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Background: Reduction in the hippocampal volume may contribute to agitated and delayed emergence after anesthesia in epilepsy surgery. We hypothesized that hippocampal volume and the duration of various recovery parameters after a short duration of sedation may be correlated. The primary objective was to evaluate the correlation between hippocampal volumes with time to recovery after the stoppage of propofol infusion. Methods: After obtaining Institute Ethical Clearance, we included all children of the age group 5-17 years, who needed sedation for brain magnetic resonance imaging (MRI) for at least 20-60 minutes for the evaluation of epilepsy. The hippocampal volume was estimated bilaterally in the pre-contrast volumetric magnetization-prepared rapid gradient-echo (MPRAGE) brain imaging by the radiologist using statistical parametric mapping. The correlation of hippocampal volume with recovery and time to discharge (assessed by the modified Aldrete score (MAS)) was obtained using Spearman's correlation coefficient (rho). A rho > ± 0.5 was considered a good correlation between the variables. Results: Data on a total of 18 children (10 males and 8 females) who required sedation for an MRI were studied over a period of six months. The correlation coefficients of right and left corrected hippocampal volumes with time to spontaneous eye opening were -0.052 and -0.195, respectively. The correlation coefficients of right and left corrected hippocampal volumes with time to respond to oral commands were -0.017 and -0.219, respectively. Conclusion: There was a weak negative correlation between hippocampal volumes and recovery parameters after a short duration of sedation with propofol in children.
RESUMO
Background: Magnetic resonance imaging (MRI) under sedation requires faster recovery for early discharge and feeding resumption in children with neuropsychiatric disorders. The use of dexmedetomidine alone results in delayed recovery. Propofol, when used alone, can cause hypotension and respiratory depression. A new regimen for sedation was evaluated by exploiting the properties of these drugs, to allow faster recovery with minimal adverse events. Materials and Methods: One hundred and fifty children aged 2-12 years requiring MRI were randomly allocated to these three groups. Group P (n = 50) received propofol bolus at 2 mg.kg-1 over 10 min followed by infusion at 100 µg.kg-1.min-1. Group D (n = 50) received dexmedetomidine bolus of 2 µg.kg-1 over 10 min followed by infusion at 1 µg.kg-1.h-1. Group PD (n = 50) received propofol bolus at 2 mg.kg-1 over 10 min followed by dexmedetomidine infusion at 1 µg.kg-1.h-1. Recovery characteristics were noted. Results: Recovery following sedation in Group PD (15 ± 7.0 min) and Group P (17.35 ± 7.4 min) were comparable and significantly (P = 0.03) lesser than Group D (27.58 ± 8.09 min). Emergence delirium scores were significantly less in Group PD (5 ± 1.08) and Group D (5.6 ± 2.4), unlike scores in Group P (9 ± 2.43). About 79.5% (39/49) of children in Group P, 88.2% (45/51) of children in Group D, and 86% (43/50) of children in Group PD completed MRI without any movement. Seven (14.58%) in Group P, 2 (4%) in Group D, and 5 (10.20%) in Group PD required rescue sedation. Conclusion: The regimen with propofol bolus and dexmedetomidine infusion provided adequate sedation and better recovery characteristics in children aged 2-12 years without systemic complications, as compared to the use of either agent alone.
RESUMO
BACKGROUND: Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome. METHODS: Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube. RESULTS: The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay. CONCLUSIONS: In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation.
