Total intravenous anesthesia will supercede inhalational anesthesia in pediatric anesthetic practice

Lauder, Gillian

doi:10.1111/pan.12553

Cited by 75 publications

(59 citation statements)

References 186 publications

(185 reference statements)

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“…There is relatively little data on the effect of interventions to reduce anxiety prior to IV cannulation in the operating room for induction of anesthesia: Studies of preoperative education, audio/visual distraction, and the use of different premedications have not yielded clear recommendations. The increasing popularity and potential benefits of total IV anesthesia necessitate IV cannulation in the awake child, though children may be more anxious before IV induction compared with inhalational induction of anesthesia . Hence, it is important to evaluate interventions to reduce children's anxiety specifically in this context.…”

Section: Introductionmentioning

confidence: 99%

Reducing preoperative anxiety with Child Life preparation prior to intravenous induction of anesthesia: A randomized controlled trial

West

Christopher

Stratton

et al. 2020

Pediatric Anesthesia

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Background Induction of anesthesia can be stressful: Up to 60% of children suffer significant anxiety immediately before surgery. Anxiety is associated with higher postoperative analgesia requirements, higher incidence of emergence delirium, and detrimental effects on sleep and behavior. Child Life preparation includes role‐play, expectation‐setting, and teaching coping strategies. Aim The aim of this trial was to determine whether preoperative Child Life preparation reduces anxiety prior to intravenous induction of anesthesia. Methods Children aged 3‐10 years, with no known preexisting anxiety and no preoperative anxiolytics, undergoing elective day surgery lasting ≤ 2 hours, were enrolled in a randomized controlled trial. Each child's baseline anxiety was assessed in the anesthetic care unit, using the modified Yale Preoperative Anxiety Scale—Short Form (mYPAS‐SF, observational scores from 22.9, minimal anxiety, to 100, maximal anxiety) as the primary outcome. The child was randomly assigned to intervention (minimum 15 minutes Child Life preparation) or control (standard practice without Child Life preparation). Participants entered the operating room with one parent. A researcher (blinded to group allocation) scored the child's operating room anxiety using mYPAS‐SF, up to the first attempt at intravenous cannulation. Results Fifty‐nine children completed the study, aged median [interquartile range] 5 [3‐7] years. Baseline mYPAS‐SF anxiety was 29.2 [22.9‐37.5] for all children, and operating room anxiety was 29.2 [22.9‐49.0]. Operating room anxiety was higher than baseline in 16/31 (52%) children in the control group and 6/28 (21%) in the Child Life preparation group. ANCOVA revealed a significant effect of baseline mYPAS‐SF anxiety and group on operating room anxiety (F = 10.31, P < .001, adjusted R2 = .24); individual parameter estimates indicated that Child Life preparation reduced operating room anxiety by 13.8 (95% CI 4.4‐23.1) points compared to control, P = .005. Conclusion A brief, targeted Child Life preparation session had a statistically significant effect on reducing preoperative anxiety prior to intravenous induction of anesthesia in young children, with no known preexisting anxiety. This effect may be clinically important and suggests that Child Life can be a valuable component of pediatric surgical care. Further research is required in specific populations.

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Section: Introductionmentioning

confidence: 99%

Reducing preoperative anxiety with Child Life preparation prior to intravenous induction of anesthesia: A randomized controlled trial

West

Christopher

Stratton

et al. 2020

Pediatric Anesthesia

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“…The national postal survey conducted by Hill et al in 2008 showed that a propofol infusion was used at least once a month for anesthesia by only 26% of Consultant members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). In recent years, there has been a drive to improve education and usage of TIVA in children through educational workshops at scientific meetings, formation of TIVA for Tots in the UK in association with the Society for Intravenous Anaesthesia (SIVA), the publication of an increasing number of journal articles and books around the subject, and establishment of a TIVA interest group among APAGBI members.…”

Section: Introductionmentioning

confidence: 99%

A follow‐up survey of total intravenous anesthesia usage in children in the U.K. and Ireland

Goh

Bagshaw

Courtman

2019

Pediatric Anesthesia

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Summary Background Total intravenous anesthesia usage in children remains relatively unpopular in the UK and Ireland. A postal survey by Hill et al in 2008 indicated that only 26% of Consultants used a propofol infusion at least once a month. Aims Following an increase in teaching and training opportunities in pediatric total intravenous anesthesia in the UK, we repeated the survey among Consultant members of Association of Paediatric Anaesthetists of Great Britain and Ireland and Society for Intravenous Anaesthesia, to see if this had affected total intravenous anesthesia usage in children and how practice may have changed. Methods We used an anonymous online survey sent to Association of Paediatric Anaesthetists of Great Britain and Ireland and Society for Intravenous Anaesthesia members. Results A total of 291 responses were analyzed. Total intravenous anesthesia was the default method of anesthesia in 8% of respondents and a further 46% used total intravenous anesthesia at least monthly. Overall total intravenous anesthesia usage had increased in the past year in 53%. The main indications were malignant hyperthermia susceptibility, and postoperative nausea and vomiting. Ear/nose/throat surgery was the most popular surgical specialty. The main reasons for not using total intravenous anesthesia were that it was too “fiddly” and lack of confidence in the user. Most respondents used propofol in combination with remifentanil. Over 80% used propofol target‐controlled infusion. The potential for propofol‐related infusion syndrome concerned many, with 74% limiting infusion duration as a result. Bispectral Index was not used routinely by the majority of anesthetists. Even though most anesthetists did not use total intravenous anesthesia routinely, 98% felt they would be confident to anesthetize an malignant hyperpyrexia‐positive patient using the technique. Conclusion This survey has shown that although total intravenous anesthesia is not the default anesthetic technique for most anesthetists, overall usage in children has more than doubled in the past 10 years, with many happy to use it in a wide variety of patients and procedures.

