Single-dose caudal anaesthesia for two infants undergoing diagnostic brain magnetic resonance imaging: high risk and nonhigh risk (original) (raw)
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Side-effects after inhalational anaesthesia for paediatric cerebral magnetic resonance imaging
Pediatric Anesthesia, 2002
Background: The aim of this study was to evaluate the type, incidence and duration of postprocedure side-effects in 168 children within the first 72 h after inhalational anaesthesia for magnetic resonance imaging (MRI). Methods: Premedication and induction followed standardized routines. Maintenance of anaesthesia was performed with inhalational anaesthetics solely: isoflurane (n ¼ 60 of 112; 53%), sevoflurane (n ¼ 32 of 112; 29%), desflurane (n ¼ 12 of 112; 11%) or halothane (n ¼ 8 of 112; 7%) using a strapped on face mask (FiO 2 ¼ 0.4; flow 5 lAEmin -1 ). When indicated, gadolinium was administered (n ¼ 45; OF 112; 40%). Results: One hundred and twelve of 168 parents (67%) responded to questionnaires. In these 112 children, pathological MR findings were found supratentorially (n ¼ 31; 28%), infratentorially (n ¼ 9; 8%), extracerebrally (n ¼ 12; 11%) or combined (n ¼ 9; 8%). In 56 of these 112 children (50%), 14 different side-effects were reported. One hour after anaesthesia, 55 children suffered between one and four sideeffects. Neurological side-effects were associated with age ‡ 5 years (P < 0.01) or infratentorial pathophysiology (P < 0.01) and abdominal side-effects (P < 0.02), especially nausea (P < 0.001) with age ‡ 5 years. Conclusions: Our findings indicate the need to inform parents of the incidence and variability of side-effects after inhalational anaesthesia for minimally invasive, diagnostic procedures, such as MRI.
Safety Profile of Chloral Sedation for MRI in Term and Preterm Neonates
Pediatric Research, 2011
Background: The aim of this study was to look for clinically significant adverse effects of chloral hydrate used in a large cohort of infants sedated for magnetic resonance imaging. Method: Case notes of infants who underwent magnetic resonance imaging (MRI) scanning from 2008 to 2010 were reviewed, with patient demographics, sedation dose, comorbidities, time to discharge, and side effects of sedation noted. Results: Four hundred and eleven infants (median [range] postmenstrual age per weight at scan 42 [31 +4 -60] weeks per 3500 g [1060-9900 g]) were sedated with chloral hydrate (median [range] dose 50 [20-80] mgÁkg À1 ). In three cases (0.7%), desaturations occurred which prompted termination of the scan. One infant (0.2%) was admitted for additional observation following sedation but had no prolonged effects. In 17 (3.1%) cases, infants had desaturations which were self-limiting or responded to additional inspired oxygen such that scanning was allowed to continue. Conclusion: When adhering to strict protocols, MRI scanning in newborn infants in this cohort was performed using chloral hydrate sedation with a relatively low risk of significant adverse effects.
Journal of PeriAnesthesia Nursing, 2019
Purpose: To describe the physiological and biological principles of anesthesia for children; nonanesthesia practices; the state of the evidence of patient-and family-centered care strategies to reduce anesthesia use; and role of nursing in ensuring patient safety through reducing anesthesia use for pediatric magnetic resonance imaging (MRI). Design: Integrative literature review. Methods: Review and synthesis of experimental and nonexperimental literature. Findings: Anesthesia use in pediatric MRI: 20 studies met inclusion criteria. Physiological and biological side effects of anesthesia in children are substantial. Of significance is the developing research on the extent to which anesthesia affects the developing brain of children. Nonanesthesia in pediatric MRI: 16 studies met inclusion criteria. Common themes were noted between patient-and family-centered care strategies and reducing anesthesia use in children requiring MRI. Conclusions: There are significant risks associated with anesthesia on the developing brain. Nurses play an important role in using patient-centered strategies to reduce pediatric anesthesia use and advocate for patient safety.
