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Post anesthesia care children

Jakob I Doerrfuss, Sylvia Kramer, Sascha Tafelski, Claudia D Spies, Klaus-Dieter Wernecke, Irit Nachtigall
BACKGROUND: Emergence Delirium (ED) is an important post-anesthetic complication in children. Although it has been thoroughly studied, data on frequency, predictive factors, and therapy of this phenomenon are inconclusive. In this study, we seek to obtain a better understanding of the frequency of ED and different therapeutic approaches, making use of the large amount of patients in our university hospital. METHODS: After approval by the local ethics committee, patients aged zero to 13 years, who were treated in the post anesthesia care of our hospital, were investigated in this observational study...
January 18, 2019: Minerva Anestesiologica
Jenna Rossoff, Margaret Locke, Irene B Helenowski, Surabhi Batra, Ben Z Katz, Nobuko Hijiya
BACKGROUND: Identification of an organism is the gold standard for the diagnosis of fungal infection; however, we have previously shown that invasive procedures infrequently lead to a change in management in children with cancer or who have undergone stem cell transplant with suspected respiratory tract invasive fungal infection (RT-IFI). There is also a paucity of data on the cost of RT-IFI in this population. We therefore compared the costs of RT-IFI diagnosed based on CT scan alone versus those who underwent a bronchoalveolar lavage (BAL) or respiratory tract biopsy (RTB)...
January 4, 2019: Pediatric Blood & Cancer
Michael Fairley, David Scheinker, Margaret L Brandeau
The operating room is a major cost and revenue center for most hospitals. Thus, more effective operating room management and scheduling can provide significant benefits. In many hospitals, the post-anesthesia care unit (PACU), where patients recover after their surgical procedures, is a bottleneck. If the PACU reaches capacity, patients must wait in the operating room until the PACU has available space, leading to delays and possible cancellations for subsequent operating room procedures. We develop a generalizable optimization and machine learning approach to sequence operating room procedures to minimize delays caused by PACU unavailability...
November 1, 2018: Health Care Management Science
Elizabeth J Kerris, Jason T Patregnani, Matthew Sharron, Anthony A Sochet
OBJECTIVE: To assess the frequency of post-procedural complications, medical interventions, and hospital costs associated with microlaryngobronchoscopy (MLB) in children prophylactically admitted for pediatric intensive care unit (PICU) monitoring for age ≤ 2 years. METHODS: We performed a single-center, retrospective, descriptive study within a 44-bed PICU in a stand-alone, tertiary, pediatric referral center. Inclusion criteria were age ≤2 years and pre-procedural selection of prophylactic PICU monitoring after MLB between January 2010 and December 2015...
December 2018: International Journal of Pediatric Otorhinolaryngology
Wenyan Xu, Yue Huang, Jie Bai, Anna M Varughese
BACKGROUND: Quality improvement methods can identify solutions and make dramatic improvements in patient safety during daily clinical care. The science of quality improvement in health care is still a very new concept in developing countries like China. AIM: We initiated a quality improvement project to minimize adverse respiratory events in our post-anesthesia care unit with the guidance of an experienced quality improvement expert from Cincinnati Children's Hospital Medical Center...
October 26, 2018: Paediatric Anaesthesia
Tariq M Wani, Mohammed Hakim, Archana Ramesh, Shabina Rehman, Yasser Majid, Rebecca Miller, Dmitry Tumin, Joseph D Tobias
BACKGROUND: Preoperative factors have been correlated with pre-incision hypotension (PIH) in children undergoing surgery, suggesting that PIH can be predicted through preoperative screening. We studied blood pressure (BP) changes in the 12 min following the induction of anesthesia to study the incidence of post-induction hypotension and to assess the feasibility of predicting PIH in low-risk children without preoperative hypotension or comorbid features. METHODS: We retrospectively evaluated 200 patients ranging in age from 2 to 8 years with American Society of Anesthesiologists' (ASA) physical status I or II, undergoing non-cardiac surgery...
December 2018: Pediatric Surgery International
Kanecia O Zimmerman, Huali Wu, Matthew Laughon, Rachel G Greenberg, Richard Walczak, Scott R Schulman, P Brian Smith, Christoph P Hornik, Michael Cohen-Wolkowiez, Kevin M Watt
BACKGROUND: Dexmedetomidine is increasingly used off-label in infants and children with cardiac disease during cardiopulmonary bypass (CPB) and in the postoperative period. Despite its frequent use, optimal dosing of dexmedetomidine in the setting of CPB has not been identified but is expected to differ from dosing in those not supported with CPB. This study had the following aims: (1) characterize the effect of CPB on dexmedetomidine clearance (CL) and volume of distribution (V) in infants and young children; (2) characterize tolerance and sedation in patients receiving dexmedetomidine; and (3) identify preliminary dosing recommendations for infants and children undergoing CPB...
