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Naz R, Özyazıcıoğlu N, Kaya M. Determination of Risk Factors for Nausea and Vomiting in Children After Appendectomy. J Perianesth Nurs 2024:S1089-9472(23)01115-2. [PMID: 38573300 DOI: 10.1016/j.jopan.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 04/05/2024]
Abstract
PURPOSE This study aimed at investigating the risk factors for postoperative nausea and vomiting (PONV) in pediatric patients undergoing appendectomy. DESIGN This is a prospective, descriptive, cross-sectional study. METHODS The study involved 163 children aged 5 to 18 years who underwent appendectomy in the pediatric surgery clinic of a tertiary hospital between December 2022 and June 2023. The study data were collected through the patient information form, Baxter Retching Faces scale, and Wong-Baker Faces Pain Rating Scale, which included questions about the descriptive and clinical characteristics of the participants and was prepared by the researcher consistent with the literature. FINDINGS A significant relationship was observed between the severity of postoperative pain and the occurrence of PONV in patients with both nonperforated and perforated appendicitis (P < .001). In addition, operative time and the time to the first oral feeding were shorter in patients with nonperforated appendicitis in the non-PONV group (P = .005 and P = .042, respectively) Logistic regression analysis revealed that postoperative pain, family history of PONV and appendix perforation were risk factors for PONV in children with both nonperforated and perforated appendicitis (P < .001, P = .040, and P < .001, respectively). CONCLUSIONS In children undergoing appendectomy, family history of PONV, severity of postoperative pain, increased operative time, and increased transition time to oral feeding are risk factors for PONV. Pediatric nurses, who have an important role in the management of PONV, should evaluate patients in terms of PONV risk in the preoperative period within the scope of evidence-based practices and perform pharmacological or nonpharmacological interventions according to the degree of risk.
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Affiliation(s)
- Rüya Naz
- Pediatric Surgery Department, University of Health Sciences, Bursa Yüksek Ihtisas Research and Training Hospital, Bursa, Turkey.
| | - Nurcan Özyazıcıoğlu
- Bursa Uludağ University, Faculty of Health Sciences, Department of Pediatric Nursing, Bursa, Turkey
| | - Mete Kaya
- Pediatric Surgery Department, University of Health Sciences. Bursa Yüksek Ihtisas Research and Training Hospital, Clinic of Pediatric Surgery, Bursa, Turkey
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Sommerfield D, Sommerfield A, Evans D, Khan RN, Luke A, Vijayasekaran S, Bumbak P, Herbert H, von Ungern-Sternberg BS. Jelly snakes to reduce early postoperative vomiting in children after adenotonsillectomy: The randomized controlled snakes trial. Anaesth Crit Care Pain Med 2024; 43:101334. [PMID: 38048987 DOI: 10.1016/j.accpm.2023.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Despite the use of dual antiemetic agents, postoperative nausea and vomiting (PONV) occurs in an unacceptably large number of patients post-tonsillectomy. There has been increased interest in alternative and non-pharmacological treatments for PONV e.g., chewing gum. We investigated if chewing a large confectionary jelly snake had prophylactic antiemetic effects postoperatively in young children. METHODS Prospective, open-label randomised controlled trial of 240 patients, 2-16 years. Patients administered a confectionary jelly snake to chew postoperatively were compared with a control group. The primary outcome was the number of episodes of vomiting within 6 h of the operation on an intention-to-treat basis. SECONDARY OUTCOMES incidence of nausea, vomiting at 6 and 24 h, rescue antiemetic use, acceptability, delayed discharge. RESULTS 233 patients were randomised to receive the confectionary snake (snake group, 118) or standard care (control group, 115). The number of vomiting episodes in 6 h was similar between groups on an intention-to-treat basis, with 39 episodes across 22 (19%) patients in the control group and 31 across 19 (16%) patients in the snake group (p = 0.666). From post anaesthetic care unit until 24 h there was no difference in doses of antiemetics or delayed discharge due to PONV. A secondary as per protocol analysis did not change this result. CONCLUSIONS Chewing of confectionery jelly snakes within one hour of waking following adenotonsillectomy with vapour-maintained anaesthesia and two prophylactic antiemetics did not further reduce the incidence of early vomiting. REGISTRATION prospective registration at the Australia and New Zealand Clinical Trials Registry (ACTRN12618000637246).
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Affiliation(s)
- David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Daisy Evans
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Australia
| | - R Nazim Khan
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Department of Mathematics and Statistics, The University of Western Australia, Crawley, Australia
| | - Abigail Luke
- School of Biomedical Sciences, The University of Western Australia, Australia.
| | - Shyan Vijayasekaran
- Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, Australia
| | - Paul Bumbak
- Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, Australia
| | - Hayley Herbert
- Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia.
