A method of administering continuous positive airway pressure via a new airway device to prevent upper airway obstruction and preserve spontaneous respiration under total intravenous anesthesia has been adapted for children undergoing deep sedation for MRI studies. Presented herein is a retrospective study of 45 pediatric patients, ages 5 months to 7 years, who underwent an MRI study under general anesthesia using a modified nasal vestibule airway (NVA®), a pressure-sealing nasal cannula that can be used in conjunction with an anesthesia circuit to deliver nasal-CPAP during anesthesia. After inhalation induction of anesthesia with sevoflurane, an intravenous infusion of propofol was used to maintain anesthesia. A NVA®, downsized to fit the nasal vestibule of the child, was inserted, taped in place, and connected to a Mapleson F circuit. An extra long extension of corrugated tubing, a SNOR-SCOPE® circuit stethoscope, and the fluctuations of a reservoir bag allowed monitoring and assisted respirations from the foot of the MRI table. Other monitors included CO2 sampled at the mouth and the fluctuations of a PORTEX® disposable pressure gauge. The records of 45 pediatric patients were reviewed. No significant anesthesia complications were found. A new approach is offered to maintain airway patency, monitoring and spontaneous respirations in pediatric patients undergoing MRI study. This pressure-sealing nasal cannula can deliver CPAP under anesthesia while avoiding the requirement of an invasive airway and facilitating additional monitoring and control not possible with an ordinary nasal cannula. This NVA may be used in other locations in pediatric patients where endotracheal intubation is not necessary or impossible.
[Show abstract][Hide abstract] ABSTRACT: Purpose of review:
The purpose of the present review is to place the current literature into historical context of what is understood about the conceptual as well as practical differences between sedation and anaesthesia, and what the potential benefits and risks may be, where paediatric imaging is concerned.
This review is timely, as there is an increasing demand for the expensive resource of anaesthesia service provision, above and beyond sedation provision. Adequate and appropriate training is the major issue in well tolerated drug administration: the practitioner must have appropriate skills to monitor and rescue the patient from general anaesthesia. There is an increasing understanding on what can be achieved with subanaesthetic doses of traditional anaesthetic drugs, as well as what can be achieved without access to anaesthetic drugs at all. The risk-benefit analysis must ultimately be taken on a patient-by-patient basis, and to this end should determine service provision and training requirements.
One single method cannot be applied to all children. Many can be sedated, but others will need anaesthesia with careful airway management, and the accompanying skilled personnel. Service models should be developed and tested to ensure maximum efficiency of service delivery.
Current opinion in anaesthesiology 05/2013; 26(4). DOI:10.1097/ACO.0b013e3283620121 · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pediatric anesthesia induction with sevoflurane usually needs a special vaporizer and gas source, which limits its use to the operating room (OR). Many children feel anxious and cry when entering the OR because of being separated from their parents, which impairs anesthesia safety and their physical and mental health. In this study, we used a portable circuit to perform sevoflurane anesthesia induction outside the OR, assessed its effects and compared them with those of ketamine anesthesia in pediatric patients.
One hundred children had anesthesia induced with either sevoflurane (sevoflurane group) through the portable inhalational anesthetic circuit, or ketamine by intramuscular injection (ketamine group), then were transferred to the OR. Peak inspired concentration (Cp) and steady state concentration (Cs) of sevoflurane were measured. Heart rate (HR) and saturation of peripheral oxygen (SpO2) were monitored. Time for anesthesia induction, awakening, leaving the OR and duration of the operation were recorded. The patients' reaction during anesthesia was also analyzed.
The Cp and Cs of sevoflurane were correlated with bodyweight. Compared with the ketamine group, the sevoflurane group showed shorter time for anesthesia induction (28 ±7 s vs. 195 ±34 s, p < 0.0001), awakening (11.2 ±3.6 s vs. 63.5 ±6.7 s, p < 0.0001) and leaving the OR (20.5 ±5.6 s vs. 43.4 ±10.6, p < 0.0001), less noncooperation during anesthesia induction (10% vs. 80%, p < 0.0001), lower HR (130 ±16 beats/min vs. 143 ±19 beats/min, p = 0.0004) and higher SpO2 (98.9 ±0.9% vs. 96.1 ±2.5%, p < 0.0001) on arrival at the OR.
Pediatric anesthesia induction by sevoflurane with the portable inhalational anesthetic circuit is convenient, safe and effective outside the OR.
Archives of Medical Science 08/2015; 11(4). DOI:10.5114/aoms.2015.50230 · 2.03 Impact Factor
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