scholarly journals Pediatric sedation in vascular malformations interventions by a non-anesthesiologist—feasibility and safety

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190781
Author(s):  
Giora Weiser ◽  
Itai Gross ◽  
Anthony Verstandig ◽  
Adam Farkas
Keyword(s):  
Interventional Radiology ◽  
Pilot Study ◽  
Adverse Events ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Single Center ◽  
Small Pilot Study ◽  
High Satisfaction ◽  
Increasing Demand

Objective: Sedation for pediatric patients undergoing interventional procedures in radiology is in increasing demand. Once only anesthesiology-performed, there is a demand for sedation services to perform sedations for these procedures. However, the safety of performing long sedations by non-anesthesiologists in interventional radiology has not been reported. This pilot study aimed at describing a single center's experience and outcome with sedation. Methods: This study reviews the sedations performed at a single center by a pediatric emergency physician who performed the sedation. The results regarding safety and satisfaction were reviewed. Results: A total of 52 sedations were documented. Four cases of significant adverse events and three adverse events occurred. In all cases, the procedures were completed. None of the patients required intubation or admission following the sedation. There was high satisfaction by the interventional radiologists. Conclusion: This small pilot study shows that sedations for procedures in interventional radiology can be performed safely and successfully by dedicated non-anesthesiology sedation services. This may be considered as an alternative when anesthesiology service is not available. Advances in knowledge: This small, single center pilot study examines the safety of sedation by a non-anesthesiologist for interventional radiology procedures. This may offer an additional method of performing procedures in the pediatric population while anesthesia is not readily available.

scholarly journals Pilot study in patients with congenital low-flow vascular malformation treated with low dose sirolimus

2020 ◽  
Author(s):  
Veroniek Harbers ◽  
Gerard Rongen ◽  
van der Carine Vleuten ◽  
Bas Verhoeven ◽  
de Peter Laat ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Vascular Malformation ◽  
Low Dose ◽  
Liver Toxicity ◽  
Vascular Malformations ◽  
Low Flow ◽  
Bone Marrow Toxicity ◽  
Serious Adverse Events ◽  
Grade Iii

Abstract Background Patients with congenital low-flow vascular malformations (capillary (CM), lymphatic (LM), venous (VM) or combined) may have an impaired quality of life (QoL), due to their symptoms, which include pain, swelling, bleeding, thrombosis, and functional impairment. Unfortunately, current treatment methods are challenging and not always successful. Previous studies have shown that the mTOR-inhibitor sirolimus is an effective treatment for these patients. Target levels of 10–15 ng/ml were well tolerated; however, grade three adverse events were observed (ranged 20–40%). Methods A pilot study was performed using a Challenge–Dechallenge–Rechallenge (CDR) design to determine the pharmacodynamics of low target levels of sirolimus (target levels 4–10 ng/ml) in respect of efficacy and adverse events in patients with disabling low-flow vascular malformations without treatment alternatives. The patients received sirolimus over a three-to-six-month period (Challenge), followed by the withdrawal of sirolimus (Dechallenge). If the complaints returned, sirolimus was reintroduced during a twelve month period (Rechallenge). Efficacy was determined on pain (end point of the pilot study) and other symptoms related to the vascular malformation; and adverse events were determined in all phases of the study. Results An improvement in symptoms was seen in 92% (n = 11/12) of patients during the Challenge phase. In the Rechallenge phase, a positive response rate of 78% was found (n = 7/9). These response rates are comparable to those found in the literature despite low target levels of sirolimus. However, less serious adverse events were observed with low dose sirolimus, especially bone marrow toxicity and grade III liver toxicity. Conclusions This pilot using low dose sirolimus showed high efficacy in patients with therapy resistant and disabling low-flow malformation, with a lower incidence of serious adverse events (especially bone marrow toxicity and grade III liver toxicity). This is extremely relevant to patients with low-flow vascular malformation, as current clinical protocols tend to advise lifelong treatment. Trial registration The pilot study was part of a phase III study. Trial registration: EudraCT number: 2016-002157-38 and ClinicalTrials.gov Identifier: NCT03987152, registered 06/14/2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03987152?term=sirolimus&cond=Vascular+Malformations&cntry=NL&draw=2&rank=1

scholarly journals Safety and Immunogenicity of Combination of Vaccines – Covishield and Covaxin – a Pilot Study