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Liang HH, Lu YW, Ou XX, Shi H, She YJ, Zhang MX. Effect of ice popsicle treatment on emergence agitation in children undergoing oral surgery with sevoflurane anaesthesia: A prospective randomized controlled study. J Pediatr Nurs 2023; 72:9-15. [PMID: 37030043 DOI: 10.1016/j.pedn.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE Emergence agitation is a common postoperative complication during recovery in children. The purpose of this study is to explore whether the use of ice popsicle could prevent emergence agitation in children undergoing oral surgery with sevoflurane anaesthesia. DESIGN AND METHODS In this prospective randomized controlled study, 100 children undergoing oral surgery were randomly assigned to Group 1 which received ice popsicle after emergence (intervention, n = 50) or Group 2 which received verbal encouragement from their parents (control, n = 50). The primary outcome was the 2-hour postoperative incidence of EA. RESULTS Group 1 had a significant lower incidence of emergence agitation (22% vs 58%, P < 0.001) compared with Group 2. The mean agitation score was significantly lower in Group 1 vs Group 2 at 10 minutes (1.64 vs 2.12, P = 0.024) and 20 min (1.60 vs 2.14, P = 0.004) after emergence. The peak agitation and pain scores were significantly lower in Group 1 than in Group 2 (P < 0.001). CONCLUSIONS Findings from this study suggest that ice popsicle is an effective, cheap, pleasurable, and easily administered method for alleviating emergence agitation in paediatric patients after oral surgery under general anaesthesia. These results are worthy of confirmation in other surgeries. PRACTICE IMPLICATIONS This approach is highly accepted by both children and their parents, and our findings support the effectiveness of ice popsicle in relieving emergence agitation and pain after oral surgery in children. CLINICAL TRIALS REGISTRATION Chinese Clinical Trial Registry, ChiCTR1800015634.
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Affiliation(s)
- Hui-Hong Liang
- Department of Anaesthesiology and Operation Room Nursing, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - You-Wei Lu
- Department of Anaesthesiology and Operation Room Nursing, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Xing-Xu Ou
- Department of Anaesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Hui Shi
- Institute of Paediatrics, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Ying-Jun She
- Department of Anaesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China
| | - Mei-Xue Zhang
- Department of Anaesthesiology and Operation Room Nursing, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou 510623, China.
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[Postoperative nausea and vomiting-recommendations for its prevention and therapy in paediatric medicine]. DIE ANAESTHESIOLOGIE 2023; 72:37-47. [PMID: 36602557 DOI: 10.1007/s00101-022-01248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Post-operative nausea and/or vomiting (PONV/POV) are among the biggest problems occurring in the paediatric recovery room and in the course of the following post-operative period. Apart from pain and emergence delirium, PONV is one of the main causes of post-operative discomfort in children. The DGAI Scientific Working Group on Paediatric Anaesthesia already worked out recommendations for the prevention and treatment of PONV in children years ago. These recommendations have now been revised by a team of experts, the current literature has been reviewed, and evidence-based core recommendations have been consented. Key elements of the new recommendations consist of effective individual measures for prevention and therapy, next to the implementation of a fixed dual prophylaxis in the clinical routine applicable to all children ≥ 3 years of age.
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Relationship between Fasting Times and Emergence Delirium in Children Undergoing Magnetic Resonance Imaging under Sedation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121861. [PMID: 36557062 PMCID: PMC9786080 DOI: 10.3390/medicina58121861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: This study aimed to determine whether there is a relationship between preoperative fasting time, fasting blood glucose (FBG), and postoperative emergence delirium (ED) in pediatric patients undergoing MRI under sedation. Materials and Methods: 110 pediatric patients were included in the study. Preoperative fasting (solid-fluid) time and FBG were recorded. The development of ED in the patients who underwent MRI under sedation was evaluated with the pediatric anesthesia emergence delirium (PAED) value for 30 min every 5 min in the recovery room. PAED score of ≥10 was grouped as having ED, and a PAED score of <10 as without ED at any time. The PAED scores were compared with other variables, ASA, age, weight, MRI examination time, and FBG level and fasting times. The risk factors affecting the occurrence of ED were examined. Results: Mean age was 3.94 ± 1.53 years, mean FBG was 106.97 ± 12.53 mg/dL, fasting time was 10.75 ± 2.61 h, solid food fasting time was 11.92 ± 2.33 h, and thirst time was 10.74 ± 2.58 h. FBG was never associated with PAED measurement at any time (p > 0.05). There was a weak positive correlation between the fasting time and the 0th, 5th, and 10th minute PAED score (r = 0.225; p = 0.018, r = 0.195; p = 0.041, r = 0.195; p = 0.041). There was a weak positive correlation between the solid food fasting time and the PAED score at the 0th, 5th, 10th, 15th, and 20th minutes (r = 0.382; p < 0.001, r = 0.357; p < 0.001, r = 0.345; p < 0.001, r = 0.360; p < 0.001, r = 0.240; p < 0.001). There was a weak positive correlation between thirst time and the PAED score at the 0th, 5th, and 10th minutes (r = 0.222; p = 0.020. r = 0.192; p = 0.045, r = 0.199; p = 0.037). The incidence of ED at any time was 34.5%. Conclusions: Prolonged fasting time, solid food fasting time and thirst time are risk factors for developing postoperative ED in children undergoing MRI under sedation.
