scholarly journals Perioperative respiratory adverse events during ambulatory anesthesia in obese children

2021 ◽  
Author(s):  
Vesna Marjanovic ◽  
Ivana Budic ◽  
Mladjan Golubovic ◽  
Christian Breschan
Keyword(s):  
Adverse Events ◽  
Pediatric Population ◽  
Preoperative Assessment ◽  
Postoperative Recovery ◽  
Obese Children ◽  
Ambulatory Anesthesia ◽  
Drug Dosing ◽  
Unplanned Hospitalizations ◽  
Clinical Conditions ◽  
Protective Mechanical Ventilation

AbstractObesity is one of the most common clinical conditions in the pediatric population with an increasing prevalence ranging from 20 to 30% worldwide. It is well known that during ambulatory anesthesia, obese children are more prone to develop perioperative respiratory adverse events (PRAEs) associated with obesity. To avoid or at least minimize these adverse effects, a thorough preoperative assessment should be undertaken as well as consideration of specific anesthetic approaches such as preoxygenation before induction of anesthesia and optimizing drug dosing. The use of short-acting opioid and nonopioid analgesics and the frequent implementation of regional anesthesia should also be included. Noninvasive airway management, protective mechanical ventilation, and complete reversion of neuromuscular blockade and awake extubation also proved to be beneficial in preventing PRAEs. During the postoperative period, continuous monitoring of oxygenation and ventilation is mandatory in obese children. In the current review, we sought to provide recommendations that might help to reduce the severity of perioperative respiratory adverse events in obese children, which could be of particular importance for reducing the rate of unplanned hospitalizations and ultimately improving the overall postoperative recovery.

The Role of Obesity in Motor Vehicle Injuries and Fatalities in the Pediatric Population: A Systematic Review

2021 ◽  
pp. 088506662199273
Author(s):  
Zana Alattar ◽  
Shelby Hoebee ◽  
Eyal Ron ◽  
Paul Kang ◽  
Eric vanSonnenberg
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Motor Vehicle ◽  
Pediatric Population ◽  
Extremity Injury ◽  
Obese Children ◽  
Patients Âgés ◽  
Vehicle Accidents ◽  
Increased Risk ◽  
Extremity Injuries

Purpose: A systematic review done to evaluate obesity as a risk factor for injuries and mortality in motor vehicle accidents (MVAs) in the pediatric population, as there has not been a systematic review done in over 10 years. This study aims to update the literature regarding obesity as a risk factor for injuries in MVAs in the pediatric population. Materials and Methods: A systematic review was conducted according to the PRISMA guidelines with strict inclusion and exclusion criteria, resulting in the use of 3 total articles to analyze obesity as a risk factor for overall injury and mortality in the pediatric population. Results: Zaveri et al demonstrated a statistically significant, but weak, decrease in the odds of extremity injury in overweight patients ages 2 to 17 years old (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-1.0, P ≤ 0.05). On the other hand, Pollack et al and Haricharan et al found an increase in extremity injury in the obese population, in ages 9 to 15 years (OR = 2.54, 95% CI = 1.15-5.59, P ≤ 0.05), and 10 to 17 years (Age 10-13: OR = 6.06, 95% CI = 2.23-16.44, P ≤ 0.05, Age 14-17 OR = 1.44, 95% CI = 1.04-2.00, P ≤ 0.05), respectively. Haricharan et al also found an increase in thoracic injuries in obese children, ages 2 to 13 and increased risk of head/face/neck injury in obese children ages 2 to 5 (OR = 3.67, 95% CI = 1.03-13.08, P ≤ 0.05), but a decreased risk of head injury in obese children ages 14 to 17 (OR = 0.33, 95% CI = 0.18-0.60, P ≤ 0.05). Conclusions: There are sparse data that are conflicting, regarding the effect of obesity on extremity injuries in the pediatric population. Obesity is not protective against thoracic, head, or abdominal injuries. However, it was found to be a risk factor for trunk injuries in ages 2 to 13, as well as head/face/neck injuries for ages 2 to 5. Since the literature is so sparse, further research is warranted in these areas.

scholarly journals Emergency Drug Kits: Pharmacological and Technical Considerations

2014 ◽  
Vol 61 (4) ◽  
pp. 171-179 ◽  
Author(s):  
Daniel E. Becker
Keyword(s):  
Adverse Events ◽  
Continuing Education ◽  
General Anesthesia ◽  
Intraoperative Monitoring ◽  
Preoperative Assessment ◽  
Procedural Sedation ◽  
Dental Procedures ◽  
Dental Practices ◽  
Emergency Drugs ◽  
Technical Considerations

Abstract The risk for complications while providing dental procedures is greatest when caring for patients having significant medical compromise. It is comforting that significant adverse events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, the office team must be prepared to manage untoward events should they arise. This continuing education article will address basic emergency drugs that should be available in all dental practices and additional agents that become essential for those practices providing various levels of procedural sedation or general anesthesia.