August 22, 2018: Anesthesia and Analgesia
Fang Chen, Chengyu Wang, Yi Lu, Mengmeng Huang, Zhijian Fu
BACKGROUND: Dexmedetomidine (DEX), a highly sensitive α2 -adrenoceptor agonist that possesses anxiolytic, sedative, and analgesic effects, has been documented as a preventative and treatment for emergence agitation (EA). The therapeutic should be given as a loading dose that is infused during a 10 min period, but if a rapid bolus injection is deemed to be hemodynamically appropriate, it would be a more opportune route of administration. So we studied the efficacy of different doses of DEX as a rapid bolus for children to prevent and treat EA...
August 7, 2018: BMC Anesthesiology
Daniel C O'Brien, Yuti Desai, Robert T Swanson, Uma Parekh, Jane Schubart, Michele M Carr
OBJECTIVES: To investigate the relationships between preoperative sleep study findings of children undergoing adenotonsillectomy anesthesia emergence time, recovery room time, and length of stay. STUDY DESIGN: Retrospective case series with chart review. SETTING: Tertiary care children's hospital. SUBJECTS AND METHODS: All children aged 1-17 years who had undergone adenotonsillectomy between 2013 and 2016 were included...
September 2018: American Journal of Otolaryngology
Andréia Melchiors Wenzel, Cláudia Schweiger, Denise Manica, Leo Sekine, Isabel Cristina Schütz Ferreira, Gabriel Kuhl, Paulo José Cauduro Marostica
PURPOSE: To assess the impact of balloon laryngoplasty on clinical and surgical outcomes in pediatric patients with acute subglottic stenosis. METHODS: Two case series were included and compared. The first group included patients treated initially either with tracheostomy (if severe symptoms) or with close follow-up (if mild symptoms). Those children underwent re-evaluation and specific treatment of their stenosis with laser incisions or open surgeries some weeks later...
September 2018: European Archives of Oto-rhino-laryngology
WooYoung In, Young Man Kim, Hee Soon Kim, SeoHee Hong, YuRi Suh, Yerin Cha, Naeun Kim, JongWon Kim, HyunJi Kang, HyoEun Kwon, YangSoo Kim, Wyunkon Park
PURPOSE: The purpose of this study was to examine the effects of parental presence on the incidence of emergence delirium (ED) of children in the postanesthesia care unit (PACU). DESIGN: A quasi-experimental pretest and post-test study with nonequivalent and nonsynchronized control groups. METHODS: About 93 children aged 3 to 6 years undergoing general anesthesia for tonsillectomy were divided into two groups: parental presence and absence...
July 10, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Elisa C Walsh, Johanna M Lee, Kristina Terzakis, David W Zhou, Sara Burns, Timothy M Buie, Paul G Firth, Erik S Shank, Timothy T Houle, Emery N Brown, Patrick L Purdon
Patients with autism spectrum disorder (ASD) often require sedation or general anesthesia. ASD is thought to arise from deficits in GABAergic signaling leading to abnormal neurodevelopment. We sought to investigate differences in how ASD patients respond to the GABAergic drug propofol by comparing the propofol-induced electroencephalogram (EEG) of ASD and neurotypical (NT) patients. This investigation was a prospective observational study. Continuous 4-channel frontal EEG was recorded during routine anesthetic care of patients undergoing endoscopic procedures between July 1, 2014 and May 1, 2016...
2018: Frontiers in Systems Neuroscience
Young Sung Kim, Jae Ryung Cha, Yoon Sook Lee, Woon Young Kim, Jae Hwan Kim, Yun Hee Kim
Objective Emergence agitation (EA) has a multifactorial origin, and the effect of sugammadex on EA has not been established. We investigated the effect of sugammadex on EA incidence and severity. Methods We performed a retrospective study of children aged 1 to 13 years who underwent strabismus surgery. Patients received sugammadex or conventional neuromuscular reversal agents. The primary outcome variables were EA incidence and severity. Secondary outcome variables were postoperative fentanyl use, postoperative nausea and vomiting, time from reversal agent administration to extubation, time from the end of surgery to arrival in the post-anesthesia care unit (PACU) and time spent in the PACU...
