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Racca F, Longhitano Y, Wolfler A, Carfagna F, Grattarola C, Serio P, Sbaraglia F, Amigoni A, Savron F, Caramelli F, Montagnini L, Astuto M, Gallo E, Zanza C, Vaschetto R, Conti G. Perioperative management of children with neuromuscular disorders based on a common protocol: A prospective, national study in Italy. Acta Anaesthesiol Scand 2021; 65:1195-1204. [PMID: 33963537 DOI: 10.1111/aas.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with neuromuscular diseases (NMDs) often display respiratory muscle weakness which increases the risk of postoperative pulmonary complications (PPCs) after general anaesthesia. Non-invasive ventilation (NIV) associated with mechanical insufflation-exsufflation (MI-E) can reduce the incidence and severity of PPCs. The aim of this study was to report our experience with a shared perioperative protocol that consists in using NIV combined with MI-E to improve the postoperative outcome of NMD children (IT-NEUMA-Ped). METHOD We conducted a multicentre, observational study on 167 consecutive paediatric patients with NMDs undergoing anaesthesia from December 2015 to December 2018 in a network of 13 Italian hospitals. RESULTS We found that 89% of the 167 children (mean age 8 years old) were at high risk of PPCs, due to the presence of at least one respiratory risk factor. In particular, 51% of them had preoperative ventilatory support dependence. Only 14 (8%) patients developed PPCs, and only two patients needed tracheostomy. Average hospital length of stay (LOS) was 6 (2-14) days. The study population was stratified according to preoperative respiratory devices dependency and invasiveness of the procedure. Patients with preoperative ventilatory support dependence showed significantly higher intensive care unit (ICU) admission rate and longer hospital LOS. CONCLUSION Disease severity seems to be more related to the outcome of this population than invasiveness of procedures. NIV combined with MI-E can help in preventing and resolve PPCs.
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Affiliation(s)
- Fabrizio Racca
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - Yaroslava Longhitano
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - Andrea Wolfler
- Department of Anaesthesiology and Intensive Care Vittore Buzzi Children's Hospital Milan Italy
| | - Fabio Carfagna
- Department of Translational Medicine University of Eastern Piedmont Amedeo Avogadro School of Medicine Novara Italy
| | - Claudia Grattarola
- Department of Anaesthesiology and Intensive Care Unit Istituto Giannina Gaslini Genova Italy
| | - Paola Serio
- Department of Paediatric Anaesthesia and Intensive Care Meyer Children Hospital Florence Italy
| | - Fabio Sbaraglia
- Department of Emergency Medicine, Anaesthesia and Intensive Care University Hospital Agostino Gemelli IRCCS Rome Italy
| | - Angela Amigoni
- Paediatric Intensive Care Unit Department of Woman's and Child's Health University Hospital of Padova Padua Italy
| | - Fabio Savron
- Department of Anaesthesia and Intensive Care Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” Trieste Italy
| | - Fabio Caramelli
- Department of Anaesthesia and Intensive Care University of Bologna Hospital of Bologna Sant'Orsola‐Malpighi Polyclinic Bologna Italy
| | - Luigi Montagnini
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - Marinella Astuto
- Dipartimento Chirurgia Generale e Specialità Medico Chirurgiche A.O.Universitaria “Policlinico‐Vittorio Emanuele”Università degli Studi di Catania Catania Italy
| | - Elisa Gallo
- Department of Translational Medicine University of Eastern Piedmont Amedeo Avogadro School of Medicine Novara Italy
| | - Christian Zanza
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
- Foundation of “Nuovo Ospedale Alba‐Bra” Department of Emergency Medicine, Anaesthesia and Critical Care Medicine Michele and Pietro Ferrero Hospital Verduno Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine University of Eastern Piedmont Amedeo Avogadro School of Medicine Novara Italy
| | - Giorgio Conti
- Department of Emergency Medicine, Anaesthesia and Intensive Care University Hospital Agostino Gemelli IRCCS Rome Italy
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Biban P, Conti G, Wolfler AM, Carlassara S, Gitto E, Rulli I, Moscatelli A, Micalizzi C, Savron F, Sagredini R, Genoni G, Binotti M, Caramelli F, Fae M, Pettenazzo A, Stritoni V, D'Amato L, Zito Marinosci G, Calderini E, Scalia Catenacci S, Berardi A, Torcetta F, Bonanomi E, Bonacina D, Ivani G, Santuz P. Efficacy and safety of exogenous surfactant therapy in patients under 12 months of age invasively ventilated for severe bronchiolitis (SURFABRON): protocol for a multicentre, randomised, double-blind, controlled, non-profit trial. BMJ Open 2020; 10:e038780. [PMID: 33077567 PMCID: PMC7574934 DOI: 10.1136/bmjopen-2020-038780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Some evidence indicates that exogenous