ABSTRACT
This study describes a population pharmacokinetic meta-analysis of propofol to characterize the influence of body size measures and age in morbidly obese and nonobese adults, adolescents, and children. Sixty morbidly obese and nonobese adult patients (55-167 kg; 21-79 years) and 34 morbidly obese and nonobese adolescents and children (37-184 kg; 9-20 years) were included. The results show that clearance increased with total body weight in an allometric function while age was found to influence clearance in a bilinear fashion with two distinct slopes, reflecting an initial increase and subsequent decrease as a result of aging. Using these two functions, the influence of both (over)weight and age on propofol clearance was well characterized, which may provide a basis for dosing across this diverse group of patients.CPT: Pharmacometrics & Systems Pharmacology (2013) 2, e73; doi:10.1038/psp.2013.47; advance online publication 11 September 2013.
ABSTRACT
Five recent cohort studies have shown a frequency of awareness in paediatric anaesthesia of between 0.2% and 1.2%, but they were not individually large enough to identify risk factors. This study pooled raw data from these five studies to identify factors associated with awareness in children. The outcome of awareness was taken as the cases judged to be most likely awareness cases in each study. Logistic regression was used to identify awareness-associated factors. A combined sample of 4486 anaesthetics revealed 33 cases of awareness. Unadjusted analysis demonstrated weak evidence that nitrous oxide used as an anaesthetic maintenance adjunct was associated with awareness (OR 2.04 (95% CI 0.97-4.33), p=0.06), and some evidence that use of a tracheal tube was associated with awareness (OR 2.78 (95% CI 1.11-6.94), p=0.03). Multivariable regression analysis revealed that nitrous oxide maintenance and use of a tracheal tube were independently associated with awareness (nitrous oxide, OR 2.4 (95% CI 1.08-5.32), p=0.03; tracheal tube, OR 3.0 (95% CI 1.20-7.56), p=0.02).
Subject(s)
Anesthesia, General/adverse effects , Intraoperative Awareness/etiology , Adolescent , Anesthetics, Inhalation/adverse effects , Child , Child, Preschool , Epidemiologic Methods , Female , Humans , Intraoperative Awareness/epidemiology , Intubation, Intratracheal/adverse effects , Male , Mental Recall , Nitrous Oxide/adverse effectsABSTRACT
BACKGROUND: Previous studies indicate a higher incidence of awareness during anaesthesia in children than in adults, that is, around 1% vs 0.2%. In this prospective cohort study, we determined the incidence of intraoperative awareness in children undergoing elective or emergency surgery at a university children's hospital. METHODS: Data from 928 consecutive paediatric patients, aged 5-18 yr, were collected prospectively over a 12 month period. Interviews using a structured questionnaire were scheduled at three time points: within 24 h after the operation, and 3-7 and 30 days after operation. Reports of suspected awareness were sent to four independent adjudicators. If they all agreed, the case was classified as a true awareness case. RESULTS: The interviews generated 26 cases of suspected awareness. Six cases were judged to be true awareness, equalling a 0.6% incidence (95% confidence interval 0.03-1.40%). Auditory and sensory perceptions were the sensations most reported by these six children. Pain, anxiety, and paralysis were less often mentioned. The children in general did not report awareness as stressful. CONCLUSIONS: The incidence of awareness in this study, in children undergoing general anaesthesia, is comparable with recent reports from other countries, and appears to be higher than that reported in adults.
Subject(s)
Anesthesia, General/methods , Awareness , Adolescent , Child , Child, Preschool , Emergencies , Female , Humans , Intraoperative Period , Male , Mental Recall , Prospective Studies , Risk Factors , SensationABSTRACT
To assess safety and efficacy of propofol and thiopental for refractory status epilepticus (RSE) in children, the authors reviewed 34 episodes of RSE. Thiopental was effective in most patients, but there were serious side effects. Propofol was used according to a strict protocol. It was effective in most patients, so that thiopental was not needed. Side effects were infrequent, of minor severity, and fully reversible. The authors suggest the use of propofol before thiopental.
