24 research outputs found
Neuromuscular blockade in clinical practice in paediatric anaesthesia: retrospective cohort trial in a tertiary paediatric anaesthesia centre
Background. Neuromuscular blockade is
associated with improved airway conditions
for intubation and superior conditions
for surgical interventions (predominantly
important in laparoscopic surgery).
Residual neuromuscular blockade in the
postoperative period is, according to recently
published data, associated with a
negative impact on perioperative morbidity
and mortality.
Aim. Te aim of the study was to describe
daily practice in clinical paediatric anaesthesia
in a tertiary children’s hospital.
Methods. Data from anaesthesiology
records during the period 1.1.2016 to
31.12.2016 were retrospectively screened.
Primary outcomes included the rate of
surgery cases with neuromuscular blockade,
the incidence of cases with perioperative
neuromuscular blockade monitoring
and the incidence of neuromuscular
pharmacologic block reversal. Secondary
outcomes were myorelaxant usage according
to the age of patients and duration of
surgery.
Results. Overall 8046 paediatric patients
underwent general anaesthesia in the study
period. Muscle relaxants were administered
in 1650 cases (20.5%). Te most frequently
administered muscle relaxant was
mivacurium (48.2 %, n=795), followed by
cis-atracurium (36.4 %, n=601), suxamethonium
(10.3 %, n=170) and rocuronium
(7.0 %, n=115). Neuromuscular blockade
monitoring was used only in 2.5% (n=41)
of cases. Active neuromuscular blockade
reversal was administered in 5.8% (n=95)
of cases.
Conclusion. Neuromuscular blockade in
paediatric anaesthesia was less frequent
compared to adults. Te low rate of neuromuscular
blockade monitoring in combination
with the low rate of active block reversal
can be considered dangerous due to
the relatively high risk of potential residual
postoperative blockade, that can negatively
influence clinical outcome
Incidence of emergence delirium in the pediatric PACU: Prospective observational trial
Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, agitation, and are at higher risk of unintentional extraction of an intravenous cannula, self-harm and nausea and vomiting. The described incidence of ED varies between 25-80%, with a higher prevalence among children younger than 6 years of age. We aimed to determine the incidence of ED in pediatric patients (>1 month) after general anesthesia in the post-anesthesia care unit (PACU), using Paediatric Anaesthesia Emergence Delirium (PAED) score, Watcha score and Richmond agitation and sedation scale (RASS). The incidence of ED was the highest in the PAED score with cutoff >= 10 points (89.0%, n = 1088). When using PAED score >12 points, ED incidence was 19.3% (n = 236). The lowest incidence was described by Watcha and RASS scores, 18.8% (n = 230) vs. 18.1% (n = 221), respectively. The threshold for PAED >= 10 points seems to give false-positive results, whereas the threshold >12 points is more accurate. RASS scale, although intended primarily for estimation of the depth of sedation, seems to have a good predictive value for ED.Web of Science910art. no. 159
Malignant Hyperthermia in PICU—From Diagnosis to Treatment in the Light of Up-to-Date Knowledge
Malignant Hyperthermia (MH) is a rare, hereditary, life-threatening disease triggered by volatile anesthetics and succinylcholine. Rarely, MH can occur after non-pharmacological triggers too. MH was detected more often in children and young adults, which makes this topic very important for every pediatric specialist, both anesthesiologists and intensivists. MH crisis is a life-threatening severe hypermetabolic whole-body reaction. Triggers of MH are used in pediatric intensive care unit (PICU) as well, volatile anesthetics in difficult sedation, status asthmaticus or epilepticus, and succinylcholine still sometimes in airway management. Recrudescence or delayed onset of MH crisis hours after anesthesia was previously described. MH can also be a cause of rhabdomyolysis and hyperpyrexia in the PICU. In addition, patients with neuromuscular diseases are often admitted to PICU and they might be at risk for MH. The most typical symptoms of MH are hypercapnia, tachycardia, hyperthermia, and muscle rigidity. Thinking of the MH as the possible cause of deterioration of a patient’s clinical condition is the key to early diagnosis and treatment. The sooner the correct treatment is commenced, the better patient´s outcome. This narrative review article aims to summarize current knowledge and guidelines about recognition, treatment, and further management of MH in PICU
Progressive multifocal leukoencephalopathy - Epidemiology, immune response, clinical differences, treatment
Progressive multifocal leukoencephalopathy (PML) is a severe disease of the central nervous system with very high mortality. It is caused by the JC virus with high seroprevalence, at up to 80%. Development of PML is typically opportunistic, particularly in acquired immunodeficiency syndrome, and usually affects patients with profound immunodeficiency. Furthermore, as a result of highly efficient immunosuppressive and immunomodulatory treatments in recent years, the number of PML cases has increased in the general population. In this article, the authors mention virological and epidemiological relationships and characteristic manifestations of PML. Possible relationships of humoral and cellular immunity are discussed and limited treatment options including prophylaxis are mentioned. © 2019, Czech Medical Association J.E. Purkyne. All rights reserved
Controversies in Pediatric Perioperative Airways
Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient