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Zhou D, Wang LK, Wu HY, Xiong GL, Yang XD. Lidocaine Spray for Acute Postsurgical Pain Control After Posterior Pharyngeal Flap Surgery. Laryngoscope 2024; 134:2438-2443. [PMID: 37991177 DOI: 10.1002/lary.31182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/03/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES This study evaluated the use of lidocaine spray for acute postsurgical pain control after posterior pharyngeal flap surgery. METHODS Fifty patients aged 4 to 14 years who were scheduled to undergo elective posterior pharyngeal flap surgery were randomized to receive 2.4% lidocaine spray (Group L) or an identical volume of placebo spray (Group C) on the surgical field at the end of the surgery. The primary outcome was the maximum postoperative pain score in the postanesthesia care unit. RESULTS The maximum pain score in Group L was significantly lower than that in Group C (p = 0.001). The incidence of moderate-to-severe pain in the postanesthesia care unit was significantly lower in Group L than that in Group C (p < 0.001). In the postanesthesia care unit, more patients in Group C were prescribed rescue analgesics (p < 0.001). The time to the first rescue analgesic was also significantly shorter in Group L (p < 0.001). The incidence and maximum score of emergence agitation were lower in Group L than in Group C. Compared with Group C, Group L showed earlier postoperative fluid intake (p = 0.001). Moreover, the score for parental satisfaction with pain control was higher in Group L than in Group C (p < 0.001). CONCLUSIONS Our findings indicated that the use of 2.4% lidocaine aerosol spray on the surgical site at the end of the surgery could produce good analgesia for acute postoperative pain, reduce the incidence and severity of EA, and shorten the time to restore fluid intake. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2438-2443, 2024.
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Affiliation(s)
- Dan Zhou
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Li-Kuan Wang
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Hai-Yin Wu
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Guo-Li Xiong
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Xu-Dong Yang
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
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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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Messerer B, Stijic M, Sandner-Kiesling A, Brillinger JM, Helm J, Scheer J, Strohmeier CS, Avian A. Is PONV still a problem in pediatric surgery: a prospective study of what children tell us. Front Pediatr 2023; 11:1241304. [PMID: 37964809 PMCID: PMC10642485 DOI: 10.3389/fped.2023.1241304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Postoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies. Methods A prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey. Results On the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8-19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9-11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1-1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5-4.4) and diclofenac (OR 2.0, 95% CI: 1. 3-3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9-4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7-11.6). Conclusions The main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.
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Affiliation(s)
- Brigitte Messerer
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Marko Stijic
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- University Clinic for Neurology, Clinical Department for Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Andreas Sandner-Kiesling
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Johanna M. Brillinger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jasmin Helm
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jacqueline Scheer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Christof Stefan Strohmeier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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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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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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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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Thomasseau A, Rebollar Y, Dupuis M, Marschal N, Mcheik J, Debaene B, Frasca D, Boisson M. Observance of preoperative clear fluid fasting in pediatric anesthesia: oral and written information versus text message information. A before-and-after study. Paediatr Anaesth 2021; 31:557-562. [PMID: 33523536 DOI: 10.1111/pan.14145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Prolonged fasting before surgery is common in pediatrics. In the literature, it is responsible for hypotension, irritability and postoperative nausea and vomiting. Despite clear instructions given during the preanesthetic consultation, fasting rules are respected in only 30%-40% of cases. We aimed to evaluate the benefit of sending a text message the day before surgery to improve the parents' observance of fasting rules. METHODS We conducted a before-and-after study at the University Hospital of Poitiers. From August to October 2018, 172 parents of children under 15 years of age scheduled for all types of surgery were enrolled into two groups according to the period: the control group with parents receiving information on preoperative fasting rules during the preanesthetic consultation several days before surgery, and the text message group, receiving the same information during consultation plus a text message the day before the surgery. RESULTS There was a difference in observance of clear fluid fasting instructions (between 2 and 3 h before the admission at hospital) in favor of the text message group 33% versus 92% OR 29.2 (10.9-95.2) p < 0.001, and in average fasting time for clear fluids 8.7 h ± 4.8 h vs. 4.3 h ± 2.4 h (p < 0.001). CONCLUSION Sending of a reminder text message to the parents the day before the surgery resulted in a significant increase in observance of fasting rules in children undergoing scheduled surgery.
