Paediatric adenotonsillectomy, part 2: considerations for anaesthesia.
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ABSTRACT:
SUBMITTER: Zalan J
PROVIDER: S-EPMC7807924 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC7808071 | biostudies-literature
Project description: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.
| S-EPMC5536636 | biostudies-literature
Project description:ObjectiveThe reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children.MethodsTwenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®).ResultsPatients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm(3), P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm(3), P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm(3), P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm(3), P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm(3), P = 0.005, respectively).ConclusionsThis is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.
| S-EPMC3648674 | biostudies-literature
Project description:ObjectiveExposure to waste anaesthetic gas (WAG) is a recognised occupational hazard for health care professionals (HCP). In recovery rooms, scavenging and ventilation systems differ from those in the operating room, raising the question as to how efficient they are. This study aims to measure the levels of ambient sevoflurane over the course of consecutive workdays in the paediatric recovery room of a tertiary academic centre.MethodsThe following is a descriptive-analytic study of ambient air sevoflurane levels measured using a MIRAN® 205B Series SapphIRe portable ambient air analyser. Samples were obtained between 7:30 am and 6:30 pm for two non-consecutive weeks on consecutive weekdays in our paediatric recovery room area.ResultsThe ambient air levels of sevoflurane exceeded the ceiling concentration of 0.5 ppm recommended by the National Institute for Occupational Safety and Health on all days of measurement. The concentration of sevoflurane in ambient air correlates directly with the number of patients present.ConclusionEven in a modern recovery room constructed according to current building standard and code, ambient air levels of WAG exceed the recommendations. Future research and practice standards are needed to reduce this occupational exposure. Disregarding whether chronic exposure to WAG is harmful, we have shown that HCP working in recovery rooms are chronically exposed to concentrations which exceed recommended levels. Strategies are needed to reduce ambient levels of WAG in post-anaesthesia care units.
| S-EPMC6157972 | biostudies-literature
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.
| S-EPMC9497683 | biostudies-literature
Project description:Future space exploration missions will take humans far beyond low Earth orbit and require complete crew autonomy. The ability to provide anaesthesia will be important given the expected risk of severe medical events requiring surgery. Knowledge and experience of such procedures during space missions is currently extremely limited. Austere and isolated environments (such as polar bases or submarines) have been used extensively as test beds for spaceflight to probe hazards, train crews, develop clinical protocols and countermeasures for prospective space missions. We have conducted a literature review on anaesthesia in austere environments relevant to distant space missions. In each setting, we assessed how the problems related to the provision of anaesthesia (e.g., medical kit and skills) are dealt with or prepared for. We analysed how these factors could be applied to the unique environment of a space exploration mission. The delivery of anaesthesia will be complicated by many factors including space-induced physiological changes and limitations in skills and equipment. The basic principles of a safe anaesthesia in an austere environment (appropriate training, presence of minimal safety and monitoring equipment, etc.) can be extended to the context of a space exploration mission. Skills redundancy is an important safety factor, and basic competency in anaesthesia should be part of the skillset of several crewmembers. The literature suggests that safe and effective anaesthesia could be achieved by a physician during future space exploration missions. In a life-or-limb situation, non-physicians may be able to conduct anaesthetic procedures, including simplified general anaesthesia.
| S-EPMC5824960 | biostudies-literature
Project description:The objective of this article is to discuss optimal imaging strategies for the evaluation of cardiac masses. The advantages and disadvantages of echocardiography, cardiac MRI, gated cardiac CT, and nuclear imaging will be discussed and specific techniques presented.Multimodality imaging plays a pivotal role in the diagnosis and surgical planning of cardiac masses. Clinical features, such as patient age, location, and imaging characteristics of the mass will determine the likely differential diagnosis.
| S-EPMC4382355 | biostudies-literature
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.
| S-EPMC7789445 | biostudies-literature
Project description:Effective communication with children is a skill, the importance of which is especially highlighted by the COVID-19 pandemic and the ubiquitous wearing of face masks. Anaesthesiology consultants have been shown to display excellent communication skills that facilitate the development of rapid rapport and patient cooperation. Good communication results in positive interactions for hospitalised children, which correlates with improved healthcare outcomes. However, interactions with a child aren't always straightforward, particularly for trainees unfamiliar with certain communication techniques, which are important to use at a time when when the wearing of face masks is commonplace.
| S-EPMC7592261 | biostudies-literature
Project description:The transport of ions through multiple drift regions is modeled to develop an equation that is useful for an understanding of the resolving power of an overtone mobility spectrometry (OMS) technique. It is found that resolving power is influenced by a number of experimental variables, including those that define ion mobility spectrometry (IMS) resolving power: drift field (E), drift region length (L), and buffer gas temperature (T). However, unlike IMS, the resolving power of OMS is also influenced by the number of drift regions (n), harmonic frequency value (m), and the phase number (Phi) of the applied drift field. The OMS resolving power dependence upon the new OMS variables (n, m, and Phi) scales differently than the square root dependence of the E, L, and T variables in IMS. The results provide insight about optimal instrumental design and operation.
| S-EPMC2735887 | biostudies-literature