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“…In this context, understanding of the anaesthetic effect on CPO in the healthy brain must be considered a prerequisite for understanding the pathology and anaesthetic influence in the diseased brain [3]. Total intravenous anaesthesia (TIVA) with a combination of propofol and remifentanil is extensively used during ambulatory surgery, paediatric surgery and neurosurgery in humans [8–11]. This combination of anaesthetics has several characteristics that preserve cerebrovascular reactivity to CO 2 and autoregulatory mechanisms [11–14], and can be a suitable basis anaestesia in experimental CPO studies.…”

Section: Introductionmentioning

confidence: 99%

The effect of dexmedetomidine on cerebral perfusion and oxygenation in healthy piglets with normal and lowered blood pressure anaesthetized with propofol-remifentanil total intravenous anaesthesia

et al. 2017

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BackgroundDuring anaesthesia and surgery, in particular neurosurgery, preservation of cerebral perfusion and oxygenation (CPO) is essential for normal postoperative brain function. The isolated effects on CPO of either individual anaesthetic drugs or entire anaesthetic protocols are of importance in both clinical and research settings. Total intravenous anaesthesia (TIVA) with propofol and remifentanil is widely used in human neuroanaesthesia. In addition, dexmedetomidine is receiving increasing attention as an anaesthetic adjuvant in neurosurgical, intensive care, and paediatric patients. Despite the extensive use of pigs as animal models in neuroscience and the increasing use of both propofol-remifentanil and dexmedetomidine, very little is known about their combined effect on CPO in pigs with uninjured brains. This study investigates the effect of dexmedetomidine on CPO in piglets with normal and lowered blood pressure during background anaesthesia with propofol-remifentanil TIVA. Sixteen healthy female Danish pigs (crossbreeds of Danish Landrace, Yorkshire and Duroc, 25–34 kg) were used. Three animals were subsequently excluded. The animals were randomly allocated into one of two groups with either normal blood pressure (NBP, n = 6) or with induced low blood pressure (LBP, n = 7). Both groups were subjected to the same experimental protocol. Intravenous propofol induction was performed without premedication. Anaesthesia was maintained with propofol-remifentanil TIVA, and later supplemented with continuous infusion of dexmedetomidine. Assessments of cerebral perfusion obtained by laser speckle contrast imaging (LSCI) were related to cerebral oxygenation measures (PbrO2) obtained by an intracerebral Clark-type Licox probe.ResultsAddition of dexmedetomidine resulted in a 32% reduction in median PbrO2 values for the LBP group (P = 0.03), but no significant changes in PbrO2 were observed for the NBP group. No significant changes in LSCI readings were observed in either group between any time points, despite a 28% decrease in the LBP group following dexmedetomidine administration. Caval block resulted in a significant (P = 0.02) reduction in median MAP from 68 mmHg (range 63–85) at PCB to 58 mmHg (range 53–63) in the LBP group, but no significant differences in either PbrO2 or LSCI were observed due to this intervention (P = 0.6 and P = 0.3 respectively).ConclusionsAddition of dexmedetomidine to propofol-remifentanil TIVA resulted in a significant decrease in cerebral oxygenation (PbrO2) measurements in piglets with lowered blood pressure. Cerebral perfusion (LSCI) did not decrease significantly in this group. In piglets with normal blood pressure, no significant changes in cerebral perfusion or oxygenation were seen in response to addition of dexmedetomidine to the background anaesthesia.Electronic supplementary materialThe online version of this article (doi:10.1186/s13028-017-0293-0) contains supplementary material, which is available to authorized users.

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Total intravenous anesthesia will supercede inhalational anesthesia in pediatric anesthetic practice

Cited by 75 publications

References 186 publications

Reducing preoperative anxiety with Child Life preparation prior to intravenous induction of anesthesia: A randomized controlled trial

Reducing preoperative anxiety with Child Life preparation prior to intravenous induction of anesthesia: A randomized controlled trial

A follow‐up survey of total intravenous anesthesia usage in children in the U.K. and Ireland

The effect of dexmedetomidine on cerebral perfusion and oxygenation in healthy piglets with normal and lowered blood pressure anaesthetized with propofol-remifentanil total intravenous anaesthesia

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