paediatric anaesthesia

32 Pages·2012·0.36 MB·English

BritishJournalofAnaesthesia108(S2):ii278–ii309(2012)
doi:10.1093/bja/aer486
PAEDIATRIC ANAESTHESIA
Paper No: 7.00 thus. Similar studies have not usually investigated overse-
dation as an outcome. One other study reported 13%
oversedation with the 6mg/kg dose. We believe that over-
6mg/kg Oral Ketamine Premedication
sedation to a level of difficult to rouse should be seen as
D
in Children Results in Oversedation o
an adverse outcome. w
n
TerenceLoughnan1, LisaAkelisi-Yockopua2, lo
a
d
HarryAgeeling3 and JosephGoswami4 References ed
1DepartmentofAnaesthesiaPortMoresbyHospital,2Dept 1 Turhanoglu S, Kurarmaz A, Ozyilmaz MA, Kaya S, Tok D. from
Anaesthesia,FrankstonHospital,Frankston,3Victoria,Australia “Effects of different doses of oral ketamine for premedication of h
DepartmentofAnaesthesiaPortMoresbyHospital,4Department children”. European Journal of Anaesthesiology. 2003 Jan; 20(1): ttps
ofAnaesthesiaPortMoresbyHospital 56–60 ://a
c
2 Darlong V, Shende D, Subramanyam MS, Sunder R, Naik A. a
d
Introduction and Objectives: We undertook this study to Oral ketamine or midazolam or low dose combination for pre- em
compare the effectiveness of placebo vs 3mg/kg vs medication in children. Anaesth Intensive Care. 2004 Apr; 32(2): ic.o
246–9 u
6mg/kg oral ketamine as a premedicant in children(ASA p
3 Sekerci C, Donmez A, Ates Y, Okten F. “Oral ketamine .c
1 and 2 aged 1-10yrs) presenting for elective surgery at o
premedication in children (placebo controlled double-blind m
Port Moresby General Hospital, Papua New Guinea. This /b
study)”. European Journal of Anaesthesiology. 1996 Nov; 13(6): ja
abegeenntreiscofmremelyenadveadilaabsleathsraofeugahnodutrethlieabwleorsleddaatnivdehfaosr 4 6G0u6st–e1in1HB, Kirsten LJ, Heard HB. Oral ketamine preanaesthetic /article
premedication and as a sole agent for sedation for proce- medicationinchildren.Anaesthesiology1992;76:28–33. /1
0
dures such as radiology where it is required that a child 5 KulkarniJA.OralketamineforpremedicationinChildren.Bombay 8/s
u
be still. HospitalJournal2003,July;45(3)6. p
p
Methods: After Institutional Ethics Committee approval l_
2
and obtaining Informed Consent from the accompanying /ii2
parent, patients received doses of study solution that was Paper No: 88.00 78
/3
administered with 0.2ml/kg cola. The level of sedation was 26
assessed after 30mins by a blinded trained observer who Anesthesia in surgical separation 14
1
scored on a four point scale from unrouseable to awake of omphalopagus conjoined twins by
and agitated. All patients were monitored and directly gu
EduardoPaganini, JoseNoya, HoracioBodor, e
observed in the Theatre Suite after administration of the DiegoCarboni and PabloGoncalvez st o
studysolution. n
1
Results: The placebogroup resulted in 20 patients assessed HospitalNacionalGervasioPosadas,BuenosAires,Argentina 6 F
as unsedated with five sedated. The 3mg/kg Ketamine eb
groupresultedinninepatientsassessedasbeingdistressed Introduction:ConjoinedtwinswerefirstreportedBC.Thefirst rua
and sixteen sedated. The 6mg/kg group resulted in no successful surgery dates back from 1689. Incidence is ry 2
0
patients being assessed as being distressed with 21 relaxed 1/50000pregnanciesandapproximately1/250000livebirths. 2
3
orasleep but four were deeplyasleep. The use of oral keta- Objectives: Description of this surgery in a non-pediatric,
mine resulted in a statistically significant increased level of general-publichospitalsetting,overcomingitsrelatedlimita-
sedation compared to placebo. These results were present tions andassuring asuccessful outcome.
in both ketamine 3mg per kg (p¼0.002) and 6mg per kg Methods: Omphalopagus twin pregnancy was ultrasound-
(p,0.001). However 4 out of 25 patients who received confirmed in the 5th month of pregnancy. C-section was
6mg/kg of Ketamine were deeply asleep compared with scheduled. Twins weighed 5.095kg in all. Apgar score for
the 3mg/kg Ketamine group where none were so affected both: 9/10. Abdominal scan showed that liver was shared
p¼0.037 on the front anterior side. Magnetic resonance angiography
Discussion and Conclusion: We found that 16% of chil- did not show cross circulation. No other abnormality was
dren who received 6mg/kg oral ketamine were overse- detected. Multidisciplinary meetings were organized to
dated and difficult to rouse whereas none of those discussthe feasibilityof asuccessful surgery. Our team was
receiving 3mg/kg ketamine or placebo were assessed composed by 2 anesthesiologists assisting each twin, and a
&
TheAuthor[2012].PublishedbyOxfordUniversityPressonbehalfoftheBritishJournalofAnaesthesia.Allrightsreserved.
ForPermissions,pleaseemail:[email protected]
BJA
AbstractspresentedatWCA2012
teamleadertocoordinatethewholeactivity.Wewerealsoin Introduction: We describe a child with chronic pain and
charge of monitoring, fluids and electrolytes control, and complex medical history who presented with several peri-
postoperative pain management. Surgery was scheduled to operative management challenges.
