Benefits of a family-centered approach to pediatric induction of anesthesia

Luehmann, Natalie C; Staubach, Michelle E.; Akay, Begum; Collier, Phillip J.; Han, Richard E.; Riggs, Thomas W.; Novotny, Nathan M.

doi:10.1016/j.jpedsurg.2018.10.015

Cited by 23 publications

(20 citation statements)

References 13 publications

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“…There is evidence in the literature to support this strategy, as prior research has shown familial presence to decrease the need for pharmacologic preoperative anxiolysis for pediatric surgery. 23 additionally, parental presence may lead to reduced salivary cortisol levels during anesthesia induction as well as in recovery, which would indicate reduced stress in the patient. 24 Intraoperatively, 62.7% typically use IV acetaminophen for this population.…”

Section: Discussionmentioning

confidence: 99%

How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy

Roberts

Sayegh

Ellison

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). Study Design: Online survey. Method: A sample of pediatric anesthesiologists received the survey by email. Results: 110 respondents were included. 46.4% worked in a free-standing children’s hospital and 32.7% worked in a children’s facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children’s hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA ( P < 0.05). Conclusion: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.

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Section: Discussionmentioning

confidence: 99%

How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy

Roberts

Sayegh

Ellison

et al. 2019

Ann Otol Rhinol Laryngol

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“…In patients with this degree of MO, ensuring the presence of two skilled and experienced anesthesiologists is advisable and probably mandatory given the ASD complicating SSO. Our approach to familiarizing the patient with the setting (special bariatric stretcher), using parental presence at induction along with distraction (watching a movie on portable device), all contributed to a safe and smooth anesthetic [11,12].…”

Section: Discussionmentioning

confidence: 99%

The Anesthetic Management of an Adolescent with Autism Spectrum Disorder and Super-Super Obesity: a Case Report

Diep

Hooper

Eipe

2019

SN Compr. Clin. Med.

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We report the anesthetic management of a 15-year-old patient with super-super obesity (SSO) and autism spectrum disorder (ASD) presenting for dental surgery and debridement of ingrown toe nails. We discuss the major perioperative implications of SSO and ASD with special attention to the challenges of the morbid obesity difficult airway (MODA). We describe a pragmatic approach for managing MODA-predict difficulty, plan and prepare appropriate equipment, position and preoxygenate the patient, making appropriate pharmacological choices, and continue attention to airway and respiration in the postoperative period. The perioperative implications of a complex combination of ASD with SSO require a multidisciplinary approach with adequate experience, expertise, and equipment.

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“…However, multiple studies have not demonstrated a decrease in anxiety or increased cooperation of the child, especially when compared to premedication [58][59][60]. Importantly, an increase in parental satisfaction has been observed [61,62], and many parents feel that their presence helps their child.…”

Section: Parental Presence During Induction Of Anesthesia (Ppia)mentioning

confidence: 99%

Behavioral and Emotional Disorders in Children and Their Anesthetic Implications

Reddy

Deutsch

2020

Children

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While most children have anxiety and fears in the hospital environment, especially prior to having surgery, there are several common behavioral and emotional disorders in children that can pose a challenge in the perioperative setting. These include anxiety, depression, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, post-traumatic stress disorder, and autism spectrum disorder. The aim of this review article is to provide a brief overview of each disorder, explore the impact on anesthesia and perioperative care, and highlight some management techniques that can be used to facilitate a smooth perioperative course.

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Benefits of a family-centered approach to pediatric induction of anesthesia

Cited by 23 publications

References 13 publications

How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy

How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy

The Anesthetic Management of an Adolescent with Autism Spectrum Disorder and Super-Super Obesity: a Case Report

Behavioral and Emotional Disorders in Children and Their Anesthetic Implications

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