The sedative effects and the attenuation of cardiovascular and arousal responses during anesthesia induction and intubation in pediatric patients: a randomized comparison between two different doses of preoperative intranasal dexmedetomidine

2013 ◽  
Vol 24 (3) ◽  
pp. 275-281 ◽  
Author(s):  
Shan-Shan Wang ◽  
Ma-Zhong Zhang ◽  
Ying Sun ◽  
Chi Wu ◽  
Wen-Yin Xu ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Anesthesia Induction ◽  
Sedative Effects ◽  
Different Doses

scholarly journals Changes in Plasma Glial Fibrillary Acidic Protein in Children Receiving Sevoflurane Anesthesia: A Preliminary Randomized Trial

2021 ◽  
Vol 10 (4) ◽  
pp. 662
Author(s):  
Eun-Hee Kim ◽  
Young-Eun Jang ◽  
Sang-Hwan Ji ◽  
Ji-Hyun Lee ◽  
Sung-Ae Cho ◽  
...  
Keyword(s):  
Glial Fibrillary Acidic Protein ◽  
Randomized Trial ◽  
Protein Concentration ◽  
Pediatric Patients ◽  
Neuronal Injury ◽  
Acidic Protein ◽  
Anesthesia Induction ◽  
Sevoflurane Anesthesia ◽  
Control Groups ◽  
Over Time

We investigated changes in plasma glial fibrillary acidic protein concentration during sevoflurane anesthesia induction in children < 3 years old and determined the effect of co-administering dexmedetomidine. This preliminary randomized trial included 60 pediatric patients who received sevoflurane anesthesia for >3 h. Patients were assigned to dexmedetomidine or control groups at a 1:1 ratio. The primary outcome was changes in plasma glial fibrillary acidic protein concentration of dexmedetomidine and control groups over time. Fifty-five patients were included in the final analysis. The median (interquartile range (IQR)) of the plasma glial fibrillary acidic protein level was 387.7 (298.9–510.8) pg·mL−1 immediately after anesthetic induction, 302.6 (250.9–412.5) pg·mL−1 at 30 min, and 321.9 (233.8–576.2) pg·mL−1 at 180 min after the first sample. These values did not change over time (p = 0.759). However, plasma glial fibrillary acidic protein increased after 180 min of infusion of dexmedetomidine compared with values at 30 min infusion (p = 0.04, mean difference and 95% confidence interval of 221.6 and 2.2 to 441.0 pg·mL−1). In conclusion, three hours of sevoflurane anesthesia in pediatric patients < 3 years old did not provoke neuronal injury assessed by the plasma biomarker. Further studies regarding the effect of prolonged dexmedetomidine infusion on anesthetic neuronal injury are required.

Factors Affecting Oculocardiac Reflex Incidence In Pediatric Strabismus Surgery: Retrospective Study

2021 ◽  
Author(s):  
Bengü Gülhan Aydın ◽  
Gamze Küçükosman ◽  
Özcan Pişkin ◽  
Bahar Aktaş ◽  
Rahşan Dilek Okyay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Sinus Bradycardia ◽  
Strabismus Surgery ◽  
Neuromuscular Blocker ◽  
Anesthesia Induction ◽  
Factors Affecting ◽  
Oculocardiac Reflex ◽  
Anesthetic Drugs ◽  
Duration Of Surgery