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Affiliation(s)
- Alexandre Thomasseau
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Yohann Rebollar
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Maxime Dupuis
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Nathalie Marschal
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France
| | - Jiad Mcheik
- Service médico-chirurgical de pédiatrie, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Bertrand Debaene
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Denis Frasca
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Matthieu Boisson
- Service d'anesthésie-réanimation et médecine périopératoire, CHU de Poitiers, Poitiers cedex, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
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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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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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Ford C, McCormick D, Parkosewich J, Derycke-Chapman K, Marshall J, Mancarella J, Chepulis A. Safety and Effectiveness of Early Oral Hydration in Patients After Cardiothoracic Surgery. Am J Crit Care 2020; 29:292-300. [PMID: 32607569 DOI: 10.4037/ajcc2020841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients fast after cardiothoracic surgery because of concerns for nausea, vomiting, dysphagia, and aspiration pneumonia; fasting, however, causes thirst, a distressing symptom. To our knowledge, no studies exist to guide hydration practices in this population. OBJECTIVE To determine the effect of early oral hydration on adverse events and thirst in patients after cardiothoracic surgery. METHODS This study applied a prospective 2-group design in which 149 patients from an 18-bed cardiothoracic intensive care unit were randomized to either usual care (a 6-hour fast) or early oral hydration after extubation. The research protocol involved nurses evaluating patients' readiness for oral hydration and then offering them ice chips. If patients tolerated the ice chips, they were allowed to drink water 1 hour later. RESULTS Most patients (91.3%) had undergone coronary artery or valve surgery, or both. Demographic and clinical variables were similar in both groups. No significant between-group differences were found for the incidence of nausea, vomiting, or dysphagia, and no aspiration pneumonia occurred. Significantly more patients with a high thirst level were in the usual care group (81.2%) than in the early oral hydration group (56.5%; P = .002, r2 test). After adjustment for demographic and clinical variables by using logistic regression, early oral hydration was independently and negatively associated with a high thirst level (odds ratio, 0.30 [95% CI, 0.13-0.69]; P = .004). CONCLUSION This research provides new evidence that oral hydration (ice chips and water) soon after extubation is safe and significantly reduces thirst in particular patients.
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Affiliation(s)
- Catherine Ford
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Donna McCormick
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Janet Parkosewich
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Katrien Derycke-Chapman
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Judith Marshall
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Jessica Mancarella
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Anne Chepulis
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
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12
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Abstract
Enhanced recovery after surgery (ERAS) protocols are widely established in adult urology, especially for cystectomies and procedures involving the (small) bowel. However, data concerning pediatric surgery and pediatric urologic surgery are scarce. Individual items of ERAS protocols have been well-studied and significant benefits have also been shown for children without increased risk of complications. In a number of small series the safety and efficacy of implementing ERAS protocols have been reported recently. A broad consensus and a guideline for a common pediatric ERAS protocol is not yet available.
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Li C, Shao H, Huang S, Zhang T, Su X, Zhu S. Effects of an Individualized Fasting Program on Fasting Time and Comfort in Infants and Young Children During the Perioperative Period. J Perianesth Nurs 2020; 35:326-330. [PMID: 31973960 DOI: 10.1016/j.jopan.2019.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/17/2019] [Accepted: 08/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The study was designed to evaluate the effect of an individualized fasting program on fasting time and comfort in infants and young children during the perioperative period. DESIGN A quasiexperimental design was used. METHODS The study included 675 children (intervention = 353, control = 322). Data collection tools included Characteristics of Children Form and the Infant Hunger Rating Scale. The fasting program included individualized fasting education and fasting in batches. On the day of the operation, clear liquids were fed 2 hours before surgery and refed after the patient woke after surgery. FINDINGS The duration of perioperative fasting and the time to refeeding were shorter, the hunger scores were lower in the intervention group than those in the control group (P < .05). There was no difference in the incidence of vomiting between the two groups (P > .05), and no coughing and bloating occurred. CONCLUSIONS The fasting program for infants and young children can shorten the duration of fasting and can reduce the degree of hunger. This program is safe and feasible.