be performed when the patientsturned 3 months old. Total CaseDescription:Atenyear-oldboywithahistoryofchronic
weight:10.720kg.Nopreviousmedicationwasadministered pain, double-inlet left ventricle with transposition of the
to reduceanypotential adverse effect.Anesthetic induction greatarteriesandpalliatedFontanphysiologywasscheduled
wasperformedsimultaneouslyinthetwinswithSevoflurane. for bilateral below the knee amputations for lower limb ne-
Endotracheal intubation was particularly difficult due to the crosis. On admission for acute onset multi-system organ
small anatomical room available to perform it. To do this, failure as a result of macrophage activation syndrome, he
one twin was placed supine and the other was supported was emergently placed on ECMO. He had a protracted
in such a manner that the space above the face of the post- ECMO course. His pain regimen consisted of gabapen-
other one was unobstructed. Induction was followed by tin, methadone, lorazepam, and clonidine patch for pre-
Remifentanil 0.4 mcg/kg/min and the relaxation was per- operative pain control and sedation. An aggressive D
o
w
formed with Atracurium 0.5mg/kg. Monitoring was per- intraoperative and postoperative plan was devised to de- n
lo
formed with central venous catheter, pulse oximetry, crease the development of phantom limb pain. Intraopera- a
d
temperaturecontrol,ECGandurineoutput.Nobloodtransfu- tively, bilateral infragluteal sciatic nerve catheters were ed
sionwasrequired.Thetotaldurationofsurgerywas120min. placed and dosed with Ropivicaine until POD 5.. Ketamine fro
m
Morphine 0.05mg/kg was administered subsequently infusion was also stared intraoperatively and continued h
for pain. until POD 3. Gabapentin and methadone doses were ttp
s
Results: After 22 days, they were successfully discharged increasedtoensureadequatepaincontrol.Healsoremained ://a
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from hospital without showing any sign of complication. onlorazepamandaclonidinepatchuntilPOD6whenthese a
d
e
Twins are alive, withoutshowing anysequel. medicationsweretapered.Thepatientexhibitednosignsof m
Discussion: The logistic and the technique to be performed phantomlimbpain,andhischronicpaindiminishedtoalevel ic.o
u
hadtobethoroughlyplannedduetothelackofantecedent managed withlorazepam,methadone, andclonidine. p
.c
ofsimilarcasesinageneralhospital.Surgicalroomwascon- Discussion:Phantomlimbpainhasbeenreportedtooccurin o
m
ditionedtomeettherequirementssoitslimitationscouldbe 48%ofchildrenwithcancer-relatedamputationsand12%of /b
ja
overcome. childrenwithtrauma-associatedamputations.(1-2)Amulti- /a
Conclusion: The satisfactory intrasurgical and postoperative modal approach and a combination of therapies can rtic
le
outcome showed that the choice of both, the moment of enhance analgesia with fewer untoward side effects in the /1
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surgery as well as the technique used, was appropriate. child with chronic pain. (3) Regional anesthesia and other 8/s
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Successful outcome proved that having an adequate team adjunct therapies such as intraoperative ketamine infusion p
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makesthiskindofsurgerypossibleeveninageneralhospital are described (4) and becoming more prevalent with l_
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setting. pediatricanesthesiologists. /ii2
7
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Keywords: Omphalopagus; Pediatric anesthesia; Surgical /3
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separationof conjoined twins References 1
4
1
1 KraneEJ,HellerLB.Theprevalenceofphantomsensationandpain b
y
References inpediatricamputees.JPainSymptomManage.1995Jan;10(1): g
u
21–9. es
1 MPecdhiautgrh.RKa,dKioiel.ly20EM06,;S3p6it:z8L9.9I–m9a1g0i.ngofconjoinedtwins(Review). 2 SmithJ,ThompsonJM.Phantomlimbpainandchemotherapyin t on
pediatricamputees.MayoClinProc.1995Apr;70(4):357–64. 1
2 VtwaninsDe(1r6W89e)i.dTewninRsMR.eTshe20fi0r4st;7s:u1cc2e5s–s1fu2l7s.eparation of conjoined 3 Kost-ByerlyS.Newconceptsinacuteandextendedpostoperative 6 Fe
b
3EbenspergerA.,etal.Gemelosonfalo´pagoscons´ındromedetrans- pain management in children. Anesthesiol Clin North America. ru
fusio´nGemelo-gemelar.Rev.ChilenadeCirug´ıa.Vol62-N82,Abril 2002Mar;20(1):115–35. ary
2010;pa´g.188-196. 4 VasL.Continuoussciaticblockforlegandfootsurgeryin160chil- 20
dren.PaediatrAnaesth.2005Nov;15(11):971–8. 23
Paper No: 100.00
Paper No: 136.00
Perioperative pain management for below
the knee amputation in a failing fontan Quality evaluation of Rocuronium bromide
patient with severe immunosupression during tracheal intubation in pediatric
from macrophage activation syndrome patients with heart diseases less than
6 months
RosalieTassone1 and R. ScottDingeman2
1UniversityofIllinoisMedicalCenteratChicago,2Children’s JuniorLima1, ManuelLima2, AntolinRomero3,
HospitalBostonandHarvardMedicalSchool AbelFacenda3 and NestorSanchez3
ii279
BJA
AbstractspresentedatWCA2012
1CardiocentroPediatricoWilliamSoler,LaHabana,Cuba, Paper No: 137.00
2HosapitalLeoploditoMartinez,Mayabeque,Cubaand
3CardiocentroPediatricoWilliamSoler,LaHabana
Internal jugular venous canalization by
Introduction: Muscle relaxants show some differences in
anterior right access for the anesthetic
pediatric patients. These differences are more pronounced
management of pediatric patients with
in neonates and infants, precisely because these age
groupsare theparticular physiologicalcharacteristics. heart diseases
Objetives: To evaluate intubation conditions using Rocuro-
JuniorLima1, ManuelLima2, AbelFacenda3,
niumbromide at60 secondsafteradministration.
AntolinRomero3 and JacquelineBarrial3
Methods:Weperformedadescriptive,prospective,transversal
study,included48cardiacpatientsyoungerthan6monthsfor 1CardiocentroPediatricoWilliamSoler.LaHabana.Cuba,
correctionofcongenitalheartdisease.Preoperativemedica- 2HosapitalLeoploditoMartinez.Mayabeque.Cuba,3Cardiocentro D
o
tionwasusedwithMidazolam0.1mg/kgIM,Racemicketa- PediatricoWilliamSoler.LaHabana w
n
mine 5mg/kg IM and Atropine 0.02mg/kg IM. The induction lo
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of anesthesia was done using total intravenous anesthesia Introduction: To prove the utility of the internal jugular de
d
withmidazolam0.1mg/kg,Fentanyl5mcg/kgandRocuronium venouscanalizationbyanteriorrightaccessforthemanage- fro
bromide0.6mg/kg.Theairwaywasapproachedoneminute ment ofpediatricpatients withheart diseases. m
h
aftertherelaxingrun.Theintubationconditionswereobserved Objetives: To determinate the usefulness of the internal ttp
according to the modified scale Domaoal 60 seconds after jugularvenouscanalizationbyanteriorrightincardiacpedi- s://a
administration of the muscle relaxant. This scale include, atricpatients. ca
d
relaxationgradeofthemassetermuscle,qualityoflaryngosp- Methods:Weperformedaprospective,analytical,descriptive e
m
copy, vocal cord movility and rejection of the endotracheal and observational study which included 200 patients ic
.o
tube. We appointed 1 to 4 points depending of the patient´s younger than 1 year, were placed supine, head in central up
response. Higher score mean greater difficulty of intubation position, 15 degrees trendelemburg and interscapular shim, .co
m
whichwasdefinedinexcellent,good,fairorpoor.Weevalu- arterial pulse was located at cartilage cricoids level and /b
atedheartrate,rhythm,SpO2andanycutaneuosanaphylactic lateral to this we proceeded to puncture the internal ja/a
reactionduringandafteranesthesiainduction.Therelation- jugular vein to place the catheter by the Seldinger method. rtic
ship between cyanotic and non cyanotic congenital heart We measured the distance between the skin to jugular le/1
defectsandtheuseofrocuroniumwasevaluatedtoo. internal lumen making a mark at skin level in intravenous 08
/s
Results: Intubation conditions were excellent in 45 patients cannulawhichwasused duringthe puncture. u
p
and good in 3, there were not modification of heart rate, Results: We localized the internal jugular vein in the first pl_
2
rhythm,SpO2.Wedidnotfindcutaneuosanaphylacticreac- attempt in 89% of patients, we located the internal /ii2
tion and there was not relationship between cyanotic and jugular vein on average 1.2cm from skin to the jugular 78
noncyanotic congenital heartdisease. lumen and it was not necessary to introduce the catheter /32
6
Conclusions:Rocuroniumbromideisaneffectiverelaxantfor more than 6cm. Complications included impossibility to 14
1
rapid control of the airway in patients with heart disease find the venous in four children, and arterial puncture in b
y
younger than6months. one of them. g
u
Conclusions: Internal jugular venous canalization by e
s
anterior right access is a useful way and easily accessible t o
n
References for the management of pediatric patients with heart 1
6
1 LeeSK,HongJH,KimAR.Istherapidsequenceinductionpossible diseases. Fe
b
with0.6mg/kgrocuroniuminpediatricpatient?;KoreanJAnesthe- ru
a
siol.2010Jan;58(1):20–4. ry
2 BockM,Haselmannl,BottigerBW,MotschJ.Primingwithrocuro- References 20
2
nium accelerates neuromuscular block in children: A prospective 3
randomizedstudy.CanJ.Anaesth2007;54:538–43 1 Roth B, Marciniak B, Engelhardt T, Bissonnette B. Anatomic rela-
3 ChatrathV,SinghI,ChatrathR,AroraN.Comparisonofintubating tionshipbetweentheinternaljugularveinandthecarotidartery
conditionsof rocuronium bromideand vecuroniumbromidewith in pre-school children: an ultrasonographic study. Pediatric
succinylcholineusing“timingprinciple”;AnaesthesiolClinPharma- Anaesth2008Nov;Vol18(11):1045–9
col.2010Oct;26(4):493–7. 2 Downie L Sschalop, Mazurek JN, Savitch G, Lelonek GJ, Olson TR.
