1,930 results match your criteria Pediatrics Sedation


A prospective investigation of interleukin-8 levels in pediatric acute respiratory failure and acute respiratory distress syndrome.

Crit Care 2019 Apr 17;23(1):128. Epub 2019 Apr 17.

Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Dr, F6790/5243, Ann Arbor, MI, 48109, USA.

Background: The association of plasma interleukin-8 (IL-8), or IL-8 genetic variants, with pediatric acute respiratory distress syndrome (PARDS) in children with acute respiratory failure at risk for PARDS has not been examined. The purpose of this study was to examine the association of early and sequential measurement of plasma IL-8 and/or its genetic variants with development of PARDS and other clinical outcomes in mechanically ventilated children with acute respiratory failure.

Methods: This was a prospective cohort study of children 2 weeks to 17 years of age with acute airways and/or parenchymal lung disease done in 22 pediatric intensive care units participating in the multi-center clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE). Read More

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http://dx.doi.org/10.1186/s13054-019-2342-8DOI Listing
April 2019
1 Read

Determination of the 90% effective dose of intranasal dexmedetomidine for sedation during electroencephalography in children.

Acta Anaesthesiol Scand 2019 Apr 14. Epub 2019 Apr 14.

Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China.

Background: The intranasal route of dexmedetomidine (DEX) administration is becoming increasingly popular for providing adequate sedation during short examinations in infants and children. However, data on the 90% effective dose (ED90) of intranasal DEX are rare in children under 3 years old.

Methods: This is a double-blind trial using a biased coin design up-and-down sequential method (BCD-UDM). Read More

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http://dx.doi.org/10.1111/aas.13372DOI Listing

Operator-Directed Procedural Sedation in the Congenital Cardiac Catheterization Laboratory.

JACC Cardiovasc Interv 2019 Apr 5. Epub 2019 Apr 5.

Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Objectives: The purpose of this study was to evaluate the association between the method of procedural sedation and outcomes for congenital cardiac catheterization procedures.

Background: The safety of operator-directed sedation (ODS) in the pediatric/congenital cardiac catheterization laboratory has been questioned. To our knowledge, the relative safety of ODS versus general anesthesia (GA) in these cases has not to date been critically evaluated. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S19368798193031
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http://dx.doi.org/10.1016/j.jcin.2019.01.224DOI Listing
April 2019
5 Reads

Sedation in the Pediatric and Congenital Catheterization Lab: Is It Time We Wake Them Up?

JACC Cardiovasc Interv 2019 Apr 5. Epub 2019 Apr 5.

Rocky Mountain Pediatric Cardiology, Denver, Colorado.

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https://linkinghub.elsevier.com/retrieve/pii/S19368798193046
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http://dx.doi.org/10.1016/j.jcin.2019.02.001DOI Listing
April 2019
2 Reads

Safety and Efficacy of Buccal Dexmedetomidine for MRI Sedation in School-Aged Children.

Hosp Pediatr 2019 Apr 10. Epub 2019 Apr 10.

Departments of Pediatrics and.

Objectives: Intranasal, intramuscular, and intravenous (IV) dexmedetomidine routes have been used successfully for pediatric MRI studies. We designed this retrospective study to determine efficacy and safety of buccal dexmedetomidine for pediatric MRI sedation.

Methods: Medical records were reviewed of outpatient children ages 5 to 18 years who received buccal dexmedetomidine with or without oral midazolam for MRI sedation at a freestanding children's hospital sedation program in 2015 and 2016. Read More

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http://dx.doi.org/10.1542/hpeds.2018-0162DOI Listing
April 2019
1 Read

Weaning in Neurally Adjusted Ventilatory Assist (NAVA): a prospective interventional study in neonates.

Minerva Pediatr 2019 Apr 5. Epub 2019 Apr 5.

Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità Hospital, Novara, Italy.

Background: Neurally adjusted ventilatory assist (NAVA) is a respiratory support triggered by the electrical activity of the diaphragm (EAdi). Only few studies evaluated NAVA short-term efficacy and safety in newborns. Aim of this study is to assess efficacy and safety of NAVA in a cohort of newborns and to analyse ventilation parameters helpful to guide weaning. Read More

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https://www.minervamedica.it/index2.php?show=R15Y9999N00A190
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http://dx.doi.org/10.23736/S0026-4946.19.05142-9DOI Listing
April 2019
5 Reads

Safety and Efficacy of Radiofrequency Ablation for Nonfunctioning Benign Thyroid Nodules in Children and Adolescents in 14 Patients over a 10-Year Period.

