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Pediatric sedation

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https://www.readbyqxmd.com/read/28439690/association-of-endotracheal-tube-repositioning-and-acute-laryngeal-lesions-during-mechanical-ventilation-in-children
#1
Denise Manica, Catia de Souza Saleh Netto, Cláudia Schweiger, Leo Sekine, Larissa Valency Enéas, Denise Rotta Pereira, Gabriel Kuhl, Paulo Roberto Antonacci Carvalho, Paulo José Cauduro Marostica
The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation...
April 24, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28438591/effect-of-anesthesia-on-intraocular-pressure-measurement-in-children
#2
REVIEW
Mikel Mikhail, Kourosh Sabri, Alex V Levin
Measurement of the intraocular pressure (IOP) is central to the diagnosis and management of pediatric glaucoma. An examination under anesthesia is often necessary in pediatric patients. Different agents used for sedation or general anesthesia have varied effects on IOP. Hemodynamic factors, methods of airway management, tonometry technique, and body positioning can all affect IOP measurements. The most accurate technique is one that reflects the awake IOP. We review factors affecting IOP measurements in the pediatric population and provide recommendations on the most accurate means to measure IOP under anesthesia based on the current literature...
April 21, 2017: Survey of Ophthalmology
https://www.readbyqxmd.com/read/28434027/can-ultrasound-be-used-as-the-primary-imaging-in-children-with-suspected-crohn-disease
#3
Timothy L Tsai, Megan B Marine, Matthew R Wanner, Matthew L Cooper, Steven J Steiner, Fangqian Ouyang, S Gregory Jennings, Boaz Karmazyn
BACKGROUND: There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. OBJECTIVE: The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease...
April 22, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28433211/adverse-events-during-a-randomized-trial-of-ketamine-versus-co-administration-of-ketamine-and-propofol-for-procedural-sedation-in-a-pediatric-emergency-department
#4
Keith Weisz, Lalit Bajaj, Sara J Deakyne, Lina Brou, Alison Brent, Joseph Wathen, Genie E Roosevelt
BACKGROUND: The co-administration of ketamine and propofol (CoKP) is thought to maximize the beneficial profile of each medication, while minimizing the respective adverse effects of each medication. OBJECTIVE: Our objective was to compare adverse events between ketamine monotherapy (KM) and CoKP for procedural sedation and analgesia (PSA) in a pediatric emergency department (ED). METHODS: This was a prospective, randomized, single-blinded, controlled trial of KM vs...
April 19, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28432404/pediatric-neuro-mri-tricks-to-minimize-sedation
#5
REVIEW
Matthew J Barkovich, Duan Xu, Rahul S Desikan, Cassandra Williams, A James Barkovich
Magnetic resonance imaging (MRI) is the workhorse modality in pediatric neuroimaging because it provides excellent soft-tissue contrast without ionizing radiation. Until recently, studies were uninterpretable without sedation; however, given development of shorter sequences, sequences that correct for motion, and studies showing the potentially deleterious effects of sedation on immature laboratory animals, it is prudent to minimize sedation when possible. This manuscript provides basic guidelines for performing pediatric neuro MRI without sedation by both modifying technical factors to reduce scan time and noise, and using a multi-disciplinary team to coordinate imaging with the patient's biorhythms...
April 22, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28430755/differentiating-delirium-from-sedative-hypnotic-related-iatrogenic-withdrawal-syndrome-lack-of-specificity-in-pediatric-critical-care-assessment-tools
#6
Kate Madden, Michele M Burns, Robert C Tasker
OBJECTIVES: To identify available assessment tools for sedative/hypnotic iatrogenic withdrawal syndrome and delirium in PICU patients, the evidence supporting their use, and describe areas of overlap between the components of these tools and the symptoms of anticholinergic burden in children. DATA SOURCES: Studies were identified using PubMed and EMBASE from the earliest available date until July 3, 2016, using a combination of MeSH terms "delirium," "substance withdrawal syndrome," and key words "opioids," "benzodiazepines," "critical illness," "ICU," and "intensive care...