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Bao K, Deng Y, Zhao X, Zhao T, Chen J, Li T, Zhu Q. Effects of liberal oral intake on postoperative outcomes after elective laparoscopic gynaecological surgery: A randomised controlled clinical trial. J Hum Nutr Diet 2022; 35:1079-1086. [PMID: 35384093 DOI: 10.1111/jhn.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Women are at risk of postoperative nausea and vomiting (PONV) after laparoscopic gynaecological surgery. Traditionally, patients who undergo laparoscopic gynaecological surgery are only allowed to initiate oral intake after return of bowel function, including bowel sounds or passage of flatus or stool. The present study was designed to assess the effect of liberal oral intake immediately after discharge from the post-anaesthesia care unit (PACU) on PONV incidence in patients who underwent elective laparoscopic gynaecological surgery. METHODS In total, 174 patients (aged 20-64 years) were randomly assigned to the traditional and liberal groups. In the traditional group, patients were allowed to initiate oral intake 6 h after discharge from the PACU. In the liberal group, patients were allowed oral intake immediately after discharge from the PACU. The primary outcome was the incidence of PONV 48 h after surgery. Secondary outcomes included ileus incidence, total dose of postoperative opiate (sufentanil) use, time to postoperative first flatus (FFL), first out-of-bed mobilisation and the duration of postoperative hospitalisation stay. RESULTS Incidence of PONV was not significantly different between both groups (32.18% vs. 33.33%, p = 0.872). Time to FFL in the liberal group was significantly shorter than that in the traditional group (14.82 ± 0.91 h vs. 17.50 ± 0.96 h, p = 0.024). The postoperative pain score at 48 h after surgery was significantly lower in the liberal group than that in the traditional group (2.48 ± 0.17 vs. 3.20 ± 0.19, p = 0.008) without an increase in sufentanil use (89.32 ± 1.02 µg vs. 89.92 ± 1.16 µg, p = 0.702). No ileus occurred in either group. When considering the time of actually return to regular diet, initiating regular diet no more than 6 h after discharge from PACU significantly shortened the time to first out-of-bed mobilisation (11.18 ± 1.01 h vs. 15.05 ± 0.70 h, p = 0.003). CONCLUSIONS Our results indicate that liberal oral intake after discharge from the PACU in patients aged 20-64 years who underwent gynaecological surgery is safe and beneficial and supports the rationale for a more liberal diet regime postoperatively.
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Affiliation(s)
- Kaibei Bao
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Yingqing Deng
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Xiaotong Zhao
- Department of Obstetrics and Gynecology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Tingting Zhao
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Jiaxin Chen
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Tian Li
- Department of Obstetrics and Gynecology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
| | - Qianqian Zhu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China
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Odendaal P, Burke A, Coetzee J. Effect of a carbohydrṇate lollipop on the gastric volume of fasted pediatric patients. Paediatr Anaesth 2022; 32:1031-1037. [PMID: 35524771 PMCID: PMC9545620 DOI: 10.1111/pan.14479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Preoperative fasting is part of routine practice. Children subjected to prolonged preoperative fasting often suffer adverse effects. Consuming a preoperative lollipop may lessen their anxiety and have clinical benefits. AIMS To assess the effect of consuming a lollipop on gastric volume and the feasibility of administering a lollipop to a child preoperatively. METHODS In this prospective, repeated measures interventional study, we measured gastric antrum volume using ultrasound in children aged 2-18 years. We measured antrum volumes after participants had fasted for a minimum of 6 h for solids and 2 h for clear fluids. They then consumed a standard carbohydrate lollipop, and we repeated the antrum volume measurements after 1 h. RESULTS Of the 38 patients enrolled, 32 completed the study; four had ingested additional food or liquid, and two were diagnosed with systemic disease the day after data collection. The gastric volume data were normally distributed. The mean volume change was 0.01 ml kg-1 (95% CI -0.02 to 0.05; p = .460). The mean postlollipop volume was 0.51 ml kg-1 (95% CI 0.43 to 0.58). CONCLUSIONS Consuming a standard lollipop did not affect the gastric volume of fasted pediatric patients.
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Affiliation(s)
- Pieter Odendaal
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
| | - Annemie Burke
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
| | - Johan Coetzee
- Department of Anesthesiology and Critical Care, Tygerberg Academic HospitalUniversity of StellenboschParowSouth Africa
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Röher K, Fideler F. [Perioperative Complications in Pediatric Anesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:563-576. [PMID: 36049740 DOI: 10.1055/a-1690-5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Perioperative complications are more frequent in younger children, especially under the age of 3 years and in infants. The anatomy and physiology of children cause more respiratory adverse events compared to adult patients. Respiratory adverse events account for 60% of all anesthetic complications. Main risk factors for respiratory adverse events are upper respiratory tract infections. Keeping the airway management as noninvasive as possible helps prevent major complications.Perioperative hypotension can compromise cerebral oxygenation, especially when hypocapnia and anemia are present. Congenital heart disease leads to a higher cardiovascular adverse event rate and should be diagnosed preoperatively whenever possible.Venous and arterial cannulation is more challenging in children and complications are more frequent even for experienced practitioners. Ultrasound is an essential tool for peripheral venous access as well as for central venous catheterization.Medication errors are more common in pediatric than in adult patients. Charts and electronic calculation of dosing can increase safety of prescriptions. Standardized storage of medications at all workplaces, avoiding look-alike medications in the same compartment and storing high-risk medications separately help prevent substitution errors.Emergence delirium and postoperative nausea and vomiting (PONV) are the most frequent postoperative adverse events. For diagnosing emergence delirium, the PAED scale is a helpful tool. Prevention of emergence delirium by pharmacological and general measures plays a key role for patient outcome. Routine prophylaxis of PONV above the age of 3 years is recommended.Frequency and severity of perioperative adverse events in pediatric anesthesia can be reduced by using algorithms and defined processes to allow for structured actions. Efficient communication and organization are mainstays for utilizing all medical options to reduce the risk of complications.
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Beels M, Stevens S, Saldien V. Perioperative fluid management in children: an updated review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.3.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Perioperative fluid management in children has been a major topic for debate.
