Perioperative morbidity in children with elastin arteriopathy

Summary

Background

Children with elastin arteriopathy (EA), the majority of whom have Williams–Beuren syndrome, are at high risk for sudden death. Case reports suggest that the risk of perioperative cardiac arrest and death is high, but none have reported the frequency or risk factors for morbidity and mortality in an entire cohort of children with EA undergoing anesthesia.

Aim

The aim of this study was to present one institution's rate of morbidity and mortality in all children with EA undergoing anesthesia and to examine patient characteristics that pose the greatest risk.

Methods

We reviewed medical records of children with EA who underwent anesthesia or sedation for any procedure at our institution from 1990 to 2013. Cardiovascular hemodynamic indices from recent cardiac catheterization or echocardiography were tabulated for each child. The incidence, type, and associated factors of complications occurring intraoperatively through 48 h postoperatively were examined.

Results

Forty-eight patients with confirmed EA underwent a total of 141 anesthetics. There were seven cardiac arrests (15% of patients, 5% of anesthetics) and nine additional intraoperative cardiovascular complications (15% of patients, 6% of anesthetics). Extracorporeal life support was initiated in five cases. There were no perioperative deaths. All children having a cardiac arrest or complication were <3 years old and had biventricular outflow tract obstruction (BVOTO). Subgroup analysis demonstrated high rates of cardiac arrest in two groups: children with BVOTO (44%) and age <3 years old (21%).

Conclusions

We have confirmed that the rate of cardiac arrest and complications is significantly elevated in children with EA undergoing anesthesia. Children <3 years old and with BVOTO were at the greatest risk in our population.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/29xVDrX
via IFTTT

Feasibility and pharmacokinetics of caudal blockade in children and adolescents with 30–50 kg of body weight

Summary

Background

Caudal blockade, although an important technique of pediatric regional anesthesia, is rarely used in children heavier than 30 kg. This reservation is due to anatomical concerns and lack of pharmacokinetic data. We therefore set out to evaluate, in pediatric patients weighing 30−50 kg, the feasibility of ultrasound-guided caudal blockade and the pharmacokinetics of caudally administered ropivacaine.

Methods

Twenty consecutive children were included. General anesthesia was used to ensure a secured airway. For the caudal punctures, we applied the same clinical standards as in smaller children, administering ropivacaine 3.1 mg·ml^-1 for a volume of 1 ml·kg⁻¹ via ultrasound guidance. Pharmacokinetic analysis was based on total plasma ropivacaine levels and included maximum concentration (C_max), time to C_max (t_max), terminal elimination half-life, area under the concentration–time curve for the 4-h sampling period, apparent total body clearance, and apparent volume of distribution.

Results

In all 19 cases of successful puncture, we identified the relevant anatomical structures (sacral cornua, sacral hiatus, dura mater) and verified correct administration of the local anesthetic by visualizing its cranial spread. Surgical blockade was successful in 18 of 20 cases (90%; one puncture was technically not possible and one child received intraoperatively 50 μg fentanyl). The pharmacokinetic profile of the administered ropivacaine 3.1 mg·ml⁻¹ indicated plasma levels within safe ranges in pediatric patients weighing 30−50 kg.

Conclusions

Based on our pharmacodynamic and pharmacokinetic results, we suggest that the body weight of 50 kg it is feasible to perform effective and safe caudal blockade in children up to 50 kg body weight.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2a18Fgm
via IFTTT

Early childhood exposure to short periods of sevoflurane is not associated with later, lasting cognitive deficits

Summary

Background

A detrimental effect of commonly used anesthetics on the neurodevelopmental and behavioral parameters has long been shown in young animals subjected to early childhood anesthesia. Epidemiologic studies suggest the possibility of a modestly elevated risk of adverse neurodevelopmental outcomes in children exposed to anesthesia during early childhood. However, these results are still preliminary and inconclusive.

Aim

To further elucidate the probability of occurrence of such adverse outcomes, we evaluated cognitive performance of children who underwent general anesthesia early in their childhood.

Method

One hundred and fifteen children aged 5‒16 years with established glaucoma were included in the study. Of these, 68 children had a history of at least one general anesthesia with sevoflurane before age 3. Phonemic and semantic verbal fluency, and forward and backward digit span tests were performed to evaluate cognitive function in the study subjects.

Results

The two-way anova revealed that all these variables showed significant changes in various age groups, but they were comparable among subjects with no, single, or multiple childhood anesthesia.

Conclusion

It can be concluded that brief periods of anesthesia with single anesthetic sevoflurane may be safe for children under age 3.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/29xVLro
via IFTTT

Pain after discharge following head and neck surgery in children

Summary

Background

It is well established that children experience significant pain for a considerable period following adenotonsillectomy. Less is known, however, about pain following other common head and neck operations.

Aim

The aim of this study was to describe the severity and duration of postoperative pain experienced by children undergoing elective head and neck procedures (primary outcomes). Behavioral disturbance, nausea and vomiting, parental satisfaction, and medical reattendance rates were also measured (secondary outcomes).