April 20, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28425334/remifentanil-for-sedation-of-children-with-traumatic-brain-injury
#7
James L Hungerford, Nicole O'Brien, Melissa Moore-Clingenpeel, Eric A Sribnick, Cheryl Sargel, Mark Hall, Jeffrey R Leonard, Joseph D Tobias
OBJECTIVE: To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation. DESIGN: Retrospective review. SETTING: Tertiary care PICU. PATIENTS: Thirty-eight patients over a 30-month period. MEASUREMENTS AND MAIN RESULTS: Median age was 9 years (interquartile range [IQR] 2...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28424007/anesthetic-related-neurotoxicity-and-neuroimaging-in-children-a-call-for-conversation
#8
Kara A Bjur, Eric T Payne, Michael E Nemergut, Danqing Hu, Randall P Flick
Each year millions of young children undergo procedures requiring sedation or general anesthesia. An increasing proportion of the anesthetics used are provided to optimize diagnostic imaging studies such as magnetic resonance imaging. Concern regarding the neurotoxicity of sedatives and anesthetics has prompted the US Food and Drug Administration to change labeling of anesthetics and sedative agents warning against repeated or prolonged exposure in young children. This review aims to summarize the risk of anesthesia in children with an emphasis on anesthetic-related neurotoxicity, acknowledge the value of pediatric neuroimaging, and address this call for conversation...
May 2017: Journal of Child Neurology
https://www.readbyqxmd.com/read/28422597/post-discharge-events-occurring-after-dental-treatment-under-deep-sedation-in-pediatric-patients
#9
Esti Davidovich, Liron Meltzer, Jacob Efrat, David Gozal, Diana Ram
PURPOSE: Deep sedation is often required in dentistry for treating children with uncooperative behavior. We assessed immediate post-sedation events during the first 24 hours after dental treatment under deep sedation in children, and examined correlations to a number of variables. STUDY DESIGN: Information was collected from medical files for a convenience sample of children between the ages of 1 and 16, who were treated under deep sedation at one clinic (propofol alone or combined with a sedative agent)...
2017: Journal of Clinical Pediatric Dentistry
https://www.readbyqxmd.com/read/28419616/the-provision-of-pediatric-cardiac-anesthesia-services-in-germany-current-status-of-structural-and-personnel-organization
#10
Torsten Baehner, Oliver Dewald, Ingo Heinze, Matthias Mueller, Ehrenfried Schindler, Uwe Schirmer, Georg Baumgarten, Andreas Hoeft, Richard K Ellerkmann
BACKGROUND: Anesthesia for pediatric cardiac surgery requires a high level of expert knowledge. There are currently no recommendations and standards for anesthetic management for congenital cardiac surgery in Germany. AIM: The aim of the present study was to assess the current status of structural and personnel anesthetic standards at pediatric cardiac surgery centers in Germany. METHOD: All cardiac surgical centers in Germany were reviewed for an active program for congenital heart surgery...
April 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28417851/nuclear-medicine-techniques-in-pediatric-bone-imaging
#11
REVIEW
Laura A Drubach
An important mandate when imaging pediatric patients is the reduction of radiation exposure to the lowest possible level consistent with good quality diagnostic imaging, so individual selection of radiopharmaceutical dosage and imaging technique is essential. Although the logistics of image acquisition and the approach to interpretation mirror the more common use in adults, the challenges of imaging young children typically require greater attention to patient preparation, positioning, and supervision during imaging, with the use of parental or family engagement in the procedure, gentle restraint, and occasionally the need for sedation...
May 2017: Seminars in Nuclear Medicine
https://www.readbyqxmd.com/read/28416265/comparison-of-outcomes-for-pediatric-paraphimosis-reduction-using-topical-anesthetic-versus-intravenous-procedural-sedation
#12
Brett Burstein, Raphael Paquin
BACKGROUND: Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS. METHODS: We performed a retrospective analysis of all patients <18years old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016...
April 11, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28414899/comparison-of-sedation-by-intranasal-dexmedetomidine-and-oral-chloral-hydrate-for-pediatric-ophthalmic-examination
#13
Qianzhong Cao, Yiquan Lin, Zhubin Xie, Weihua Shen, Ying Chen, Xiaoliang Gan, Yizhi Liu
BACKGROUND AND AIM: Pediatric ophthalmic examinations can be conducted under sedation either by chloral hydrate or by dexmedetomidine. The objective was to compare the success rates and quality of ophthalmic examination of children sedated by intranasal dexmedetomidine vs oral chloral hydrate. METHODS: One hundred and forty-one children aged from 3 to 36 months (5-15 kg) scheduled to ophthalmic examinations were randomly sedated by either intranasal dexmedetomidine (2 μg·kg(-1) , n = 71) or oral chloral hydrate (80 mg·kg(-1) , n = 70)...
April 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28410275/implementation-of-an-icu-bundle-an-interprofessional-quality-improvement-project-to-enhance-delirium-management-and-monitor-delirium-prevalence-in-a-single-picu
#14
Shari Simone, Sarah Edwards, Allison Lardieri, L Kyle Walker, Ana Lia Graciano, Omayma A Kishk, Jason W Custer
OBJECTIVES: To examine the impact of an ICU bundle on delirium screening and prevalence and describe characteristics of delirium cases. DESIGN: Quality improvement project with prospective observational analysis. SETTING: Nineteen-bed PICU in an urban academic medical center. PATIENTS: All consecutive patients admitted from December 1, 2013, to September 30, 2015. INTERVENTIONS: A multidisciplinary team implemented an ICU bundle consisting of three clinical protocols: delirium, sedation, and early mobilization using the Plan-Do-Study-Act cycles as part of a quality improvement project...
