Comparative study between intranasal dexmedetomidine and intranasal ketamine as a premedication for anxiolysis and sedation before pediatric general anesthesia

Abstract Background This study compared dexmedetomidine versus ketamine as regard sedation and anxiolysis produced by giving them through intranasal route to pediatric patients undergoing adenotonsillectomy. This study was double-blinded randomized comparative prospective interventional clinical study done in Ain Shams University Hospital (El Demerdash Hospital) on 76 pediatric patients who underwent adenotonsillectomy, and they were randomly allocated equally into two main groups; group D received 2 μg/kg intranasal dexmedetomidine and group K received 5 μg/Kg intranasal ketamine 30 min before the operation, and the aim of this study was to compare the efficacy of intranasal dexmedetomidine versus intranasal ketamine for anxiolysis and sedation to alleviate stress, agitation, and anxiety in children before general anesthesia and for promoting good level of sedation for them. Results Results of this study as regards sedation level that was assessed by modified Ramsay sedation score showed that there was statistically significant difference between both groups at 10, 20, and 30 min from intranasal application of the drug (P value < 0.05), the median (IQR) of sedation score at 10, 20, and 30 min preoperative in group D was (2 (2 – 2)), (3 (3 – 4)), (4 (4 – 5)) compared to (2 (2 – 3)), (3 (2 – 3)), (4 (3 – 4)) in group K respectively which revealed that there was better and effective sedation in group D more than in group K, this difference was statistically significant but clinically insignificant as both drugs produced an acceptable level of sedation and decreased the level of anxiety in children. Conclusion Both drugs produce effective and favorable sedation level with superiority to dexmedetomidine in sedation scores and time of onset of sedation, and also there was little decrease in heart rate and mean arterial pressure which is favorable during such surgeries; also, there was accepted level of cannulation and parental separation scores, and the parents were highly satisfied with the procedure and were grateful for us due to alleviating stress and anxiety from them and from their children.

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A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i2.25453 ◽

2019 ◽

Vol 4 (2) ◽

pp. 724-728

Author(s):

Sabin Gauchan ◽

Chitra Thapa ◽

Abha Prasai

Keyword(s):

General Anesthesia ◽

Separation Anxiety ◽

Elective Surgery ◽

Sedation Score ◽

Preoperative Anxiety ◽

Parental Separation ◽

Emergence Agitation ◽

Oral Midazolam ◽

Significant Difference ◽

Group D

Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist. Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia. Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups. Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication. Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.

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Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients

Children ◽

10.3390/children8080642 ◽

2021 ◽

Vol 8 (8) ◽

pp. 642

Author(s):

Giuliano Marchetti ◽

Alessandro Vittori ◽

Fabio Ferrari ◽

Elisa Francia ◽

Ilaria Mascilini ◽

...

Keyword(s):

General Anesthesia ◽

Pediatric Patients ◽

Pain Syndrome ◽

Intercostal Nerve ◽

Anesthetic Technique ◽

Intercostal Nerve Block ◽

Thoracic Epidural ◽

Burning Pain ◽

Significant Difference ◽

Group B

We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.

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The Efficacy and Safety of Nabufen and Sufentanil in the Prevention of Visceral Pain After Gynecological Laparoscopic Surgery: A Randomised Controlled Trial

10.21203/rs.3.rs-125287/v1 ◽

2020 ◽

Author(s):

Xiaoxia Gu ◽

Jingjing Wang ◽

Huihua Liao ◽

Jian Mo ◽

Weiming Huang ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Adverse Reactions ◽

Visceral Pain ◽

Sedation Score ◽

Efficacy And Safety ◽

Significant Difference ◽

Group A ◽

Group B ◽

Group D ◽

Ramsay Sedation Score

Abstract Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number：ChiCTR1900025076 . Prospectively registered on 10 August 2019.

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Comparison of morphine and fentanyl in attenuation of Intra operative stress response under general anesthesia: A randomized double blinded study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i4.9796 ◽

2014 ◽

Vol 5 (4) ◽

pp. 65-68

Author(s):

R Krishna Prabu ◽

P Rani ◽

NP Madhu

Keyword(s):