INTRODUCTION: Oculocardiac reflex (OCR) activation is common during the strabismus surgery. As a result of the OCR, sinus bradycardia, atrioventricular block, ventricular fibrillation and even asystole may occur. Pediatric patients are also more vulnerable to harmful effects of this reflex. The aim of this study was to determine the possible risk factors affecting the incidence of OCR in pediatric patients undergoing strabismus surgery. METHODS: The medical records of the pediatric patients who underwent strabismus surgery between January 2015 and September 2018 were retrospectively reviewed. Operations performed by only one surgeon. OCR was defined as a more than 20% reduction in HR induced by the extraocular muscle (EOM) manipulation. Demographic data, duration of surgery, history of any previous strabismus surgery and possible development of OCR, anesthesia management, neuromuscular blocker and anesthetic drugs used for the anesthesia induction and maintenance as well as the airway management, the number of operated eyes, and also the muscle types of the patients were all recorded. Risk factors for OCR were evaluated by logistic regression analysis. RESULTS: Out of 92 pediatric patients who were initially evaluated, six were excluded from the study because their files were missing. A total of 86 patients were included in the study. During surgery, OCR occurred in 29 (33.7%) patients. The absence of administering benzodiazepine for premedication (p=0.03) and neuromuscular blocker after induction (p=0.046) in pediatric patients are specified as independent risk factors. We found that the use of a neuromuscular blocker and benzodiazepine in premedication reduced the risk of OCR by 3.64 and 3.11 times, respectively. DISCUSSION AND CONCLUSION: The incidence of OCR may decrease with preventive measures such as neuromuscular blocker application, premedication with benzodiazepine in strabismus surgeries.

scholarly journals Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries

2021 ◽  
Vol 12 ◽  
Author(s):  
Yu-Hang Cai ◽  
Cheng-Yu Wang ◽  
Yang Li ◽  
Jia Chen ◽  
Jun Li ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Separation Anxiety ◽  
Anesthesia Induction ◽  
Inhalation Induction ◽  
Beneficial Effects ◽  
Oral Midazolam ◽  
Sedative Effects ◽  
Drug Regimens ◽  
Group D

Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction.Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time.Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p &lt; 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p &lt; 0.001).Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.

scholarly journals Sleep quality and emergence delirium in children undergoing strabismus surgery: a comparison between preschool- and school-age patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wangseok Do ◽  
Hyo-Sung Kim ◽  
Seung Ha Kim ◽  
Hyunjong Kang ◽  
Dowon Lee ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Pediatric Patients ◽  
Group Analysis ◽  
Pediatric Anesthesia ◽  
Strabismus Surgery ◽  
Preschool Age ◽  
Anesthesia Induction ◽  
Emergence Delirium ◽  
Scale Scores ◽  
The Relationship

Abstract Background Emergence delirium (ED) is common in pediatric patients undergoing general anesthesia with sevoflurane. Preoperative sleep quality is associated with the risk factors for ED. However, research on the relationship between sleep quality and ED is limited. We aimed to investigate the relationship between ED and preoperative sleep quality in pediatric patients undergoing strabismus surgery. Methods This clinical trial included pediatric patients aged 4–12 years who underwent elective strabismus surgery. The patients and their parents were questioned about the patients’ preoperative sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For anesthesia induction, thiopental (5 mg/kg) and rocuronium (0.6 mg/kg) were used, and anesthesia was maintained with sevoflurane (minimum alveolar concentration, 1–1.5). After administration of a reversal drug, extubation was performed, and the patients were transferred to a post-anesthesia recovery unit. At 10 min after extubation, the degree of ED was measured using the pediatric anesthesia emergence delirium (PAED) and Watcha scale scores. Results Of the 62 enrolled patients, three pediatric patients were excluded. The overall incidence of ED was 22%. A total of 59 patients were divided into the two groups. The ED group and the non-ED group comprised 13 and 46 patients. Age, height and weight were significantly lower in the ED group than in the non-ED group. Preoperative PSQI and Watcha scale score were significantly higher in the ED group than in the non-ED group. Multivariate analysis showed that age (adjusted OR [95% CI]: 0.490 [0.290–0.828], p = 0.008) and preoperative PSQI score (adjusted OR [95% CI]: 2.149[1.224–3.771], p = 0.008) was associated with ED. In sub-group analysis, PAED scale and Watcha scale scores showed a moderate correlation with preoperative sleep quality in preschool-age patients. Conclusion In conclusion, the incidence of ED tended to be higher in younger age and poorer preoperative sleep quality in pediatric patients. In particular, the poorer sleep quality score was associated with higher incidence of ED in the preschool-age. Large-scale clinical studies and long-term follow-up studies on ED and sleep quality are required. Trial registration This study was registered with Clinicaltrials.gov (NCT03332407) at November 5th 2017.