surfactant therapy may be effective in infants with acute viral bronchiolitis, even though more confirmatory data are needed. To date, no large multicentre trials have evaluated the effectiveness and safety of exogenous surfactant in severe cases of bronchiolitis requiring invasive mechanical ventilation (IMV). METHODS AND ANALYSIS This is a multicentre randomised, placebo-controlled, double-blind study, performed in 19 Italian paediatric intensive care units (PICUs). Eligible participants are infants under the age of 12 months hospitalised in a PICU, suffering from severe acute hypoxaemic bronchiolitis, requiring IMV. We adopted a more restrictive definition of bronchiolitis, including only infants below 12 months of age, to maintain the population as much homogeneous as possible. The primary outcome is to evaluate whether exogenous surfactant therapy (Curosurf, Chiesi Pharmaceuticals, Italy) is effective compared with placebo (air) in reducing the duration of IMV in the first 14 days of hospitalisation, in infants suffering from acute hypoxaemic viral bronchiolitis. Secondary outcomes are duration of non-invasive mechanical ventilation in the post-extubation phase, number of cases requiring new intubation after previous extubation within 14 days from randomisation, PICU and hospital length of stay (LOS), duration of oxygen dependency, effects on oxygenation and ventilatory parameters during invasive mechanical respiratory support, need for repeating treatment within 24 hours of first treatment, use of other interventions (eg, high-frequency oscillatory ventilation, nitric oxide, extracorporeal membrane oxygenation), mortality within the first 14 days of PICU stay and before hospital discharge, side effects and serious adverse events. ETHICS AND DISSEMINATION The trial design and protocol have received approval by the Italian National Agency for Drugs (AIFA) and by the Regional Ethical Committee of Verona University Hospital (1494CESC). Findings will be disseminated through publication in peer-reviewed journals, conference/meeting presentations and media. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, issue date 22 May 2019. NCT03959384.
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Affiliation(s)
- Paolo Biban
- Department of Neonatal and Paediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giorgio Conti
- Paediatric Anesthesia and Intensive Care, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Andrea Michele Wolfler
- Paediatric Anesthesia and Intensive Care, Ospedale dei Bambini Vittore Buzzi, Milano, Italy
| | - Silvia Carlassara
- Department of Neonatal and Paediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Eloisa Gitto
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria G. Martino, Messina, Italy
| | - Immacolata Rulli
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria G. Martino, Messina, Italy
| | - Andrea Moscatelli
- Paediatric Anesthesia and Intensive Care, Ospedale Giannina Gaslini, Genova, Italy
| | - Camilla Micalizzi
- Paediatric Anesthesia and Intensive Care, Ospedale Giannina Gaslini, Genova, Italy
| | - Fabio Savron
- Paediatric Anesthesia and Intensive Care, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Raffaella Sagredini
- Paediatric Anesthesia and Intensive Care, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Giulia Genoni
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Marco Binotti
- Neonatal and Paediatric Intensive Care, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Fabio Caramelli
- Paediatric Anesthesia and Intensive Care, Azienda Ospedaliera-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Monica Fae
- Paediatric Anesthesia and Intensive Care, Azienda Ospedaliera-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Pettenazzo
- Paediatric Intensive Care, Azienda Ospedaliera Universitaria Padova, Padua, Italy
| | - Valentina Stritoni
- Paediatric Intensive Care, Azienda Ospedaliera Universitaria Padova, Padua, Italy
| | - Luigia D'Amato
- Paediatric Anesthesia and Intensive Care, Ospedale Pediatrico Santobbono, Napoli, Italy
| | | | - Edoardo Calderini
- Paediatric Anesthesia and Intensive Care, Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Alberto Berardi
- Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Francesco Torcetta
- Neonatal Intensive Care, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Ezio Bonanomi
- Paediatric Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Daniele Bonacina
- Paediatric Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Ivani
- Paediatric Anesthesia and Intensive Care, Ospedale Infantile Regina Margherita Sant'Anna, Torino, Italy
| | - Pierantonio Santuz