4 Liou J, Hsu J, Liu F, Ching-Wah Sum D, Lui P. Pretreatment with BilateralDuplicatedInternalJugularVeins:CaseStudyandLitera-
small-dose ketamine reduces withdrawal movements associated tureReview.ClinicalAnatomy.2007;20:260–6.
with injection of rocuronium in pediatric patients. Anesthesia 3 Satheesha Nayak. Surgically Important Variations of the Jugular
And Analgesia [serial on the Internet]. (2003, Nov), [cited Veins.ClinicalAnatomy.2006;19:544–546.
June29,2010];97(5):1294–1297.Availablefrom:MEDLINEwith 4 Arul Ganeshan, Dinuke R, Warakaulle , Raman Uberoi. Central
FullText. VenousAccess.CardiovascInterventRadiol.2007;30:26–33.
ii280
BJA
AbstractspresentedatWCA2012
Paper No: 154.00 securesthereversalofneuromuscularblockadeandshortens
thetimeforextubation.Morestudieswithlargersamplesize
are necessary forsaferresults.
Calculating dose of sugammadex in obese
male children undergoing minor urological
procedures Paper No: 161.00
NikolaosNoulas1,GiorgosLoukas2,DMaliamanis1,
DSkodis2andSavasStokidis2 Age-specific web-based information
1DepartmentofAnaesthesia,NHS-HospitalStateofCorinth, to prepare children and parents for
Corinth-Greece,2UrologyClinic,NHS-HospitalStateofCorinth anaesthesia and surgery
GunillaLo¨o¨f, UlfLindsten and Per-ArneLo¨nnqvist
Introduction: According to International Obesity Task Force D
o
(IOTF), children with BMI above the 95th position (for sex AstridLindgrenChildrensHospital,KarolinskaUniversityHospital, w
n
and age) are obese. Greece has the highest percentage of Stockholm lo
a
overweight children in Europe. The latest statistical data de
d
showed that about 4/10 children are obese under 10 years Introduction:Despitetheuseofverbalandwritteninforma- fro
old. Sugammadex is anew reversal neuromuscularagent. tion prior to anaesthesia and surgery many children and m
h
Objectives: The purpose of this study is to determine the parents still arrive to the OR unprepared for the experience. ttp
s
effective dose of this drug according to the total body The goal of this project was to create a web-based age- ://a
weight ortheideal body weight. specific information system that may improve children and c
a
d
Method: The study took place from February 2010 to May parentcomfort priorto anaestheticinduction. e
m
2011. After writtenconcent ofparentsand approval of hos- Background: Following a preparation period of 9 months in- ic
.o
pital ethical committee, 22 obese children between 5-11 volvingamultidisciplinaryteam(nurses,doctors,advertising u
p
years old, ASA I were enrolled. Induction of anaesthesia agencies and web-designers) plus extensive interviews with .c
o
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was achieved with Atropine 0,01mg/kg, Propofol 2mg/kg, children and parents the information system was launched /b
Remifentanyl 0,3 mcg/kg/min and Rocuronium 0,6mg/kg at our hospital in November 2006. The system is interactive ja
/a
basedonactualbodyweight.Formaintenanceofanaesthe- and contains forexample age-specific cartoons, web-books, rtic
siaweusedmixtureO2/air(40/60),Desflurane7%,Remifen- videos and interviews with pre-school and school children le
/1
tanyl 0,2 mcg/kg/min and repeated doses of rocuronium as well as teenagers. It also contains information for 08
/s
0,15mg/kg as needed. At the end of the surgical procedure parents in 25 languages. The site has an average 1500 visi- u
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they were randomized to receive either Sugammadex tors monthly, including visitors from more than 20 different pl_
2mg/kg (n¼11, according to IBW), or Sugammadex 2mg/ countriesto date. 2/ii2
kg (n¼11, according to TBW) at 2/4 TOF responses using Patients and methods: During the audit period September- 7
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acceleromyography (AMG). At first we calculated time from December 2007, 2076 children underwent anaesthesia of /32
6
administration of sugammadex to reached TOF. 0,9 (time which1350(65%)wereelective.Allfamilieswhosechildren 1
4
1
TOF). Secondly we measured time from administration of wereplannedforelectiveproceduresassociatedwithanaes- b
y
sugammadex to tracheal extubation (time EXTUB). Data thesiawhereencouragedintheirschedulinglettertovisitthe g
u
were presented as mean,plus-minus standard deviation. web-sitepriortotheirhospitalvisit.Aquestionnairewaspre- e
s
Student T-test was used for comparison using SPSS version pared for parents and distributed to them immediately fol- t o
n
17.Ap-value ,0,05wasconsideredstatisticallysignificant. lowing the anaesthesia induction. The parents were asked 1
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Results: Demographic data were statistically similar in both to answer the questions during their stay in the waiting Fe
b
groups as well as dose of Sugammadex and time TOF. The roomandcollectedbythestaff at therecoveryunit. ru
a
only difference was a shorter extubation time observed in Results: 94% of the respondent parents felt well-informed ry
2
group TBW. Group TBW (n¼11) Group IBW (n¼11) after visiting the website. 93% of the respondent parents 0
2
p-value Age (years) 7,78+1,71 7,64+1,34 0,838 Weight also felt that their child was well-informed after the visit. 3
(kg) 46,32+11 45,08+8,07 0,768 Length(m2) 1,39+0,12 Whenaskedwhattheywouldliketoreceiveassupplemental
1,40+0,10 0,856 Dose Sugammadex 92,64+22 informationtofuturepre-anaestheticvisitstotheanaesthe-
85,81+15,03 0,407 time TOF(sec) 88+10 95+8 0,087 time siologist,mostpreferredweb-basedinformationoverwritten
EXTUB(sec) 138+16155+140,018**p,0,05. information or an operating room tour (table 1). 22% of
Conclusions: Calculating Sugammadex in a dose of 2mg/kg therespondent felt well-informed after visiting theweb-site
according to TBW seems to be safe in obese children, and expressed no need for additive information to the
Web-siteinformation:47% Writteninformation:17% Operation-roomvisit:14% Noneedforadditiveinformation:22%
ii281
BJA
AbstractspresentedatWCA2012
pre-anaesthetic visit to the anaesthesiologist. Table 1 What anesthesia monitoring and pre-oxygenation, inhalation
informationwouldyouliketoreceiveinthefutureasacom- inductionwasdonewithoxygenandsevoflurane8%,breath-
plement to the regular pre-anaesthetic visits to the ing spontaneously, than no¼1,5 I-gel was administered to
anaesthesiologist? secure the airway. The oxygen saturation was 97-98%
Limitations/Future development: Despite that parents and throughout theprocedure.
