scholarly journals EMERGENCE DELIRIUM IN PEDIATRIC PATIENTS UNDERGOING GENERAL ANESTHESIA

2021 ◽  
Vol 31 (4) ◽  
pp. 19-25
Author(s):  
Greta Patapavičiūtė ◽  
Laura Lukošienė ◽  
Ilona Razlevičė ◽  
Andrius Macas
Keyword(s):  
Postoperative Period ◽  
Pediatric Population ◽  
Recovery Period ◽  
Pediatric Anesthesia ◽  
Perioperative Period ◽  
Anesthesia Induction ◽  
Early Recovery ◽  
Pain Group ◽  
Emergence Delirium ◽  
Late Postoperative Period

Background: Emergence delirium (ED) is described as a transient state of cognitive disturbance and psychomotor agitation, which begins with emergence from anesthesia and continues through the early recovery period. The incidence of ED in the pediatric population remains unclear and ranges from 10 to 80%. The pathophysiology and underlying mechanisms of ED are also uncertain. This study aimed to determine the prevalence of ED, potential risk factors that may contribute to the development of ED and observe behaviour changes related to ED in the late postoperative period. Methods: A prospective observational study was carried out with children aged 1 to 12 years. The child’s behaviour before anesthesia was evaluated using the Pediatric Anesthesia Behavior (PAB) score. Medications used during the perioperative period were registered. The Watcha scale was used to evaluate if children developed ED and the Visual Analogue Scale (VAS) was used to register pain intensity during the first 15 minutes after the awakening. Parents of patients who experienced agitation were asked to assess their child’s behaviour two weeks after the anesthesia. Results: Among 136 observed patients 24 (17.6%) had ED. The duration of anesthesia among ED experienced patients was 45.42 (SD 18.35) min and it was significantly shorter than among children who didn’t develop ED – 60 (SD 29.03) min, p = 0.016. Eighteen (15.5%) patients in a mild pain group (VAS 0 to 3) experienced ED while in a moderate-25 severe pain group (VAS 4-10) there were 6 (37.5%) children who developed ED, p=0.033. However, age, the American Society of Anesthesiologists Classification (ASA) class, surgery type, behaviour before anesthesia induction and perioperative medications were not associated with ED. Conclusions: The prevalence of ED observed during our study, short duration of anesthesia and postoperative pain association with ED coincided with the results specified by other researchers. ED associated behavior changes were reported in the late postoperative period. Our other findings appeared to be not consistent with the results reported in other studies. Thus, the dilemma of ED still remains unresolved.

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.

Anaesthetic complications and emergencies preparedness part 2: intraoperative and recovery period complications

2020 ◽  
Vol 25 (1) ◽  
pp. 18-25
Author(s):  
Stéphanie Marotto ◽  
Carl A Bradbrook ◽  
Aurora Zoff
Keyword(s):  
Risk Factors ◽  
Veterinary Medicine ◽  
Postoperative Period ◽  
Severe Pain ◽  
Recovery Period ◽  
Perioperative Period ◽  
Spontaneous Seizure ◽  
Reference Guide ◽  
Emergency Situations ◽  
Life Threatening

This is a straightforward reference guide designed to assist in diagnosing and treating anaesthetic complications and emergency situations in the perioperative period. Each complication is presented with its risk factors, signs for recognition and differential diagnoses when indicated. Management is presented in a step-by-step manner. Whenever possible, advice on how to prevent these situations from occurring is also provided. This second part focuses on complications more commonly observed in the intraoperative and postoperative period. It includes common situations, such as spontaneous/seizure-like movement or agitation; rare but life-threatening emergencies, such as malignant hyperthermia; and postoperative conditions less recognised in veterinary medicine, such as nausea and severe pain. The complications are presented in alphabetic order in each section (intraoperative and postoperative periods) for easy, rapid consultation.

Patterns of development of insomnia in patients with early recovery period of stroke

2019 ◽  
Vol 17 (7) ◽  
pp. 95-99
Author(s):  
O. V. Kurushina ◽  
◽  
E. A. Kurakova ◽  
Keyword(s):  
Recovery Period ◽  
Early Recovery ◽  
Early Recovery Period

Opportunities of ultrasound diagnostics of lung injury in SARS-CoV-2 infection (COVID-19): a clinical case

2020 ◽  
Vol 98 (11) ◽  
pp. 51-56
Author(s):  
G. V. Neklyudova ◽  
А. V. Chernyak ◽  
N. А. Tsareva ◽  
S. N. Аvdeev
Keyword(s):  
Lung Injury ◽  
Clinical Case ◽  
Ultrasound Examination ◽  
Recovery Period ◽  
Early Recovery ◽  
Acute Period ◽  
Ultrasound Diagnostics ◽  
Early Recovery Period

The article describes a clinical case demonstrating the results of the lungs ultrasound examination in the COVID-19 patient during the acute period of the disease and early recovery period.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

Recovery of Vocal Cord Motion Among Pediatric Patients

2021 ◽  
pp. 000348942110333
Author(s):  
Courtney Ann Prestwood ◽  
Ashley B. Brown ◽  
Romaine F. Johnson
Keyword(s):  
Vocal Cord ◽  
Spontaneous Recovery ◽  
Vocal Cord Paralysis ◽  
Pediatric Population ◽  
Current Evidence ◽  
Symptom Improvement ◽  
Patient Counseling ◽  
Early Recovery ◽  
Kaplan Meier ◽  
Recovery Group