Specific diseases: chronic heart failure/hypertension

ESC CardioMed ◽  
2018 ◽  
pp. 2663-2665
Author(s):  
Rodrigo Modolo ◽  
Ana Paula de Faria
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Adverse Events ◽  
Heart Function ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
Cardiac Markers ◽  
Perioperative Morbidity ◽  
Clinical Conditions

Hypertension and chronic heart failure are clinical conditions that greatly impact perioperative adverse outcomes of patients undergoing non-cardiac surgery. Although the first does not have a major impact on morbidity and mortality, it is the most frequent condition present in these patients. The second—chronic heart failure—is increasing in prevalence, with the ageing of the population and with the identification of incipient structural cardiac abnormalities, and has a major impact on the perioperative morbidity and mortality. For those reasons, the proper identification of these conditions in the perioperative setting is imperative in order to diminish perioperative adverse events. This chapter summarizes the current indications for identification, assessment of heart function and of cardiac markers, and the therapeutic management of these patients.

scholarly journals A Systematic Review of Pediatric and Adult In-Flight Medical Emergencies

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Christina Sul ◽  
Sherif M. Badawy
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Health Outcomes ◽  
Pediatric Population ◽  
Air Travel ◽  
Serious Adverse Events ◽  
Significant Events ◽  
Medical Emergencies ◽  
The Subject

In-flight medical emergencies (IMEs) are acute onboard events of illnesses or injuries with potential immediate risk to a passenger’s short- or long-term health, or life. IMEs are significant events that are related to public safety concerns. With the increasing amount of annual air travel every year, it is expected that the number of encountered IMEs will continue to grow. Thus, it will be critical to develop and implement appropriate measures to manage IMEs with the best possible outcome. Despite the fact that most IMEs are self-limited with no serious adverse events, serious IME can lead to death, disability, or other unfavorable health outcomes, particularly as a result of suboptimal medical care. In this article, we systematically reviewed the published up-to-date evidence on the subject of in-flight emergencies with a specific focus on pediatric population.

scholarly journals Anaesthetists’ drug dosing practices in class III obese surgical patients: A bi-national survey

2019 ◽  
Vol 47 (6) ◽  
pp. 516-521
Author(s):  
Zahid Hussain ◽  
Karl Gadd ◽  
Colin Curtain ◽  
Corinne Mirkazemi ◽  
Gregory M Peterson ◽  
...  
Keyword(s):  
Body Weight ◽  
New Zealand ◽  
Adverse Events ◽  
Total Body Weight ◽  
Surgical Patients ◽  
Lean Body Weight ◽  
Obese Patients ◽  
Class Iii ◽  
Drug Dosing ◽  
Zealand College

Class III obese (body mass index ≥ 40 kg/m2) patients, now regularly encountered clinically, have increased perioperative risks, including potentially from suboptimal drug dosing. However, current dosing guidelines are based on low-level evidence and may not be widely accepted. This study aimed to investigate anaesthetists’ dosing practices for class III obese surgical patients, explore if they had experienced an increased incidence of adverse events potentially related to drug dosing with these patients and assess which resources they consulted for dosing advice in this population. An electronic survey was emailed to 1000 randomly selected members of the Australian and New Zealand College of Anaesthetists. Data were summarised and the Pearson’s χ2 test was used to compare respondents’ genders, geographic locations and seniority designations with the greater Australian and New Zealand College of Anaesthetists’ membership. There were 230 completed responses (response rate 23%). A large proportion (46%–76%) of respondents indicated they dose class III obese patients in keeping with current recommendations; however, substantial heterogeneity in dosing practices was found. Lean body weight was the most frequently used regimen for dosing propofol, non-depolarising muscle relaxants, sugammadex and opioids, whereas total body weight was most frequently used for suxamethonium. Nearly 70% of respondents reported using at least one resource to assist their dosing practices in obesity. Importantly, increased incidences of adverse events in class III obese patients related to drug dosing were commonly experienced by respondents. Until higher-level evidence is available for dosing class III obese patients, anaesthetists should consider current recommendations and exercise increased attention to dosing. Further clinician education may assist in optimising dosing in this patient group.

