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Neonatal anesthesia

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https://www.readbyqxmd.com/read/27901551/prolonged-second-stage-what-is-the-optimal-length
#1
Alexis C Gimovsky, Vincenzo Berghella
Importance: Prolonged second stage of labor is a clinical dilemma in which controversy exists on whether extending labor in nulliparous women with epidural anesthesia decreases the incidence of cesarean delivery without increasing maternal or neonatal risks. Objective: This narrative review was conducted to assess the current literature on management of and risks associated with a prolonged second stage in nulliparous women with epidurals. Evidence Acquisition: A review of the current literature was performed to evaluate the incidence of cesarean delivery and the maternal and neonatal outcomes...
November 2016: Obstetrical & Gynecological Survey
https://www.readbyqxmd.com/read/27898690/isoflurane-exposure-induces-cell-death-microglial-activation-and-modifies-the-expression-of-genes-supporting-neurodevelopment-and-cognitive-function-in-the-male-newborn-piglet-brain
#2
Kevin D Broad, Jane Hassell, Bobbi Fleiss, Go Kawano, Mojgan Ezzati, Eridan Rocha-Ferreira, Mariya Hristova, Kate Bennett, Igor Fierens, Ryan Burnett, Badr Chaban, Daniel Alonso-Alconada, Aaron Oliver-Taylor, Ilias Tachsidis, Jamshid Rostami, Pierre Gressens, Robert D Sanders, Nicola J Robertson
Exposure of the brain to general anesthesia during early infancy may adversely affect its neural and cognitive development. The mechanisms mediating this are complex, incompletely understood and may be sexually dimorphic, but include developmentally inappropriate apoptosis, inflammation and a disruption to cognitively salient gene expression. We investigated the effects of a 6h isoflurane exposure on cell death, microglial activation and gene expression in the male neonatal piglet brain. Piglets (n = 6) were randomised to: (i) naive controls or (ii) 6h isoflurane...
2016: PloS One
https://www.readbyqxmd.com/read/27896911/the-timing-and-prevalence-of-intraoperative-hypotension-in-infants-undergoing-laparoscopic-pyloromyotomy-at-a-tertiary-pediatric-hospital
#3
Allan F Simpao, Luis M Ahumada, Jorge A Gálvez, Christopher P Bonafide, Elicia C Wartman, William Randall England, Arul M Lingappan, Todd J Kilbaugh, Abbas F Jawad, Mohamed A Rehman
BACKGROUND: Intraoperative hypotension may be associated with adverse outcomes in children undergoing surgery. Infants and neonates under 6 months of age have less autoregulatory cerebral reserve than older infants, yet little information exists regarding when and how often intraoperative hypotension occurs in infants. AIMS: To better understand the epidemiology of intraoperative hypotension in infants, we aimed to determine the prevalence of intraoperative hypotension in a generally uniform population of infants undergoing laparoscopic pyloromyotomy...
November 29, 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27896270/the-assessment-of-facial-expressions-in-piglets-undergoing-tail-docking-and-castration-toward-the-development-of-the-piglet-grimace-scale
#4
Pierpaolo Di Giminiani, Victoria L M H Brierley, Annalisa Scollo, Flaviana Gottardo, Emma M Malcolm, Sandra A Edwards, Matthew C Leach
Many piglets are exposed to potentially painful husbandry procedures within the first week of life, including tail docking and castration, without the provision of either anesthesia or analgesia. The assessment methods used to evaluate pain experienced by piglets are often affected by low specificity and practical limitations, prompting the investigation of alternative methodologies. The assessment of changes in facial expression following a painful event has been successfully applied to several species. The objective of this pilot study was to evaluate the utility of a Grimace Scale applied to neonatal pigs to evaluate pain evoked by tail docking and castration...
2016: Frontiers in Veterinary Science
https://www.readbyqxmd.com/read/27895665/sugammadex-enhanced-neuronal-apoptosis-following-neonatal-sevoflurane-exposure-in-mice
#5
Maiko Satomoto, Zhongliang Sun, Yushi U Adachi, Koshi Makita
In rodents, neonatal sevoflurane exposure induces neonatal apoptosis in the brain and results in learning deficits. Sugammadex is a new selective neuromuscular blockade (NMB) binding agent that anesthesiologists can use to achieve immediate reversal of an NMB with few side effects. Given its molecular weight of 2178, sugammadex is thought to be unable to pass through the blood brain barrier (BBB). Volatile anesthetics can influence BBB opening and integrity. Therefore, we investigated whether the intraperitoneal administration of sugammadex could exacerbate neuronal damage following neonatal 2% sevoflurane exposure via changes in BBB integrity...