Objectives: Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent interventions. This study aims to determine the time to recover spontaneously and vocal cord movement in a pediatric population and create a model for evidence-based patient counseling. Study Design: Retrospective longitudinal cohort study. Methods: The report is a single institution longitudinal study on vocal cord paralysis recovery. Patients were categorized based on spontaneous recovery with vocal cord movement or no recovery. Recovery rates were determined using the Kaplan-Meier method. Results: Of 158 cases of vocal cord paralysis over a 4-year period, 36 had spontaneous recovery with symptom improvement and motion return. The average recovery was 8.8 months for those who recovered, and 78% recovered within 9 months. Two groups emerged from the data: an early recovery group with spontaneous recovery before 12 months and a late recovery group after 12 months. Children with dysphonia and paralysis due to cardiac surgery were less likely to recover, and children with aspiration were more likely to recover. Children with gastrointestinal comorbidities were less likely to recover; however, those who did recover were more likely to have recovered after 12 months. Based on our model, there is about a 3% chance of recovery between 9 and 12 months. Conclusions: Patients should be counseled about earlier interventions. Waiting the conventional 12 months for only a 3% chance of spontaneous recovery without intervention or laryngeal EMG may not be the preferred option for some patients and their families.

A Randomized Trial of the Long-term Effects of Digital Ocular Compression in the Late Postoperative Period

2001 ◽  
Vol 10 (4) ◽  
pp. 266-270 ◽  
Author(s):  
Jeffrey D. Henderer ◽  
Michael C. Heeg ◽  
George L. Spaeth ◽  
Marlene R. Moster ◽  
Jonathan S. Myers ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Postoperative Period ◽  
Long Term Effects ◽  
Late Postoperative Period

scholarly journals Function of the nucleus accumbens in motor control during recovery after spinal cord injury

Science ◽  
2015 ◽  
Vol 350 (6256) ◽  
pp. 98-101 ◽  
Author(s):  
Masahiro Sawada ◽  
Kenji Kato ◽  
Takeharu Kunieda ◽  
Nobuhiro Mikuni ◽  
Susumu Miyamoto ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Nucleus Accumbens ◽  
High Frequency ◽  
Neuronal Damage ◽  
Recovery Period ◽  
Oscillatory Activity ◽  
Finger Movements ◽  
Early Recovery ◽  
Cord Injury

Motivation facilitates recovery after neuronal damage, but its mechanism is elusive. It is generally thought that the nucleus accumbens (NAc) regulates motivation-driven effort but is not involved in the direct control of movement. Using causality analysis, we identified the flow of activity from the NAc to the sensorimotor cortex (SMC) during the recovery of dexterous finger movements after spinal cord injury at the cervical level in macaque monkeys. Furthermore, reversible pharmacological inactivation of the NAc during the early recovery period diminished high-frequency oscillatory activity in the SMC, which was accompanied by a transient deficit of amelioration in finger dexterity obtained by rehabilitation. These results demonstrate that during recovery after spinal damage, the NAc up-regulates the high-frequency activity of the SMC and is directly involved in the control of finger movements.

Parental Presence during Induction of Anesthesia Improves Compliance of the Child and Reduces Emergence Delirium

2021 ◽  
Author(s):  
Diego Gil Mayo ◽  
Pascual Sanabria Carretero ◽  
Luis Gajate Martin ◽  
Jose Alonso Calderón ◽  
Francisco Hernández Oliveros ◽  
...  
Keyword(s):  
Pediatric Surgery ◽  
Pediatric Anesthesia ◽  
Preoperative Anxiety ◽  
Preoperative Preparation ◽  
Parental Presence ◽  
Emergence Delirium ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Preparation Strategy

Abstract Introduction Preoperative stress and anxiety in pediatric patients are associated with poor compliance during induction of anesthesia and a higher incidence of postoperative maladaptive behaviors. The aim of our study was to determine which preoperative preparation strategy improves compliance of the child during induction and decreases the incidence and intensity of emergence delirium (ED) in children undergoing ambulatory pediatric surgery. Materials and Methods This prospective observational study included 638 pediatric American Society of Anesthesiologists I–II patients who underwent ambulatory pediatric surgery, grouped into four preoperative preparation groups: NADA (not premedicated), MDZ (premedicated with midazolam), PPIA (parental presence during induction of anesthesia), and PPIA + MDZ. The results were subsequently analyzed in four age subgroups: Group 1 (0–12 months), Group 2 (13–60 months), Group 3 (61–96 months), and Group 4 (> 96 months). Preoperative anxiety (modified Yale Preoperative Anxiety Scale [m-YPAS]), compliance of the child during induction (Induction Compliance Checklist [ICC]), and ED (Pediatric Anesthesia Emergence Delirium scale) were analyzed in each group. Results Eighty-one percent of patients in the PPIA + MDZ preparation group presented a perfect compliance during the induction of anesthesia (ICC = 0), less preoperative anxiety (mean score m-YPAS = 26), less probability of ED (odds ratio: 10, 5 [3–37.5]; p < 0.05), and less ED intensity compared with the NADA group (1.2 vs. 5.8; p = 0.001). Conclusion PPIA associated with midazolam premedication improves compliance during induction and decreases the incidence and intensity of ED.

Sign in / Sign up

Export Citation Format

Share Document