- Department of Neonatal and Paediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Wolfler A, Piastra M, Amigoni A, Santuz P, Gitto E, Rossetti E, Tinelli C, Montani C, Savron F, Pizzi S, D'amato L, Mondardini MC, Conti G, De Silvestri A. A shared protocol for porcine surfactant use in pediatric acute respiratory distress syndrome: a feasibility study. BMC Pediatr 2019; 19:203. [PMID: 31215483 PMCID: PMC6580470 DOI: 10.1186/s12887-019-1579-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Pediatric ARDS still represents a difficult challenge in Pediatric Intensive Care Units (PICU). Among different treatments proposed, exogenous surfactant showed conflicting results. Aim of this multicenter retrospective observational study was to evaluate whether poractant alfa use in pediatric ARDS might improve gas exchange in children less than 2 years old, according to a shared protocol. Methods The study was carried out in fourteen Italian PICUs after dissemination of a standardized protocol for surfactant administration within the Italian PICU network. The protocol provides the administration of surfactant (50 mg/kg) divided in two doses: the first dose is used as a bronchoalveolar lavage while the second as supplementation. Blood gas exchange variations before and after surfactant use were recorded. Results Sixty-nine children, age 0–24 months, affected by Acute Respiratory Distress Syndrome treated with exogenous porcine surfactant were enrolled. Data collection consisted of patient demographics, respiratory variables and arterial blood gas analysis. The most frequent reasons for PICU admission were acute respiratory failure, mainly bronchiolitis and pneumonia, and septic shock. Fifty-four children (78.3%) had severe ARDS (define by oxygen arterial pressure and inspired oxygen fraction ratio (P/F) < 100), 15 (21.7%) had moderate ARDS (100 < P/F < 200). PO2, P/F, Oxygenation Index (OI) and pH showed a significant improvement after surfactant use with respect to baseline (p < 0.001 at each included time-point for each parameter). No significant difference in blood gas variations were observed among four different subgroups of diseases (bronchiolitis, pneumonia, septic shock and others). Overall, 11 children died (15.9%) and among these, 10 (90.9%) had complex chronic conditions. Two children (18.2%) died while being treated with Extracorporeal Membrane Oxygenation (ECMO). Mortality for severe pARDS was 20.4%. Conclusion The use of porcine Surfactant improves oxygenation, P/F ratio, OI and pH in a population of children with moderate or severe pARDS caused by multiple diseases. A shared protocol seems to be a good option to obtain the same criteria of enrollment among different PICUs and define a unique way of use and administration of the drug for future studies.
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Affiliation(s)
- Andrea Wolfler
- Division of Anesthesia and Intensive Care Unit, Department of Pediatrics, Children's Hospital Vittore Buzzi, Via Castelvetro 32, 20152, Milan, Italy.
| | - Marco Piastra
- Pediatric ICU, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Amigoni
- Pediatric ICU, Department of Woman's and Child's Health, University Hospital, Padova, Italy
| | - Pierantonio Santuz
- Department of Neonatal and Pediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Eloisa Gitto
- Pediatric ICU, Pediatric Department, University Hospital G Martino, Messina, Italy
| | - Emanuele Rossetti
- Pediatric ICU, Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit - Foundation IRCCS San Matteo, Pavia, Italy
| | - Cinzia Montani
- Pediatric ICU, Department of Anesthesia and Intensive Care, Foundation IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Savron
- Pediatric ICU, Department of Anesthesia and Intensive Care, Institute for Maternal and Child health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Simone Pizzi
- Pediatric ICU, Department of Anesthesia and Intensive Care, Children's Hospital Salesi, Ancona, Italy
| | - Luigia D'amato
- Pediatric ICU, Department of Anesthesia and Intensive Care, Children's Hospital Santobono-Pausillipon, Naples, Italy
| | - Maria Cristina Mondardini
- Pediatric ICU, Department of Pediatric Anesthesia and Intensive Care, University Hospital St. Orsola Malpighi Polyclinic, Bologna, Italy
| | - Giorgio Conti
- Pediatric ICU, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometric Unit - Foundation IRCCS San Matteo, Pavia, Italy
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Sperotto F, Mondardini MC, Vitale F, Daverio M, Campagnano E, Ferrero F, Rossetti E, Vasile B, Dusio MP, Ferrario S, Savron F, Brugnaro L, Amigoni A. Prolonged sedation in critically ill children: is dexmedetomidine a safe option for younger age? An off-label experience. Minerva Anestesiol 2018; 85:164-172. [PMID: 30394067 DOI: 10.23736/s0375-9393.18.13062-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dexmedetomidine (DEX) is an alpha-2-adrenergic agonist, recently approved by Italian-Medicines-Agency for difficult sedation in pediatrics, but few data exist regarding prolonged infusions in critically-ill children, especially in younger ages. Aim of our study was to evaluate DEX use and safety for prolonged sedation in Pediatric Intensive Care Units (PICUs). METHODS Patients