children were encouraged to visit the web-site at the Conclusion:Therewerenodescriptionsofproblemswithven-
regular preoperative meeting with the anaesthesiologist tilationbefore,during,orafterinduction,suggestingthatthe
still only a minority in fact did so (30%). To generate even supraglottic airway device (I-gel) provided excellent airway
better results substantial efforts are needed to improve the control in PRS.
use ofthisinformationtool.
Conclusions: Based on the results of the audit of our web- References
based information system we conclude that it was well
1 DennyAD,TalismanR,HansonPR,RecinosRF.Mandibulardistrac-
receivedbythefamiliesandwaspreferredtomoretradition- D
tionosteogenesisinveryyoungpatientstocorrectairwayobstruc- o
w
al options, e.g. written information and pre-anaesthetic tion.PlastReconstrSurg2001:108:302–311. n
lo
operating room tours. This web-based information system 2 SchaeferRB,StadlerIIIJA,GosainAK.Todistractornottodistract: ad
provides a new, modern and effective tool to provide an algorithm for airway management in isolated Pierre Robin ed
pre-anaesthetic information. sequence.PlastReconstrSurgery2004:113:1113–1125. fro
m
h
ttp
s
Paper No: 260.00 Paper No: 265.00 ://a
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Airway management with supraglottic Neonatal anesthesia and mortality in The em
ic
airway device at pierre robin sequence University Hospital of Neiva (Colombia) .o
u
p
ElifCopuroglu, AlkinColak, GonulSagiroglu, in 2011 .c
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CemCopuroglu and IsilGunday KarenRussi-Garcia1andDanielRiveraTocancipa´2 /b
ja
TArnaeksytaheUsnioivleorgsyitya,nFdacRuelatnyiomfaMtieodni,cEindeir,nDee,pTaurrtkmeyentof N13erivday-eaCrolAonmebsitah,e2siAanReessthideesniat-PrSoogurathm-CeoDloirmecbtiaonr-University- /article
South-Colombian /1
0
Introduction: Pierre Robin Sequence (PRS) is a congenital 8/s
u
syndrome characterized with glossoptosis, retrognathia and Introduction: Neonatal anesthesia is the highest level of p
p
micrognathia. Also a high incidence of temporomandibular complexity in pediatric patients. In order to ensure a better l_
2
jointankylosishasbeendescribedinPRS(1).Thosecraniofa- service quality in the surgery rooms, it is necessary to /ii2
7
cial anomalies often make mask ventilation and airway achieve the basis for the analysis and the measures of 8
/3
management difficult. Neonates and babies with PRS may improvement by knowing the mortality of the neonatal 26
1
be affected in different degrees of airway obstruction, anesthesia. 4
1
feeding difficultiesand chronic hypoxemia (2). Objective:Weretrospectivelyreviewedthecasesofallnew- by
Objective: Is to describe the successful technique of awake bornstakentoanyprocedureundergeneralanesthesiaand gu
e
insertionofanewsupraglotticairwaydevice(I-gel),followed theirmortalityup to 7daysto determine ourstatistics. st o
by inhalated induction of anesthesia of two patients with Methods: A retrospective and descriptive study was per- n
1
PRS. formed in which the admission and discharge books from 6 F
Methods:Firstcase:A-28-day-oldpretermneonateweighing the neonatal intensive care unit and surgical wards of Uni- eb
2,4kg with PRS having micrognathia was admitted for gas- versityHospital ofNeivawere takenasasource ofinforma- rua
trostomy.Difficultintubationwasanticipated.Aftersecuring tion. Taking a look at the period between January 1st and ry 2
0
intravenous access and connecting to the monitors, 100% May31st,2011, 32cases werefound butonly 22out of the 2
3
oxygen was administered for 3 minutes. His baseline heart 32 fulfilled the records for the study. Age, main diagnoses,
rate was 135 /min, blood pressure was 70/45mmHg, and proceduresperformeduntiltheageof28days,typeofanes-
oxygen saturation was 98%. After inhalation induction with thesia administered and mortality in 7 d post surgery were
oxygen and sevoflurane 8%, breathing spontaneously, taken intoaccount.
direct laryngoscopy with an optic view laryngoscope was Results:Allpatientsreceivedgeneralanesthesia,9outofthe
made and intubation was tried, but it was unsuccessful. 22 (40,9%) got inhaled: general anesthesia, 4 patients
Than no¼1 I-gel was administered to secure the airway. (18,18%) were balanced with remifentanil and 9 patients
The oxygen saturation was 97-99% throughout the proced- (40,9%) were balanced with caudal anesthesia. One case of
ure. Second case: A-60-day-old infant weighing 3,5kg with endocarditis in a patient led central venous catheter inser-
severe micrognathia, cleft palate, extremity anomalies was tion finally died at 6 days postoperatively, another patient
admitted for right and left achillotomy. Her respiratory who was hemodynamically unstable, anasarca, low output,
sounds were rough, bilaterally. After routine standard oligoanuria and finally died at 72 postoperative hours. One
ii282
BJA
AbstractspresentedatWCA2012
morepatientdiedat24postoperativehoursinalargedeteri- these to the different grades of Cormack and Lehane
oration of general condition, previously critical. Finally a classificationobservedatthetimeof laryngoscopy.
death occurred in a patient with dysmorphism, necrosis † Evaluate the relationship between distance from nares
andhemoperitoneumafter6postoperativedays.Sixpatients to tragus with the different grades of Cortmack and
were preterm newborns (27,27%) and 2 (9,09%) out of the Lehane classification.
sixdied.
