Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study

BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1–6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event

The usage of remifentanil and alfentanil in alleviating pain and anxiety during bone marrow aspiration in pediatric patients

Aims: To investigate the efficacy and safety of remifentanil and alfentanil compared with local anesthesia in providing analgesia and sedation during bone marrow aspiration procedures. Methods: Seventy-four children who underwent a diagnostic bone marrow aspiration were included in this study. Patients were assigned to one of 3 treatment groups (remifentanil, alfentanil and local anesthesia). Vital signs, sedation, pain scores, and somatic responses were recorded during and after bone marrow aspiration procedure. Results: There were no statistical differences between pain scores of the remifentanil group and the alfentanil group. Pain scores were significantly higher in the local anesthesia group compared with the other groups. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression. Conclusions: Remifentanil and alfentanil are effective in children and can be used safely in bone marrow aspiration procedure

Utility of color duplex sonography in the assessment of efficacy of the stellate ganglion blockade

PubMedID: 14510755Purpose: To assess the hemodynamic changes in the upper extremity arteries after sympathetic ganglion blockade (SGB) by using spectral Doppler parameters and to determine the applicability of these parameters for the evaluation of SGB efficacy. Material and Methods: Spectral Doppler parameters (peak systolic velocity (PSV), end diastolic velocity (EDV), mean velocity (mean V), flow volume, resistive and pulsatility indices (RI, PI), inner arterial diameters (intima to intima) (D) with simultaneous recordings of heart rate (HR), systolic and diastolic blood pressures and upper extremity surface temperature changes) were recorded before and 5 min after during the first, fifth and tenth SGB procedures. Results: SGB induced an increase in skin temperature in the ipsilateral hand and persistent dilatation of the radial diameter accompanied by reduction of RI and PI in the radial and third digital arteries in all patients. Conclusion: Hemodynamic changes assessed by spectral Doppler parameters could be used as sensitive and objective measurements of peripheral sympathetic nervous activity and vascular tonus, and may confirm a successfully performed SGB

Safe and effective sedation and analgesia for bone marrow aspiration procedures in children with alfentanil, remifentanil and combinations with midazolam

PubMedID: 15725319Background: Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil-midazolam (RM), and alfentanil-midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration. Methods: Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5-16 years (mean 9.20 ± 3.00 years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure. Results: There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P > 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression. Conclusions: Remifentanil, alfentanil, remifentanil-midazolam, and alfentanil-midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group. © 2004 Blackwell Publishing Ltd

Pulmonary crisis in sickle cell anemia [Orak hücre anemisinde pulmoner kriz]

Sickle cell anemia is a chronic hemolytic anemia with vasoocclusive crisis and is the most common symptomatic event that causes tissue hypoxia in many systems. Pulmonary crisis is one of them and its the major cause of mortality and morbidity in sickle cell anemia. Furthermore, pulmonary crisis is the second clinical situation for hospitalization. Pneumoia must be thought in differential diagnosis and is too difficult to rule out. Two cases with pulmonary crises with sickle cell anemia were presented with up to date knowledge