut.3c00778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This study aims to explore and characterize the role of pediatric sedation via rectal route. A pediatric physiologically based pharmacokinetic-pharmacodynamic (PBPK/PD) model of midazolam gel was built and validated to support dose selection for pediatric clinical trials. Before developing the rectal PBPK model, an intravenous PBPK model was developed to determine drug disposition, specifically by describing the ontogeny model of the metabolic enzyme. Pediatric rectal absorption was developed based on the rectal PBPK model of adults. The improved Weibull function with permeability, surface area, and fluid volume parameters was used to extrapolate pediatric rectal absorption. A logistic regression model was used to characterize the relationship between the free concentrations of midazolam and the probability of sedation. All models successfully described the PK profiles with absolute average fold error (AAFE) < 2, especially our intravenous PBPK model that extended the predicted age to preterm. The simulation results of the PD model showed that when the free concentrations of midazolam ranged from 3.9 to 18.4 ng/mL, the probability of "Sedation" was greater than that of "Not-sedation" states. Combined with the rectal PBPK model, the recommended sedation doses were in the ranges of 0.44-2.08 mg/kg for children aged 2-3 years, 0.35-1.65 mg/kg for children aged 4-7 years, 0.24-1.27 mg/kg for children aged 8-12 years, and 0.20-1.10 mg/kg for adolescents aged 13-18 years. Overall, this model mechanistically quantified drug disposition and effect of midazolam gel in the pediatric population, accurately predicted the observed clinical data, and simulated the drug exposure for sedation that will inform dose selection for following pediatric clinical trials.
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Affiliation(s)
- Jinying Zhu
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
- Department of Clinical Pharmacology, School of Pharmacy College, Nanjing Medical University, Nanjing 211166, China
| | - Sufeng Zhou
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Lu Wang
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Yuqing Zhao
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Jie Wang
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Tangping Zhao
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
- Department of Clinical Pharmacology, School of Pharmacy College, Nanjing Medical University, Nanjing 211166, China
| | - Tongtong Li
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
- Department of Clinical Pharmacology, School of Pharmacy College, Nanjing Medical University, Nanjing 211166, China
| | - Feng Shao
- Phase I Clinical Trial Unit, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
- Department of Clinical Pharmacology, School of Pharmacy College, Nanjing Medical University, Nanjing 211166, China
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Swann-Thomsen HE, Tivis R, Sitts C, Hanks J. An innovative approach for coordinating multiple sedated procedures in medically complex pediatric patients. Soc Work Health Care 2024; 63:237-247. [PMID: 38354742 DOI: 10.1080/00981389.2024.2316706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024]
Abstract
Children and youth with special health care needs often undergo a higher frequency of sedated procedures, increasing their risk for complications, prolonged hospitalizations, as well as increased time and cost burdens. By consolidating multiple procedures requiring anesthetic sedation, the risk and cost can be reduced for both families and health care systems. In this paper, we discuss an innovative model to coordinate procedures across internal and external providers to improve quality of care for this vulnerable patient population. Although preliminary, our findings suggest this approach may be beneficial to both the patient, family, and health system.
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Affiliation(s)
| | - Rick Tivis
- Applied Research Division, St. Luke's Health System, Boise, Idaho, USA
| | - Claire Sitts
- St. Luke's Children's Hospital, Boise, Idaho, USA
| | - John Hanks
- St. Luke's Children's Hospital, Boise, Idaho, USA
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Sanna G, Camporesi A, Diotto V, Abbiati G, Torri A, Gemma M. Virtual sedation as a substitute to pharmacological sedation during PICC placement in pediatric patients: A feasibility study. J Vasc Access 2024; 25:313-317. [PMID: 35773952 DOI: 10.1177/11297298221085424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In pediatric patients, PICC insertion is often performed under sedation to reduce pain and anxiety, which is associated with risks such as laryngospasm, apnea, and hypoxia. Furthermore, it requires a pediatric anesthesiologist. The aim of our study was to evaluate the VR as an alternative to pharmacological sedation to reduce those risks and the overall cost. METHODS We tested a VR immersive experience for ten children requiring a PICC. To achieve this, we ran a software, specifically designed for the pediatric healthcare setting, on a commercially available VR headset.In order to evaluate this new practice, we recorded the following data:Patient's anxiety before and after the procedure, recorded through a modified numeric rating scale from 0 (no anxiety) to 10 (worst anxiety imaginable).Patient's pain before (e.g., because of preexisting medical conditions) and after the procedure through a Wong-Baker scale.Caregiver's satisfaction.No active or passive restraint was enforced during the whole procedure, patients had to keep their arms still all by themselves. RESULT Out of the 10 patients only in a single case, we had to interrupt the attempt with the VR technique and let the anesthesiologist perform a sedation. From the immediate beginning said patient had trouble adapting to the virtual environment and tried to remove the headset.In all other cases, we noticed a drop in the anxiety level of the patient and the pain never increased. Globally, caregivers were pleased with the experience and reported an average satisfaction rate of 9.3 out of 10. CONCLUSION Virtual reality seems a valid alternative to traditional sedation in pediatric patients undergoing a PICC placement procedure. Additional studies, with adequate sample size, of patients are necessary to assess the benefit from this new approach, as well as its impact on the overall procedure length.
