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Sedation children

Jae Young Choe, Byung-Ho Choe
Foreign body (FB) ingestion of children is a common pediatric emergency requiring medical attention. Pediatric emergency physicians and gastroenterologists often encounter nervous and distressed situations, because of children presenting with this condition in the common clinical practice. When determining the appropriate timing and indications for intervention, physicians should consider multiple patient- and FB-related factors. The utilization of a flexible endoscopy is considered safe and effective to use in these cases, with a high success rate, for the effective extraction of FBs from the gastrointestinal tract of a child...
March 2019: Pediatric Gastroenterology, Hepatology & Nutrition
Rotem Elitsur, April Hollenbeck, Laura Tasan, Kathryn S Torok, Elaine Cassidy, Brian Blasiole, Erika Parsons, Chelsea Acock, Joseph Angelelli, Isabela-Cajiao Angelelli
BACKGROUND: Intra-articular corticosteroid injections (IACI) are frequently used in the treatment of juvenile idiopathic arthritis. There is a paucity of evidence-based research describing methods of pain and anxiety control for this procedure. IACI were mostly performed under general anesthesia for children younger than 13 years old in our institution as of 2014. We started to integrate sedation services more commonly in our institution with the minimal sedation/anxiolysis (MSA) protocol outlined as an alternative to general anesthesia for IACI in 2015...
March 20, 2019: Pediatric Rheumatology Online Journal
Steven G Schauer, Patrick C Ng, Michael D April, Guyon J Hill, Allyson A Arana, Vikhyat S Bebarta
BACKGROUND: Vascular access in critically ill pediatric patients can be challenging with delays potentially leading to worse outcomes. Intraosseous (IO) access has a low rate of complications and can be utilized to administer lifesaving medications. Combat medics are trained to treat adults but may also be required to treat children in the deployed setting. Vascular access in children can be challenging, especially in a hypovolemic state. There are limited data on prehospital lifesaving interventions in children in the combat setting...
March 19, 2019: Pediatric Emergency Care
Vanessa Marchesini, Nicola Disma
PURPOSE OF REVIEW: In the last 20 years, data from studies of laboratory animals, including nonhuman primates, have provided ample evidence that general anaesthetic drugs cause pathological changes in developing central nervous system (neurotoxicity). Recently, a new area of research has been developed in order to recognize any possible actions that can attenuate anaesthetics neurotoxicity. This review aims to provide an overview of the recent literature on neuroprotection. RECENT FINDINGS: Neuroprotection includes a variety of actions that aim to preserve neuronal structures and/or function against insults caused by sedative and anaesthetic agents...
March 15, 2019: Current Opinion in Anaesthesiology
Malek I Makki, Ruth L O'Gorman, Philip Buhler, Olivier Baledent, Christian J Kellenberger, Carola Sabandal, Markus Weiss, Ianina Scheer, Achim Schmitz
BACKGROUND: Multiple sedation regimes may be used to facilitate pediatric MRI scans. These regimes might affect cerebral blood flow and hemodynamics to varying degrees, particularly in children who may be vulnerable to anesthetic side effects. PURPOSE: To compare the effects of propofol monosedation solely (Pm group) vs. a combination of propofol and ketamine (KP group) on brain hemodynamics and perfusion. STUDY TYPE: Prospective double-blind randomized trial...
March 20, 2019: Journal of Magnetic Resonance Imaging: JMRI
Krishna Mohan Gulla, Ganganath Gunathilaka, Kana Ram Jat, Jhuma Sankar, Madan Karan, Rakesh Lodha, Sushil K Kabra
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration (EUS-B-FNA) are useful modalities in the evaluation of mediastinal pathologies in adults. However, sparse data are available in children. OBJECTIVE: To describe the utility and safety of EBUS-TBNA and EUS-B-FNA in children with mediastinal pathologies of unknown etiology. DESIGN: Chart review...