Objectives: Our aim is to review the current evidence on perioperative fluid management in children including: type of fluid, administration rates, preoperative fluid intake and monitoring techniques.
Design: Narrative review.
Method: Following the PRISMA-S guidelines we performed a search (2010-March 2022) in databases Medline (through PubMed) and Cochrane Library. 4297 citations were found and screened by two independent researchers. After screening, 64 articles were withheld for our review.
Results: The perioperative administration of isotonic fluids is safer than hypotonic solutions, concerning the development of hyponatremia. A balanced isotonic solution with 1-2,5% glucose should be used as perioperative maintenance IV fluid in children (1 month to 18 years). Colloids can be used in children when inadequate effect in volume correction is achieved with crystalloids. The preferred synthetic colloid for children is a third generation HES in a balanced solution. To date, most clinicians use the “4-2-1 rule” for calculating fluid rate. This may not be the optimal fluid rate, as little research has been done. Preoperative fasting for clear fluids should be limited to 1 hour, children should even be encouraged to drink up until 1 hour before induction. Respiratory variation of aortic blood flow peak velocity (ΔVpeak) with echocardiography is currently the most reliable technique for evaluating fluid responsiveness in children.
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Abstract
OBJECTIVE A gap between clinical practice and evidence is common. The present multicentre study was designed to explore the actual postoperative fasting practice, including the instructed fasting time from the ward staff and the actual postoperative fasting time. DESIGN Multicentre survey. SETTING Four tertiary hospitals in Shenzhen City, China. PARTICIPANTS A total of 988 patients completed a survey on instructed and actual postoperative fasting. OUTCOMES All patients received postoperative instructed fasting time from the ward staff. The median instructed fasting time for fluids from ward staff was 6 hours (IQR, 4-6 hours), and the median instructed fasting time for solid food was also 6 hours (IQR 5-6 hours) after surgery. The actual postoperative fasting time, including fluid and solid food intake, was significantly longer than the time recommended by the ward staff (both p<0.001). RESULTS The median time to postoperative first flatus (FFL) was 16.5 hours (IQR 8-25.5 hours), and the median time to postoperative first faeces (FFE) was 41 hours (IQR 25-57 hours). The fasting time was significantly shorter than the time to FFL and the time to FFE, regardless of surgery type or anaesthesia type (all p<0.001). Postoperative nausea and vomiting (PONV) occurred in 23.6% of patients. After surgery, 58.70% of patients reported thirst, and 47.47% reported hunger. No ileus occurred. CONCLUSION Approximately half of the patients reported thirst and hunger postoperatively. Patients initiated oral intake earlier than the time to FFL or FFE without increasing serious complications. This study may support the rationale for interventions targeting postoperative oral intake time in future studies.
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Affiliation(s)
- Lifei Lai
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Lianghua Zeng
- Department of Anesthesiology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Zhijing Yang
- Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen, China
| | - Yingling Zheng
- Department of Anesthesiology, Integrated Traditional Chinese and Western Medicine Hospital, Shenzhen, China
| | - Qianqian Zhu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Ying Y, Xu HZ, Han ML. Enhanced recovery after surgery strategy to shorten perioperative fasting in children undergoing non-gastrointestinal surgery: A prospective study. World J Clin Cases 2022; 10:5287-5296. [PMID: 35812657 PMCID: PMC9210880 DOI: 10.12998/wjcc.v10.i16.5287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/02/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery strategies are increasingly implemented to improve the management of surgical patients.
AIM To evaluate the effects of new perioperative fasting protocols in children ≥ 3 mo of age undergoing non-gastrointestinal surgery.
METHODS This prospective pilot study included children ≥ 3 mo of age undergoing non-gastrointestinal surgery at the Children’s Hospital (Zhejiang University School of Medicine) from January 2020 to June 2020. The children were divided into either a conventional group or an ERAS group according to whether they had been enrolled before or after the implementation of the new perioperative fasting strategy. The children in the conventional group were fasted using conventional strategies, while those in the ERAS group were given individualized fasting protocols preoperatively (6-h fasting for infant formula/non-human milk/solids, 4-h fasting for breast milk, and clear fluids allowed within 2 h of surgery) and postoperatively (food permitted from 1 h after surgery). Pre-operative and postoperative fasting times, pre-operative blood glucose, the incidence of postoperative thirst and hunger, the incidence of perioperative vomiting and aspiration, and the degree of satisfaction were evaluated.
RESULTS The study included 303 patients (151 in the conventional group and 152 in the ERAS group). Compared with the conventional group, the ERAS group had a shorter pre-operative food fasting time [11.92 (4.00, 19.33) vs 13.00 (6.00, 20.28) h, P < 0.001), shorter preoperative liquid fasting time [3.00 (2.00, 7.50) vs 12.00 (3.00, 20.28) h, P < 0.001], higher preoperative blood glucose level [5.6 (4.2, 8.2) vs 5.1 (4.0, 7.4) mmol/L, P < 0.001], lower incidence of thirst (74.5% vs 15.3%, P < 0.001), shorter time to postoperative feeding [1.17 (0.33, 6.83) vs 6.00 (5.40, 9.20), P < 0.001], and greater satisfaction [7 (0, 10) vs 8 (5, 10), P < 0.001]. No children experienced perioperative aspiration. The incidences of hunger, perioperative vomiting, and fever were not significantly different between the two groups.
