Perioperative anxiety has been associated with adverse clinical outcomes such as emergence delirium, increased analgesic requirements and negative postoperative behavioural changes such as sleep disturbance, separation anxiety, eating problems and new-onset enuresis. Predictors of preoperative anxiety have been identified, and these include, among other factors, the age and temperament of the child. Any plan for anaesthetic induction in a child must take into account these factors. The anaesthetic plan must be individualised for special situations, for example, the child with behavioural disorder or at risk of aspiration. This article details the pharmacological and nonpharmacological methods to minimise preoperative anxiety and the techniques of anaesthetic induction in infants and children undergoing surgery. The benefits and limitations of inhalational and intravenous induction and the current status of rapid sequence induction in children are discussed. MEDLINE database was searched for this narrative review using the keywords including preoperative anxiety, child, premedication, paediatric and anaesthetic induction. Search was restricted to articles in English, but without any publication date restrictions.
Background and Aims:The laryngoscope is a potential source of cross-infection as it involves contact with the mucous membrane, saliva and occasionally blood. This study compared efficacy and cost-effectiveness of two Centre for Disease Control approved agents for disinfection of laryngoscope blades.Methods:One hundred and sixty patients requiring laryngoscopy and intubation for general anaesthesia were randomly allocated into two groups. After tracheal intubation, used laryngoscope blades were cleaned with tap water. The blades were then immersed in either 2% w/v glutaraldehyde for a contact time of 20 min or 0.55% w/v ortho-phthalaldehyde (OPA) for 10 min. The handles were wiped with 0.5% w/v chlorhexidine wipes. Samples were collected using sterile cotton swabs from the tip, flange and light bulb area of the laryngoscope blade and one from the handle. They were cultured aerobically on blood and McConkey agar.Results:In 2% glutaraldehyde group, of 240 samples sent from the blades, 2 (0.8%) showed the growth of methicillin-resistant coagulase-negative staphylococci (MRCONS) and Enterobacter. In OPA group, of 240 samples, 2 (0.8%) showed growth of MRCONS. Thus, 2% glutaraldehyde and 0.55% OPA were comparable in terms of efficacy of disinfection. Growth was seen on 4 out of 160 handles.Conclusions:We suggest OPA for high-level disinfection of laryngoscope blades as it is equally efficacious as compared to glutaraldehyde, with a shorter contact time and available as a ready to use formulation.
Background and Aims:Neonatal endotracheal intubation is challenging due to the miniature anatomy, which is distinct from adults and reserves only less oxygen and time before desaturation begins. As a result, teaching neonatal intubation becomes fraught with difficulties. This study aimed to determine the efficacy and safety of videolaryngoscopy-guided verbal feedback compared to conventional laryngoscopy verbal feedback in neonatal and infant intubation.Methods:In this prospective randomised cross over study, 24 trainees were randomly allocated to two groups, video-assisted verbal feedback followed by conventional verbal feedback (V/C) and conventional verbal feedback followed by video-assisted verbal feedback (C/V). one hundred forty-four ASA grade I-II patients aged 1 day to 6 months requiring general anaesthesia with endotracheal intubation were included. Each trainee performed three intubations with one technique and switched to other technique to perform three more intubations. Primary outcome was first attempt success rate and secondary outcomes were time to best view, time to intubation, ease of intubation, manoeuvres used and complications.Results:Overall first attempt intubation success rate was higher with video-assisted verbal feedbacks compared to conventional verbal feedback (83.3% vs. 44.4%, P value = <0.001). The time to best view (19.8 s vs. 26.8 s, P value = <0.001) and intubation (30 s vs. 41.7 s) was achieved faster with video-assisted part of the study.Conclusion:Our study results show that video-assisted verbal feedback to trainees resulted in high intubation success rate and reduced complications like oesophageal intubation and desaturation in neonatal and infant intubations.
Background and Aims: There have been various methods tested for reducing preoperative anxiety in children, but very limited literature is available in the Indian scenario. Our aim was to analyse the effect of an informative video about the anaesthetic technique on preoperative anxiety in children. Methods: In all, 94 children were randomly allotted into two groups. Children in the study group were shown a peer modelling video depicting induction of general anaesthesia and recovery during the preanaesthetic check (PAC). Patients in the control group were given only verbal information during PAC. Anxiety was assessed on visual analog scale (VAS) for anxiety at two times. Baseline VAS score was recorded during PAC and preoperative VAS score was assessed prior to induction of anaesthesia. The VAS score was represented as median value. Data were analysed using the Mann–Whitney U -test for ordinal data and skewed quantitative data. Categorical data was analysed by using Chi-square test and t-test was applied for quantitative data. The significance threshold of P value was set at <0.05. Results: The median (interquartile range) preoperative VAS score was significantly lower in the study group [1 (0–1.3)] when compared with the control group [5 (3–5)] ( P < 0.001). The mean preoperative pulse rate, mean preoperative systolic blood pressure and mean preoperative diastolic blood pressure were significantly lower in the study group when compared with the control group ( P < 0.001). Conclusion: Multimedia information in the form of a peer modelling video helped reduce preoperative anxiety in children between 7 and 12 years of age.
Background and Aims: The purpose of this study was to compare the analgesic efficacy of ultrasonography-guided transversus abdominis plane (TAP) blocks with local port site infiltration in children undergoing laparoscopic surgeries. Methods: After ethics committee approval and informed consent, 92 children aged 2–12 years posted for laparoscopic surgeries were randomly divided into Group T and Group L. Port site infiltration was performed in Group L by the surgeon at the time of port placement and end of surgery with 0.4mL/kg of 0.25% bupivacaine. Bilateral TAP block was performed in Group T after induction of anaesthesia, under ultrasonographic guidance with a Logiq E7 GE portable ultrasound unit and a linear 5–10 MHz probe. A 22G hypodermic needle and 0.4 mL/kg of 0.25% bupivacaine were used on each side for the TAP block. The parameters recorded were intraoperative haemodynamics, opioid requirements, postoperative pain scores and the need for rescue analgesia in the first 6 h postoperatively. Results: The median (interquartile range) pain scores were significantly lower in the TAP block group than the local infiltration group at 10 min [2 (0–2.5) vs 2 (3–4); P = 0.011], 30 min [1.5 (0–3) vs 3 (2–5);P < 0.001], 1 h [1.5 (0–2) vs 2 (2–3);P < 0.001] and 2 h [2 (0–2) vs 2 (1.5–2.5); P = 0.010] postoperatively. The need for intraoperative opioids and rescue analgesia was also significantly lower in the TAP block group ( P < 0.001). Conclusion: TAP block is superior to local infiltration for intra- and immediate postoperative analgesia in paediatric laparoscopic surgeries.
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