Material and Method: This quasi experimental study was
Conclusions:Ahighmortality(18,18%)wasfoundinseverely
performedatAgaKhanUniversityHospital,Karachi,afterap-
illpatientsAperformanceofhighlycomplexproceduresfora
provalfromtheethicalcommittee.Onehundredandninety
general high complexity non pediatric hospital is observed.
six pediatric patients, age range between infant to eight
A poor record and file system is evident. This will generate
years and ASA I and II grade undergoing elective surgery
an incentive to seek a self-registration and monitoring of
undergeneralanaesthesiawithplannedendotrachealintub-
patients understudy to generate adatabase.
ation were included. Demographic and clinical measure-
D
ments like age, sex, weight (kg), Body Mass Index (BMI), ow
n
References distance between tragus to nares (cm), Mallampati grades lo
a
and thyromental distance (cm) were noted. Relationship of d
1 Benjamin F van der Griend, Nichole A Lister, Ian M McKenzie, e
d
MartinNick,PhilipGRagg,SuzetteJSheppard,AndrewJDavidson. these variables with Cormack and Lehane grading at the fro
PostoperativeMortalityinChildrenAfter101,885.Anestheticsata time of laryngoscopy was recorded. All tracheal intubations m
TertiaryPediatricHospitalAnesthAnalg2011;112:1440–7. were done byone author. http
2 BFerarnzaGnodbebsoLuLecaianndoroA,uGgoubsbtoo,BPrianzheDiaronilMo,o´dDoaloCrNuozrmDeayvSidueSlia,nBtroasz, Rine2su2l%ts:oCfocrhmildarcekna,nd5yLeeahrasnaesgcroamdepsa2redan0d2%3 woafschoibldsreernve.d s://ac
a
Cerqueira Jose´ Reinaldo. Mortality In Anesthesia: A Systematic 5 years (p,0.001). In children ,5 years increasing grade de
Review.Clinics2009;64(10):999–1006. m
(2&3) of Cormack and Lehane classification was seen with ic
3 ChanRPCJr,AulerJOCJr.Retrospectivestudyofanestheticdeaths decreasing tragus to nares distance (p,0.002) but this .ou
inthefirst24hours.Reviewof82,641anesthetics.RevBrasAnes- p
trend was not observed in older children. A similar trend .c
tesiol2002;52:719–27. o
was observed with thyromental distance in children ,5 m
4 Jime´nez Me´ndez E, Vidal Pineda D´ıaz M, Gonza´lez Guzma´n M P. /b
Indice De Mortalidad Pedia´trica Asociada Con Anestesia Y years(p0.025)and .5years(p0.02).Therewasnosignifi- ja/a
Cirug´ıa. Revisio´n De 56,358 Casos En El Hospital General Del cantrelationshipseenforCormackandLehaneclassification rtic
CentroMe´dicoLaRaza.FedMexColAnestRev1997Oct;9(5). withrespecttogender,bodymassindex(BMI)anddistance le
/1
5 CohenMM,CameronCB,DuncanPG.Pediatricanesthesiamorbid- betweentragusto nares forchildren5 yearsandabove. 0
8
ityandmortalityin the perioperativeperiod.Anesth Analg1990; Conclusion: We conclude that thyromental distance (Tm), /su
70:160–7. distance between tragus to nares (Tn) can be helpful in as- pp
l_
sessment of difficult airway in pediatric patients younger 2/ii2
than 5years of age. Further studies are required on larger 7
Paper No: 269.00 8
sample size. /3
2
6
1
4
Pre-operative airway assessment References 1 by
in pediatric patients g
u
1 KoppVJ,BaileyA,ValleyRD,etal.UtilityoftheMallampaticlassi- e
s
NosheelaRafique1 and FauziaKhan2 ficationfor predicting intubation in pediatric patients. Anesthesi- t o
n
1AgaKhanUniversityHospital,Karachi,2PakistanAgaKhan ology1995;83:A1147. 16
UniversityHospital,Karachi,Pakistan 2 Samsoon GLT, Young JRB: Difficult tracheal intubation: A retro- Fe
spectivestudy.Anaesthesia1987;42:487–490. b
ru
a
Introduction:Severalclinicalcriteriaarebeingroutinelyused ry
2
inadults,inordertoidentifypatientswithadifficultairway. Paper No: 290.00 02
This is essential in planning anesthetic management and 3
endotracheal intubation. Several anatomical airway differ-
ences exist between adults and children. There is very Previous exposure to anesthesia and
scant literature available which relates to pre-operative
autism spectrum disorder (ASD): a puerto
airwayassessment in pediatrics and its relationship to diffi-
rican population-based cohort study
cultintubation.
Objective: OsmarCreagh-Bandera1, HectorTorres1,
KarinesRivera1, CesarHernandez-Arroyo1 and
† Toassessthefollowingvariablesi.e.,age,gender,body
massindex(BMI)andbodyweight,Mallampaticlassifi- DavidWarner2
cationandthyromentaldistanceintwogroupsofpedi- 1ofAnesthesiology,UniversityofPuertoRico-SchoolofMedicine,
atric patients (pre-school; less than 5years and school SanJuanPuertoRico,2DepartmentofAnesthesiology,MayoClinic
going; more than 5years) pre-operativelyand correlate Rochester
ii283
BJA
AbstractspresentedatWCA2012
Introduction: Autism Spectrum Disorder (ASD) is character- Paper No: 291.00
ized byimpaired social interaction and communication, and
by restricted and repetitive behavior, that begins before a Assessment of postoperative vomiting in
child is three years old.(1) Researchers have shown that
retinoblastoma patients and their siblings
prevalence rates in the U.S. may be as high as 91 in
undergoing eye exams under anesthesia
10,000. As many as 1.5 million people in U.S. may have
someformofautism.(2)Anumberofstudieshaveexamined PascalOwusu-Agyemang, ElizabethRebello,
theeffectsofearlyexposuretoanesthesiaonbraindevelop- RadhaArunkumar, JosephRuiz and DanGombos
ment and subsequent impairment in neurocognitive func-
UniversityofTexasM.D.AndersonCancerCenter
tion; yet, little is known about the possible effects of
anesthetic agents onsocial-behavioralfunctioning.