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Affiliation(s)
- Canping Li
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China.
| | - Hanqing Shao
- Department of Respiratory, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Shoujiang Huang
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Tingting Zhang
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Xiaohua Su
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Shuangping Zhu
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
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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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Haid B, Karl A, Koen M, Mottl W, Haid A, Oswald J. Enhanced Recovery after Surgery Protocol for Pediatric Urological Augmentation and Diversion Surgery Using Small Bowel. J Urol 2018; 200:1100-1106. [DOI: 10.1016/j.juro.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Alexander Karl
- Department of Urology, Ludwig Maximilians University, Munich, Germany
| | - Mark Koen
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Wolfgang Mottl
- Department of Anesthesiology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Anton Haid
- Department of General and Thoracic Surgery, Feldkirch General Hospital, Feldkirch, Austria
| | - Josef Oswald
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
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Efune PN, Minhajuddin A, Szmuk P. Incidence and factors contributing to postdischarge nausea and vomiting in pediatric ambulatory surgical cases. Paediatr Anaesth 2018; 28:257-263. [PMID: 29436139 DOI: 10.1111/pan.13333] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known regarding the incidence and contributing factors of postdischarge nausea and vomiting in children. AIMS The aim of this study was to determine the incidence of postdischarge nausea and vomiting in day surgery patients and to identify demographic, intraoperative, and postoperative variables that influence the risk. METHODS In this prospective observational study, a postdischarge questionnaire was administered to parents of ambulatory patients who received anesthesia and the electronic records were reviewed. RESULTS Of 1041 ambulatory patients who received general anesthesia, 143 (14%) experienced postdischarge nausea and vomiting. Patients who did not receive intraoperative opioids had a lower incidence (8%) than those who received short-acting opioids (14%) (difference of 6%, 95% CI 1.9%-10.2%, P < .001) or long-acting opioids (24%) (difference of 16%, 95% CI 8.1%-24.3%, P < .001). Patients who received short-acting opioids also had a lower incidence than those who received long-acting opioids (difference of 10%, 95% CI 2.2%-18.1%, P < .001). The incidence also differed between those patients who received postdischarge opioids at home (29%) and those who did not (13%) (difference of 16%, 95% CI 7.5%-27.6%, P < .001). There was no association with age, gender, airway management, nitrous oxide use, amount of intravenous fluids, duration of anesthesia, intraoperative antiemetic administration or dosage, length of time from recovery room discharge to first oral intake, or length of ride home from the hospital. Multivariate generalized linear regression analysis confirmed intraoperative (short-acting opioids odds ratio 1.686, 95% CI 1.020-2.787; long-acting opioids odds ratio 3.093, 95% CI 1.634-5.874) and postdischarge (odds ratio 2.037 95% CI 1.142-3.632) opioids to be independent risk factors for postdischarge nausea and vomiting. CONCLUSION We found an incidence of postdischarge nausea and vomiting of 14%. Intraoperative and postdischarge opioids increase the risk, with long-acting intraoperative opioids further accentuating the risk.
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Affiliation(s)
- Proshad N Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA.,Outcome Research Consortium, Cleveland Clinic, OH, USA
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Le Pape S, Boisson M, Loupec T, Vigneau F, Debaene B, Frasca D. Postoperative fasting after general anaesthesia: A survey of French anaesthesiology practices. Anaesth Crit Care Pain Med 2017; 37:245-250. [PMID: 29233755 DOI: 10.1016/j.accpm.2017.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/16/2017] [Accepted: 11/06/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preoperative fasting is well codified worldwide. In contrast, the literature on the postoperative fasting (POF) is scarce, leading to potentially wide discrepancies among anaesthesiology practices. This survey assessed French POF practices. METHODS From March 2013 to January 2014, a survey was conducted among anaesthesiologists, members of the French Society of Anaesthesiology and Intensive Care Medicine (SFAR). The POF durations of either fluid or solid food intake was assessed according to airway management procedures (endotracheal intubation [EI] or laryngeal mask [LMA]) and age of the patients (adult or paediatric). RESULTS Seven hundred and fifty-four surveys were returned (67% from public hospital practitioners and 33% from private hospital and clinic practitioners). The majority of anaesthesiologists allowed fluid intake 2h after EI and immediately after discharge from PACU following LMA. For solid food resumption, it was 2h for children and 4h for adults after EI and 2h for both children and adults after LMA. Regardless of the airway management procedures, fasting was permitted immediately after PACU discharge more frequently in public than in private hospitals (36% vs. 33%, P<0.05). Four hours after the end of surgery, the rate was significantly higher in private than in public hospitals (93% vs. 89 %, P<0.001). CONCLUSIONS All in all, POF lasted less than 4hours after surgery regardless of airway management. They were shorter with regard to fluid intake, paediatric patients and LMA in comparison with solid food, adult patients and EI respectively.
