Nurse‐driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first‐stage palliation surgery: A pilot study

Michel, Jörg; Hofbeck, Michael; Gerbig, Ines; Icheva, Vanya; Heimberg, Ellen; Jost, W; Schlensak, Christian; Kumpf, Matthias; Blumenstock, Gunnar; Neunhoeffer, Felix

doi:10.1111/pan.13274

Cited by 10 publications

(21 citation statements)

References 28 publications

(67 reference statements)

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“…A structured approach to introduce delirium bundle at the PICU may prevent delirium. We have sustainably implemented a functioning nursedriven analgesia and sedation protocol on our PICU, that was feasible and safe and reduces length of PICU stay, cumulative dose of benzodiazepines and withdrawal symptoms (19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Delirium Bundle for Pediatric Intensive Care Patients

et al. 2022

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Background and ObjectiveDelirium represents the most common form of acute cerebral dysfunction in critical illness. The prevention, recognition, and treatment of delirium must become the focus of modern pediatric intensive care, as delirium can lead to increased morbidity and mortality. The aim of this study is to evaluate the impact of a delirium bundle consisting of mainly non-pharmacological measures.Material and MethodsThis is a pre-/post-implementation study in an interdisciplinary pediatric intensive care unit of a tertiary care university hospital. In the pre-implementation period, pediatric intensive care delirium was monitored using the Sophia Observation withdrawal Symptoms and Pediatric Delirium scale. After introduction of a delirium bundle consisting of non-pharmacological prevention and treatment measures a period of 4 months was interposed to train the PICU staff and ensure that the delirium bundle was implemented consistently before evaluating the effects in the post-implementation period. Data collection included prevalence of delirium and withdrawal, length of PICU stay, duration of mechanical ventilation, and cumulative dose of sedatives and analgesics.ResultsA total of 792 critically ill children aged 0–18 years were included in this study. An overall delirium prevalence of 30% was recorded in the pre-implementation group and 26% in the post-implementation group (p = 0.13). A significant reduction in the prevalence of pediatric delirium from was achieved in the subgroup of patients under 5 years of age (27.9 vs. 35.8%, p = 0.04) and in patients after surgery for congenital heart disease (28.2 vs. 39.5%, p = 0.04). Young age, length of PICU stay, and iatrogenic withdrawal syndrome were found to be risk factors for developing delirium.ConclusionsBased on a validated delirium monitoring, our study gives new information regarding the prevalence of pediatric delirium and the characteristics of intensive care patients at risk for this significant complication. Especially young patients and patients after surgery for congenital heart disease seem to benefit from the implementation of non-pharmacological delirium bundles. Based on our findings, it is important to promote change in pediatric intensive care—toward a comprehensive approach to prevent delirium in critically ill children as best as possible.

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Section: Introductionmentioning

confidence: 99%

Implementation of a Delirium Bundle for Pediatric Intensive Care Patients

et al. 2022

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“…Moreover, muscle relaxation is needed to avoid excessive airway reactivity of laryngeal mask insertion (e.g., laryngeal spasm, hypersalivation, coughing), to reduce laryngeal mask insertion-related complications (e.g., postoperative throat pain), and to reduce the incidence of airway complications such as hypoxia, ineffective ventilation, and sternal muscle stiffness that are induced by opioid analgesics [6][7][8]. Analgesic and narcotic agents are required in high dosages without the use of muscle relaxants, and an overdose of analgesic agents can inhibit the patient's haemodynamics [9]. Small doses of neuromuscular blocking agents (NMBAs) may improve mandibular relaxation and shorten the time required for laryngeal mask placement, thereby improving the laryngeal mask placement conditions [10].…”

Section: Introductionmentioning

confidence: 99%

The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery

et al. 2020

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Background: In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis-atracurium dosage for laryngeal mask insertion has not been standardised. We aimed to determine the optimal dose of cis-atracurium using a sequential method for successful laryngeal mask insertion.Methods: The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered cis-atracurium doses as follows: 150, 100, 70, 50, 30, and 20 μg·kg − 1 . The main outcome involved the determination of the response to laryngeal mask airway insertion: ≥16 points and < 16 points indicated "satisfactory" and "unsatisfactory" responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from "satisfactory" and "unsatisfactory" responses. The primary outcome involved the determination of the median effective dose (ED50) of cis-atracurium for laryngeal mask airway insertion. Results:The median effective dose of cis-atracurium was 26.5 μg·kg − 1 (95% CI 23.6-29.8) using the sequential method. Heart rate was decreased in the 50 μg·kg − 1 group compared to that in the 30 μg·kg − 1 group at timepoints T7, T8, and T10 (P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference was observed in the 20 μg·kg − 1 group. Systolic blood pressure was decreased in the 50 μg·kg − 1 group compared to that in the 20 μg·kg − 1 group at timepoints T2, T3, and T4 (P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg − 1 group than in the 30 μg·kg − 1 group at timepoint T3 (P = 0.0326). Conclusions: The ED50 of cis-atracurium was 26.5 μg·kg − 1 for laryngeal mask airway insertion.

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Section: Introductionmentioning

confidence: 99%

The Median Effective Dose (ED50) of cis-Atracurium for Laryngeal Mask Airway Insertion during General Anaesthesia for Patients Undergoing Urinary Surgery

Wang

Huang

Yan

et al. 2020

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Background In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis- atracurium dosage for laryngeal mask insertion is not standardised. We aimed to determine the optimal dose of cis- atracurium using a sequential method for successful laryngeal mask insertion. Methods : The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered doses (μg· kg -1 ) of cis- atracurium as follows: 150, 100, 70, 50, 30, and 20. The main outcome was the response to laryngeal mask airway insertion: ≥16 points and <16 points indicated “satisfactory” and “unsatisfactory” responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from “satisfactory” and “unsatisfactory” responses. The primary outcome was to determine the median effective dose (ED50) of cis- atracurium for laryngeal mask airway insertion. Results : The median effective dose of cis- atracurium was 26.5 μg·kg -1 (95% CI 23.6-29.8) using the sequential method. The heart rate was decreased in the 50μg·kg -1 group compared to the 30μg·kg -1 group at timepoints T7, T8, and T10 ( P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference with 20 μg·kg -1 group. The systolic blood pressure was decreased in the 50 μg·kg -1 group compared to the 20 μg·kg -1 group at timepoints T2, T3, T4 ( P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg -1 group than in the 30 μg·kg -1 group at timepoint T3( P = 0.0326). Conclusions : The ED50 of cis- atracurium was 26.5 μg·kg -1 for laryngeal mask airway insertion.

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Nurse‐driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first‐stage palliation surgery: A pilot study

Abstract: A nurse-driven protocol for analgesia and sedation of children with extracorporeal life support is feasible. Patients with extracorporeal life support do not need deeper sedation levels and have not higher cumulative sedation requirements than children without extracorporeal life support.

Cited by 10 publications

References 28 publications

Implementation of a Delirium Bundle for Pediatric Intensive Care Patients

Implementation of a Delirium Bundle for Pediatric Intensive Care Patients

The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery

The Median Effective Dose (ED50) of cis-Atracurium for Laryngeal Mask Airway Insertion during General Anaesthesia for Patients Undergoing Urinary Surgery

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