Introduction:Postoperativevomiting(POV)inchildrenisone
Objectives:Toidentifyifchildrenwhohadpreviousexposure
to anesthesia either during their developing brain years or oftheleadingcauses ofdelayeddischargeandreadmission D
o
tothehospital.Mostpediatricpatientscannotvoiceafeeling w
laterare at riskof developing autism and its severe form of n
ofnauseaandriskfactorshavebeenassociatedwithPOV(1). lo
thedisease. a
Methods: Data was obtained from structured interviews Objectives:Thepurposeofthisstudywastoevaluatethein- ded
administeredtoasampleof514parents/guardiansdistribu- cidenceofemesisinthePACUinpediatricpatientsundergo- fro
ing eye exams ofminimal stimulationunderanesthesia. m
ted in two groups: ASD¼262 children diagnosed with this h
condition and Non-ASD: 253 children (siblings of ASD Methods:Weanalyzeddatafromophthalmologicprocedures ttp
group) without diagnosis (95% confidence interval) that thatdidnotinvolveasurgicalincision,laser,andcryotherapy s://a
from our Automated Anesthesia Information System. c
freely decided to participate and agreed to a consent form. a
d
Between January 2006 and July 2010 we found 76 patients e
Variables studied include: demographics, diagnosis and m
severityofASD,exposuretoanesthesia,andageofexposure. withadiagnosisoforneedforscreeningforretinoblastoma. ic.o
Our endpoint was administration of an antiemetic or the u
Children less than 2 years of age are considered to have p
documentation of emesis in the PACU. Descriptive statistics .c
developing brain. Data was analyzed using Chi-square or o
m
Fisherexact test. were used indataanalysis. /b
Results:Sixty-threepercentofpatientsreceivedprophylactic ja
Results: In contrast to non-ASD group, most of the children /a
within ASD group were male, 74% (n¼193, p¼0.0001). Of anti-emetics:40/76 (53%) receivedondansetron alone,6/76 rtic
(8%) received both ondansetron and dexamethasone, and le
the 262 ASD patients, 99 had exposure to anesthetics /1
before their diagnosis while in Non-ASD population, 110 2o/v7e6ral(l2.i6n%cid)epnacteieonftsemreecesiisveidn dtheixsamstuedthyasgoronuepawloanse.1.T3h%e 08/su
had exposure to anesthesia, demonstrating no statistically p
significant association between both groups (p¼0.2091). (1/76 patients). The incidence of emesis in the group of pl_
2
Out of 99 ASD patients exposed to anesthesia prior to their patients receiving anti-emetics and those not receiving /ii2
anti-emeticswas0%and 3%respectively 7
diagnosis, 72 were exposed before age 2. When compared 8
to the 110 Non-ASD patients exposed to anesthesia, 86 Conclusion: In our study where identified risk factors were /326
present butwithessentiallynosurgicalstimulationtheinci- 1
hadexposureduringthisdevelopingbrainperiod,whichindi- 4
1
cates no statistically significant association (p¼0.4207). In denceofPOVinthePACUwaslowerthanthebaselineof9% by
addition, most of the ASD children exposed to anesthesia with no risk factors2. However, the discomfort associated gu
withPOVmayjustifyprophylacticanti-emeticadministration. e
before diagnosis were diagnosed with mild degree of the st o
disease when compared to ASD children without any previ- n
ousexposuretoanesthesia(p¼0.9700).Whentheexposure Reference 16 F
occurred before age 2, ASD children developed mild form of 1 GanTJ,etal.SocietyforAmbulatoryAnesthesiaGuidelinesforthe eb
thediseaseascomparedwithASDchildrenwithoutanypre- ManagementofPostoperativeNauseaandVomiting.Anesthesia& rua
vious exposure to anesthesia (p¼0.1699). Analgesia2007;105(6),1615–1628. ry 2
0
Conclusions:Earlyexposuretoanesthesiainchildren,includ- 2
3
ing during the brain development period, does not increase
Paper No: 295.00
the probability to develop neither ASD nor severe form of
thedisease.
The Comparison of Intravenous Magnesium
Sulfate and Lidocaine to Prevent
References Laryngospasm after Tonsillectomy
1 O’BrienG,PearsonJ.Autismandlearningdisability.Autism2004; and/or Adenoidectomy
8:125–40.
ElahehAllahyary and Shoja-ul-haghTaregh
2 Shattuck PT, Durkin M, Maenner M, et al. Timing of identification
amongchildrenwithanautismspectrumdisorder:findingsfrom
a population-based surveillance study. J Am Acad Child Adolesc Introduction: Complications following extubation remain an
Psychiatry2009;48:474–83. important risk factor in anesthesia. Laryngospasm is the
ii284
BJA
AbstractspresentedatWCA2012
most common cause of upper airway obstruction after tra- 6 OkayamaH,AikawaT,OkayamaM,etal.Bronchodilatingeffectof
cheal extubation. It is particularly frequent in children after intravenous magnesium sulfate in bronchial asthma. Ann Emerg
oropharngeal surgeries like adenotonsillectomy (1-2). Med2000;36(3):181–190.
Several studies focused on prevention of laryngospasm 7 Rowe BH, Bretzlaff JA, Bourdon C, et al. Intravenous magnesium
sulfatetreatmentforacuteasthmaintheemergencydepartment:
(3-7).Theroleoflidocaineinpreventingpostextubationlar-
A systemic review of the literature. Ann Emerg Med 2001; 37(5):
yngospasm and stridor has been contemplated by previous
552–553.
researches (3). Magnesium, the fourth most common
cationinthebody,hasbeentherecentfocusofmuchclinical
and scholarlyinterest. Paper No: 312.00
Objectives:Inthisstudywesoughttoassessthehypothesis
that magnesium sulfate will reduce the incidence of post
extubationlaryngospasmandtocompareitwithintravenous Risk of laryngospasm and bronchospasm
lidocaine. with the Layngeal mask airway compared Do
w
Methods: 185 children with ASA physical status I and II, to endotracheal intubationin neonatesless nlo
aged 3-16 years, scheduled to undergo elective tonsillec- a
tomy and/or adenoidectomy under standard general anes- than six months of age: A retrospective ded
thesia were enrolled in this double blinded study. All study of 4,173 patients fro
m
patients randomly entered to three groups to receive SamehNour and patrickRoss h
equal volumes of medication or placebo at two distinct ttp
s
times, first 2 minutes after intubation and second, just PhilTsaiChildren’sHospitalofLosAngeles ://a
c
before extubation. The patients received normal saline a
d
Intoduction: Though the laryngeal mask airway (LMA) has e
and lidocaine 1mg.kg-1 in lidocaine group, magnesium m
sulfate 15mg.kg-1 and normal saline in magnesium group beenvalidatedasaneffectivemeansofprovidingventilation ic.o
duringneonatalresuscitation(1),theroutineuseofLMAsfor u
and normal saline in both mentioned times in control p
group. Deep extubation was carried out in all the patients elective surgeryin infantsremainscontroversial. .co
m
at the end of operation and the incidence of laryngospasm Objective:Todate,therehavebeennostudiescomparingthe /b
were observed and recorded until the time of discharge frequency of airway complications with LMA versus endo- ja/a
from the post anesthesia care unit. tracheal intubation (ETT) in neonates undergoing elective rtic
Results:Bothmagnesiumandlidocainegroupsrevealedless surgery. le/1
0
laryngospasmthanthecontrolgroup(PV¼ 0.008and0.001 Methods: We performed a retrospective analysis to deter- 8/s
mine the incidence of laryngospasm and bronchospasm u
respectively),andnodifferencewasfoundbetweenmagne- p
p
sium and lidocaine groups regarding laryngospasm (PV¼ with LMA and ETT in infants less than 6 months of age. All l_
2
0.493). The plasma magnesium concentrations were signifi- theanestheticrecordsfromJune2003toJune2010atChil- /ii2
cantly higher in magnesium group than two another drens Hospital Los Angeles were screened. After inclusion 78
/3
groups(PV¼0.0001), butwere notmore than2.5mmol.l-1. and exclusion criteria were applied, a total of 4,173 cases 26
Conclusions:Magnesiumsulfatecanreducetheincidenceof remainedforanalysis.Dataextractedincludeddemographic 14
1
postoperativelaryngospasmaswellasintravenouslidocaine information, case information, written comments, and the by
inpediatricpatientsundergoingadenotonsillectomysurgery. use of medications common in the treatment of laryngos- gu
pasmandbronchospasm.Vecuronium0.1mg/Kgwasadmi- es
References nistred forendotracheal intubation for the ETT group. Three t on
independent investigators reviewed records which had 16
1 AsaiT,KogaK,VaughanRS.Respiratorycomplicationsassociated F
yielded positive results. Comparison of categorical data e
with tracheal intubation and extubation. Br J Anesth 1998; 80: b
betweenETTandLMAgroupswasmadeusingthechi-square ru
767–775. a
testorFishersexacttestifdatacontainedsamplesizesless ry
2 Haghberg C, Georgi R, Krier C. Complications of managing the 2
airway. Best Practice & Research Clinical Anesthesiology 2005; than six. Analysis of continuous data between the two 02
3
19(4):641–659. groupswasmadewith theWilcoxon rank-sumtest.