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Affiliation(s)
- Sylvain Le Pape
- Department of Anaesthesia and Intensive Care, University hospital of Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Faculty of Medicine and Pharmacy, Poitiers University, 86000 Poitiers, France; Inserm U1082, 86000 Poitiers, France
| | - Matthieu Boisson
- Department of Anaesthesia and Intensive Care, University hospital of Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Faculty of Medicine and Pharmacy, Poitiers University, 86000 Poitiers, France; Inserm U1070, 86000 Poitiers, France
| | - Thibault Loupec
- Department of Anaesthesia and Intensive Care, University hospital of Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Faculty of Medicine and Pharmacy, Poitiers University, 86000 Poitiers, France
| | - Fabien Vigneau
- Department of Anaesthesia and Intensive Care, University hospital of Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Faculty of Medicine and Pharmacy, Poitiers University, 86000 Poitiers, France
| | - Bertrand Debaene
- Department of Anaesthesia and Intensive Care, University hospital of Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Faculty of Medicine and Pharmacy, Poitiers University, 86000 Poitiers, France
| | - Denis Frasca
- Department of Anaesthesia and Intensive Care, University hospital of Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France; Faculty of Medicine and Pharmacy, Poitiers University, 86000 Poitiers, France.
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Ashok V, Bala I, Bharti N, Jain D, Samujh R. Effects of intraoperative liberal fluid therapy on postoperative nausea and vomiting in children-A randomized controlled trial. Paediatr Anaesth 2017; 27:810-815. [PMID: 28585750 DOI: 10.1111/pan.13179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is one of the most distressing complications following surgery. Supplemental perioperative fluid therapy might be an effective strategy to reduce PONV in children. OBJECTIVES The study was conducted to evaluate the effects of intraoperative liberal fluid therapy with crystalloids on PONV in children. METHODS In this randomized trial, a total of 150 children of 3-7 years undergoing lower abdominal and penile surgery under general anesthesia were randomly assigned into two groups. "Restricted group" received 10 mL kg-1 h-1 and "Liberal group" received 30 mL kg-1 h-1 infusion of Ringer's lactate solution intraoperatively. All patients received a caudal block and intravenous paracetamol for analgesia. No opioids and muscle relaxants were used. All episodes of nausea-vomiting and the requirement of rescue antiemetic were assessed during 24 hours postoperatively. RESULTS The incidence of PONV was significantly less in the liberal group patients as compared to the restricted group; 33 (45.8%) patients in the restricted group had vomiting as compared to 20 (27.4%) patients in the liberal group (RR 0.59, 95% CI: 0.38-0.93, P=.021). The adjusted odds ratio of PONV for the liberal group vs restricted group was 2.24 (95% CI: 1.12-4.48, P=.022). The incidence of fluid intake during the first 6 postoperative hours was significantly higher in the restricted group patients; 60 (83%) children in the restricted group complained of thirst as compared to 12 (17%) children in the liberal group (RR 0.19, 95% CI: 0.18-0.33, P=.0001). The parents of the liberal group were more satisfied as compared to the restricted group (mean difference -0.9, 95% CI: -1.8, -0.1, P=.04). None of the children had any complication attributed to the liberal fluid therapy. CONCLUSION Liberal intraoperative fluid therapy was found to be effective in reducing PONV in children undergoing lower abdominal surgery.