March 19, 2019: Pediatric Pulmonology
Christina Samel, Christian Albus, Ralf Tebest, Kristin Forster, Markus Lüngen, Alexander Niecke, Holger Pfaff, Klaus M Peters
Upcoming challenges in providing care for thalidomide impaired individuals Abstract. BACKGROUND: Between 1957 and 1962 an approximate 5000 children were born in Germany with severe birth defects as their mothers took the substance Thalidomide during pregnancy as a sedative and effective relief from morning sickness. OBJECTIVE: The aim of this study was to describe the care and assistance needed by the individuals impaired by Thalidomide and indicate upcoming challenges...
March 19, 2019: Pflege
A Lyne, J Johnson, D Baldwin
BACKGROUND: Inhalation sedation (IHS), using nitrous oxide and oxygen, is a commonly used form of pharmacological behaviour management in paediatric dentistry. Previous studies suggest that IHS causes a delay in reaction time, which recovers to baseline within 10 min. AIM: To observe the reaction times (RT) of children before and after undergoing IHS for dental treatment. DESIGN: Sixty children from clinics at St Thomas' Hospital (London, UK) participated in this observational study...
March 16, 2019: European Archives of Paediatric Dentistry: Official Journal of the European Academy of Paediatric Dentistry
Cory M Resnick, Carly E Calabrese, Salim Afshar, Bonnie L Padwa
PURPOSE: Opioid abuse is a public health concern. Oral opioids are prescribed after removal of third molars, but the amount needed for adequate postoperative analgesia is unknown. The purpose of this study was to quantify opioid need after third molar extractions. MATERIALS AND METHODS: This is a prospective cohort study of consecutive patients who had asymptomatic third molars extracted with intravenous sedation at the Boston Children's Hospital (Boston, MA) from June through October 2018 by 3 attending surgeons...
February 16, 2019: Journal of Oral and Maxillofacial Surgery
Maja Pavcnik, Mojca Groselj Grenc
BACKGROUND: Light sedation is the prerequisite for weaning from mechanical ventilation. Our aim was to evaluate the technical feasibility and efficacy of sevoflurane delivered by anesthetic conserving device (ACD) for sedation of children during weaning from mechanical ventilation. METHODS: Prospective observational feasibility study in paediatric ICU. Patients who were identified as ready for weaning from mechanical ventilation and had Withdrawal-Assessment- Tool version 1 (WAT-1) score of ≥ 8 were switched from intravenous sedatives to sevoflurane sedation by ACD (AnaConDa) placed at the inspiratory limb of the ventilator (INSP group) or at Y-piece (Y group)...
March 12, 2019: Minerva Anestesiologica
Su-Zhen Dong, Ming Zhu, Dorothy Bulas
MRI is used widely in infants and young children. However, in these young cases deep sedation or general anesthesia is often required to minimize motion artifacts during MRI examinations. Although the benefits of MR typically outweigh the potential risks of sedation when delivered by an experienced team, there are increasing concerns regarding the affect of sedation on young children. There continues to be a push to develop various strategies that can minimize the need for sedation. The present review summarizes several technical and clinical approaches that can help decrease the need for sedation in the pediatric patient...
March 14, 2019: Journal of Magnetic Resonance Imaging: JMRI
Weili Lin, Kristine R Baluyot, Manjiang Yao, Jian Yan, Li Wang, Gang Li, Brittany Howell, Jed T Elison, Dinggang Shen
Brain development in the first years of life is the most dynamic and perhaps the most important phase of brain maturation. While it is widely recognized that nutrition plays a key role in early brain development, particular nutrients will most likely differentially affect distinct aspects of brain development. The critical dosage windows and time frames for various nutrients at different stages of brain development are likely dissimilar. Therefore, efforts have been devoted to identifying potential associations between nutrients and early brain development...
2019: Nestlé Nutrition Institute Workshop Series
Anna Trofimova, Nadja Kadom
OBJECTIVE: The purposes of this article are to describe implementation of an abbreviated brain MRI protocol for use in children with primary headache and to present an experience with the adaptation of the protocol in practice, work flow integration, and effects on sedation use. CONCLUSION: The abbreviated brain MRI protocol reduced the need for sedation for 74% of the study sample. Use of this protocol in this particular patient population continues, but further validation is required before its use is expanded to other pediatric populations...