2016: Anesthesiology Research and Practice
https://www.readbyqxmd.com/read/27891080/enhanced-burst-suppression-and-disruption-of-local-field-potential-synchrony-in-a-mouse-model-of-focal-cortical-dysplasia-exhibiting-spike-wave-seizures
#6
Anthony J Williams, Chen Zhou, Qian-Quan Sun
Focal cortical dysplasias (FCDs) are a common cause of brain seizures and are often associated with intractable epilepsy. Here we evaluated aberrant brain neurophysiology in an in vivo mouse model of FCD induced by neonatal freeze lesions (FLs) to the right cortical hemisphere (near S1). Linear multi-electrode arrays were used to record extracellular potentials from cortical and subcortical brain regions near the FL in anesthetized mice (5-13 months old) followed by 24 h cortical electroencephalogram (EEG) recordings...
2016: Frontiers in Neural Circuits
https://www.readbyqxmd.com/read/27882447/neonatal-repeated-exposure-to-isoflurane-not-sevoflurane-in-mice-reversibly-impaired-spatial-cognition-at-juvenile-age
#7
Jianhui Liu, Yanhong Zhao, Junjun Yang, Xiaoqing Zhang, Wei Zhang, Peijun Wang
Inhalation anesthetics facilitate surgical procedures in millions of children each year. However, animal studies demonstrate that exposure to the inhalation anesthetic isoflurane may cause neuronal cell death in developing brains. The long-term cytotoxic effects of sevoflurane, the most popular pediatric anesthetic, have not been compared with isoflurane. Thus, this study was designed to compare the effects of equipotent doses of these two anesthetics on neonatal long-term neurotoxicity. Postnatal 7-day-old (P7) C57/BL male mice were exposed to 1...
November 24, 2016: Neurochemical Research
https://www.readbyqxmd.com/read/27873010/regional-block-via-continuous-caudal-infusion-as-sole-anesthetic-for-inguinal-hernia-repair-in-conscious-neonates
#8
Claudia M Mueller, Tiffany J Sinclair, Megan Stevens, Micaela Esquivel, Noah Gordon
PURPOSE: The use of general anesthesia in young children has come under increasing scrutiny due to its potential long-term neurotoxic effects. Meanwhile, regional anesthesia for surgical procedures in neonates has many advantages, including preservation of respiratory status and faster return to feeding. We describe the successful use of 3% 2-chloroprocaine administered via continuous caudal infusion as the sole anesthetic agent during elective surgical procedures in infants. METHODS: A retrospective chart review of all patients who underwent elective surgical procedures under continuous caudal regional anesthetic at a single institution was performed...
November 21, 2016: Pediatric Surgery International
https://www.readbyqxmd.com/read/27871903/review-of-preclinical-studies-on-pediatric-general-anesthesia-induced-developmental-neurotoxicity
#9
Jennifer L Walters, Merle G Paule
Thousands of infants and children undergo complicated surgical procedures that require prolonged periods of anesthesia and/or sedation each year. A growing body of preclinical research suggests pediatric anesthetics are harmful to the developing brain; yet, the extent to which these effects generalize to the clinical setting remains unclear. As there will be a continuing need for surgical and other interventions requiring sedation and/or anesthesia during the neonatal period, it seems clear that research efforts should focus on determining the extent to which general anesthetics can affect the developing brain as well as determining strategies for preventing or ameliorating the adverse effects associated with exposure to such agents...