September 2018: Journal of International Medical Research
Ruiqiang Sun, Guolin Wang, Xuesong Gao, Shuzhen Wang
Despite its benignity, upper respiratory infections (URIs) 1 increase the risk of postoperative respiratory complications during the perioperative and postoperative periods. Flumazenil could improve the symptoms of respiratory obstruction.To evaluate the effect of flumazenil on the occurrence of respiratory complications during anesthesia emergence of children with preoperative URI.This was a prospective study of 164 consecutive pediatric patients who underwent strabismus surgery under general anesthesia at the Tianjin Eye Hospital between August 2016 and April 2017...
April 2018: Medicine (Baltimore)
Elif Doğan Bakı, Şahin Ulu, Ahmet Yüksek, Hüseyin Arıcan, Remziye Sıvacı
OBJECTIVE: The aim of this study was to investigate the effect of listening to music on the consumption of an anesthetic agent as well as postoperative recovery and pain in children undergoing elective tonsillectomy. MATERIALS AND METHODS: Fifty patients were randomized into those to whom music was played during surgery (group M) and a control group to whom music was not played (group C). The depth of anesthesia was provided by entropy levels of 50 ± 5 in both groups...
2018: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
Alexandra M Arambula, Deborah X Xie, Amy S Whigham
OBJECTIVES: To characterize postoperative respiratory complications following adenotonsillectomy (AT) in children with obstructive sleep apnea (OSA) and to identify variables associated with pediatric intensive care unit (PICU) admission. METHODS: Retrospective analysis of 133 pediatric OSA patients with prior AT. Assessment of the postoperative hospital course informed patient stratification based on respiratory event severity, PICU admission status, and unscheduled escalation of care...
April 2018: International Journal of Pediatric Otorhinolaryngology
Nicolas Poinot, Jean-Francois Fils, Hélène Demanet, Hugues Dessy, Dominique Biarent, Pierre Wauthy
BACKGROUND: Repair of congenital heart defects involving the right ventricular outflow tract may require the implantation of a right ventricle to pulmonary artery conduit. This conduit is likely to be replaced during childhood. This study compares the operative outcomes of the replacement procedure of Contegra® and homografts in pulmonary position. METHODS: From 1999 to 2016, 82 children underwent 87 right ventricle to pulmonary artery conduit replacements (60 Contegra® and 27 homografts)...
January 17, 2018: Journal of Cardiothoracic Surgery
Adam C Adler, Stephanie Helman, Cynthia Field, Judith J Stellar, Lauren A Brown, Nicole Omensetter, Andrew T Costarino, Mahsun Yuerek, Karen S Bender
OBJECTIVES: To reduce the number of ischemic arterial catheter injuries in children with congenital or acquired heart disease. DESIGN: This is a quality improvement study with pre- and postintervention groups. SETTING: University-affiliated pediatric cardiac center in a quaternary care freestanding children's hospital. PATIENTS: All patients with an indwelling peripheral arterial catheter placed in the Children's Hospital of Philadelphia Cardiac Center associated with an admission to the Cardiac Intensive Cardiac Unit from January 2015 to July 2017 are included...
March 2018: Pediatric Critical Care Medicine
Hiromi Kako, Jennifer Tripi, Hina Walia, Dmitry Tumin, Mark Splaingard, Kris R Jatana, Joseph D Tobias, Vidya T Raman
INTRODUCTION: The prevalence of pediatric obstructive sleep apnea (OSA) has increased concurrently with the increasing prevalence of obesity. We have previously validated a short questionnaire predicting the occurrence of OSA on polysomnography (PSG). This follow-up study assessed the utility of the questionnaire in predicting postoperative outcomes. METHODS: Children undergoing surgery and completing a sleep study were prospectively screened for OSA using a short questionnaire...
November 2017: International Journal of Pediatric Otorhinolaryngology
James FitzSimons, Laura S Bonanno, Stephanie Pierce, Jennifer Badeaux
BACKGROUND: Emergence delirium is defined as a cognitive disturbance during emergence from general anesthesia resulting in hallucinations, delusions and confusion manifested by agitation, restlessness, involuntary physical movement and extreme flailing in bed. Postoperative emergence delirium develops in 12% to 18% of all children undergoing general anesthesia for surgery. This post-anesthetic phenomenon changes cognitive and psychomotor behavior, and puts pediatric patients and health care personnel at risk of injury...
July 2017: JBI Database of Systematic Reviews and Implementation Reports
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