2021 ◽  
Author(s):  
Bhanu Prakash Reddy Attunuru ◽  
Podduturi Naveenchander Reddy ◽  
Sasikala Mitnala ◽  
Gujjarlapudi Deepika ◽  
Sadhana Yelamanchili Veturi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Observational Study ◽  
Immune Responses ◽  
Healthy Volunteers ◽  
Prospective Observational Study ◽  
Single Center ◽  
Rt Pcr ◽  
Combination Vaccines ◽  
Mix And Match

Abstract This single-center prospective observational study was conducted to assess the safety and immunogenicity of combination vaccines AstraZeneca’s ChAdOx1-nCov-19 (Covishield in India) and inactivated whole virion BBV152 (Covaxin). A total of 330 unvaccinated healthy volunteers were screened for SARS-COV2 seropositivity. RT PCR tests were conducted for seronegative volunteers (n =44). They were randomly assigned to four groups and given either same or mixed vaccines at an interval of 4 weeks between the two doses. Mix and match of vaccines did not evoke any adverse events. Combination of vaccines elicited similar immune responses in 4 groups. In Conclusion, Combination vaccines are safe and immunogenic.

scholarly journals Severe bandemia is not associated with increased risk for adverse events in general pediatric emergency department patients

2021 ◽  
Author(s):  
Daniel Najafali ◽  
Emilie Berman ◽  
Tiffany T Cao ◽  
Allison Karwoski ◽  
Norvir Kaur ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Clinical Judgment ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Adverse Outcomes ◽  
Imaging Data ◽  
Patient Centered ◽  
Increased Risk ◽  
Logistic Regressions

ABSTRACTBackgroundThe presence of band cells >10% of the total white blood cell (WBC) count (“bandemia”) is often used as an indicator of serious bacterial illness (SBI). Results from studies of bandemia as a predictor of SBI were conflicting and little is known about the relationship between severe bandemia (SB) and clinical outcomes from SBI in children.ObjectivesIn this retrospective patient-centered study, we hypothesized that SB (band level >20%) is not associated with adverse outcomes in an emergency department (ED) pediatric population.MethodsMedical records from children between the ages of 2 months and 18 years with SB who presented to a tertiary referral regional hospital were studied. Outcomes were categorized as severe adverse events (SAEs) or moderate adverse events (MAEs). Multivariate logistic regressions were used to assess the association between SB and outcomes.ResultsWe analyzed 102 patients. Mean age (standard deviation [SD]) was 5.25(0.5) years, 18 (18%) had MAE, 21 (21%) had SAE, and no patients died. Mean band levels were similar between groups: no adverse events [28 (10)] vs. SAE [31 (9)] vs. MAE [27(8)], p=0.64. Multivariate logistic regressions showed SB was not associated with any adverse events (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.9-1.1, p=0.27). Non-normal X-ray (XR) (OR 17, 95% CI 3.3-90, p<0.001) was associated with MAE, while non-normal computerized tomography (CT) scan (OR 15.4, 95% CI 2.2-100+, p=0.002) was associated with SAE.ConclusionSevere bandemia was not associated with higher odds of adverse events among the general ED pediatric population. Clinicians should base their clinical judgment on the overall context of history, physical examinations, and other laboratory and imaging data.

scholarly journals Safety and Immunogenicity of Mix-Match of Vaccines -Covishield and Covaxin – a Pilot Study

2022 ◽  
Author(s):  
Bhanu Prakash Reddy Attunuru ◽  
Podduturi Naveenchander Reddy ◽  
Sasikala Mitnala ◽  
Gujjarlapudi Deepika ◽  
Sadhana Yelamanchili Veturi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Observational Study ◽  
Immune Responses ◽  
Prospective Observational Study ◽  
Single Center ◽  
Rt Pcr ◽  
Combination Vaccines ◽  
Mix And Match ◽  
Immunogenic Response

