[Optimization of anesthetic maintenance using two-channel laryngeal masks Proseal during endovascular correction of congenital defects in infants and young children].

The paper analyzes the efficiency of the authors' procedure for anesthetic maintenance based on a combination of inhalational (sevoflurane) and intravenous (1% propofol) anesthesia on spontaneous breathing through a ProSeal laryngeal mask airway in the X-ray endovascular correction of congenital heart diseases in infants and young children. The study included 118 children aged 2 to 7 years with secondary atrial septal defect, who had undergone endovascular defect correction, by applying an Amplazer septal occluder. The key points of the anesthetic maintenance proposed by the authors are: (1) substitution of routine pharmacological premedication for psychological (the presence of parents); (2) inhalational (sevoflurane) anesthesia in the induction of anesthesia; (3) replacement of an endotracheal tube by a ProSeal laryngeal mask; (4) refusal of myorelaxants and respiratory support without artificial ventilation. The authors' anesthesia protocol during these operations provides a safe perioperative period.

Maternal heart rate variability just before surgery significantly correlated with emergence behavior of children undergoing general anesthesia.

BACKGROUND: Emergence agitation in pediatric anesthesia is associated with preanesthesia child anxiety, which is strongly influenced by maternal mental conditions. Mental stress affects the autonomic nervous system, thereby influencing heart rate variability (HRV). The present study tested the correlations between preanesthesia maternal HRV and perioperative child behavior. METHODS: A total of 27 pairs of mothers and children were analyzed in the present study. Maternal HRV was recorded from the night before the child's surgery to arrival to the operation room and thereafter recorded data were analyzed. The children underwent minor plastic surgery under general anesthesia, and induction and emergence behavior were assessed. RESULTS: Quality of mask induction did not correlate with the ratio of low-frequency (LF) components to high-frequency (HF) components (LF/HF ratio) of preanesthesia maternal HRV either obtained during 21:00-06:00 (stage I) or 06:00-08:00 (stage II). Scores of the child's emergence behavior did not correlate with the LF/HF ratio of maternal HRV of stage I; however, the LF/HF ratio of maternal HRV of stage II significantly correlated with emergence behavior. CONCLUSIONS: Two-hour maternal HRV just before surgery significantly correlated with emergence behavior of children undergoing general anesthesia.

Giving toys to children reduces their anxiety about receiving premedication for surgery.

Children have increased anxiety during the preoperative period. The administration of oral premedication to children is often met with apprehension, reluctance, or refusal. We sought to determine whether giving a small toy to the children would decrease the anxiety associated with taking oral premedication. This was a prospective study involving 100 children 3-6 yr of age randomized into two equal groups. The anxiety of each child was assessed using the Modified Yale Preoperative Anxiety Scale. The results showed significantly less anxiety in children who received a toy before oral administration of midazolam.

Parental anxiety levels during pediatric induction with and without administration of premedication for general anesthesia.

This study measured parental anxiety before, during, and after elective dental procedures under general anesthesia using the Spielberger State-Trait Anxiety questionnaire. State anxiety started relatively high before the procedures, peaked immediately after induction using general anesthesia, and dropped during recovery to below the initial score. Parents, whose children were premedicated and fathers in general, had significantly higher anxiety immediately after induction. This study supports interventions to lower anxiety of the parents as well as that of children.

[Evaluation of preoperative anxiety in patients with and without premedication].

BACKGROUND: The purpose of this investigation was to determine whether elimination of premedication before general anesthesia affects preoperative anxiety. METHODS: Subjects were assigned to one of two groups: a sedative group (0.5 mg midazolam i.m., n = 111) or a no-premedication group (n = 98). We used patients' responses to a questionnaire to compare the no-premedication group and the sedative group. RESULTS: Eighty-three percent of patients in the no-premedication group entered the operating room ambulatory. The responses concerning preoperative anxiety were not different between the two groups. There was a high rate of recall of the conversation before anesthesia induction in the no-premedication group, and most of these patients replied that making conversation before general anesthesia was beneficial to them. Increases in heart rate and blood pressure at the point of entrance to operating room were observed in the no-premedication group, but the degrees of increase were not considered clinically important. CONCLUSION: We conclude that elimination of premedication does not increase anxiety in comparison with patients receiving sedatives, but makes patients feel comfortable by way of preoperative conversation. Elimination of premedication also makes ambulatory entrance possible, both improving safety with respect to patient identification and reducing the demand on nursing.

Dental anxiety in adolescents with a history of childhood dental sedation.

The purpose of this study was to determine whether adolescents with a history of childhood dental treatment using sedation had a higher level of self-reported dental anxiety than adolescents without such a history. A group of 287 adolescents were identified who had received dental treatment using an identical sedation regime during childhood (mean age 5.05 +/- 0.16 years). A cover letter and a modified Dental Anxiety Scale (DAS) were mailed to the parents of all subjects. Sixty-one subjects (n = 61, 21 males, 40 females, mean age = 14.79 +/- 0.16 years) (+/- SE) completed and returned the form. Age matched control subjects (n = 38, 18 females, 20 males, mean age = 14.36 +/- 0.06 years) who had no history of sedation or general anesthesia for dental or medical procedures also completed the DAS. Using the Mann-Whitney U test, the DAS score for test subjects (13.49 +/- 0.76) was found to be significantly higher (p < 0.05) than the DAS score for control subjects (10.84 +/- 0.69).

[Children's anxiety is reduced by the presence of parents at induction of anesthesia].

