ABSTRACT
Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke, indoor fireplaces, silos containing large quantities of wood pellets, engine exhaust fumes, and when using hookahs. Symptoms of CO poisoning are nonspecific and can range from dizziness, headache, and angina pectoris to unconsciousness and death. This guideline presents the current state of knowledge and national recommendations on the diagnosis and treatment of patients with CO poisoning. The diagnosis of CO poisoning is based on clinical symptoms and proven or probable exposure to CO. Negative carboxyhemoglobin (COHb) levels should not rule out CO poisoning if the history and symptoms are consistent with this phenomenon. Reduced oxygen-carrying capacity, impairment of the cellular respiratory chain, and immunomodulatory processes may result in myocardial and central nervous tissue damage even after a reduction in COHb. If CO poisoning is suspected, 100% oxygen breathing should be immediately initiated in the prehospital setting. Clinical symptoms do not correlate with COHb elimination from the blood; therefore, COHb monitoring alone is unsuitable for treatment management. Especially in the absence of improvement despite treatment, a reevaluation for other possible differential diagnoses ought to be performed. Evidence regarding the benefit of hyperbaric oxygen therapy (HBOT) is scant and the subject of controversy due to the heterogeneity of studies. If required, HBOT should be initiated within 6 h. All patients with CO poisoning should be informed about the risk of delayed neurological sequelae (DNS).
Subject(s)
Carbon Monoxide Poisoning , Hyperbaric Oxygenation , Carbon Monoxide Poisoning/diagnosis , Carbon Monoxide Poisoning/therapy , Carboxyhemoglobin , Dizziness , Humans , OxygenABSTRACT
Children with certain risk factors, such as comorbidities or severe obstructive sleep apnea syndrome (OSAS) are known to require extended postoperative monitoring after adenotonsillectomy. However, there are no recommendations available for diode-laser-assisted tonsillotomy. A retrospective chart review of 96 children who underwent diode-laser-assisted tonsillotomy (07/2011-06/2013) was performed. Data for general and sleep apnea history, power of the applied diode-laser (λ = 940 nm), anesthesia parameters, the presence of postoperative respiratory complications and postoperative healing were evaluated. After initially uncomplicated diode-laser-assisted tonsillotomy, an adjustment of post-anesthesia care was necessary in 16 of 96 patients due to respiratory failure. Respiratory complications were more frequent in younger children (3.1 vs. 4.0 years, p = 0.049, 95 % CI -1.7952 to -0.0048) and in children who suffered from nocturnal apneas (OR = 5.00, p < 0.01, 95 % CI 1.4780-16.9152) or who suffered from relevant comorbidities (OR = 4.84, p < 0.01, 95 % CI 1.5202-15.4091). Moreover, a diode-laser power higher than 13 W could be identified as a risk factor for the occurrence of a postoperative oropharyngeal edema (OR = 3.45, p < 0.01, 95 % CI 1.3924-8.5602). Postoperative respiratory complications should not be underestimated in children with sleep-disordered breathing (SDB). Therefore, children with SDB, children with comorbidities or children younger than 3 years should be considered "at risk" and children with confirmed moderate to severe OSAS should be referred to a PICU following diode-laser-assisted tonsillotomy. We recommend a reduced diode-laser power (<13 W) to reduce oropharyngeal edema.
Subject(s)
Laser Therapy/adverse effects , Lasers, Semiconductor/therapeutic use , Postoperative Complications , Sleep Apnea, Obstructive/etiology , Tonsillectomy/adverse effects , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Laser Therapy/methods , Male , Postoperative Period , Retrospective Studies , Risk Factors , Sleep Apnea, Obstructive/physiopathology , Tonsillectomy/methodsABSTRACT
BACKGROUND: The use of electroencephalogram (EEG) monitoring devices for assessing the depth of hypnosis is most difficult in children under 5 years of age. METHODS: Forty five children aged 0-60 months were included in a prospective observational study. A direct comparison of the processed EEG variables Bispectral Index (BIS, version 3.4) and Narcotrend Index (NI, version 2.0AF) was to be achieved by simultaneous recording. The ability of these parameters to differentiate between various clinical states was evaluated by using the prediction probability (P(k)). Age-related effects on the BIS and NI were analyzed by dividing the children into three age groups: 0-6, 7-18 and 19-60 months. RESULTS: The preanesthesia, conscious children were differentiated from anesthetized patients by the BIS and NI with no overlap (P(k) = 1.0). In the awake period the BIS was superior to the NI (P(k) to differentiate 'end of anesthesia' from 'awakening' was 0.97 vs 0.73 respectively; P = 0.002). Patients aged 7-18 months showed higher BIS and NI values in the course of anesthesia than the younger and older children (P = 0.001). On awakening, children aged 0-6 months showed the lowest mean BIS (n.s.) and NI (P = 0.006) values. CONCLUSIONS: The BIS currently seems to be superior to the NI, but age-related processing algorithms of the raw EEG must be implemented in both BIS and NI in order to be useful in children younger than 5 years of age.