3 Staffel JG, Weissler MC, Tyler EP, et al. The prevention of post- Results: Of 4,173 total cases, 3,418 anesthetics were admi-
operative stridor and laryngospasm with topical lidocaine. Arch nistered using an ETT, while 755 cases utilized a LMA.The
OtolaryngolHeadNeckSurg1991;117:1123–1128. LMA group was found to be older, heavier, and healthier
4 KumarBatraY,IvanovaM,ShujatAliS,etal.Theefficacyofasub- than the ETT group. The incidence of laryngospasm was
hypnotic dose of propofol in preventing laryngospasm following
1.7% in the LMA group and 0.7% in the ETT group (p,
tonsillectomyandadenoidectomyinchildren.PediatricAnesthesia
0.05), and the incidence of bronchospasm was 0.4% in the
2005;15:1094–1098.
LMA group and 0.5% in the ETT group (p,0.05) which is
5 Schulz-StubnerS,WettmannG,Reyle-HahnSM,etal.Magnesium
not statstically significant. Our study is the first to compare
aspartofbalancedgeneralanesthesiawithpropofol,remifentanil
andmivacorium:adouble-blind,randomizedprospectivestudyin the incidence of airway complications with LMA versus ETT
50patients.EurJAnaesthesiol2001;18(11):723–729. in the neonatal population. The increased risk of
ii285
BJA
AbstractspresentedatWCA2012
laryngospasmwhenusingLMAsinneonatesmaybesecond- Paper No: 383.00
arytodifficultywithproperpositioningofsmallersizedLMAs
(2).
Subclavian vein cannulation in neonates
Conclusion: Though overall complication rates are low, the
and children: analysis of 272 patients
results from this study suggest that the anesthesiologist
shouldhaveaheightenedawarenesstopossibleintraopera- RezaAminnezhad1,YasharNasiriMoghaddam1,
tive problemswhenLMAs are used insmallinfants. AlirezaMahdavi2,SajjadRazavi3andRozaAlikhani4
1ResidentofAnesthesiology,MofidPediatricHospital,Tehran,
References
Iran,2Anesthesiologist,MofidPediatricHospital,Tehran,Iran,
1 GreinAJ,WeinerGM.Laryngealmaskairwayversusbag-maskven- 3AnesthesiologistandDirectorofthePediatricIntensive,
tilation or endotracheal intubation for neonatal resuscitation. 4ResidentofPsychiatry,TehranUniversityofMedical
CochraneDatabaseSystRev.2005Apr18;(2):CD003314.
D
2 Von Ungern-Sternberg BS, Wallace CJ, Sticks S, Erb TO, Introduction and Objectives: The cannulation of a central o
w
ChambersNA.Fibreopticassessmentofpaediatricsizedlaryngeal vein allows administration of large volumes of fluids in nlo
maskairways.AnaesthIntensiveCare.2010Jan;38(1):50–4. a
short times and at high osmolarities for rehydration, d
e
Paper No: 351.00 vtioolnu.mPeercruetpalanceeomusencet,ntcrhaelmveontohuesralipnyeainnsdertpioanrehnatesrarelpnlaucterid- d from
peripheral venous cutdown as the primary mode of short http
termvenous access in children. s
The induction of anesthesia with Methods:272 subclavianveincannulations inneonatesand ://ac
sevoflurane in pediatric neurosurgical a
childrenupto8yearsoldwereanalyzedregardingsuccessful d
e
patients with intracranial hypertension firstattemptforcatheterizationandearlycomplicationrates mic
aftertheprocedureretrospectively. .o
IrinaSavvina, NathaliaLesteva, AnnaPetrova and u
p
Results:Wehad84newbornpatients(first28daysoflife)in .c
OlgaPilat o
ourstudypopulation.Inthisgroup,54cannulations(64.2%) m
/b
weresuccessfulinfirstattempt,1patient (1.2%)werecom- ja
Introduction and objectives: The choice of anesthetic is /a
important to provide stable intracranial pressure and auto plicatedwithpneumothorax,in24cases(28.5%)guidewires rtic
became ruined and only in 4 cases (4.8%) attempts to can- le
regulation of brain circulation during changing of system /1
nulation were failed. Appropriate size venous cannulas 0
homodynamicand PaCO2andpreventseizures. werenotaccessible,soarteriallineswereappliedinallneo- 8/s
u
Methods: We have analyzed the induction of anesthesia in p
nates.Intheremaining188patients,1monthto8yearsold, p
34 neurosurgical patients with intracranial hypertension (14 l_
only1attempttocannulationofsubclavianvein(0.5%)was 2
patients aged 1-12 months with hydrocephaly, 20 patients failed and in 172 cases (91.4%) cannulation performed /ii27
from1to15yearswithbraintumorsofdifferentlocalization 8
successfullyatfirst attempt. /3
includingposteriorcranialfosseandalsowithhydrocephaly). Discussion and Conclusion: Cannulation of central vein in 261
The induction of anesthesia started with sevoflurane (8%) 4
neonatesandchildreninaskilledhand,wouldbeperformed 1
breeafochreedthine3v0e-n4o0ussecc.aTthheetnearilzlatthioenp.aMtiAenCtsofresceevivoefldurfaenntawnaysl with great success rate andlowearlycomplications. by gu
e
(5 mcg/kg), clophelin (1,4mcg/kg), and Rocuronium bromide st o
(0,6mg/kg)whichwasfollowed byorotrachealintubation. Paper No: 385.00 n 1
Results: No patients developed coughing and psychomotor 6 F
excitement. We observed no cases of increasing blood eb
pressure during intubation. Total anesthesia was provided Spanish Video in Anesthesia as an rua
by fentanyl (2, 5 mcg/kg), clophelin (0,5mcg/kg), sevofluran Uncertainty and Anxiety Reducer Tool ry 2
0
2, 5 vol.%. The condition of the brain was stable and com- in Spanish Speaking Parents 2
3
fortable forsurgeons.