The present study aims to examine if children's anxiety could be reduced by the presence of the parent at induction of anesthesia. The subjects were children aged from 6 months to 6 years who underwent general anesthesia. Forty children (Group A) received premedication and without the parent at induction of anesthesia. Thirty-eight children (Group B) received premedication and with the parent. Thirty-eight children (Group C) did not receive premedication and were with the parent. We examined whether children were crying or not during anesthetic induction. Number of crying children accompanied by the parent during induction were fewer than those who were not accompanied. We conclude that allowing the parent to be present during anesthetic induction reduces the number of crying children and we consider that the presence of the parent decreased the children's anxiety.

Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children.

The purpose of this prospective multicentre survey was to evaluate the occurrence and the type of changes in children's behaviour during the first 4 weeks following the day of surgery, and to assess the significance of some patient-related factors on the incidence. Pre- and postoperative questionnaires were completed by the parents of 551 children aged 4 months to 13.4 years in five hospitals incorporating nine operative units in Northern Finland. The overall incidence of problematical behavioural changes was 47% and that of beneficial changes 17%. Problematical changes were most common in the 1.0 to 2.9 year olds and the incidence decreased significantly from 46% on the day of the operation to 9% 4 weeks later (p < 0.0001). Predictors by multiple logistic regression analysis were age, mild pain at home following surgery, severe pain and a previous bad experience of health care which had adversely affected the attitude of the child towards doctors or nurses. Hospital influenced playing was a significant factor 3 and 4 weeks after the operation. By the 4th week, beneficial and problematical changes were equally common (9%). Gender, previous operations and experience of repeated paracenteses (for treatment of middle ear infection) did not have a significant effect on the incidence. Pain on the day of the operation predicted the occurrence of behavioural problems up to the 4th week, 2-4 weeks longer than the duration of pain itself. The results emphasise the importance of effective prevention of postoperative pain as well as the importance of avoiding unpleasant experiences in all contacts children have with health care. Playing could perhaps be used to help children cope with a short hospital experience.

Pre-operative analgesia for acute surgical patients: no place for complacency.

Pain is common in patients presenting with acute surgical conditions but there has been little discussion of the provision of pre-operative analgesia. This study analyses the pattern of pre-operative analgesic administration and questions the practices of the admitting medical officers in a district hospital. It shows that pre-operative analgesia is often omitted or that an unduly long time is taken to administer it. We suggest that this is an area worthy of audit.

The use of midazolam in premedication.

Socio-psychological factors, such as increased anxiety in developed societies and cultures, and separation anxiety, particularly in children, justify the use of premedicants. In addition, the link between a central nervous "anxiety centre" and biochemical stress responses is blocked by an efficient anxiolytic. The elimination half-life of midazolam is longer in the elderly than in the young and in the obese than in the thin, which demands longer intervals between repeated doses in old and fat patients. The hypoxic ventilatory response is depressed in most patients and the ventilatory CO2 response in patients with chronic pulmonary disorders, which justifies increased monitoring of O2 saturations. It is important for the choice of dose and for estimating the duration of recovery time to know that midazolam is at least four times as potent as diazepam.

Interrelations among children, parents, premedication, and anaesthetists in paediatric day stay surgery.

OBJECTIVE: To investigate the incidence of difficulties associated with parental presence during the induction of anaesthesia in children and the influence of premedication with special reference to vomiting after papaveretum. DESIGN: Mixed factual and multiple choice questionnaire completed by medical and nursing staff and parents during and after admission. SETTING: Teaching hospital with regional paediatric general surgical unit where parental presence during induction of anaesthesia is long established. PATIENTS: 151 Children aged 1-14 years who had not previously undergone surgery attending with parents for day stay general surgical procedures. INTERVENTION: Children were randomly allocated to receive no premedication (group 1), oral diazepam elixir (0.3 mg/kg) (group 2), or intramuscular papaveretum with hyoscine (0.3 mg/kg with 0.006 mg/kg) (group 3). No other modification to established day stay routine was made. RESULTS: No major problems were associated with the presence of parents during the induction of anaesthesia. Only 10 of the 141 parents who accompanied their child caused some difficulty, and five became distressed. Premedication with both diazepam and papaveretum resulted in sedation but did not ease induction of anaesthesia. Papaveretum greatly reduced pain and distress immediately after the operation, pain and discomfort being observed in only 15% of children (7/48) compared with 66% (27/41) in group 1 and 49% (22/45) in group 2. Papaveretum, however, must be given intramuscularly, and nurses observed that the children preferred being given premedication orally to intramuscularly. In addition, the incidences of nausea and vomiting were significantly higher in the postoperative ward and at home with papaveretum, although no patient who had been given the drug was nauseous or vomited in the recovery area. The incidences of nausea in group 3 were 62% (31/50) and 57% (27/47) in the postoperative ward and at home, respectively, v 21% (7/33) and 14% (4/29) in group 1 and 13% (5/38) and 14% (5/37) in group 2; the incidences of vomiting in group 3 were 60% and 43% in the postoperative ward and at home, respectively, v 18% and 7% in group 1 and 11% and 11% in group 2. Finally, neither the administration or otherwise of premedication nor the drug given affected the children's or parents' perception of day care surgery. CONCLUSIONS: Difficulties with parents in anaesthetic rooms were not common or severe. Premedication provides preoperative sedation and papaveretum improves the immediate postoperative course but the incidences of nausea and vomiting after operation are higher with its use than without.