COMPARATIVE STUDY OF INTRAVENOUS DEXMEDETOMIDINE AND MIDAZOLAM AS A PREOPERATIVE SEDATION UNDER SPINAL ANESTHESIA

2019 ◽  
pp. 2-3
Author(s):  
Anisha Chokshi
Keyword(s):  
Spinal Anesthesia ◽  
Ventilatory Response ◽  
Young Patients ◽  
Psychological Trauma ◽  
Sedative Effect ◽  
Comfort Level ◽  
Anesthesia Induction ◽  
Negative Experience ◽  
Sedative Effects ◽  
Group D

INTRODUCTION: Preoperative anxiety is a frequent condition. Comfortable anesthesia induction and maintenance can be achieved by controlling anxiety. Various agents are used to relieve anxiety and provide sedation. We conducted this study to compare the sedative effects of dexmedetomidine versus midazolam for patients undergoing spinal anesthesia. AIMS AND OBJECTIVES : To compare the sedative effect of both drugs and observe intraoperative and postoperative comfort level, cardiovascular and respiratory changes and side effects of both drugs. MATERIALS AND METHODS: Sixty patients between 18-65 years of age requiring spinal anaesthesia for their procedures were selected randomly and division was done in 2 groups (Each group having 30 patients). Group D was given Inj. Dexmedetomidine at the dose of 1 mcg/kg within 10 mins in 100 ml NS and group M was given Inj Midazolam at the dose of 0.04 mg/kg in 100 ml NS within 10 mins. DISCUSSION: Anxiety is more common among young patients, women, and people with negative experience of anesthesia or fear that arises just before the operation and anesthesia my lead to psychological trauma. Various agents such as phenothiazines, bezodiazepines, barbiturates, opioids, propofol, ketamine, dexmedetomidine or clonidine and antihistamines are used to relieve anxiety and provide sedation. Midazolam is a benzodiazepine,commonly used as an intravenous sedative agent for pre-operative sedation. Dexmedetomidine is an alpha-2 agonist which acts on adrenoreceptors in many tissues including the nervous, cardiovascular and respiratory systems. Unlike midazolam, dexmedetomidine does not affect the ventilatory response to carbon dioxide, it also produces analgesia which could potentially alleviate pain.

scholarly journals The Correlation between the Change in Thoracic Fluid Content and the Change in Patient Body Weight in Fontan Procedure

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Tae-Gyoon Yoon ◽  
Kyunghwan Jang ◽  
Chung-Sik Oh ◽  
Seong-Hyop Kim ◽  
Woon-Seok Kang
Keyword(s):  
Body Weight ◽  
Weight Gain ◽  
Fluid Balance ◽  
Pediatric Patients ◽  
Body Weight Gain ◽  
Fontan Procedure ◽  
Fluid Management ◽  
Cardiac Output Monitoring ◽  
Anesthesia Induction ◽  
Fluid Content

Background. The thoracic fluid content (TFC) and its percent change compared to the baseline (TFCd0%) derived from a bioreactance technique using a noninvasive cardiac output monitoring (NICOM) device correlate well with the amount of fluid removal in patients undergoing hemodialysis and with intraoperative fluid balance in pediatric patients undergoing cardiac surgery. We hypothesized that TFC or TFCd0% would also be a useful indicator allowing fluid management in pediatric patients undergoing a Fontan procedure. Methods. The medical records of patients who underwent an elective Fontan procedure were reviewed retrospectively. The intraoperative variables recorded at two time points were used in the analysis: when the NICOM data obtained just after anesthesia induction (T0) and just before transfer of the patient from the operating room to the ICU (T1). The analyzed variables were hemodynamic parameters, TFC, TFCd0%, stroke volume variation, body weight gain, change in the central venous pressure, and difference in the TFC (ΔTFC). Results. The correlation coefficient between TFCd0% and body weight gain was 0.546 (p=0.01); between TFCd0% and body weight gain% 0.572 (p=0.007); and between TFCd0% and intraoperative fluid balance 0.554 (p=0.009). The coefficient of determination derived from a linear regression analysis of TFCd0% versus body weight gain was 0.30 (p=0.01); between TFCd0% and body weight gain% 0.33 (p=0.007); and between TFCd0% and intraoperative fluid balance 0.31 (p=0.009). Conclusions. TFCd0% correlated well with body weight gain, body weight gain%, and intraoperative fluid balance. It is a useful indicator in the intraoperative fluid management of pediatric patients undergoing a Fontan procedure. Trial Registration. This trial is registered with Clinical Research Information Service KCT0002062.