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Affiliation(s)
- Gianuario Sanna
- Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Lombardy, Italy
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children Hospital, Milan, Lombardy, Italy
| | - Veronica Diotto
- Pediatric Anesthesia and Intensive Care Unit, "Vittore Buzzi" Children Hospital, Milan, Lombardy, Italy
| | - Giacomo Abbiati
- Anesthesia and Intensive Care Unit, Fatebenefratelli Hospital, Milan, Lombardy, Italy
| | - Adriano Torri
- Specialist on vascular access, Becton, Dickinson and Company, Milano, Lombardia, Italy
| | - Marco Gemma
- Department of Neuroanesthesia and Critical Care, "Carlo Besta" Neurological Institute, Milan, Italy
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Angelopoulou VA, Pouliakis A, Alexiou N, Ioannidi P, Vagiona D, Ekmektzoglou K, Xanthos T, Boutsikou T, Iliodromiti Z, Iacovidou N. The Effects of Dexmedetomidine on Children Undergoing Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis. Children (Basel) 2023; 10:948. [PMID: 37371178 DOI: 10.3390/children10060948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/30/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) is a valuable diagnostic tool but often requires sedation to complete, especially in children. Dexmedetomidine (DEX) is an a2 agonist, for which there are experimental findings that support its potential neuroprotective effects. Given the potential risks of anesthetic drugs, we ran this study to examine DEX's effectiveness and cardiopulmonary safety as a sedative drug for children undergoing MRI. MATERIAL AND METHODS Systematic research was conducted in PubMed, Google Scholar, Scopus and Cochrane databases for randomized controlled trials published between 2010 and 6th/2022 and involving children undergoing MRI who received DEX as sedative medication. The records which met the including criteria, after indexing via the PRISMA chart and assessing for bias, were processed, and a meta-analysis was carried out with the random effects method. RESULTS Thirteen studies were included. Out of 6204 measurements obtained, in 4626, it was planned for the participants to only receive DEX (measure group) as an anesthetic drug throughout the procedure. The participants' mean age was 57 months (Ι2 = 4%, τ2 = 0.5317, p = 0.40). A total of 5.6% (95% CI: 0.6-14.1%, I2 = 98%, p < 0.01) of the patients needed a second dose of DEX. In total, 6% (95% CI: 1-15%, I2 = 93%, τ2 = 0.0454, p < 0.01) required the administration of another drug, besides DEX, to complete the imaging (sedation failure). The effectiveness of the only-DEX method was 99% (95% CI: 97.5-100%, I2 = 81%, τ2 = 0.0107, p < 0.01). The whole rate of adverse events was 15% (95% CI: 9.3-21.5%, I2 = 92%, p < 0.01). Hypotension was reported in 8.7% of the cases (95% CI: 3.1-16.4%, I2 = 84%, p < 0.01), hypertension in 1.1% (95% CI: 0-5.4%, I2 = 89%, p < 0.01), bradycardia in 10% (95% CI: 4-18%, I2 = 95%, p < 0.01) and desaturation in 1.2% (95% CI: 0-4%, I2 = 68%, p < 0.01). There was no statistically significant incidence in respiratory rate decrease (comparing the children who received DEX to their baseline). Five cases of vomiting and one of apnea were recorded. CONCLUSIONS Given that DEX seems to be an effective as well as respiratory and hemodynamically safe drug, it may be a future spotlight in (pediatric) sedation for imaging procedures such as MRI.