CONCLUSION Optimizing fasting and clear fluid drinking before non-gastrointestinal surgery in children ≥ 3 mo of age is possible. It is safe and feasible to start early eating after evaluating the recovery from anesthesia and the swallowing function.
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Affiliation(s)
- Yan Ying
- Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
| | - Hong-Zhen Xu
- Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
| | - Meng-Lan Han
- Department of General Surgery, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang Province, China
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Prevalência e intensidade da sede de crianças no pós-operatório imediato. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao02931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pre-operative fasting in children: A guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol 2022; 39:4-25. [PMID: 34857683 DOI: 10.1097/eja.0000000000001599] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes for many years and have not altered much in the last decades. Recent publications have employed more liberal fasting regimes with no evidence of increased aspiration or regurgitation rates. In this first solely paediatric European Society of Anaesthesiology and Intensive Care (ESAIC) pre-operative fasting guideline, we aim to present aggregated and evidence-based summary recommendations to assist clinicians, healthcare providers, patients and parents. We identified six main topics for the literature search: studies comparing liberal with conservative regimens; impact of food composition; impact of comorbidity; the use of gastric ultrasound as a clinical tool; validation of gastric ultrasound for gastric content and gastric emptying studies; and early postoperative feeding. The literature search was performed by a professional librarian in collaboration with the ESAIC task force. Recommendations for reducing clear fluid fasting to 1 h, reducing breast milk fasting to 3 h, and allowing early postoperative feeding were the main results, with GRADE 1C or 1B evidence. The available evidence suggests that gastric ultrasound may be useful for clinical decision-making, and that allowing a 'light breakfast' may be well tolerated if the intake is well controlled. More research is needed in these areas as well as evaluation of how specific patient or treatment-related factors influence gastric emptying.
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A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost. Plast Reconstr Surg 2021; 147:978e-989e. [PMID: 34019509 DOI: 10.1097/prs.0000000000007987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigates the associations between local anesthesia practice and perioperative complication, length of stay, and hospital cost for palatoplasty in the United States. METHODS Patients undergoing cleft palate repair between 2004 and 2015 were abstracted from the Pediatric Health Information System database. Perioperative complication, length of stay, and hospital cost were compared by local anesthesia status. Multiple logistic regressions controlled for patient demographics, comorbidities, and hospital characteristics. RESULTS Of 17,888 patients from 49 institutions who met selection criteria, 8631 (48 percent), 4447 (25 percent), and 2149 (12 percent) received epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone, respectively. The use of epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with decreased perioperative complication [adjusted OR, 0.75 (95 percent CI, 0.61 to 0.91) and 0.63 (95 percent CI, 0.47 to 0.83); p = 0.004 and p = 0.001, respectively]. Only bupivacaine- or ropivacaine-alone recipients experienced a significantly reduced risk of prolonged length of stay on adjusted analysis [adjusted OR, 0.71 (95 percent CI, 0.55 to 0.90); p = 0.005]. Risk of increased cost was reduced in users of any local anesthetic (p < 0.001 for all). CONCLUSIONS Epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with reduced perioperative complication following palatoplasty, while only the latter predicted a decreased postoperative length of stay. Uses of epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone were all associated with decreased hospital costs. Future prospective studies are warranted to further delineate the role of local anesthesia in palatal surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Abstract
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA.
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Nutan, Verma VK, Singh S, Thakur VK. Early post-operative oral fluid intake in paediatric surgery under general anaesthesia: A randomised controlled clinical study. Indian J Anaesth 2020; 64:979-981. [PMID: 33487684 PMCID: PMC7815012 DOI: 10.4103/ija.ija_407_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/28/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nutan
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vinod K Verma
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Swati Singh
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vinit K Thakur
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Gupta A, Sen I, Bhardwaj N, Yaddanapudi S, Mathew PJ, Sahni N, Bhatia A. Prospective audit of sedation/anesthesia practices for children undergoing computerized tomography in a tertiary care institute. J Anaesthesiol Clin Pharmacol 2020; 36:156-161. [PMID: 33013027 PMCID: PMC7480298 DOI: 10.4103/joacp.joacp_16_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/25/2019] [Accepted: 09/03/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: The aim of the study was to enumerate the sedative drugs used, assess the efficacy of sedative drugs, and determine the incidence of adverse events. Material and Methods: A prospective audit of children sedated for computerized tomography (CT) by anesthesiology team was conducted for a period of 4 months. The data included patient demographic variables, fasting period, medications administered, adequacy of sedation, imaging characteristics, adverse events, and requirement for escalated care. Results: A total of 331 children were enrolled for sedation by the anesthesia team. The drugs used for sedation were propofol, ketamine, and midazolam. Twenty-two percent children received one sedative drug, 60% children were administered two drugs, and 5% children required a combination of all three drugs for successful sedation. Sedation was effective for successful conduct of CT scan in 95.8% patients without the requirement of a repeat scan. Twelve (5%) children experienced adverse events during the study period. However, none of the adverse events necessitated prolonged postprocedural hospitalization or resulted in permanent neurologic injury or death. Conclusions: The current practice of sedation with propofol, ketamine, and midazolam, either single or in combination was efficacious in a high percentage of patients. The incidence of adverse events during the study period was low.