April 13, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28410087/racial-and-ethnic-disparities-in-parental-refusal-of-consent-in-a-large-multisite-pediatric-critical-care-clinical-trial
#15
Joanne E Natale, Ruth Lebet, Jill G Joseph, Christine Ulysse, Judith Ascenzi, David Wypij, Martha A Q Curley
OBJECTIVE: To evaluate whether race or ethnicity was independently associated with parental refusal of consent for their child's participation in a multisite pediatric critical care clinical trial. STUDY DESIGN: We performed a secondary analyses of data from Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE), a 31-center cluster randomized trial of sedation management in critically ill children with acute respiratory failure supported on mechanical ventilation...
May 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28409254/pediatric-brain-mri-part-1-basic-techniques
#16
REVIEW
Mai-Lan Ho, Norbert G Campeau, Thang D Ngo, Unni K Udayasankar, Kirk M Welker
Pediatric neuroimaging is a complex and specialized field that uses magnetic resonance (MR) imaging as the workhorse for diagnosis. Standard MR techniques used in adult neuroimaging are suboptimal for imaging in pediatrics because there are significant differences in the child's developing brain. These differences include size, myelination and sulcation. MR protocols need to be tailored to the specific indication and reviewed by the supervising radiologist in real time, and the specialized needs of this population require careful consideration of issues such as scan timing, sequence order, sedation, anesthesia and gadolinium administration...
May 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28409253/review-of-key-concepts-in-magnetic-resonance-physics
#17
REVIEW
Michael M Moore, Taylor Chung
MR physics can be a challenging subject for practicing pediatric radiologists. Although many excellent texts provide very comprehensive reviews of the field of MR physics at various levels of understanding, the authors of this paper explain several key concepts in MR physics that are germane to clinical practice in a non-rigorous but practical fashion. With the basic understanding of these key concepts, practicing pediatric radiologists can build on their knowledge of current clinical MR techniques and future advances in MR applications...
May 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28409251/advanced-imaging-techniques-in-pediatric-body-mri
#18
REVIEW
Jesse Courtier, Anil G Rao, Sudha A Anupindi
While there are many challenges specific to pediatric abdomino-pelvic MRI, many recent advances are addressing these challenges. It is therefore essential for radiologists to be familiar with the latest advances in MR imaging. Laudable efforts have also recently been implemented in many centers to improve the overall experience of pediatric patients, including the use of dedicated radiology child life specialists, MRI video goggles, and improved MR suite environments. These efforts have allowed a larger number of children to be scanned while awake, with fewer studies being done under sedation or anesthesia; this has resulted in additional challenges from patient motion and difficulties with breath-holding and tolerating longer scan times...
May 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28399933/intranasal-sedation-using-ketamine-and-midazolam-for-pediatric-dental-treatment-naso-study-protocol-for-a-randomized-controlled-trial
#19
Heloisa Sousa Gomes, Analya Rodrigues Miranda, Karolline Alves Viana, Aline Carvalho Batista, Paulo Sucasas Costa, Anelise Daher, Geovanna de Castro Morais Machado, Joji Sado-Filho, Liliani Aires Candido Vieira, Patrícia Corrêa-Faria, Marie Therese Hosey, Luciane Rezende Costa
BACKGROUND: Uncooperative children may need to receive dental treatment under sedation, which is indicated when nonpharmacological behavior guidance is unsuccessful. There are randomized controlled trials (RCTs) comparing different sedative protocols for dental procedures; however, the evidence for superiority of one form over another is weak. The primary aim of this study is to investigate the efficacy of intranasally administered ketamine plus midazolam for the dental treatment of children...
April 11, 2017: Trials
https://www.readbyqxmd.com/read/28398941/the-season-of-hoverboards-a-case-series-of-fractures
#20
Chester J Donnally, Charles M Lawrie, Augustus J Rush, Avi C Baitner
OBJECTIVE: The aim of this study was to identify the types of pediatric orthopedic extremity fractures that are sustained as a result of hoverboard (self-balancing, self-propelling, 2-wheeled boards) use. METHODS: We performed a retrospective review of all orthopedic consultations from the emergency department at our institution from December 1 to 31, 2015. Data was collected on the injury mechanism, fracture location, management, and patient characteristics including sex, age, and hand dominance...
April 11, 2017: Pediatric Emergency Care
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