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Affiliation(s)
- Valentina-Anastasia Angelopoulou
- Department of Radiology, General Hospital of Elefsina "Thriasio", 19600 Attica, Greece
- Postgraduate Study Program (MSc) "Resuscitation", School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, "Attikon" University Hospital, National and Kapodistrian University of Athens, 12464 Athens, Greece
| | - Nikolaos Alexiou
- First Department of Internal Medicine, General Hospital of Elefsina "Thriasio", 19600 Attica, Greece
| | - Parthena Ioannidi
- Department of Invasive Radiology, General Hospital of Athens "Evangelismos", 10676 Athens, Greece
- European Board of Interventional Radiology (EBIR), 1010 Vienna, Austria
| | - Dimitra Vagiona
- Primary Health Center of Nevrokopi, General Hospital of Drama, 66100 Drama, Greece
| | - Konstantinos Ekmektzoglou
- Postgraduate Study Program (MSc) "Resuscitation", School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | - Theodoros Xanthos
- School of Health Sciences, University of West Attica, 12243 Athens, Greece
| | - Theodora Boutsikou
- Department of Neonatology, "Aretaieio" Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Zoi Iliodromiti
- Department of Neonatology, "Aretaieio" Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikoletta Iacovidou
- Postgraduate Study Program (MSc) "Resuscitation", School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Neonatology, "Aretaieio" Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Cortellazzo Wiel L, Monasta L, Pascolo P, Servidio AG, Levantino L, Fasoli S, Saccari A, Cozzi G, Barbi E. Recovery characteristics and parental satisfaction in pediatric procedural sedation. Paediatr Anaesth 2022; 32:452-461. [PMID: 34964198 DOI: 10.1111/pan.14390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/24/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite being a standard of care for children undergoing stressful procedures, little data exist on parental perception of pediatric sedation. AIMS This study aimed to investigate recovery characteristics and parental satisfaction for pediatric sedations performed with four widely used sedative regimens. METHODS A prospective observational study was conducted at the Institute for Maternal and Child Health of Trieste, Italy, enrolling children undergoing procedural sedation with one of the following pharmacological regimens: propofol, propofol + midazolam, ketamine + propofol, and dexmedetomidine + midazolam. A questionnaire was used to assess the occurrence of symptoms upon recovery from sedation and the following day, and the caregivers' satisfaction for both the recovery pattern and the overall sedation experience, according to a numerical rating scale (0-10). Answers were collected through a telephone survey. The primary outcome was the difference in the quality of the recovery as perceived by caregivers; the secondary and tertiary outcomes were the perceived quality of the overall sedation experience and the frequency of sedation-related adverse events, respectively. RESULTS Data from 655 patients, 149 receiving propofol, 245 propofol + midazolam, 134 ketamine + propofol, and 127 dexmedetomidine + midazolam, were analyzed. The level of parents' satisfaction for both the recovery and the sedation experience was overall high and increased with the patients' age in all the pharmacological groups (Spearman's rank correlation, ρ .083, p = .033, and ρ .087, p = .026, respectively), with no statistically significant differences between groups when adjusting for age. The occurrence of irritability, prolonged sleepiness, hyperactivity, unsteadiness, hallucinations, emesis, and respiratory distress at any moment negatively affected parental satisfaction. CONCLUSIONS In this study, caregivers' satisfaction with pediatric sedation was high, regardless of the regimen used. Lower parental satisfaction was associated with younger age, irritability after sedation, prolonged sleepiness, hyperactivity, unsteadiness, hallucinations, emesis, and respiratory distress.
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Affiliation(s)
| | - Lorenzo Monasta
- Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Paola Pascolo
- Dipartimento Materno-Infantile, Ospedale San Polo, Azienda Sanitaria Giuliano Isontina, Monfalcone, Italy
| | | | | | | | - Alessia Saccari
- Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Giorgio Cozzi
- Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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Kim PH, Park YS, Yoon HM, Jung AY, Joo EY, Choi IC, Song MH. Factors Associated with Occurrence of Atelectasis during Sedation for Imaging in Pediatric Patients: A Retrospective Single Center Cohort Study. J Clin Med 2021; 10:jcm10163598. [PMID: 34441894 PMCID: PMC8397091 DOI: 10.3390/jcm10163598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022] Open
Abstract
Sedation can induce atelectasis which may cause suboptimal image quality. This study aimed to identify factors associated with the occurrence of atelectasis during sedation for imaging in pediatric patients. Patients < 18 years who had undergone whole-body magnetic resonance imaging (MRI) under sedation with propofol or dexmedetomidine were included in this study. The development of atelectasis was visually and quantitatively assessed by coronal short tau inversion recovery images of the thoracic level. Multivariable logistic regression was performed to identify the independent factors associated with the development of atelectasis. Ninety-one patients were included in the analysis. In the multivariable analysis, administration of supplemental oxygen was the only factor significantly associated with the occurrence of atelectasis (adjusted odds ratio, 4.84; 95% confidence interval, 1.48-15.83; p = 0.009). Univariable analysis showed that the use of dexmedetomidine was associated with a lower incidence of atelectasis; however, this could not be verified in the multivariable analysis. Among the pediatric patients who had undergone imaging under sedation, additional oxygen supplementation was the only independent factor associated with atelectasis occurrence. A prospective clinical trial is required to identify the cause-effect relationship between oxygen administration and occurrence of atelectasis during sedation.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (P.H.K.); (H.-M.Y.); (A.Y.J.)
| | - Yong-Seok Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
| | - Hee-Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (P.H.K.); (H.-M.Y.); (A.Y.J.)
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (P.H.K.); (H.-M.Y.); (A.Y.J.)