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Affiliation(s)
- Aakriti Gupta
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Sen
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J Mathew
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeru Sahni
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res 2020; 9. [PMID: 32913634 PMCID: PMC7429924 DOI: 10.12688/f1000research.21832.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/10/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,The White Mountain Institute, The Sea Ranch, Sonoma, CA, 95497, USA.,Instituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine-UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90095, USA
| | - Hillenn Cruz Eng
- Department of Anesthesiology, PennState Hershey Medical Center, Hershey, PA, 17033, USA
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Pierotti I, Nascimento LAD, Rossetto EG, Furuya RK, Fonseca LF. Elaboration, validation and reliability of the safety protocol for pediatric thirst management. Rev Lat Am Enfermagem 2020; 28:e3321. [PMID: 32696920 PMCID: PMC7365611 DOI: 10.1590/1518-8345.3333.3321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: to elaborate, validate and evaluate the reliability of the Safety Protocol
for Pediatric Thirst Management in the immediate postoperative period. Method: methodological quantitative research, based on the assumptions on measurement
instrument development. The protocol was elaborated after literature review,
interview with specialists and observation of the child’s anesthetic
recovery. The judges performed theoretical validation through apparent,
semantic and content analysis. Content Validity Index was calculated for
content validation, whose minimum established concordance was 0.80.
Protocol’s reliability was evaluated in children between three and 12 years
old in the Post Anesthesia Care Unit. Results: in its final version, the protocol consisted of five evaluation criteria:
level of consciousness, movement, airway protection, breathing pattern and
nausea and vomiting. It presented easy comprehension and relevant content,
and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses
applied the protocol 116 times to 58 children, resulting in a high
reliability index (kappa general = 0.98) Conclusion: the unprecedented protocol developed is valid and is a useful tool for use in
anesthetic recovery, aiming to assess safety for reducing the thirst of
infant patients.
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Affiliation(s)
- Isadora Pierotti
- Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | | | | | | | - Lígia Fahl Fonseca
- Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, PR, Brazil
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Dongare PA, Bhaskar SB, Harsoor SS, Garg R, Kannan S, Goneppanavar U, Ali Z, Gopinath R, Sood J, Mani K, Bhatia P, Rohatgi P, Das R, Ghosh S, Mahankali SS, Singh Bajwa SJ, Gupta S, Pandya ST, Keshavan VH, Joshi M, Malhotra N. Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J Anaesth 2020; 64:556-584. [PMID: 32792733 PMCID: PMC7413358 DOI: 10.4103/ija.ija_735_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Pradeep A Dongare
- Assistant Professor, Department of Anaesthesiology, ESIPGIMSR, Bengaluru, India
| | - S Bala Bhaskar
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, India
| | - S S Harsoor
- Professor, Department of Anaesthesiology, Dr BR Ambedkar Medical College and Hospital, Bengaluru, India
| | - Rakesh Garg
- Additional Professor, Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Sudheesh Kannan
- Professor, Department of Anaesthesiology, BMCRI, Bengaluru, India
| | - Umesh Goneppanavar
- Professor, Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India
| | - Zulfiqar Ali
- Associate Professor, Department of Anesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ramachandran Gopinath
- Professor and Head,Department of Anaesthesiology and Intensive Care, ESIC Medical College and Hospital, Hyderabad, India
| | - Jayashree Sood
- Honorary. Joint Secretary, Board of Management, Chairperson, Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Kalaivani Mani
- Scientist IV, Department of Biostatistics, AIIMS, New Delhi, India
| | - Pradeep Bhatia
- Professor and Head, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rekha Das
- Professor and Head, Department Anaesthesiology, Critical care and Pain, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, India
| | - Santu Ghosh
- Assistant Professor, Department of Biostatistics, St John's Medical College, Bengaluru, India
| | | | - Sukhminder Jit Singh Bajwa
- Professor and Head, Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Punjab, India
| | - Sunanda Gupta
- Professor and Head, Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, India
| | - Sunil T Pandya
- Chief of Anaesthesia and Surgical ICU, AIG Hospitals, Hyderabad, India
| | - Venkatesh H Keshavan
- Senior Consultant and Chief, Department of Neuroanaesthesia and Critical Care, Apollo Hospitals, Bengaluru, India
| | - Muralidhar Joshi
- Head, Department of Anaesthesia and Pain Medicine, Virinchi Hospitals, Hyderabad, India
| | - Naveen Malhotra
- Professor, Department of Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS, Haryana, India
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Ames WA, Machovec K. An update on the management of PONV in a pediatric patient. Best Pract Res Clin Anaesthesiol 2020; 34:749-758. [PMID: 33288124 DOI: 10.1016/j.bpa.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/27/2022]
Abstract
Postoperative nausea and vomiting (PONV) is a major cause of patient dissatisfaction following anesthesia. The difficulty in diagnosing nausea in much of the pediatric population has led to an emphasis on anti-emetic prophylaxis for all. Assessment scores and prognostic tools enable the anesthesiologist to identify patients who are at a greater risk and appropriately apply more aggressive prophylactic, multi-drug strategies. New antiemetics emerging from other medical disciplines, particularly oncology, may have potential use in prophylaxis and treatment of nausea and vomiting in the pediatric surgical population. New agents, many of which have a long duration of action, will augment the anesthesiologist's ability to adequately prevent PONV, and to treat persistent nausea and vomiting that extend beyond the immediate post-operative period.