Method

Parents of children (0–18 years) undergoing common head and neck operations were invited to participate. Pain scores on the day of surgery and each day post discharge were collected via multiple telephone interviews. Data collected included pain levels, analgesia prescribed and given, behavioral disturbance rates, and nausea and vomiting scores. Follow-up was continued until pain resolved.

Results

Two hundred and fifty-one patients were analyzed (50 adenoidectomy, 51 adenotonsillectomy, 19 myringoplasty, 52 myringotomy, 43 strabismus, and 36 tongue tie divisions). On the day of surgery myringoplasty, strabismus surgery, and adenotonsillectomy patients on average had moderate pain, whereas adenoidectomy, tongue tie, and myringotomy patients had mild pain. Adenotonsillectomy patients continued to have moderate pain for several days with pain lasting on average 9 days. From day 1 postoperatively mild pain was experienced in the other surgical groups with the average duration of pain varying from 1 to 3 days depending on the surgery performed. Frequency of behavioral issues closely followed pain scores for each group. Analgesic prescribing and regimes at home varied widely, both within and between the different surgical groups. Rates of nausea and vomiting following discharge were low in all groups. The overall unplanned medical reattendance rate was 16%.

Conclusion

Adenotonsillectomy patients represent the biggest challenge in postoperative pain management of the head and neck surgeries evaluated. The low rates of pain, nausea, and vomiting reported in the days following surgery for the other procedures suggests that children can be cared for at home with simple analgesia. Discharge information and analgesia prescribing on discharge should be tailored to the operation performed.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2a18KAy
via IFTTT

Respiratory depression detected by capnography among children in the postanesthesia care unit: a cross-sectional study

Summary

Background

Children are at risk for respiratory depression while recovering from anesthesia. Currently, monitoring children in the postanesthesia care unit (PACU) with pulse oximetry is recommended. However, pulse oximetry does not reliably recognize hypoventilation or apnea, particularly in the presence of supplemental oxygen. Capnography is a sensitive monitor of ventilation that is not often used in the PACU.

Aim

To determine the frequency of hypoventilation and apnea as detected by capnography among children in the PACU.

Methods

In a cross-sectional study, capnography monitoring was applied to healthy children of age 1–17 years in the PACU of a tertiary care hospital. Staff was blinded to the capnography monitor; alarms were disabled. Staff provided routine care and monitoring with pulse oximetry to all patients. Vital signs, patient interventions, and medication administration were recorded by a research assistant every 30 s until all monitoring was discontinued by staff. Outcome measures included frequency of hypoventilation and apnea as measured by capnography and oxygen desaturations as measured by pulse oximetry, as well as staff interventions for these events.

Results

Data from 194 children were analyzed. Capnography detected hypoventilation or apnea in 45.5% (95% CI 38.5%, 52.5%) of patients. Oxygen desaturations occurred in 19% (95% CI 13%, 24%) of patients. Interventions occurred in 9% (95% CI 5%, 13%) of patients. Patients who received narcotic medications were more likely to experience hypoventilation (OR 2.3, 95% CI 1.02, 5.3) and apnea (OR 2.7, 95% CI 1.1, 7). Hypoventilation was seen more often among children who received supplemental oxygen (OR 3.1, 95% CI 1.1, 12).

Conclusions

Hypoventilation and apnea are common among children in the PACU; however, few interventions occur to address these events. Routine monitoring with capnography may improve recognition of respiratory depression and enhance patient safety in the PACU.

from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/29xVbde
via IFTTT

Effects of Ionizing Radiation on the Heart

Publication date: Available online 10 July 2016
Source:Mutation Research/Reviews in Mutation Research
Author(s): Marjan Boerma, Vijayalakshmi Sridharan, Xiao-Wen Mao, Gregory A. Nelson, Amrita K. Cheema, Igor Koturbash, Sharda P. Singh, Alan J. Tackett, Martin Hauer-Jensen
This article provides an overview of studies addressing effects of ionizing radiation on the heart. Clinical studies have identified early and late manifestations of radiation-induced heart disease, a side effect of radiation therapy to tumors in the chest when all or part of the heart is situated in the radiation field. Studies in preclinical animal models have contributed to our understanding of the mechanisms by which radiation may injure the heart. More recent observations in human subjects suggest that ionizing radiation may have cardiovascular effects at lower doses than was previously thought. This has led to examinations of low-dose photons and low-dose charged particle irradiation in animal models. Lastly, studies have started to identify non-invasive methods for detection of cardiac radiation injury and interventions that may prevent or mitigate these adverse effects. Altogether, this ongoing research should increase our knowledge of biological mechanisms of cardiovascular radiation injury, identify non-invasive biomarkers for early detection, and potential interventions that may prevent or mitigate these adverse effects.



from Genetics via xlomafota13 on Inoreader http://ift.tt/29rRRgZ
via IFTTT

Reality Training: Severe head wound behind home plate

How would you treat a baseball umpire's significant head laceration as players, fans and television viewers watch your every move?

from EMS via xlomafota13 on Inoreader http://ift.tt/29xLdsm
via IFTTT