| | - Eun-Young Joo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
| | - Myung-Hee Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
- Correspondence: ; Tel.: +82-2-3010-3992; Fax: +82-2-3010-6790
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Nie Q, Hui P, Ding H, Wang Z. Rectal chloral hydrate sedation for computed tomography in young children with head trauma. Medicine (Baltimore) 2021; 100:e25033. [PMID: 33655976 PMCID: PMC7939168 DOI: 10.1097/md.0000000000025033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
Children evaluated in the emergency department for head trauma often undergo computed tomography (CT), with some uncooperative children requiring pharmacological sedation. Chloral hydrate (CH) is a sedative that has been widely used, but its rectal use for child sedation after head trauma has rarely been studied. The objective of this study was to document the safety and efficacy of rectal CH sedation for cranial CT in young children.We retrospectively studied all the children with head trauma who received rectal CH sedation for CT in the emergency department from 2016 to 2019. CH was administered rectally at a dose of 50 mg/kg body weight. When sedation was achieved, CT scanning was performed, and the children were monitored until recovery. The sedative safety and efficacy were analyzed.A total of 135 children were enrolled in the study group, and the mean age was 16.05 months. The mean onset time was 16.41 minutes. Successful sedation occurred in 97.0% of children. The mean recovery time was 71.59 minutes. All of the vital signs were within normal limits after sedation, except 1 (0.7%) with transient hypoxia. There was no drug-related vomiting reaction in the study group. Adverse effects occurred in 11 patients (8.1%), but all recovered completely. Compared with oral CH sedation, rectal CH sedation was associated with quicker onset (P < .01), higher success rate (P < .01), and lower adverse event rate (P < .01).Rectal CH sedation can be a safe and effective method for CT imaging of young children with head trauma in the emergency department.
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Affiliation(s)
- Quanmin Nie
- Department of Neurosurgery, Weifang People's Hospital, Weifang
| | - Peiquan Hui
- Department of Neurosurgery, Weifang People's Hospital, Weifang
| | - Haitao Ding
- Department of Neurosurgery, Linyi Central Hospital, Yishui, Shandong, China
| | - Zengwu Wang
- Department of Neurosurgery, Weifang People's Hospital, Weifang
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Mian MN, Alwasiah N, Savitz A. The use and safety of intramuscular midazolam during in-office botulinum toxin injections in pediatric patients. J Pediatr Rehabil Med 2021; 14:213-218. [PMID: 33896852 DOI: 10.3233/prm-190629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Pediatric outpatient procedures can be traumatic experiences for patients. This retrospective study, evaluates intramuscular midazolam as a safe option for anxiolysis during spasticity management injections. METHODS We performed a retrospective chart review of 72 patients from a Tertiary Pediatric Hospital Outpatient Clinic. One hundred and twenty injections were administered over two years by a single practitioner. Comorbidities included asthma, sleep apnea, chronic obstructive disease, and epilepsy. Duration of sedation, safety of midazolam as determined through the use of the REACT (Respiration, Energy, Alertness, Circulation, Temperature) score, and frequency of side effects (prolonged sedation, breakthrough crying, medication reversal, and emergent evaluation) were recorded. A student's t test evaluated the relationship between the above comorbidities and duration of sedation. RESULTS The average duration of sedation was 29 minutes (95% CI 26.51-31.35) with an average dose of midazolam of 0.20 mg/kg (95% CI 0.9-0.21). None of the subjects required medication reversal or emergent evaluation. 39% of the patients had prolonged sedation (> 30 minutes after medication administration), 22% had breakthrough crying, and 0% had respiratory events requiring oxygen, intubation or an emergency evaluation. No statistical significance found between the comorbidities and duration of sedation. CONCLUSION Intramuscular midazolam is a possible effective anxiolytic medication strategy for outpatient pediatric injections. Additional studies are needed to ensure its safety and efficacy.
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Affiliation(s)
- Mariam N Mian
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Nadia Alwasiah
- Department of Rehabilitation and Physiotherapy, American Hospital Dubai, Dubai, United Arab Emirates
| | - Ariel Savitz
- Department of Orthopedic Medicine, Tufts Medical Center, Boston, MA, USA
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Firth PG, Mai CL. The evolution of pediatric sedation and anesthesia patient safety: An interview with Dr Charles J. "Charlie" Coté. Paediatr Anaesth 2020; 30:1183-1190. [PMID: 33569801 DOI: 10.1111/pan.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
The career of Dr Charles J. Coté covered a period of major advances in pediatric anesthesia patient safety. Dr Coté (1946 --), Professor Emeritus in Anaesthesia at Harvard Medical School, helped develop pediatric sedation guidelines, conducted influential clinical research, edited a major textbook, and promoted pediatric anesthesia training fellowships in low- and middle-income countries. Based on a series of interviews with Dr Coté, this article reviews the career of this Robert M. Smith Award winner through the lens of improvements in pediatric sedation and anesthesia patient safety.
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Affiliation(s)
- Paul G Firth
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christine L Mai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
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Gupta A, Sen I, Bhardwaj N, Yaddanapudi S, Mathew PJ, Sahni N, Bhatia A. Prospective audit of sedation/anesthesia practices for children undergoing computerized tomography in a tertiary care institute. J Anaesthesiol Clin Pharmacol 2020; 36:156-161. [PMID: 33013027 PMCID: PMC7480298 DOI: 10.4103/joacp.joacp_16_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/25/2019] [Accepted: 09/03/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: The aim of the study was to enumerate the sedative drugs used, assess the efficacy of sedative drugs, and determine the incidence of adverse events. Material and Methods: A prospective audit of children sedated for computerized tomography (CT) by anesthesiology team was conducted for a period of 4 months. The data included patient demographic variables, fasting period, medications administered, adequacy of sedation, imaging characteristics, adverse events, and requirement for escalated care. Results: A total of 331 children were enrolled for sedation by the anesthesia team. The drugs used for sedation were propofol, ketamine, and midazolam. Twenty-two percent children received one sedative drug, 60% children were administered two drugs, and 5% children required a combination of all three drugs for successful sedation. Sedation was effective for successful conduct of CT scan in 95.8% patients without the requirement of a repeat scan. Twelve (5%) children experienced adverse events during the study period. However, none of the adverse events necessitated prolonged postprocedural hospitalization or resulted in permanent neurologic injury or death. Conclusions: The current practice of sedation with propofol, ketamine, and midazolam, either single or in combination was efficacious in a high percentage of patients. The incidence of adverse events during the study period was low.