receiving DEX for ≥24 hours were retrospectively evaluated to analyze DEX indications, dosages, use of analgesics or sedatives, adverse events (AEs), withdrawal syndrome or delirium. RESULTS Forty-seven patients (median 0.7years) from nine PICUs were enrolled. Main indications were adjuvant for drugs sparing (59.6%) and for analgosedation weaning (36.2%). Median infusion duration was 82.0 hours (IQR 62.2-126.0), with dosages between 0.4 (IQR 0.2-0.5) and 0.8 mcg/kg/h (IQR 0.6-1.2). Fifty-nine-percent of patients received other sedatives, 83% other analgesics. Twenty-one-percent presented withdrawal syndrome, 4.2% delirium, none of them DEX-related. Forty-six-percent experienced a potentially-DEX-related AE. AEs were all hemodynamic, 14.9% requiring intervention but none DEX interruption. The median minimum and maximum dosages were significantly higher in patients with AEs (0.5 vs. 0.3,P=0.001; 1.0 vs. 0.7,P<0.001), without correlations with the infusion duration. AEs rate was higher in patients receiving benzodiazepines (P=0.020) or more than one analgesic (P=0.003) and in those presenting withdrawal syndrome (P<0.001). CONCLUSIONS DEX was confirmed as useful and relatively safe drug for prolonged sedation in critically-ill children, particularly in younger ages. Main AEs were cardiovascular, reversible, related with higher doses, with the concomitant use of benzodiazepines or multiple sedation drugs and with the presence of withdrawal syndrome.
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Affiliation(s)
- Francesca Sperotto
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy -
| | - Maria C Mondardini
- Unit of Pediatric Intensive Care, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Vitale
- Unit of Pediatric Intensive Care, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marco Daverio
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Emiliana Campagnano
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Federica Ferrero
- Unit of Pediatric and Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy
| | - Emanuele Rossetti
- Unit of Pediatric Intensive Care, Bambino Gesù Children's Hospital, Rome, Italy
| | - Beatrice Vasile
- Department of Pediatric Anesthesia and Intensive Care, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maria P Dusio
- Unit of Pediatric Intensive Care, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Stefania Ferrario
- Unit of Pediatric Intensive Care, V. Buzzi Children's Hospital, Milan, Italy
| | - Fabio Savron
- Unit of Pediatric Intensive Care, Burlo Garofalo Hospital, University of Trieste, Trieste, Italy
| | - Luca Brugnaro
- Department Education and Training, University Hospital of Padua, Padua, Italy
| | - Angela Amigoni
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Pittalis A, Tuccillo ML, Savron F, Schember C, Morri D, Dell'Oste C. Pediatric enoxaparin overdose: more attention to thromboelastography monitoring. Minerva Anestesiol 2013; 79:1203-1204. [PMID: 23558766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- A Pittalis
- Anesthesia and Intensive Care Unit. Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste - Italy -
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Patarino F, Norbedo S, Barbi E, Poli F, Furlan S, Savron F. Acute Respiratory Failure in a Child after Talc Inhalation. Respiration 2010; 79:340. [DOI: 10.1159/000181013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
BACKGROUND Current international guidelines state that heart rate counted at the brachial pulse must be absent or <60 b x min(-1) to diagnose cardiac arrest. Some data suggest that this site may not be the best to check cardiac activity. Hypotension is a likely real scenario of the need for chest compressions in infants. We compared the performance of three sites of pulse palpation (brachial, carotid, and femoral) for detecting and counting heartbeat in hypotensive infants. METHODS In an operating theater of a pediatric teaching hospital in Italy, we studied 40 anesthetized hypotensive infants just prior to surgery, checked by two doctors and two nurses by a cross-sectional, repeated-measures study design. Each examiner, blind to the monitoring data of the patient, was asked to find the infant's arterial pulse within 10 s and count heart rate for 15 s. During each examination, the order of the three sites was randomized. RESULTS Among successful detections, femoral pulse palpation resulted as the most successful, rapid, and accurate site to detect and count heart rate in hypotensive infants. CONCLUSIONS Femoral palpation proved to be the best site for detecting heartbeat and counting heart rate in hypotensive infants. These findings challenge the current guidelines. More data are needed, but the current standard of brachial pulse assessment is debatable.
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Affiliation(s)
- Armando Sarti
- Department of Anaesthesia and Intensive Care, IRCCS Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy.