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Affiliation(s)
- Warwick Aubrey Ames
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Kelly Machovec
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
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Evaluation of a Safety Protocol for the Management of Thirst in the Postoperative Period. J Perianesth Nurs 2019; 35:193-197. [PMID: 31864832 DOI: 10.1016/j.jopan.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To associate medications, anesthetic techniques, and clinical conditions that interfere in the time of patient approval in the safety protocol for thirst management. DESIGN A quantitative, analytical, and longitudinal study conducted in Southern Brazil. METHODS A nonprobabilistic sample, of 203 adult patients in the immediate postoperative period, evaluated every 15 minutes for 1 hour. FINDINGS A general prevalence of thirst of 67.7%, and mean intensity of 6.38. Fentanyl, morphine, rocuronium, and sevoflurane increased lack of approval in the protocol within 30 minutes (P < .05). General anesthesia (P < .0001) and level of consciousness (95.4%) presented the highest nonapproval rates. CONCLUSIONS Anesthetics and general anesthesia delayed protocol approval; however, after 30 minutes, 75.4% of patients had been approved. Level of consciousness was the main criterion of disapproval. The protocol identified crucial clinical conditions that made it impossible for the patient to receive thirst relief strategies and demonstrated that thirst can be satiated precociously with safety.
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Abstract
Preprocedural/preoperative fasting is a key part of preparing a patient for undergoing sedation or anaesthesia to minimise the risk of pulmonary aspiration of gastric contents. As part of caring for elective surgical patients it is important that healthcare staff in the perioperative environment have a good understanding of both the current guidelines and underpinning evidence so that they can effectively manage preoperative patients. This article looks to summarise the latest guidelines regarding perioperative fasting for adult and paediatric patients, the underlying evidence behind these guidelines and finally review current literature which will inform future practice. This article therefore looks to reinforce best practice, to ensure that the safety and comfort of patients in the perioperative period is optimised.
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Affiliation(s)
- Mark Dorrance
- Department of Anaesthesia Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - Michael Copp
- Department of Anaesthesia Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
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Abstract
PURPOSE OF REVIEW The composition and type of intravenous fluids during paediatric anaesthesia have been subjects of debates for decades. Errors in perioperative fluid management in children may lead to serious complications and a negative outcome. Therefore, in this review, historical and recent developments and recommendations for perioperative fluid management in children are presented, based on physiology and focused on safety and efficacy. RECENT FINDINGS Optimized fasting times and liberal clear fluid intake until 1 h improve patient comfort and metabolic and haemodynamic condition after induction of anaesthesia. Physiologically composed balanced isotonic electrolyte solutions are safer than hypotonic electrolyte solutions or saline 0.9% to protect young children against the risks of hyponatraemia and hyperchloraemic acidosis. For intraoperative maintenance infusion, addition of 1-2% glucose is sufficient to avoid hypoglycaemia, lipolysis or hyperglycaemia. Modified fluid gelatine or hydroxyethyl starch in balanced electrolyte solution can safely be used to quickly normalize blood volume in case of perioperative circulatory instability and blood loss. SUMMARY Physiologically composed balanced isotonic electrolyte solutions are beneficial for maintaining homeostasis, shifting the status more towards the normal range in patients with preexisting imbalances and have a wide margin of safety in case of accidental hyperinfusion.
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Yamashita K, Kibe T, Ohno S, Uchino M, Higa Y, Niiro A, Nakamura N, Sugimura M. Time to Recovery of Feeding After Alveolar Bone Graft Is Associated With Postoperative Nausea and Vomiting Within 2 Hours in Children. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519855387. [PMID: 31236013 PMCID: PMC6572887 DOI: 10.1177/1179556519855387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
Objective: To examine the relationship between the method of anesthesia for alveolar bone graft surgery and postoperative nausea and vomiting (PONV) based on the difference in surgical timing and to assess factors related to the postoperative quality of life. Design: Retrospective observational study. Setting: Hospital. Participants: Patients with cleft lip and palate who underwent alveolar bone graft surgery under general anesthesia. The subjects were divided into two groups based on surgical timing: secondary bone graft (SBG) and late secondary bone graft (LSBG) groups. Main Outcome Measures: Relationship between time to recovery of feeding and the types of anesthesia, PONV, and postoperative pain period. Results: The mean patient age was 9.97 ± 1.33 years in the SBG group and 15.39 ± 0.31 years in the LSBG group. In the SBG group, patients who were administered fentanyl or remifentanil had significantly higher incidence of PONV than those who were not administered these drugs. In the SBG group, the time to recovery of feeding was significantly longer in patients experiencing PONV within 2 hours or that lasted for 24 hours than in those without PONV. In the LSBG group, there was no significant difference regarding any of the above factors. Conclusions: Our results suggest that the occurrence of PONV within 2 hours or lasting for 24 hours postoperatively in school-age children prolonged the time to recovery of feeding. This indicates that the time to recovery of feeding can be predicted based on the occurrence of PONV within the first 2 hours.