Body Weight ◽

Stress Response ◽

General Anesthesia ◽

Elective Surgery ◽

Serum Cortisol ◽

Blood Samples ◽

Significant Difference ◽

Blinded Study ◽

Cortisol Levels ◽

Double Blinded

Background: This randomized double blinded study was done to compare the effect of intravenous morphine and fentanyl in attenuation of stress response during surgeries under general anesthesia in adults. The attenuation of stress response was analyzed with changes in serum cortisol and glucose levels one hour after induction of anesthesia. Methods: Fifty consented healthy volunteers in age group 20-50, under ASA I and ASA II posted for elective surgery were included in the study. Two groups of 25 each, group M who received 0.2 mg/kg body weight of morphine and group F who received 2 microgram/kg body weight of fentanyl before anaesthetic induction were compared. The members of two groups were randomly allocated and double blinded using sealed envelope technique. Blood samples were collected for baseline glucose and cortisol in all the subjects. One hour after the administration of study drugs, which was given at the time of induction blood samples were collected for analysis of glucose and cortisol. The changes in blood glucose and serum cortisol levels were compared at the end of the study using independent samples ‘t’ test. Results: There was no significant difference in blood sugar levels in both groups at the end of 1 hour. But there was significant increase in serum cortisol levels in group F compared to group M. Conclusion: This study concludes that morphine is better than fentanyl in attenuation of Intraoperative stress by effectively controlling serum cortisol levels. DOI: http://dx.doi.org/10.3126/ajms.v5i4.9796 Asian Journal of Medical Sciences 2014 Vol.5(4); 65-68

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The effects of buccal administration of azaperone on the sedation level and biochemical variables of weaned piglets

Acta Veterinaria Brno ◽

10.2754/avb202190010047 ◽

2021 ◽

Vol 90 (1) ◽

pp. 47-56

Author(s):

Martin Svoboda ◽

Zdeněk Fajt ◽

Michaela Mruvčinská ◽

Jan Vašek ◽

Jana Blahová

Keyword(s):

Body Weight ◽

Blood Plasma ◽

Animal Health ◽

Weaned Piglets ◽

Sedation Level ◽

Biochemical Variables ◽

Group A ◽

Group B ◽

Double Blinded ◽

Group D

The aim of the study was to compare the efficacy of buccal and parenteral administration of azaperone in order to achieve pig sedation. The type of study was prospective randomized and double blinded. A total of 40 weaned piglets were divided into 4 groups (10 each) and monitored. Group A was injected intramuscularly (i.m.) with azaperone (Stresnil®, 40 mg/ml inj., Elanco Animal Health) at a dose of 2 mg/kg body weight (b.w.). Group B (control) was given 1 ml of saline buccally. Group C received a dose of 2 mg/kg b.w. of azaperone buccally. Group D was given azaperone buccally at a dose of 4 mg/kg b.w. The response to defined stimulus (a blunt blow of a metal rod into the metal edge of the pen), degree of salivation, movement level, blood plasma azaperone concentration, and the haematological and biochemical variables were included in the study. We found that the buccal administration of azaperone is effective, however, a dose of 4 mg/kg b.w. is required to induce a sedation level comparable to the standard 2 mg/kg b.w. i.m. administration.

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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

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01498-8 ◽

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.

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Tracheal Diameter Estimates Using Age-Related Formula Versus Radiographic Findings: Which Approximates the Actual Tracheostomy Tube in Pediatric Patients?

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v33i2.271 ◽

2018 ◽

Vol 33 (2) ◽

pp. 32-36

Author(s):

Isaac Cesar S. De Guzman

Keyword(s):

Endotracheal Tube ◽

Tracheostomy Tube ◽

Pediatric Patients ◽

University Hospital ◽

Estimation Methods ◽

Radiographic Findings ◽

Average Value ◽

Age Related ◽

Significant Difference ◽

The Difference

Objective: To compare actual tracheostomy tube sizes with estimated endotracheal tube sizes using age-related formula and tracheal diameter from preoperative radiographs among pediatric Filipino patients aged 0-18 years old undergoing tracheostomy. Methods: Study Design: Review of records Setting: Tertiary Private University Hospital in Dasmarinas, Cavite, Philippines Patients: Pediatric patients regardless of gender, aged 0 to 18 years old, with a preoperative radiograph of the trachea, and who subsequently underwent tracheostomy anytime from January 1, 2007 to December 31, 2016 were considered for inclusion. Radiographs were measured, endotracheal tube sizes were computed using age-related formula, and recorded tracheotomy tube sizes were retrieved. Results: Twenty-two patients (12 males, 10 females) aged 10 months to 18-years-old (median age: 11 years) were included in the study. Mean tube sizes were 6.46mm (+/- 1.492 SD) for age-related formula, 5.67mm (+/- 1.1849 SD) for radiograph-based estimation, and 5.0 for actual tracheostomy tube inserted in each patient. The Bland-Altman plot showed the bias estimate at 0.7913 and the lower and upper limits of agreement at -1.3598 and 2.9423 (confidence level 95% or 2 standard deviations away from the mean). Conclusions: The average value derived from radiograph-based estimation is less than the corresponding average value from age-related formula. There is a significant difference between age-related formula-based estimation and actual tracheostomy tube inserted. Since the range of differences between the two estimation methods is high, these results imply that the bias or the difference between measures from the two methods is not consistent, with the two methods exhibiting very poor agreement. Keywords: Tracheostomy, Intubation, Intra Tracheal, Penlington Formula, Trachea Radiograph Measurement, age related formula for endotracheal tube estimation