November 18, 2016: Neurotoxicology and Teratology
https://www.readbyqxmd.com/read/27863823/general-endotracheal-vs-non-endotracheal-regional-anesthesia-for-elective-inguinal-hernia-surgery-in-very-preterm-neonates-a-single-institution-experience
#10
Jean Gurria, Phillip Kuo, Angie Kao, Luisa Christensen, AiXuan Holterman
BACKGROUND: Very pre-term infants (VP) at <32 weeks post menstrual age PMA have a high incidence of bronchopulmonary dysplasia BPD. BPD places them at risk for pulmonary-related perioperative complications from general endotracheal anesthesia GE during elective inguinal hernia repair. METHODS: A retrospective cohort study was done to compare pulmonary-related perioperative risks between VP patients undergoing non-emergent inguinal hernia repair prior to NICU discharge under GE (n=58) vs regional anesthesia RA (n=37)...
October 27, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27836791/pharmacological-inhibition-of-pten-attenuates-cognitive-deficits-caused-by-neonatal-repeated-exposures-to-isoflurane-via-inhibition-of-nr2b-mediated-tau-phosphorylation-in-rats
#11
Lei Tan, Xin Chen, Wei Wang, Jianfang Zhang, Shiyong Li, Yilin Zhao, Jintao Wang, Ailin Luo
Evidence has shown that children exposed to repeated anesthesia in early childhood display long-term cognitive disabilities. However, the underlying mechanisms remain largely unclear. Our previous study has indicated the involvement of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) in isoflurane-induced decrease of self-renewal capacity in hippocampal neural precursor cells. Additionally, it is demonstrated by others that PTEN inhibition could protect against cognitive impairment via reduction of tau phosphorylation in the alzheimer's disease model...
November 8, 2016: Neuropharmacology
https://www.readbyqxmd.com/read/27824005/neonatal-propofol-and-etomidate-exposure-enhance-inhibitory-synaptic-transmission-in-hippocampal-cornus-ammonis-1-pyramidal-neurons
#12
Jia-Qiang Zhang, Wan-Ying Xu, Chang-Qing Xu
BACKGROUND: Propofol and etomidate are the most important intravenous general anesthetics in the current clinical use and that mediate gamma-aminobutyric acid's (GABAergic) synaptic transmission. However, their long-term effects on GABAergic synaptic transmission induced by neonatal propofol or etomidate exposure remain unclear. We investigated the long-term GABAergic neurotransmission alterations, following neonatal propofol and etomidate administration. METHODS: Sprague-Dawley rat pups at postnatal days 4-6 were underwent 6-h-long propofol-induced or 5-h-long etomidate-induced anesthesia...
2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27822105/the-danish-national-quality-database-for-births
#13
REVIEW
Charlotte Brix Andersson, Christina Flems, Ulrik Schiøler Kesmodel
AIM OF THE DATABASE: The aim of the Danish National Quality Database for Births (DNQDB) is to measure the quality of the care provided during birth through specific indicators. STUDY POPULATION: The database includes all hospital births in Denmark. MAIN VARIABLES: Anesthesia/pain relief, continuous support for women in the delivery room, lacerations (third and fourth degree), cesarean section, postpartum hemorrhage, establishment of skin-to-skin contact between the mother and the newborn infant, severe fetal hypoxia (proportion of live-born children with neonatal hypoxia), delivery of a healthy child after an uncomplicated birth, and anesthesia in case of cesarean section...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27820621/association-of-anesthesia-and-surgery-during-childhood-with-long-term-academic-performance
#14
Pia Glatz, Rolf H Sandin, Nancy L Pedersen, Anna-Karin Bonamy, Lars I Eriksson, Fredrik Granath
Importance: The results of preclinical studies suggest that anesthetic drugs administered to neonatal animals cause widespread neuronal apoptosis and later neurocognitive impairment. Adequately powered studies in the pediatric surgical population are scarce, and it is unclear whether such preclinical findings are relevant for the pediatric setting. Objective: To examine the association of anesthesia and surgery before age 4 years with long-term academic and cognitive performance indexed by school grades at age 16 years and IQ test scores at military conscription...
November 7, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/27820300/neonatal-sevoflurane-exposure-induces-adulthood-fear-induced-learning-disability-and-decreases-glutamatergic-neurons-in-the-basolateral-amygdala
#15
Maiko Satomoto, Zhongliang Sun, Yushi U Adachi, Koshi Makita
BACKGROUND: Neonatal mice exposed to sevoflurane show certain cognitive and behavioral impairments in adulthood. However, the mechanisms underlying long-term cognitive deficits induced by sevoflurane exposure remain unknown. The present study was performed to investigate whether there is differential neuronal activation between naive mice and sevoflurane-exposed neonates in fear-conditioning tests based on immediate early gene (c-Fos) expression. METHODS: Male mice were exposed to 3% sevoflurane (SEVO group) or carrier gas alone (no anesthesia, NA group) for 6 hours on postnatal day 6...