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Affiliation(s)
- Kaoru Yamashita
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Toshiro Kibe
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Sachi Ohno
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Minako Uchino
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yurina Higa
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ayako Niiro
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Norifumi Nakamura
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsutaka Sugimura
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Developmental Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Continuous caudal epidural analgesia and early feeding in delayed bladder exstrophy repair: a nine-year experience. J Pediatr Urol 2019; 15:76.e1-76.e8. [PMID: 30600203 DOI: 10.1016/j.jpurol.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/27/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Children undergoing primary closure of bladder exstrophy experience blood loss and significant fluid shifts and require protracted periods of postoperative immobilization to avoid compromising the repair. Suboptimal anxiolysis and pain management is associated with increased morbidity. There is a lack of consensus on the optimal analgesic technique and studies have not previously described analgesic management in delayed bladder exstrophy closure. In exstrophy management, opioid infusions and benzodiazepine sedation are commonplace but are associated with dose-dependent respiratory and gastrointestinal side-effects. We present nine years of caudal epidural anaesthesia in delayed bladder exstrophy repair and describe its facilitation of early extubation and early feeding (within 12 h) without surgical complication. METHODS We retrospectively evaluated consecutive infants with classic bladder exstrophy undergoing delayed primary closure with anterior pelvic osteotomies between November 2007 and January 2016. Outcomes and complications were evaluated in terms of postoperative comfort (using the FLACC score-Face, Legs, Activity, Cry, Consolability), epidural failure rate, re-intubation rate and gastrointestinal complications. RESULTS Forty-four infants had average age of 5.8 months (range 1.6-17.1 months) and weight of 7.0 kg (range 3.5-11.8 kg), and their duration of surgery was 9.5 h (range 6.9-14.3 h). Forty-two of 44 (95.5%) patients received caudal epidural catheters. At 24 h, 15 of 42 (35.7%) caudal epidurals required supplementation with intravenous opioids. Fewer patients with optimally functioning epidurals required postoperative ventilation (1/27 [3.7%] compared with 3/15 [20.0%]). None of the patients with caudal epidural catheters required re-intubation. Pain scores were lower in infants with isolated caudal epidurals catheters than those with caudal epidurals supplemented by intravenous opioids (day 1 [18 vs 53; P = 0.008]; day 2 [8 vs 15; P > 0.05] and overall [32 vs 65; P = 0.014]). Infants with intravenous opioids experienced higher complications: pruritus (25% [95% confidence interval {CI}: 5%-57%] vs 0% [95% CI: 0%-13%]; P = 0.026) and nausea and vomiting (25% [95% CI: 5%-57%] vs 8% [95% CI: 1%-25%]; P = 0.30) requiring treatment. Nineteen of 44 (43.1%) infants were fed early (within 12 h of surgery). Infants who were fed early had lower pain scores than infants feeding late (day 1 [17.5 vs 31; P > 0.05]; day 2 [5.5 vs 15; P = 0.045]; overall [26 vs 55.5; P = 0.015]) without increase in complications (nausea and vomiting [6.3% vs 20.0%; P = 0.06]; ileus [0.0% vs 0.0%]; aspiration [0.0% vs 0.0%] and re-intubation aspiration [0.0% vs 0.0%]). CONCLUSIONS Caudal epidural analgesia facilitates postoperative extubation in infants undergoing delayed exstrophy repair. Early feeding (within the first 12 h) in delayed bladder exstrophy repair is likely to improve patient comfort and consolability without increasing the incidence of gastrointestinal complications. Intravenous opioid may be associated with increased postoperative complications that may influence peri-operative outcomes.
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Khanna P, Saini K, Sinha R, Nisa N, Kumar S, Maitra S. Correlation between duration of preoperative fasting and emergence delirium in pediatric patients undergoing ophthalmic examination under anesthesia: A prospective observational study. Paediatr Anaesth 2018; 28:547-551. [PMID: 29752842 DOI: 10.1111/pan.13381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preoperative fasting in children can cause anxiety, which may ultimately lead to postoperative emergence delirium. However, no data are available whether duration of preoperative fasting correlates with postoperative emergence delirium. AIMS The aim of this study was to identify if there is any correlation between the duration of preoperative fasting and emergence delirium in children undergoing ophthalmic examination under anesthesia. METHODS In this prospective observational study, 100 children between the age group 2-6 years of American Society of Anesthesiologists physical status I or II, scheduled for examination of the eye under general anesthesia with sevoflurane were recruited. Data regarding preoperative fasting was recorded and presence of emergence delirium was assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5 minute interval till 30 minutes from the time of leaving the operation theater. No premedication was used in any patients but parental presence was allowed in all of them. RESULTS Mean (standard deviation) duration of fasting to clear liquid was 6.3 (1.7) hrs. Twenty-four children (24%) had at least 1 recorded PAED score >10 at any time point in the postoperative period. PAED scores at 15 and 25 minutes were significantly correlated with duration of fasting (r2 [95% CI] = .24 [0.04, 0.41], P = .02, Pearsons's correlation and r2 [95% CI] = .23 [0.04, 0.41], P = .02, Pearsons's correlation, respectively). No correlation has been found between duration of fasting and blood glucose level (r2 [95% CI] = -.05 [-0.24, 0.15], P = .65, Pearsons's correlation) between fasting blood glucose and PAED score at any time point. CONCLUSION Increased preoperative fasting duration may be a risk factor for postoperative emergence delirium in children undergoing ophthalmic examination under general anesthesia.
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Affiliation(s)
- Puneet Khanna
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kulbhushan Saini
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Sinha
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Niseville Nisa
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shailendra Kumar
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Frykholm P, Schindler E, Sümpelmann R, Walker R, Weiss M. Preoperative fasting in children: review of existing guidelines and recent developments. Br J Anaesth 2018; 120:469-474. [DOI: 10.1016/j.bja.2017.11.080] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/09/2017] [Accepted: 08/12/2017] [Indexed: 12/11/2022] Open
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