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Pediatric Gram-Negative Bacteremia: Hidden Agenda

Journal of Child Science ◽

10.1055/s-0037-1618564 ◽

2018 ◽

Vol 08 (01) ◽

pp. e1-e6

Author(s):

Elham Bukhari ◽

Abdulkarim Alrabiaah

Keyword(s):

Pediatric Patients ◽

University Hospital ◽

Gram Negative ◽

Hidden Agenda ◽

Significant Difference ◽

Gram Negative Bacteremia ◽

Common Clinical Presentation ◽

Healthcare Associated ◽

Epidemiological Characteristics ◽

Community Onset

Background Recently, new types of community-onset bacteremia have been introduced as healthcare associated (HCA) in which the infection onset started outside the hospital and there were interactions with the healthcare system. Little data exist differentiating community-acquired (CA) and HCA bacteremia from hospital-acquired bacteremia (HA). Objectives This article determines differences in the epidemiological characteristics and bacteriology of community-onset (i.e., CA and HCA) and HA gram-negative bacteremia in Saudi pediatric patients. Methods We conducted a prospective cohort of all pediatric patients diagnosed with gram-negative bacteremia at the King Khalid University Hospital over a year (2015). We received daily electronic notifications of all blood culture positive cases for gram-negative bacilli. Results A total of 92 children were hospitalized with gram-negative bacteremia; among these 64 (71.1%) were with HA bacteremia, 20 (21.1%) with CA bacteremia, and 8 (7.8%) with HCA bacteremia. Urinary tract infection was common clinical presentation (50%) in the patients diagnosed with CA and HCA bacteremia. Up to 92% of HA bacteremia and 2% of CA bacteremia were presented with septic shock. The most common gram-negative bacteria causing bacteremia is Klebsiella pneumoniae, constituting almost 29.3% of all organisms, and was only isolated from HA bacteremia. The antimicrobial susceptibility among the 92 isolates showed that the organisms were nonextended spectrum β-lactamase (non-ESBL) in 90%, and 10% of the isolates were ESBL. There was a significant difference in the total frequency of isolates between CA and HA incidences, regardless of ESBL or non-ESBL (p < 0.001). Conclusion The most common type of gram-negative bacteremia is HA bacteremia followed by the CA and HCA bacteremia.

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Effects of the Two Doses of Dexmedetomidine on Sedation, Agitation, and Bleeding During Pediatric Adenotonsillectomy

Anesthesiology and Pain Medicine ◽

10.5812/aapm.118424 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

Amir Shafa ◽

Hastisadat Aledavud ◽

Hamidreza Shetabi ◽

Sedige Shahhosseini

Keyword(s):

Clinical Trial ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Recovery Room ◽

Pediatric Patients ◽

Sedation Score ◽

Control Group ◽

The Mean ◽

Double Blinded

Background: Due to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy. Methods: This double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes. Results: Our data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients. Conclusions: The use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

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First Realizations of Spinal Anesthesia in Neonates and Infants - Preterms or Ex prematures - in Antananarivo, Madagascar

10.21203/rs.3.rs-33908/v1 ◽

2020 ◽

Author(s):

Harifetra Mamy Richard Randriamizao ◽

Aurelia Rakotondrainibe ◽

Lova Dany Ella Razafindrabekoto ◽

Prisca Funken Ravoaviarivelo ◽

Andriambelo Tovohery Rajaonera ◽

...

Keyword(s):

General Anesthesia ◽

Spinal Anesthesia ◽

Pediatric Patients ◽

Low Cost ◽

Perioperative Period ◽

University Hospital ◽

Hyperbaric Bupivacaine ◽

Data Files ◽

Neonates And Infants ◽

The University

Abstract Objective: The aim of this study was to describe the first realizations of spinal anesthesia in neonates and infants (preterms or ex prematures) in Antananarivo - Madagascar, because spinal anesthesia – a low cost technique – can limit respiratory complications and postoperative apnea and also general anesthesia can present perioperative risks for pediatric patients.Results: In a retrospective, descriptive, seven-year (2013 to 2019) period study, conducted in the University Hospital Joseph Ravoahangy Andrianavalona, data files of 69 babies planned to have spinal anesthesia were recorded. These pediatric patients were predominantly male (sex ratio = 2.8) and 37 [28 - 52] days old. The smallest anesthetized child weighed 880 g; the youngest was 4 days old. Twenty-seven (27) of them were premature and 20.3% presented respiratory diseases. They were mostly scheduled for hernia repair (97.1%). Spinal anesthesia was performed, with a Gauge 25 Quincke spinal needle, after 2 [1 - 2] attempts with hyperbaric bupivacaine of 4 [3.5 - 4] mg. Failure rate was 5.8% needing general anesthesia conversion. The heart rate was stable throughout perioperative period and no complications were observed.

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