scholarly journals A comparison of the outcomes of dexmedetomidine and remifentanil with sufentanil-based general anesthesia in pediatric patients for the transthoracic device closure of ventricular septal defects

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ling-Shan Yu ◽  
Wen-Peng Xie ◽  
Jian-Feng Liu ◽  
Jing Wang ◽  
Hua Cao ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Pediatric Patients ◽  
Length Of Hospital Stay ◽  
Clinical Information ◽  
Skin Incision ◽  
Anesthesia Induction ◽  
Ventricular Septal Defects ◽  
Device Closure ◽  
Septal Defects ◽  
Significant Difference

Abstract Objective To compare the safety and efficacy of dexmedetomidine and remifentanil with sufentanil-based general anesthesia for the transthoracic device closure of ventricular septal defects (VSDs) in pediatric patients. Methods A retrospective analysis was performed on 60 children undergoing the transthoracic device closure of VSDs from January 2019 to June 2020. The patients were divided into two groups based on different anesthesia strategies, including 30 cases in group R (dexmedetomidine- and remifentanil-based general anesthesia) and 30 cases in group S (sufentanil-based general anesthesia). Results There was no significant difference in preoperative clinical information, hemodynamics before induction and after extubation, postoperative pain scores, or length of hospital stay between the two groups. However, the hemodynamic data of group R were significantly lower than those of group S at the time points of anesthesia induction, skin incision, thoracotomy, incision closure, and extubation. The amount of intravenous patient-controlled analgesia (PCA), the duration of mechanical ventilation, and the length of the intensive care unit (ICU) stay in group R were significantly less than those in group S. Conclusion Dexmedetomidine combined with remifentanil-based general anesthesia for the transthoracic device closure of VSDs in pediatric patients is safe and effective.

scholarly journals Diazepam causes sedative rather than anxiolytic effects in C57BL/6J mice

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marina Pádua-Reis ◽  
Diana Aline Nôga ◽  
Adriano B. L. Tort ◽  
Martina Blunder
Keyword(s):  
Time Course ◽  
Anxiolytic Effect ◽  
Positive Control ◽  
General Assumption ◽  
Point Of View ◽  
Behavioral Experiments ◽  
Plus Maze ◽  
Sedative Effects ◽  
Anxiolytic Drugs ◽  
Different Doses

AbstractDiazepam has been broadly accepted as an anxiolytic drug and is often used as a positive control in behavioral experiments with mice. However, as opposed to this general assumption, the effect of diazepam on mouse behavior can be considered rather controversial from an evidence point of view. Here we revisit this issue by studying the effect of diazepam on a benchmark task in the preclinical anxiety literature: the elevated plus maze. We evaluated the minute-by-minute time-course of the diazepam effect along the 10 min of the task at three different doses (0.5, 1 and 2 mg/kg i.p. 30 min before the task) in female and male C57BL/6J mice. Furthermore, we contrasted the effects of diazepam with those of a selective serotoninergic reuptake inhibitor (paroxetine, 10 mg/kg i.p. 1 h before the task). Diazepam had no anxiolytic effect at any of the tested doses, and, at the highest dose, it impaired locomotor activity, likely due to sedation. Noteworthy, our results held true when examining male and female mice separately, when only examining the first 5 min of the task, and when animals were subjected to one hour of restrain-induced stress prior to diazepam treatment. In contrast, paroxetine significantly reduced anxiety-like behavior without inducing sedative effects. Our results therefore suggest that preclinical studies for screening new anxiolytic drugs should be cautious with diazepam use as a potential positive control.

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