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Affiliation(s)
- Aakriti Gupta
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Sen
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J Mathew
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeru Sahni
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lee FC, Queliza K, Chumpitazi BP, Rogers AP, Seipel C, Fishman DS. Outcomes of Non-anesthesiologist-Administered Propofol in Pediatric Gastroenterology Procedures. Front Pediatr 2020; 8:619139. [PMID: 33604318 PMCID: PMC7885908 DOI: 10.3389/fped.2020.619139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Non-anesthesiologist-administered propofol (NAAP) has been found to have an acceptable safety profile in adult endoscopy, but its use remains controversial and pediatric data is limited. Our aim was to examine the safety and efficacy of NAAP provided by pediatric hospitalists in pediatric endoscopy. Methods: We retrospectively reviewed 929 esophagogastroduodenoscopy (EGD), colonoscopy, and combined EGD/colonoscopy cases in children aged 5-20 years between April 2015 and December 2016 at a large children's hospital. We analyzed the data for adverse events in relation to demographics and anthropometrics, American Society of Anesthesiologists physical classification score, presence of a trainee, comorbid conditions, and procedure time. Results: A total of 929 cases were included of which 496 (53%) were completed with NAAP. Seventeen (3.4%) of NAAP cases had an adverse event including the following: 12 cases of hypoxia, 2 cardiac, and 3 gastrointestinal adverse events. General anesthesia cases had 62 (14.3%) adverse events including the following: 54 cases of hypoxia, 1 cardiac, 7 gastrointestinal, and 1 urologic adverse event. No adverse events in either group required major resuscitation. NAAP vs. general anesthesia had a lower overall adverse event rate (3.4 vs. 14.3%, p < 0.0004) and respiratory adverse event rate (2.4% vs. 12.5%, p < 0.0004). Overall, cardiac and gastrointestinal adverse event rates between the two groups were comparable. When accounting for all captured factors via logistic regression, both younger age (P < 0.001) and general anesthesia (P < 0.0001) remained risk factors for an adverse event. Conclusion: The overall adverse event rate of NAAP was low (3.4%) with none requiring major resuscitation or hospitalization. This is comparable to studies of NAAP in adult endoscopy and suggests that NAAP provided by pediatric hospitalists has an acceptable safety profile.
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Affiliation(s)
- Frances C Lee
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, United States
| | - Karen Queliza
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, United States
| | - Bruno P Chumpitazi
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, United States.,Children's Nutrition Research Center, United States Department of Agriculture, Houston, TX, United States
| | - Amber P Rogers
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, United States.,Department of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Catherine Seipel
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, United States
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, United States
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Nagoshi M, Reddy S, Bell M, Cresencia A, Margolis R, Wetzel R, Ross P. Low-dose dexmedetomidine as an adjuvant to propofol infusion for children in MRI: A double-cohort study. Paediatr Anaesth 2018; 28:639-646. [PMID: 29882298 PMCID: PMC6105415 DOI: 10.1111/pan.13400] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Propofol is an effective sedative for magnetic resonance imaging. Nevertheless, it may cause hemodynamic and respiratory complications in a dose dependent fashion. We investigated the role of low-dose dexmedetomidine (0.5 μg/kg) as an adjuvant to propofol sedation for children undergoing magnetic resonance imaging. We hypothesized that dexmedetomidine would decrease the propofol dose required, airway complications, and hemodynamic instability. METHODS We performed a retrospective chart review of patients' age of 1 month to 20 years. Children were divided into 2 groups; group P received only propofol; group D + P received intravenous bolus of dexmedetomidine (0.5 μg/kg) and propofol. RESULTS We reviewed 172 children in P and 129 in D + P (dexmedetomidine dose, median: 0.50 μg/kg (IQR: 0.45-0.62). An additional dexmedetomidine bolus was given to 17 children for sedation lasting longer than 2 hours. Total propofol dose (μg/kg/min) was significantly higher in group P than D + P; 215.0 (182.6-253.8) vs 147.6 (127.5-180.9); Median Diff = -67.8; 95%CI = -80.6, -54.9; P < .0001. There was no difference in recovery time (minutes); P: 28 (17-39) vs D + P: 27 (18-41); Median Diff = -1; 95%CI = -6.0, 4.0; P = .694. The need for airway support was significantly greater in P compared to D + P; 15/172 vs 3/129; OR = 0.25; 95%CI = 0.07 to 0.90; P = .02 (2-sample proportions test). Mean arterial pressure was significantly lower in P compared to D + P across time over 60 minutes after induction (coef = -0.06, 95%CI = -0.11, -0.02, P = .004). DISCUSSION & CONCLUSION A low-dose bolus of dexmedetomidine (0.5 μg/kg) used as an adjuvant can decrease the propofol requirement for children undergoing sedation for magnetic resonance imaging. This may decrease the need for airway support and contribute to improved hemodynamic stability without prolonging recovery time.