November 4, 2016: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/27803982/magnesium-in-obstetric-anesthesia-and-intensive-care
#16
REVIEW
Marija S Kutlesic, Ranko M Kutlesic, Tatjana Mostic-Ilic
Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects...
November 1, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27793236/isoflurane-provides-neuroprotection-in-neonatal-hypoxic-ischemic-brain-injury-by-suppressing-apoptosis
#17
De-An Zhao, Ling-Yun Bi, Qian Huang, Fang-Min Zhang, Zi-Ming Han
BACKGROUND AND OBJECTIVES: Isoflurane is halogenated volatile ether used for inhalational anesthesia. It is widely used in clinics as an inhalational anesthetic. Neonatal hypoxic ischemia injury ensues in the immature brain that results in delayed cell death via excitotoxicity and oxidative stress. Isoflurane has shown neuroprotective properties that make a beneficial basis of using isoflurane in both cell culture and animal models, including various models of brain injury. We aimed to determine the neuroprotective effect of isoflurane on hypoxic brain injury and elucidated the underlying mechanism...
November 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/27793105/assessment-of-risk-factors-for-cerebral-oxygen-desaturation-during-neonatal-and-infant-general-anesthesia-an-observational-prospective-study
#18
Ilona Razlevice, Danguole C Rugyte, Loreta Strumylaite, Andrius Macas
BACKGROUND: Cerebral oxygen saturation (rSO2c) decrease from baseline greater than 20 % during infant cardiac surgery was associated with postoperative neurologic changes and neurodevelopmental impairment at 1 year of age. So far, there is no sufficient evidence to support the routine monitoring of rSO2c during general surgical procedures in children. We aimed to find out the frequency of cerebral desaturation 20 % or more from baseline and to identify possible predictors of change in cerebral oxygen saturation during neonatal and infant general surgery...
October 28, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27785338/dose-dependent-effects-of-sevoflurane-exposure-during-early-lifetime-on-apoptosis-in-hippocampus-and-neurocognitive-outcomes-in-sprague-dawley-rats
#19
Xue Zhou, Wenda Li, Xiaohui Chen, Xiaoyu Yang, Zhibin Zhou, Dihan Lu, Xia Feng
Sevoflurane has become a main method for induction of anesthesia in pediatric populations. Preclinical evidence suggest the neurotoxic effect of volatile anesthetics on the developing brain including sevoflurane. This study investigates the effect of different doses of sevoflurane on the developing brain. In this study, Sprague-Dawley rats of postnatal (P) day 7 were exposed to 0.3%, 1.3% and 2.3% sevoflurane for 6 hours. 6 hours after exposure, Nissl staining was performed to observe the morphological changes of the hippocampus and western-blot was done to evaluate the expression changes in cytochrome c, cleaved caspase-3, Bcl-2 and Bax...
2016: International Journal of Physiology, Pathophysiology and Pharmacology
https://www.readbyqxmd.com/read/27768673/summary-of-the-update-session-on-clinical-neurotoxicity-studies
#20
Teeda Pinyavat, David O Warner, Randall P Flick, Mary Ellen McCann, Dean B Andropoulos, Danquig Hu, Jeffrey W Sall, Marisa N Spann, Caleb Ing
During the Fifth Pediatric Anesthesia Neurodevelopmental Assessment Symposium, experts and stakeholders met to present and discuss recent advances made in the study of neurodevelopmental outcomes after exposure to anesthetic drugs in infants and children. This article summarizes the update of 5 ongoing clinical studies: General Anesthesia compared to Spinal Anesthesia, Toxicity of Remifentanil and Dexmedetomidine, Mayo Anesthesia Safety in Kids, the University of California San Francisco human cohort study, and Columbia University Medical Center Neonatal Magnetic Resonance Imaging study...
October 2016: Journal of Neurosurgical Anesthesiology
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