Abstract This single-center prospective observational study was conducted to assess the safety and immunogenicity of combination vaccines AstraZeneca’s ChAdOx1-nCov-19 (Covishield in India) and inactivated whole virion BBV152 (Covaxin). A total of 330 unvaccinated healthy volunteers were screened for SARS-COV2 seropositivity. RT PCR tests were conducted for seronegative volunteers (n =44). They were randomly assigned to four groups and given either same or mixed vaccines at an interval of 4 weeks between the two doses. Mix and match of vaccines did not evoke any adverse events. Combination of vaccines elicited similar immune responses in 4 groups. They were further studied dividing into homologous and heterologous vaccine groups. In Conclusion, Combination vaccines are safe and immunogenic and heterologous vaccines elicit better immunogenic response.

scholarly journals Feasibility of Minocycline and Doxycycline Use as Potential Vasculostatic Therapy for Brain Vascular Malformations: Pilot Study of Adverse Events and Tolerance

2008 ◽  
Vol 25 (1-2) ◽  
pp. 157-163 ◽  
Author(s):  
Tim Frenzel ◽  
Chanhung Z. Lee ◽  
Helen Kim ◽  
Nancy J. Quinnine ◽  
Tomoki Hashimoto ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Vascular Malformations

Musculoskeletal Interventional Radiology in the Pediatric Population: State of the Art

2021 ◽  
Vol 25 (01) ◽  
pp. 176-183
Author(s):  
Francesco Arrigoni ◽  
Antonio Izzo ◽  
Federico Bruno ◽  
Pierpaolo Palumbo ◽  
Massimo De Filippo ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Vascular Malformations ◽  
Pediatric Population ◽  
Arterial Embolization ◽  
Bone Cysts ◽  
Sclerosing Agents ◽  
Aneurysmal Bone Cysts ◽  
Intracystic Injection ◽  
Interventional Radiology Procedures ◽  
Lower Morbidity

AbstractInterventional radiology procedures have been proven to be as effective as traditional surgery but usually are characterized by lower morbidity rates. In this article, the most diffuse IR treatments for pediatric lesions are reviewed with the aim of describing main advantages and drawbacks. Ablation procedures (in particular RFA and MRgFUS) are widely used for the management of osteoid osteoma and osteoblastoma whereas intracystic injection of methylprednisolone acetate is performed for simple bone cysts. Sclerosing agents and where possible, selective arterial embolization are used for treatment of aneurysmal bone cysts and other vascular malformations. In the management of malignant muscoloskeletal tumors, the role interventional radiology is mainly represented by percutaneous biopsies, and by adiuvant selective embolizations in presence of hypervascular lesions to be submitted to surgery.

scholarly journals Incidence of Adverse Effects of Propofol for Procedural Sedation/Anesthesia in the Pediatric Emergency Population: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Pengfei Guo ◽  
YingChun Ran ◽  
Xiaoxiao Ao ◽  
Qing Zou ◽  
Liping Tan
Keyword(s):  
Systematic Review ◽  
Sensitivity Analysis ◽  
Adverse Effects ◽  
Adverse Events ◽  
Subgroup Analysis ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Pediatric Emergency ◽  
Cochrane Library

Background. To investigate the incidence of adverse effects of propofol among pediatric population for sedation or anesthesia. Methods. We performed Cochrane Library, PubMed, CNKI, VIP, and Wanfang databases to research relevant literature. We did sensitivity analysis to assess the incidence of adverse effects of propofol among pediatric population for sedation or anesthesia. Results. In 132 studies, eight RCTs were included in this analysis. The result showed that adverse events (bradypnea, hypotension, hypertension, and apnea) were significantly improved in the pediatric emergency population in the propofol group, but it had no effect on the incidence of cough attacks, desaturation, agitation, stridor, and laryngospasm. Furthermore, the subgroup analysis showed that those who received propofol for had decreased adverse effects compared with the patients who received ketamine treatment ( SMD = 0.44 , 95 % CI = 0.28 , 0.67 , I 2 = 0 %, and P = 0.0002 ), which demonstrated that propofol could decrease the incidence of adverse effects compared with ketamine and ketofol. Conclusions. The study demonstrated that propofol may decrease the incidence of bradypnea, hypotension, hypertension, and apnea, but it had no effect on the incidence of cough attacks, desaturation, agitation, stridor, and laryngospasm. Furthermore, more large RCTs are needed to assess incidence of adverse effects of propofol among pediatric population.

Sign in / Sign up

Export Citation Format

Share Document