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Affiliation(s)
- Makoto Nagoshi
- Department of Anesthesiology and Critical Care Medicine; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Swayta Reddy
- Department of Anesthesiology and Critical Care Medicine; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Marisa Bell
- Department of Anesthesiology and Critical Care Medicine; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Allan Cresencia
- Department of Anesthesiology and Critical Care Medicine; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Rebecca Margolis
- Department of Anesthesiology and Critical Care Medicine; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Randall Wetzel
- Department of Anesthesiology and Critical Care Medicine; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Patrick Ross
- Department of Anesthesiology and Critical Care Medicine; Children's Hospital Los Angeles; Keck School of Medicine; University of Southern California; Los Angeles CA USA
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Tripathi S, Raju V, Horack KA, Bronson DL, Deshpande GG. Successful Development and Implementation of Pediatric Sedation-Analgesia Curriculum for Residents. J Pediatr Intensive Care 2018; 7:129-134. [PMID: 31073485 DOI: 10.1055/s-0038-1624570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022] Open
Abstract
Pediatric residency graduates are increasingly asked to provide procedural sedations. Currently, most programs provide minimal exposure to residents outside of PICU for procedural sedations. We describe the pediatric sedation and analgesia (PSA) evolution and resident experience over the past 6 years at our institution (fiscal year 2010-2015). Administrative database of the PSA team and resident evaluations obtained by respective residency programs were analyzed and presented with standard descriptive analysis. Commutative or where appropriate year-by-year data were analyzed. Over the past 6 years, 100 residents performed 1,742 sedations with 17 ± 6.4 sedations per resident. Lumbar puncture and MRI were the most frequent procedures for sedations performed by residents. There was no statistical difference in complication rates in sedations performed by residents (28.6 ± 16.6) versus those by attending only (36.2 ± 31.2). Overall, residents were satisfied with the educational experience with an average score of 6.1 ± 0.17 out of maximum 7. Resident involvement in PSA is well liked by residents and does not lead to an increase in sedation-related complications.
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Affiliation(s)
- Sandeep Tripathi
- Division of Cardiac Critical Care, Lurie Children's Hospital, Chicago, Illinois, United States.,Pediatric Sedation and Analgesia Team, Children's Hospital of Illinois, Peoria, Illinois, United States
| | - Venkedesh Raju
- Pediatric Hospitalist, Mercy Hospital, Iowa City, Iowa, United States
| | - Kimberly A Horack
- Pediatric Sedation and Analgesia Team, Children's Hospital of Illinois, Peoria, Illinois, United States
| | - Donna L Bronson
- Pediatric Sedation and Analgesia Team, Children's Hospital of Illinois, Peoria, Illinois, United States
| | - Girish G Deshpande
- Pediatric Sedation and Analgesia Team, Children's Hospital of Illinois, Peoria, Illinois, United States
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Salehi F, Riasi HR, Ebrahimzadeh A, Askari Janatabadi S. The Effect of Oral Midazolam and Chloral Hydrate Before Echocardiography in Pediatric Patients: A Randomized Double-Blind Clinical Trial. Glob Pediatr Health 2017; 4:2333794X17735972. [PMID: 29085865 PMCID: PMC5648089 DOI: 10.1177/2333794x17735972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 09/13/2017] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compare the effects of oral midazolam and chloral hydrate in pre-echocardiography sedation of children. In this double-blind clinical trial, 68 children were randomly assigned to midazolam (0.2 mg/kg) or chloral hydrate (50 mg/kg). The intensity, duration, and onset of the drugs’ effects were assessed. Data were analyzed using the χ2 and Mann-Whitney tests (P ≤ .05). The average onset and duration of sedation in the children assigned to midazolam was shorter than in those assigned chloral hydrate (6.35 ± 3.65 and 19.14 ± 5.86 minutes, P = .0001, and 27.64 ± 8.34 and 48.97 ± 14.81 minutes, P = .0001). Gastrointestinal side effects were more frequent in the chloral hydrate group (23.5% against 0%, P = .003). According to the results of the present study, chloral hydrate and midazolam can be appropriate choices for pre-echocardiography sedation of patients without cardiovascular risk factors. Considering the similar effectiveness, more rapid onset, and shorter duration of sedation, besides less side effects in the midazolam group, researchers recommend the routine use of this drug.