Albertode Armendi1, StephenGillaspy2,
Conclusions: The method of bolus induction of anesthesia
MohanadShukry1, MarteMartinez1 and
with sevoflurane (8%) together with fentanyl (5 mcg/kg)
andclophelin(1,4mcg/kg)andnon-depolarizingmyorelaxant JorgeCure1
could prevent undesirable effects (coughing and psycho- 1TheUniversityofOklahomaHealthSciencesCenter,Deparment
motor excitement) which lead to increasing of intracranial ofAnesthesiology,2TheUniversityofOklahomaHealthSciences
pressureandcouldprovidelevelofneurovegetativestabiliza- Center
tiondeepenoughtoescapetheincreasingofbloodpressure
during intubation. The decreasing of arterial blood pressure Introduction:Parentsexperienceanxietywhentheirchildren
aftertheinductionofanesthesia(about25%frompreopera- undergoanesthesia.Lackofriskinformationpriortosurgery
tive level) do not cause harmful effects on the intraopera- create parental stress and anxiety. 1 Parental uncertainty is
tionalcondition of thebrain. associated with anxiety. 2 Prior anesthesia knowledge
ii286
BJA
AbstractspresentedatWCA2012
should reduce parental anxiety. Our study shows that His- Introduction:Hypoxiaisnotararecomplicationofintra-and
panic parents who viewed a Pre-Anesthesia Spanish video postoperative periods. It is an important component of the
have decreased anxiety. free radical oxidation activation. For the prevention and
Objective: We hypothesize that showing parents a Spanish reduction of oxidative stress study and application of
video on the risks and benefits of anesthesia within two topical agents with antioxidant properties include a salt of
weeks prior to surgery willreduce parentalanxiety. succinicacid(succinate).Oneofthepreparationscontaining
Methods:Subjectswererandomizedintotwostudygroups:1) succinate, a 1.5% solution for infusion “Reamberin”,
viewing the Pre-Anesthesia Spanish video or 2) not viewing produced by OOO “NTFF” POLYSAN” Russia, consisting of
the video. Both groups completed, before and again after active substances - sodium salt of N-metilglyukaminovaya
viewing the videos, a Parent Perception of Uncertainty in succinicacidandtrace elements.
Illness Scale (PPUS), a State Trait Anxiety Inventory Test Objectives:Thedrugwasoriginallyregistered“Reamberin”in
(STAIT Y1, Y2) and the Amsterdam Preoperative Anxiety and Russia in 1999, then - registered and successfullyapplied in
Information Scale (APAIS). Parents repeated the same three Ukraine, Belarus, Kazakhstan, Georgia, Uzbekistan, Laos, D
o
w
testsbeforetheoperationonthedayofthesurgery. Parents Vietnam, Kombodzhe, Burma. More than30 million patients n
lo
alsocompletedasatisfactionquestionnaireaftersurgery. were treated with this drug for 12 years. The study of the a
d
Results: APAIS scores generally decreased in the parents antioxidantactivityof1.5%solutionforinfusion“Reamberin” ed
exposedtothevideo.Asignificantstatisticalinteractionindi- in serum in children in post-anesthesia period using the fro
m
cates that the PPUS scores of thosewho watched the video method of chemiluminescence. This is 3b phase of clinical h
changed in a different direction after intervention than did trial of the drug has received approval of the local ethics ttp
s
the scores in the control group. Separate within-group committee. ://a
c
analyses do not yet show significant change over time, Methods: Eleven children aged 6-14 years operated under a
d
however, the divergence of responses is interesting. STAIT general intravenous anesthesia (fentanyl+propofol+ em
scores may beincreasing more forthe standard care group. rocuronium bromid) were included into the study. “Ream- ic.o
u
Conclusions: Hispanic parents who viewed a Pre-Anesthesia berin” was administered for 2min at the dose of 4ml / kg p
.c
Spanishvideo had lower APAIS scores and loweranesthesia 10min before applying the last stitch on the skin. Antioxi- o
m
anxietyscores. dant activity of serum was determined before the “Ream- /b
ja
berin”, 2-3min and 10min after its introduction by the /a
References chemiluminescencemethod (HL). rticle
Results: Application of 0.5ml of “Reamberin”, 1.0ml and /1
0
1 ZMeaeuvraNH,ofsKtaaidnteMr,DLi,ndSahuC,MMainyegsMWDanPagr,enLtisaalDeAs,ireCaforarmPeircioopeMraD-, 1.5mlinvitrowasaccompaniedbydose-dependentincrease 8/su
oftheantioxidantactivityofthedrug.For2-3minutesafter p
tiveInformationandInformedConsent:ATwo-PhaseStudy.Anes- p
the “Reamberin” introduction duration of the latent period l_
thesia&Analgesia1997;84:299–306. 2
2 HoffAL,MullinsLL,GillaspySR,PageEMC,VanPeltJC,ChaneyJM (T/T0) HL declining in all the patients, that characterized /ii27
An Intervention to Decrease Uncertainty and Distress Among the ability of the intercept free radicals and eliminate them 8/3
Parents of Children Newly Diagnosed With Diabetes. Families, from the system. The intensity of the slow luminescence (I/ 26
1
Systems,&Health2005;23:329–342. I0)(amplitudeHL)remainedpracticallyunchanged.Thisindi- 4
1
3 CassadyJF,WysockiTT,MillerKM,CancelDD,IzenbergNUseofa cated not highly active interception of free radicals in the by
Preanesthetic Video for Facilitation of Parental Education and system. At 10 minutes after drug administration T/T0 HL in gu
Agensxiiaol1y9si9s9B;e8f8o:r2e4P6e–d2ia5t0ri.cAmbulatorySurgery.Anesthesia&Anal- 9 patients returned to their original performance or est o
increased. In 1 patient T/T0 HLcontinued to decline. Taking n
1
thevaluesofestimatedparametersbeforethe“Reamberin” 6 F
Paper No: 417.00 100%,afteritsintroduction,togetT/T0-85,46Aˆ+15,3(p, eb
0.05)and103,94Aˆ+19,5(p,0.05),andforI/I0-100,8Aˆ+ rua
12,9 and 99,42 Aˆ+ 12,2, respectively, 2-3 and 10 minutes. ry 2
Effect of 1.5% solution of succinic acid - 0
These results suggest that the main effect of “Reamberin” 2
3
“reamberin” on the antioxidant activity on the parameters of HL, accompanying the peroxidation
of plasma in post-anesthesia period of membrane lipids of liposomes is presented by the
change of T/T0, which is influenced by the concentration of
in children
Fe2+[6].
VladimirLazarev, LeonydThsypin, Conclusions: Solution “Reamberin” has dose-dependent
IrinaKhelimskaya and GennadyKlebanov short antioxidant effect due to oxidationof the catalytically
active ferrous ions and inhibiting the initiation stage of free
RSMU,Moscow,RussiaRSMU,Moscow,RussiaRSMU,Moscow,
radical reactions of lipid peroxidation in serum in children
RussiaDepartmentofPediatricAnesthesiologyandIntensiveCare
RussianStateMedicalUniversity,Moscow,Russia inpost-anesthesiaperiod.
ii287