Preterm Versus Term Children: Analysis of Sedation/Anesthesia Adverse Events and Longitudinal Risk

Havidich, Jeana E.; Beach, Michael L.; Dierdorf, Stephen F.; Onega, Tracy; Suresh, Gautham; Cravero, Joseph P.

doi:10.1542/peds.2015-0463

Cited by 79 publications

(40 citation statements)

References 39 publications

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“…Former preterm infants have an increased risk of postanesthesia apnea, 377 but it is unclear whether a similar risk is associated with sedation, because this possibility has not been systematically investigated. 378 Other concerns regarding the effects of anesthetic drugs and sedating medications on the developing brain are beyond the scope of this document. At this point, the research in this area is preliminary and inconclusive at best, but it would seem prudent to avoid unnecessary exposure to sedation if the procedure is unlikely to change medical/dental management (eg, a sedated MRI purely for screening purposes in preterm infants).…”

Section: Neonates and Former Preterm Infantsmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Coté¹,

Wilson²

2016

Pediatrics

251

199

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age-and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, suffi cient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the

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Section: Neonates and Former Preterm Infantsmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Coté¹,

Wilson²

2016

Pediatrics

251

199

View full text Add to dashboard Cite

show abstract

“…However concern has been raised about possible long-term adverse effects resulting from sedation and anesthesia [1–4]. For example, a recent report stated that 8.6% of all children under sedation/anesthesia experienced an adverse event, most of which were minor, and 57.7% of those events occurred during MRI scans, more often than any other ordered procedure [5]. In view of studies such as this, there is an increasing need to develop techniques for motion-robust MRI in young patients to help avoid using sedation in these patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of motion and its effect on brain magnetic resonance image quality in children

et al. 2016

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Background Motion artifacts pose significant problems for the acquisition of MR images in pediatric populations. Objective To evaluate temporal motion metrics in MRI scanners and their effect on image quality in pediatric populations in neuroimaging studies. Materials and methods We report results from a large pediatric brain imaging study that shows the effect of motion on MRI quality. We measured motion metrics in 82 pediatric patients, mean age 13.4 years, in a T1-weighted brain MRI scan. As a result of technical difficulties, 5 scans were not included in the subsequent analyses. A radiologist graded the images using a 4-point scale ranging from clinically non-diagnostic because of motion artifacts to no motion artifacts. We used these grades to correlate motion parameters such as maximum motion, mean displacement from a reference point, and motion-free time with image quality. Results Our results show that both motion-free time (as a ratio of total scan time) and average displacement from a position at a fixed time (when the center of k-space was acquired) were highly correlated with image quality, whereas maximum displacement was not as good a predictor. Among the 77 patients whose motion was measured successfully, 17 had average displacements of greater than 0.5 mm, and 11 of those (14.3%) resulted in non-diagnostic images. Similarly, 14 patients (18.2%) had less than 90% motion-free time, which also resulted in non-diagnostic images. Conclusion We report results from a large pediatric study to show how children and young adults move in the MRI scanner and the effect that this motion has on image quality. The results will help the motion-correction community in better understanding motion patterns in pediatric populations and how these patterns affect MR image quality.

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“…This higher incidence of AE in patients with cerebral palsy could be attributed to multiple factors such as muscle tone, pharyngeal collapse, increased secretions and drug interactions with various medications used daily such as baclofen 20 . We excluded all patients with a recent active upper respiratory infection as sedation candidates as there are some publications which have elucidated to the higher risk of adverse events and sedation failure in these patients 21] The risk for AE in our patients with prematurity, gastrooesophageal reflux disease and cardiac disease was not statistically significant, although studies have shown that these patients are at higher risk for AE with sedation 15,22,23,24 . This study has several limitations.…”

Section: Discussionmentioning

confidence: 98%

Paediatric procedural sedation at a tertiary care university teaching hospital in India

Dubhashi

Silveira

Hebbar

et al. 2018

Sri Lanka J Child Health

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Preterm Versus Term Children: Analysis of Sedation/Anesthesia Adverse Events and Longitudinal Risk

Cited by 79 publications

References 39 publications

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Evaluation of motion and its effect on brain magnetic resonance image quality in children

Paediatric procedural sedation at a tertiary care university teaching hospital in India

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