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Anticholinergic premedication-induced fever in paediatric ambulatory ketamine anaesthesia.

ABSTRACT: A randomized, double-blind, prospective study to evaluate the effect of anticholinergic drugs on thermoregulation in paediatric patients undergoing ambulatory anaesthesia with ketamine.Patients were randomized to receive either 0.005?mg/kg glycopyrrolate or the equivalent volume of normal saline (placebo) at 30?min before ketamine anaesthesia. Body temperature was measured tympanically at baseline and at 0, 30, 60 and 90?min postoperatively. The quantity of saliva prodiced during surgery and incidence of fever were recorded.Body temperature was significantly higher in the glycopyrrolate group (n?=?42) than the placebo group (n?=?42) at 30, 60 and 90?min after surgery, and higher than baseline at 0, 30, 60 and 90?min after surgery. In the placebo group, body temperature was significantly higher than baseline at 0 and 30?min after surgery. Saliva secretion was significantly lower in the glycopyrrolate group than the placebo group.Routine premedication with adjunctive anticholinergics should not be considered in paediatric patients receiving ketamine sedation due to the increased risk of fever.Trial registration number, Clinicaltrials.gov: NCT02430272.

SUBMITTER: Kim KW

PROVIDER: S-EPMC5536636 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Anticholinergic premedication-induced fever in paediatric ambulatory ketamine anaesthesia.

Kim Kyung Woo KW Choe Won Joo WJ Kim Jun Hyun JH Kim Kyung-Tae KT Lee Sang-Il SI Park Jang Su JS Kim Jung Won JW Heo Min Hee MH

The Journal of international medical research 20160525 4

<h4>Objective</h4>A randomized, double-blind, prospective study to evaluate the effect of anticholinergic drugs on thermoregulation in paediatric patients undergoing ambulatory anaesthesia with ketamine.<h4>Methods</h4>Patients were randomized to receive either 0.005 mg/kg glycopyrrolate or the equivalent volume of normal saline (placebo) at 30 min before ketamine anaesthesia. Body temperature was measured tympanically at baseline and at 0, 30, 60 and 90 min postoperatively. The quantity of sali ...[more]

PMID: 27225859

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Project description:(1) Background: Rapid sequence induction (RSI) is carried out by anaesthetists to secure the airway promptly in patients who are at risk of aspirating gastric content during induction of anaesthesia. RSI requires variation in the paediatric population. We conducted a survey to investigate current practice of paediatric RSI by anaesthetists. (2) Methods: A descriptive, contextual, cross-sectional research design was followed. The study population consisted of all anaesthetists working in the Department of Anaesthesia at the University of the Witwatersrand. Data was collected in the form of a self-administered questionnaire. (3) Results: Of 138 questionnaires that were distributed, 126 were completed. Clinical indication for RSI was predominantly for appendicitis with peritonitis (115/124; 92.7%). Preoxygenation was performed by 95.1% of anaesthetists for children, 87% for infants and 89.4% for neonates. Cricoid pressure was used significantly more in children (56%) than in infants (20.8%) and neonates (10.3%) (p < 0.001). Rocuronium was the paralytic agent of choice in children (42.7%) and infants (38.2%), while cisatracurium was used most frequently in neonates (37.4%). Suxamethonium was used least in neonates. Cuffed ETTs were used most frequently for children (99.2%) and least for neonates (49.6%). Eighty-five percent of anaesthetists omitted cricoid pressure during RSI for pyloromyotomy, for which a controlled RSI was performed more by consultants and senior registrars (p < 0.01). A classic RSI was performed by 53.6% of anaesthetists for laparotomy for small bowel obstruction. Consultants and PMOs were more likely to intubate a child for forearm MUA who was starved for 6 h and received opioids (p < 0.05). Controlled RSI with cisatracurium was the technique of choice for Tenkhoff insertion in a child with renal failure. (4) Conclusions: RSI practice for paediatric patients varied widely among anaesthetists. This may be attributed to a combination of anaesthetic experience, training in paediatric anaesthesia, and patient specific factors, along with the individualised clinical scenario’s aspiration risk. A controlled RSI technique appears to be implemented more frequently by anaesthetists with increased experience.

Project description:ObjectivesEmergence delirium (ED) occurs in approximately 25% of paediatric general anaesthetics and has significant adverse effects. The goal of the current systematic review was to identify the existing literature investigating performance of predictive models for the development of paediatric ED following general anaesthesia and to determine their usability.DesignSystematic review using the Prediction model study Risk Of Bias Assessment Tool (PROBAST) framework.Data sourcesMedline (Ovid), PubMed, Embase (Ovid), Cochrane Database of Systematic Reviews (Ovid), Cochrane CENTRAL (Ovid), PsycINFO (Ovid), Scopus (Elsevier) and Web of Science (Clarivate Analytics), ClinicalTrials.gov, International Clinical Trials Registry Platform and ProQuest Digital Dissertations and Theses International through 17 November 2020.Eligibility criteria for selecting studiesAll randomised controlled trials and cohort studies investigating predictive models for the development of ED in children undergoing general anaesthesia.Data extraction and synthesisFollowing title, abstract and full-text screening by two reviewers, data were extracted from all eligible studies, including demographic parameters, details of anaesthetics and performance characteristics of the predictive scores for ED. Evidence quality and predictive score usability were assessed according to the PROBAST framework.ResultsThe current systematic review yielded 9242 abstracts, of which only one study detailing the development and validation of the Emergence Agitation Risk Scale (EARS) met the inclusion criteria. EARS had good discrimination with c-index of 0.81 (95% CI 0.72 to 0.89). Calibration showed a non-significant Homer-Lemeshow goodness-of-fit test (p=0.97). Although the EARS demonstrated low concern of applicability, the high risk of bias compromised the overall usability of this model.ConclusionsThe current systematic review concluded that EARS has good discrimination performance but low usability to predict ED in a paediatric population. Further research is warranted to develop novel models for the prediction of ED in paediatric anaesthesia.Prospero registration numberCRD42019141950.

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Anticholinergic premedication-induced fever in paediatric ambulatory ketamine anaesthesia.

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Anticholinergic premedication-induced fever in paediatric ambulatory ketamine anaesthesia.

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