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Affiliation(s)
- Vighnesh Ashok
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Bala
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bharti
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Jain
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Chauvin C, Schalber-Geyer A, Lefebvre F, Bopp C, Carrenard G, Marcoux L, Mayer J, Schwaab C, Joshi G, Diemunsch P. Early postoperative oral fluid intake in paediatric day case surgery influences the need for opioids and postoperative vomiting: a controlled randomized trial † †This Article is accompanied by Editorial Aew450. Br J Anaesth 2017; 118:407-414. [DOI: 10.1093/bja/aew463] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
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Sümpelmann R, Becke K, Brenner S, Breschan C, Eich C, Höhne C, Jöhr M, Kretz FJ, Marx G, Pape L, Schreiber M, Strauss J, Weiss M. Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. Paediatr Anaesth 2017; 27:10-18. [PMID: 27747968 DOI: 10.1111/pan.13007] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 12/19/2022]
Abstract
This consensus- based S1 Guideline for perioperative infusion therapy in children is focused on safety and efficacy. The objective is to maintain or re-establish the child's normal physiological state (normovolemia, normal tissue perfusion, normal metabolic function, normal acid- base- electrolyte status). Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. A physiologically composed balanced isotonic electrolyte solution (BS) with 1-2.5% glucose is recommended for the intraoperative background infusion to maintain normal glucose concentrations and to avoid hyponatremia, hyperchloremia, and lipolysis. Additional BS without glucose can be used in patients with circulatory instability until the desired effect is achieved. The additional use of colloids (albumin, gelatin, hydroxyethyl starch) is recommended to recover normovolemia and to avoid fluid overload when crystalloids alone are not sufficient and blood products are not indicated. Monitoring should be extended in cases with major surgery, and autotransfusion maneuvers should be performed to assess fluid responsiveness.
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Affiliation(s)
- Robert Sümpelmann
- Clinic for Anaesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany
| | - Karin Becke
- Department of Anaesthesiology and Intensive Care Medicine, Cnopf'sche Kinderklinik/Klinik Hallerwiese, Nuremberg, Germany
| | - Sebastian Brenner
- Department of Pediatric and Adolescent Medicine, University Hospital Dresden, Dresden, Germany
| | | | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | - Claudia Höhne
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Martin Jöhr
- Section of Paediatric Anaesthesia, Department of Anaesthesia, Kantonsspital, Luzern, Switzerland
| | - Franz-Josef Kretz
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Gernot Marx
- Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hanover Medical School, Hanover, Germany
| | - Markus Schreiber
- Department of Anesthesiology, Ulm University Medical Center, Ulm, Germany
| | - Jochen Strauss
- Clinic for Anesthesiology, Perioperative Medicine and Pain Therapy, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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Abstract
PURPOSE OF REVIEW The aim of this review was to discuss recent developments in paediatric anaesthesia, which are particularly relevant to the practitioner involved in paediatric outpatient anaesthesia. RECENT FINDINGS The use of a pharmacological premedication is still a matter of debate. Several publications are focussing on nasal dexmedetomidine; however, its exact place has not yet been defined. Both inhalational and intravenous anaesthesia techniques still have their advocates; for diagnostic imaging, however, propofol is emerging as the agent of choice. The disappearance of codeine has left a breach for an oral opioid and has probably worsened postoperative analgesia following tonsillectomy. In recent years, a large body of evidence for the prevention of postoperative agitation has appeared. Alpha-2-agonists as well as the transition to propofol play an important role. There is now some consensus that for reasons of practicability prophylactic antiemetics should be administered to all and not only to selected high-risk patients. SUMMARY Perfect organization of the whole process is a prerequisite for successful paediatric outpatient anaesthesia. In addition, the skilled practitioner is able to provide a smooth anaesthetic, minimizing complications, and, finally, he has a clear concept for avoiding postoperative pain, agitation and vomiting.