scholarly journals Severe obesity in children as an independent risk factor for perioperative respiratory adverse events during anaesthesia for minor non-airway surgery, a retrospective observational study

2018 ◽  
Vol 28 (2) ◽  
pp. 83-89
Author(s):  
Kavitha Raghavan ◽  
Daphne Xin Ying Moo ◽  
Zihui Tan
Keyword(s):  
Adverse Events ◽  
Fold Increase ◽  
Normal Weight ◽  
Obese Children ◽  
Medical Comorbidities ◽  
Airway Surgery ◽  
Respiratory Airway ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Severely Obese

Purpose: The purpose of this article is to quantify grades of obesity and their independent effects on perioperative adverse events in children having ambulatory minor non-airway surgery. Methods: After obtaining ethics committee approval, we selected every tenth child aged 2 to 16 years who was identified as having been a day case between January 2012 and December 2014. Weight groups were defined based on age- and gender-specific body mass index (BMI) cutoff points. A sample size of 1102 was calculated to demonstrate a three-fold increase in the primary outcome measure, perioperative respiratory-airway adverse events, among obese children, with a power of 80% and an alpha error of 5%. Chi-squared and Fisher exact tests were used to compare proportions, and independent sample t tests were used to compare means. Results: Severely obese children had a significantly higher incidence of perioperative respiratory-airway adverse events when compared to normal-weight children despite no difference in respiratory and other comorbidity. Obese children had higher prevalence of overall medical comorbidities and obstructive sleep apnoea when compared to normal-weight children and there was no significant difference in the incidence of perioperative respiratory-airway adverse events and other outcome measures between obese and normal-weight children. Conclusions and recommendations: Severely obese children have a higher risk of perioperative respiratory-airway adverse events even during minor non-airway surgery despite absence of medical comorbidities. We recommend the use of age- and sex- specific BMI cutoffs or BMI percentile charts to identify children who are severely obese to anticipate and prevent major respiratory adverse events.

Evaluation of Adverse Events Noted in Children Receiving Continuous Infusions of Dexmedetomidine in the Intensive Care Unit

2010 ◽  
Vol 15 (1) ◽  
pp. 30-37
Author(s):  
Brooke L. Honey ◽  
Donald L. Harrison ◽  
Andrew K. Gormley ◽  
Peter N. Johnson
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Cumulative Dose ◽  
Bolus Dose ◽  
Pediatric Population ◽  
Neurological Manifestations ◽  
Analgesic Effects ◽  
Icu Length Of Stay ◽  
Potential Risk Factors ◽  
Median Cumulative Dose

OBJECTIVES Dexmedetomidine is an α2-adrenergic receptor agonist with sedative and analgesic effects in mechanically ventilated adults and children. Safety and efficacy data are limited in children. The purpose of this study is to retrospectively identify the incidence and types of adverse events noted in children receiving continuous infusions of dexmedetomidine and evaluate potential risk factors for adverse events. METHODS Between July 1, 2006, and July 31, 2007, data were collected on all children (< 18 years) who received continuous infusions of dexmedetomidine. Data collection included demographics, dexmedetomidine regimen, and type/number of adverse events. The primary endpoint was the total number of adverse events noted, including: transient hypertension, hypotension, neurological manifestations, apnea, and bradycardia. Secondary endpoints included categorization of each type of adverse event and an assessment of risk factors. A logistic regression model was used to assess the relationship of adverse events with independent variables including length of ICU stay, cumulative dose, peak infusion rate, duration of therapy, PRISM III score, and bolus dose. RESULTS Thirty-six patients received dexmedetomidine representing 41 infusions. The median age was 16 months (range, 0.1–204 months) and median PRISM III score was 2 (range, 0–18). Eighteen (43.9%) patients received a bolus dose of dexmedetomidine. The median cumulative dose (mcg/kg) and peak dose (mcg/kg/hr) were 8.5 (range, 2.2–193.7) and 0.5 (range, 0.2–0.7), respectively. Dexmedetomidine was continued for a median of 20 (range, 3–263) hours. Six (14.6%) patients were slowly tapered off the continuous infusions. Twenty-one adverse events were noted in 17 patients, including 4 neurologic manifestations. Fourteen patients required interventions for adverse events. ICU length of stay was the only independent risk factor (p=0.036) for development of adverse events. CONCLUSIONS Several potential adverse events were noted with dexmedetomidine continuous infusions including possible neurological manifestations. Further studies are needed looking at adverse events associated with dexmedetomidine use in the pediatric population.

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