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Affiliation(s)
- Forod Salehi
- Birjand University of Medical Sciences, Birjand, Iran
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15
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McGuirt D. Alternatives to Sedation and General Anesthesia in Pediatric Magnetic Resonance Imaging: A Literature Review. Radiol Technol 2016; 88:18-26. [PMID: 27601689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/08/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To assess alternatives to sedation and general anesthesia to prepare children for magnetic resonance (MR) imaging examinations. METHODS Online databases were searched for articles discussing methods of preparing children for MR imaging procedures. Because of the large number of articles returned, criteria were limited to only studies that prepared patients without the use of sedation or general anesthesia. RESULTS Twenty-four studies were deemed appropriate for inclusion in the review. The following methods emerged as alternatives to pediatric sedation: mock scanners, MR-compatible audiovisual systems, feed-sleep manipulation, play therapy, infant incubators/immobilizers, photo diaries, sucrose solutions, and guided imagery. The approaches with the most extensive research were mock MR scanners and feed-sleep manipulation. DISCUSSION Evidence supports the use of these alternative techniques as valid substitutes for pediatric sedation and general anesthesia. CONCLUSION To reduce the risks associated with sedation of pediatric patients, institutions could implement the alternatives discussed in this review. Cost analyses should be conducted first because some methods are more expensive than others. Finally, further research is needed to better assess the effectiveness of lesser-practiced methods, including photo diaries, sucrose solutions, and guided imagery.
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Fauman KR, Durgham R, Duran CI, Vecchiotti MA, Scott AR. Sedation after airway reconstruction in children: A protocol to reduce withdrawal and length of stay. Laryngoscope 2015; 125:2216-9. [PMID: 26152806 DOI: 10.1002/lary.25176] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/19/2014] [Accepted: 01/05/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Karen R Fauman
- Department of Pediatrics-Critical Care Medicine, Floating Hospital for Children, Boston, Massachusetts, U.S.A
| | - Rashed Durgham
- Department of Pediatrics-Critical Care Medicine, Floating Hospital for Children, Boston, Massachusetts, U.S.A
| | - Carlos I Duran
- Department of Pediatrics-Critical Care Medicine, Floating Hospital for Children, Boston, Massachusetts, U.S.A
| | - Mark A Vecchiotti
- Department of Pediatric Otolaryngology and Facial Plastic Surgery, Floating Hospital for Children, Boston, Massachusetts, U.S.A
| | - Andrew R Scott
- Department of Pediatric Otolaryngology and Facial Plastic Surgery, Floating Hospital for Children, Boston, Massachusetts, U.S.A
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Scherrer PD, Mallory MD, Cravero JP, Lowrie L, Hertzog JH, Berkenbosch JW. The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth 2015; 25:689-97. [PMID: 25817924 DOI: 10.1111/pan.12627] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the impact of obesity on adverse events and required interventions during pediatric procedural sedation. METHODS The Pediatric Sedation Research Consortium database of prospectively collected procedural sedation encounters was queried to identify patients for whom body mass index (BMI) could be calculated. Obesity was defined as BMI ≥95th percentile for age and gender. Sedation-related outcomes, adverse events, and therapeutic interventions were compared between obese and nonobese patients. RESULTS For analysis, 28,792 records were eligible. A total of 5,153 patients (17.9%) were obese; they were predominantly male and older and had a higher median American Society of Anesthesiologists Physical Status classification (P < 0.001). Total adverse events were more common in obese patients (odds ratio [OR] 1.49, 95% confidence interval [1.31, 1.70]). Respiratory events (airway obstruction OR 1.94 [1.54, 2.44], oxygen desaturation OR 1.99 [1.50, 2.63], secretions OR 1.48 [1.01, 2.15], laryngospasm OR 2.30 [1.30, 4.05]), inability to complete the associated procedure (OR 1.96 [1.16, 3.30]), and prolonged recovery (OR 2.66 [1.26, 5.59]) were increased in obese patients. Obese patients more frequently required airway intervention including repositioning, suctioning, jaw thrust, airway adjuncts, and bag-valve-mask ventilation. Multivariate regression analysis demonstrated obesity to be independently associated with minor and moderate but not major adverse events. CONCLUSIONS Obesity is an independent risk factor for adverse respiratory events during procedural sedation and is associated with an increased frequency of airway interventions, suggesting that additional vigilance and expertise are required when sedating these patients.