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Abstract
PURPOSE OF REVIEW Postoperative nausea and vomiting (PONV) has a high incidence in children and requires prophylactic and therapeutic strategies. RECENT FINDINGS PONV can be reduced by the avoidance of nitrous oxide, volatile anesthetics, and the reduction of postoperative opioids. The use of dexamethasone, 5-HT3 antagonists, or droperidol alone is potent, but combinations are even more effective to reduce PONV. Droperidol has a Food and Drug Administration warning. Hence, dexamethasone and 5-HT3 antagonists should be preferred as prophylactic drugs. It is further reasonable to adapt PONV prophylaxis to different risk levels. Prolonged surgery time, inpatients, types of surgery (e.g. strabismus and ear-nose-throat surgery), and patients with PONV in history should be treated as high risk, whereas short procedures and outpatients are to be treated as low risk. SUMMARY Concluding from the existing guidelines and data on the handling of PONV in children at least 3 years, the following recommendations are given: outpatients undergoing small procedures should receive a single prophylaxis, outpatients at high risk a double prophylaxis, inpatients with surgery time of more than 30 min and use of postoperative opioids should get double prophylaxis, and inpatients receiving a high-risk surgical procedure or with other risk factors a triple prophylaxis (two drugs and total intravenous anesthesia). Dimenhydrinate can be used as a second choice, whereas droperidol and metoclopramide can only be recommended as rescue therapy.
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Abstract
The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.
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Sylvester DC, Rafferty A, Bew S, Knight LC. The use of ice-lollies for pain relief post-paediatric tonsillectomy. A single-blinded, randomised, controlled trial. Clin Otolaryngol 2012; 36:566-70. [PMID: 22070741 DOI: 10.1111/j.1749-4486.2011.02410.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess whether the use of ice-lollies after tonsillectomy with or without adenoidectomy in children aged 2-12 reduces pain in the immediate postoperative period. DESIGN A prospective, randomised, single-blinded study design consisting of two groups with an intention to treat analysis. SETTING Tertiary referral centre. PARTICIPANTS Children aged 2-12 undergoing tonsillectomy with or without adenoidectomy. MAIN OUTCOME MEASURES Pain assessment by nursing staff in the form of the validated modified Children's Hospital of Eastern Ontario Pain Scale at 15, 30 and 60 min and 4 h. RESULTS Ninety-two patients were recruited into the study with 46 allocated to receive an ice-lolly and 41 not to receive an ice-lolly after exclusion of those with incomplete data. The two groups were comparable for number, age, sex and diagnosis. The pain score at every time interval was lower in the group that had received the ice-lolly compared with the group that had not. This was statistically significant at 30 (P = 0.008) and 60 min (P = 0.049). CONCLUSION Our data suggest that ice-lollies are a cheap, effective and safe method of reducing postoperative pain up to one hour following paediatric tonsillectomy.
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Affiliation(s)
- D C Sylvester
- Department of Otolaryngology, York District Hospital, York, UK
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Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011; 28:556-69. [PMID: 21712716 DOI: 10.1097/eja.0b013e3283495ba1] [Citation(s) in RCA: 501] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This guideline aims to provide an overview of the present knowledge on aspects of perioperative fasting with assessment of the quality of the evidence. A systematic search was conducted in electronic databases to identify trials published between 1950 and late 2009 concerned with preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. One study on preoperative fasting which had not been included in previous reviews and a further 13 studies published since the most recent review were identified. The searches also identified 20 potentially relevant studies of oral carbohydrates and 53 on early resumption of oral intake. Publications were classified in terms of their evidence level, scientific validity and clinical relevance. The Scottish Intercollegiate Guidelines Network scoring system for assessing level of evidence and grade of recommendations was used. The key recommendations are that adults and children should be encouraged to drink clear fluids up to 2 h before elective surgery (including caesarean section) and all but one member of the guidelines group consider that tea or coffee with milk added (up to about one fifth of the total volume) are still clear fluids. Solid food should be prohibited for 6 h before elective surgery in adults and children, although patients should not have their operation cancelled or delayed just because they are chewing gum, sucking a boiled sweet or smoking immediately prior to induction of anaesthesia. These recommendations also apply to patients with obesity, gastro-oesophageal reflux and diabetes and pregnant women not in labour. There is insufficient evidence to recommend the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery in non-obstetric patients, but an H2-receptor antagonist should be given before elective caesarean section, with an intravenous H2-receptor antagonist given prior to emergency caesarean section, supplemented with 30 ml of 0.3 mol l(-1) sodium citrate if general anaesthesia is planned. Infants should be fed before elective surgery. Breast milk is safe up to 4 h and other milks up to 6 h. Thereafter, clear fluids should be given as in adults. The guidelines also consider the safety and possible benefits of preoperative carbohydrates and offer advice on the postoperative resumption of oral intake.
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