Chloral hydrate sedation for magnetic resonance imaging in newborn infants
Paediatric Anaesthesia, 2014
Background: The aim of this study was to look for clinically significant adverse effects of chloral hydrate used in a large cohort of infants sedated for magnetic resonance imaging. Method: Case notes of infants who underwent magnetic resonance imaging (MRI) scanning from 2008 to 2010 were reviewed, with patient demographics, sedation dose, comorbidities, time to discharge, and side effects of sedation noted. Results: Four hundred and eleven infants (median [range] postmenstrual age per weight at scan 42 [31 +4 -60] weeks per 3500 g [1060-9900 g]) were sedated with chloral hydrate (median [range] dose 50 [20-80] mgÁkg À1 ). In three cases (0.7%), desaturations occurred which prompted termination of the scan. One infant (0.2%) was admitted for additional observation following sedation but had no prolonged effects. In 17 (3.1%) cases, infants had desaturations which were self-limiting or responded to additional inspired oxygen such that scanning was allowed to continue. Conclusion: When adhering to strict protocols, MRI scanning in newborn infants in this cohort was performed using chloral hydrate sedation with a relatively low risk of significant adverse effects.
Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes
British Journal of Anaesthesia, 2000
Quality assurance data were collected prospectively for children who were sedated (nϭ922) or given general anaesthesia (nϭ140) for magnetic resonance imaging (MRI) or computerized tomography (CT). The data included patient characteristics, concurrent medication, adequacy of sedation, adverse events and requirement for escalated care. The quality of scans was evaluated. Reasons for preselection of general anaesthesia included previously failed sedation (28%), potential for failed sedation (32%) and perceived medical risk (14%). Hypoxaemia occurred in 2.9% of sedated children, and was more common in children classified as ASA III or IV. Sedation was inadequate for 16% of children and failed in 7%. Failed sedation was associated with greater age (Pϭ0.009), higher ASA status (Pϭ0.04) and use of benzodiazepines as sole sedatives (PϽ0.03). More of the children who underwent general anaesthesia were ASA III or IV than sedated children, yet the procedure was successful in all the children who underwent general anaesthesia, with one incident of laryngospasm. Excessive motion was noted in 12% of scans of sedated children and 0.7% of those completed with general anaesthesia. We conclude that sedation of children for MRI and CT is associated with risks of hypoxaemia and of inadequate or failed sedation. These adverse events were more likely to occur in older children, those with a higher ASA status and those in whom benzodiazepines had been used as sole sedatives. For a preselected high-risk group of children, general anaesthesia may make MRI and CT scans more successful with minimal adverse events.
Sedation of neurologically impaired children undergoing MRI: a sequential approach
Pediatric Anesthesia, 2007
Background: The purpose of this retrospective study was to determine the efficacy of a sequential approach meant to rescue failed chloral hydrate sedation and to obtain a low rate of adverse events along with predictable timings in neurologically impaired children undergoing magnetic resonance imaging. Methods: We retrospectively evaluated 1104 chloral hydrate sedations performed between 2002 and 2004 on 862 children weighing <26 kg. If the desired sedation score (3 on the Skeie Scale) was not reached within 30 min after oral administration of chloral hydrate, sedation was considered as potentially failed, and supplementation with sevoflurane, i.m. or i.v. ketamine, and i.v. pentobarbital and midazolam was started. Results: Twenty-seven sessions failed because of excessive movement. Mean induction time was significantly higher for patients who received supplementation (52.2 min vs 39.1 min), while no differences in recovery and total sedation times were found. Supplementation significantly increased the incidence of respiratory obstruction (4.6% vs 2.4%), although the incidence of other adverse events was unaffected. Conclusions: Administering up to 1.5 g of chloral hydrate without supplementation was associated with a failure rate of approximately 20%, but the proposed sequential approach enabled us to rescue the majority of failed sedations while maintaining an acceptably low incidence of adverse events.
Apnea after Awake Regional and General Anesthesia in Infants
Anesthesiology, 2015
Background:Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia.Methods:Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded.Results:Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); howe...