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Affiliation(s)
- Patricia D Scherrer
- Children's Respiratory and Critical Care Specialists, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Michael D Mallory
- Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta at Scottish Rite Hospital, Atlanta, GA, USA
| | - Joseph P Cravero
- Department of Anesthesiology, Boston Children's Hospital, Boston, MA, USA
| | - Lia Lowrie
- Department of Pediatrics, St Louis University at Cardinal Glennon Children's Hospital, St Louis, MO, USA
| | - James H Hertzog
- Department of Anesthesiology and Critical Care Medicine, Alfred I duPont Hospital for Children, Wilmington, DE, USA
| | - John W Berkenbosch
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville, Louisville, KY, USA
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Abstract
BACKGROUND THE GOAL OF THIS INVESTIGATION WAS TO COMPARE THE BEHAVIORAL AND PHYSIOLOGICAL EFFECTS OF THREE SEDATIVE DRUG REGIMENS: oral meperidine (OM), submucosal meperidine (SM) and oral midazolam (M) in healthy pediatric patients. MATERIALS AND METHODS This study sample consisted of thirty children aged 24-72 months (mean = 41.1) exhibiting definitely negative behavior. Three sedative regimens including: Oral meperidine/hydroxyzine, oral midazolam/hydroxyzine and submucosal meperidine/oral hydroxyzine were administered randomly during three consecutive appointments with a crossover design. Houpt behavioral scale was employed for evaluating the sedation effect of each regimen by a calibrated independent Pediatric dentist. Physiologic parameters were also recorded including blood oxygen saturation and pulse rate. Data was analyzed using Wilcoxon-signed ranked test, Mc-Nemar, GEE Logistic regression, Friedman, Fisher exact and Cochran tests for significance. RESULTS Overall success rates were 50%, 46.7% and 26.7% for submucosal meperidine, oral meperidine and oral midazolam, respectively (P = 0.03). The probability of achieving a success in behavior control was more in 48-72 month olds. Child's age and drug type were the two main predictors of altered behavior. Evaluating the differences between the effects of three tested regimens on recorded physiological parameters showed no significant differences. CONCLUSION All three regimens were proved safe within the limits of the current study. Meperidine sedation in both routes was considered to be more effective. Although there was less sleep and more head/oral resistance in midazolam group, the difference between groups was not significant.
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Affiliation(s)
- Lida Toomarian
- Department of Pedodontics, Dental School, Shahid Beheshti Medical University, Tehran
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Abstract
Background: Propofol and pentobarbital are commonly used to sedate children undergoing magnetic resonance imaging (MRI). Aim/Objective: To compare the safety of three types of sedation: intravenous propofol (PROP), mixed pentobarbital/propofol (PENT), and mixed pentobarbital group requiring supplemental sedation (PENT SUPP) regimens in pediatric patients following deep sedation (DS) for noncardiac MRI. Materials and Methods: We conducted a case-control study matching 619 cases with complications with 619 controls using data from our institution's sedation database for children deeply sedated for noncardiac MRI. Cases were defined as patients with any complication and we characterized complications from cases, and used a conditional logistic regression model to assess the association between three DS methods and occurrence of complications after adjusting for confounding variables. Results: We found that complications occurred in association with 794 (10.1%) of the 7,839 DSs performed for MRI between 1998 and 2008. Of the 794 cases, 619 cases met inclusion criteria for the study. Among the 619 cases that met inclusion criteria, 24 (0.3% of 7,839 DSs total) were associated with major complications. Type of sedation was significantly associated with the occurrence of complications, and the PENT group was associated with decreased odds of complications when compared to the PROP regimen (OR 0.68; 95% CI 0.46, 0.98; P=0.040) and compared to the PENT SUPP group (OR 0.60; 95% CI 0.31, 0.89; P<0.0001). Conclusions: DS with a pentobarbital technique was associated with decreased odds for complications when compared to a propofol-based technique or a pentobarbital technique requiring supplemental sedation.
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Affiliation(s)
- Solina Tith
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon, USA
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Piraccini E, Albarello R, Biagini C, Novi A, Agnoletti V, Gambale G. Spinal anesthesia plus ketamine-midazolam sedation for pediatric orthopedic surgery in a developing country. HSR Proc Intensive Care Cardiovasc Anesth 2012; 4:176-8. [PMID: 23439924 PMCID: PMC3485388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Spinal anesthesia produces a profound and uniformly distributed sensory block with rapid onset and muscle relaxation, and results in complete control of cardiovascular and stress responses. Ketamine is an anesthetic agent that is widely used for pediatric sedations in settings where safety and efficacy of the agents are mandatory because of limited healthcare resources. The authors report on their experience in a refugee hospital located in Bol-la (Saharawi, Algeria). METHODS Spinal anesthesia was performed for orthopedic surgery procedures in children. Before the spinal puncture, the patients were sedated with intramuscular ketamine followed by intravenous ketamine and midazolam. Boluses of midazolam were also administered throughout the surgery to keep the patients sedated; spinal anesthesia was performed with levobupivacaine 0.25 mg/kg. RESULTS There were no intraoperative adverse events; vital signs were within the normal pediatric ranges during the procedures and there was no need to switch to general anesthesia. In the postoperative period, no symptoms of dural puncture headache or postoperative delirium or nightmares were reported. CONCLUSION Based on the authors' experience, the combination of spinal anesthesia and sedation with midazolam and ketamine was found to be a safe approach for children undergoing orthopedic surgery in a low resources setting.
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Affiliation(s)
- E Piraccini
- Anaesthesia and Intensive Care Unit, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - R Albarello
- Pediatric intensive Care Unit, Sant\'Orsola Malpighi Hospital, University of Bologna, Italy
| | - C Biagini
- Orthopedic Unit, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - A Novi
- Anaesthesia and Intensive Care Unit, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - V Agnoletti
- Anaesthesia and Intensive Care Unit, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
| | - G Gambale
- Anaesthesia and Intensive Care Unit, "G.B. Morgagni-Pierantoni" Hospital, Forlì, Italy
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