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Abstract
OBJECTIVE To compare the performance of four clinical methods (apex ear auscultation; brachial, carotid, and femoral pulse palpation) for detecting and counting heart beat in infants. DESIGN Cross-sectional, repeated-measures study design. Prospective data collection. SETTING A postanesthesia care unit of a pediatric teaching hospital in Italy. PATIENTS Fifty-six normotensive sedated infants, aged 1-12 mos, were evaluated by 14 pediatric basic life support (PBLS)-qualified health professionals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The proportion of successful heartbeat detections ranged from 60% with carotid pulse palpation to 98% with apex auscultation. Among successful detections, apex auscultation proved to be the most rapid way to detect heart rate (median, 4 secs) and the most accurate with a median discrepancy of 8 beats/min (vs. 12 with the other methods) from the electrocardiographic results. Differences between apex auscultation and pulse palpation were statistically significant (p < .0001). In contrast, no significant differences were found among the three methods of pulse checking. CONCLUSIONS Apex listening is the most successful, rapid, and accurate method to detect and count the heartbeat by PBLS-certified professionals in normotensive infants without instruments. Pulse checking remains important for assessing the effectiveness of circulation. Palpating the brachial, carotid, or femoral pulse is equally effective.
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Affiliation(s)
- Armando Sarti
- Department of Anaesthesia and Intensive Care, IRCCS Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy
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Abstract
This report describes a complication of post-operative oedema of the palate, tongue and pharynx after a Perko-revised cleft palate repair, which resulted in a life-threatening airway obstruction in an infant with Pierre Robin syndrome. Although infants experiencing airway problems after Wardill-Kilner, von Langenbeck and Furlow palatoplasty have been described, airway complications in a group of Perko-revised repair children have not been previously reported. We speculate that this complication, which occurred in the absence of a history of previous airway problems, is due to prolonged operating time and excessive pressure exerted on the base of the tongue by the Kilner-Doughty retractor. Acknowledgments of this risk permits to identify those patients prior to surgery so that they can be managed appropriately.
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Affiliation(s)
- C Dell'Oste
- Department of Anesthesia and Intensive Care, IRCCS Instituto per l'Infanzia Burlo Garofolo, Triest, Italy.
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Bortolussi R, Fabiani F, Savron F, Testa V, Lazzarini R, Sorio R, De Conno F, Caraceni A. Acute morphine intoxication during high-dose recombinant interleukin-2 treatment for metastatic renal cell cancer. Eur J Cancer 1994; 30A:1905-7. [PMID: 7880626 DOI: 10.1016/0959-8049(94)00257-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Da Broi U, Pasqualucci A, Savron F. [ARDS in a severe case of primary pulmonary infection caused by Legionella pneumophila]. Minerva Anestesiol 1993; 59:455-8. [PMID: 8278069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The authors report a case of ARDS following pneumonia caused by Legionella pneumophila, in a thirty year old young man. Mechanical ventilation was maintained for twenty days. The gravity of ARDS and pneumonia, perhaps was caused because infective agent and the efficacious antibiotic were identified too late: twelve days after the comparison of symptoms. In fact, early laboratory diagnosis of Legionella pneumonia, is currently very difficult. A primitive extranocosomial pneumonia with rapid development to ARDS, in a good health young man, is an uncommon event. The exclusion of particular causes of ARDS, such as narcotic over-dose, AIDS, lung cancer, lymphatic carcinomatosis, and the clinical suspicion of Legionella pneumonia presence, can be useful: waiting for the right diagnosis from the laboratory, it will be possible to begin antibiotic therapy with Erythromycin (often used for slight respiratory infections), and to prevent the evolution of illness.
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Affiliation(s)
- U Da Broi
- I Servizio Anestesia e Rianimazione, Ospedale Civile di Udine
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Bartoloni A, Savron F, Rigo V, Pasetto A, Spezie C, Ischia A, Perbellini A. [Effectiveness of regional anesthesia for loco-regional carotid surgery. Retrospective review of 147 interventions]. Minerva Anestesiol 1991; 57:75-82. [PMID: 1870730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Authors present a retrospective review that compares general anesthesia with regional anesthesia performed during carotid endarterectomy surgery. The study includes 147 procedures, performed on 144 patients: 76 had general anesthesia and 71 had regional anesthesia. After emphasizing the importance of conscience preservation during regional anesthesia to allow a simple and secure monitoring of the patient's neurologic functions, the Authors point out the decrease of peri- and postoperative accidents, whether neurologic or not, obtained with regional anesthesia. Another essential advantage of this technique is the possibility to insert the transitory shunt only when objectively necessary, ulteriorly reducing neurologic complications. Cervical plexus block is primarily indicated for high risk patients with instable neurologic simptomatology, severe stenosis of the contralateral carotid, coronary heart disease. The technique has proved to be of easy execution, safe and well accepted by the patient and the surgeon.
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Affiliation(s)
- A Bartoloni
- Istituto di Anestesia e Rianimazione, Università degli Studi di Verona
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