March 12, 2019: AJR. American Journal of Roentgenology
Lisa Dann, Jaime Doody, Ruth Howard, Carol Blackburn, John Russell, Michael Barrett
BACKGROUND: Nasal foreign body(-ies) (FB) cause local irritation, inflammation, and mucosal erosion and carry a potential risk of aspiration. The aim is to describe the management of nasal FBs in our Emergency Department (ED). METHOD: A retrospective study of 100 sequential suspected nasal FB presentations to a tertiary paediatric ED. Patient age, gender, FB typology, doctor/nurse seniority, sedation/analgesia usage, removal method, ENT referral rate, extraction time and disposition were collected...
March 11, 2019: Irish Journal of Medical Science
Youbing Tu, Yubing Liang, Yong Xiao, Jing Lv, Ruicong Guan, Fei Xiao, Yubo Xie, Qiang Xiao
Background: Propofol is a commonly used general anesthetic for the induction and maintenance of anesthesia and critical care sedation in children, which may add risk to poor neurodevelopmental outcome. We aimed to evaluate the effect of propofol toward primary hippocampal neurons in vitro and the possibly neuroprotective effect of dexmedetomidine pretreatment, as well as the underlying mechanism. Materials and procedures: Primary hippocampal neurons were cultured for 8 days in vitro and pretreated with or without dexmedetomidine or phosphorylation inhibitors prior to propofol exposure...
2019: Drug Design, Development and Therapy
Pradip P Kamat, Carmen Sulton, Sapna R Kudchadkar, Courtney E McCracken, Khristopher M Nguyen, Stephen F Simoneaux, Michael D Mallory, Harold K Simon
OBJECTIVES: To determine the characteristics of children who met the risk criteria for potential neurotoxicity defined by the US Food and Drug Administration (2016 warning) in a procedural sedation (PS) service. STUDY DESIGN: A single center retrospective review of all infants and children aged <3 years receiving PS outside the operating room from 2014 to 2016. Demographics, duration of, and the reason for PS were analyzed. RESULTS: A total of 2950 patients with 3653 sedation encounters were included...
March 8, 2019: Academic Pediatrics
Marion Wiegele, Peter Marhofer, Per-Arne Lönnqvist
Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain...
April 2019: British Journal of Anaesthesia
Scott Hemphill, Luke McMenamin, Mark C Bellamy, Philip M Hopkins
Propofol infusion syndrome is a rare, potentially fatal condition first described in children in the 1990s and later reported in adults. We provide a narrative review of what is currently known about propofol infusion syndrome, including a structured analysis of all published case reports; child and adult cases were analysed separately as propofol is no longer used for long-term sedation in children. The review contains an update on current knowledge of the pathophysiology of this condition along with recommendations for its diagnosis, prevention, and management...
April 2019: British Journal of Anaesthesia
Joji Sado-Filho, Karolline Alves Viana, Patrícia Corrêa-Faria, Luciane Rezende Costa, Paulo Sucasas Costa
PURPOSE: The optimal sedative regime that provides the greatest comfort and the lowest risk for procedural sedation in young children remains to be determined. The aim of this randomized, blinded, controlled, parallel-design trial was to evaluate the efficacy of intranasal ketamine and midazolam as the main component of the behavioral guidance approach for preschoolers during dental treatment. MATERIALS AND METHODS: Children under seven years of age, with caries and non-cooperative behavior, were randomized into three groups: (KMIN) intranasal ketamine and midazolam; (KMO) oral ketamine and midazolam; or (MO) oral midazolam...
2019: PloS One
Michelle Seiler, Georg Staubli
AIMS OF THE STUDY: The spectrum of agents available for procedural analgosedation (PAS) in paediatric emergency departments (EDs) has increased over the last few decades, yet the pharmacological agents most used in our ED are ketamine and nitrous oxide (N2O). The aim of this study was to assess which patient characteristics in an ambulatory setting were associated with physicians selecting N2O 70% or ketamine as the sedating agent in our paediatric ED, after N2O 70% was introduced. METHODS: Patients aged 0 to 16 years who received PAS in a tertiary children&rsquo;s hospital ED in 2007 (before N2O 70% implementation) and 2016 (after N2O implementation) were included in this retrospective, single-centre cohort study...
February 25, 2019: Swiss Medical Weekly
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