Caffeine in children with obstructive sleep apnea

Children with obstructive sleep apnea [OSA] have a higher rate of adverse post-extubation respiratory events, such as laryngospasm, upper airway obstruction, apnea, desaturation and/or need for re-intubation. They are overly sensitive to sedatives and narcotics. Although the etiology of OSA is primarily obstruction [mechanical or neuromuscular], a central element may contribute to OSA. Caffeine citrate has been shown to be effective in treating apnea of prematurity. This study evaluated whether the administration of caffeine benzoate to children with OSA decreases the number of children who experience adverse post-extubation respiratory events. In a randomized, double-blind and placebo-controlled study, children with OSA scheduled for adenotonsillectomy [T and A] received either caffeine benzoate, 20 mg/kg IV, [caffeine group, n = 36] or saline [placebo group, n = 36]. The primary outcome evaluated the number of children who developed adverse post-extubation respiratory events, and the secondary outcome was the incidence of those events. The results demonstrated the two groups differed in the number of children who developed adverse post-extubation respiratory events [p = 0.032]. The overall incidence of adverse postoperative respiratory events was less in the caffeine group than the placebo group [p = 0.0196]. In children with OSA scheduled for T and A, administration of caffeine benzoate, 20 mg/kg IV, decreased the number of children who developed adverse post-extubation respiratory events and decreased the overall incidence of adverse post-extubation respiratory events. PACU duration, hospital discharge time and postoperative delirium did not differ between groups

Presurgical caudal block attenuates stress response in children

Our aim was to determine if the anesthesia technique for pain relief in children affects-the stress response after minor surgery. A rise in blood glucose reflects stress-related effects in children who do not receive glucose preoperatively. Twenty-eight children, ages 17-81 mos, undergoing elective urologic procedures, were enrolled. For pain relief, patients received presurgical caudal block [group 1], intravenous narcotics [group 2], or postsurgical caudal block [group 3]. Blood samples were analyzed for glucose concentrations immediately after induction of anesthesia at baseline, 15 min after surgical incision [second sample], and 30 min after end of surgery [third sample]. In group 1 there was no change in glucose concentration in the second or third samples compared to baseline, while in group 3 there were significant increases in those samples, and in group 2 there was a significant increase in the second sample compared to baseline. Children in group 1 required significantly fewer narcotics in the post anesthesia care unit [PACU], and those in group 2 had significantly longer PACU and hospital durations. Presurgical caudal analgesia attenuates the stress response of anesthesia and surgery and decreases postoperative narcotic use while narcotics prolong PACU and discharge times