J Vasc Interv Radiol 2019 Apr 5. Epub 2019 Apr 5.

Department of Radiology, Gil Medical Center, Gachon University School of Medicine, Incheon, 21565, Korea.

Purpose: To evaluate the efficacy and safety of radiofrequency ablation (RFA) ablation for nonfunctioning benign thyroid nodules in children and adolescents.

Materials And Methods: Fourteen pediatric patients (10 female, 4 male; mean age 15.7 ± 2. Read More

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http://dx.doi.org/10.1016/j.jvir.2018.10.034DOI Listing
April 2019
2 Reads

A school-aged boy with super-refractory status epilepticus secondary to cortical dysplasia treated with dexmedetomidine.

J Clin Neurosci 2019 Apr 3. Epub 2019 Apr 3.

University of Florida, Department of Pediatrics, Division of Neurology, 1600 SW Archer Road, Gainesville, FL 32608, United States. Electronic address:

This case report details a novel approach to the management of super-refractory status epilepticus (SRSE) in a boy with new-onset seizures progressing to SRSE. After exhausting multiple medications, dexmedetomidine, an α2-adrenoreceptor agonist used for sedation, stopped his SRSE. Dexmedetomidine provides a unique mechanism of action to treat this condition. Read More

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http://dx.doi.org/10.1016/j.jocn.2019.03.050DOI Listing
April 2019
1 Read

Sedation Optimization: A Core Priority of Modern Quality Improvement in Critical Care.

Authors:
Rambod Amirnovin

Pediatr Crit Care Med 2019 Apr;20(4):382-383

Department of Pediatrics, University of Southern California Keck School of Medicine; and Department of Anesthesia Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.

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http://dx.doi.org/10.1097/PCC.0000000000001890DOI Listing

Sudden cardiac death associated with cardiac catheterization in Williams syndrome: a case report and review of literature.

Cardiol Young 2019 Apr 5:1-5. Epub 2019 Apr 5.

Department of Pediatrics, Division of Pediatric Critical Care Medicine,Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health,Indianapolis, IN,USA.

Williams syndrome is a rare genetic disease that affects elastin production, leading to medium and large vessel stenoses and other abnormalities. Cardiac manifestations of Williams syndrome are the most life-threatening, occurring in 80% of children. Children with Williams syndrome are known to be at risk for sudden cardiac death. Read More

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http://dx.doi.org/10.1017/S1047951119000295DOI Listing
April 2019
1 Read

Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events.

J Perinatol 2019 Apr 2. Epub 2019 Apr 2.

Center for simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Objective: To determine the impact of premedication for tracheal intubation (TI) on adverse TI associated events, severe oxygen desaturations, and first attempt success STUDY DESIGN: Retrospective cohort study in neonatal intensive care units (NICU) participating in the National Emergency Airway Registry for Neonates from 10/2014 to 6/2017. Premedication for TI was categorized as sedation with neuromuscular blockade, sedation only, or no medication.

Results: 2260 TIs were reported from 11 NICUs. Read More

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http://dx.doi.org/10.1038/s41372-019-0367-0DOI Listing
April 2019
2.347 Impact Factor

Sedation and The FDA Warning: What a Pediatric Gastroenterologist, Hepatologist and Pancreatologist Should Know.

J Pediatr Gastroenterol Nutr 2019 03 26. Epub 2019 Mar 26.

University of Massachusetts School of Medicine, Department of Pediatrics; Umass Memorial Children’s Medical Center, Division of Pediatric Gastroenterology and Nutrition

Pediatric gastroenterologists recommend and perform a range of procedures requiring sedation and anesthesia in young children. A recent warning from the US FDA states that "repeated or lengthy use of general anesthetics and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains.' 1 As it relates to time, the FDA warning details risks of 'procedures lasting longer than 3 hours or if multiple procedures are required. Read More

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http://dx.doi.org/10.1097/MPG.0000000000002346DOI Listing

Foreign Body Removal in Children Using Foley Catheter or Magnet Tube from Gastrointestinal Tract.

Pediatr Gastroenterol Hepatol Nutr 2019 Mar 5;22(2):132-141. Epub 2019 Mar 5.

Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea.

Foreign body (FB) ingestion of children is a common pediatric emergency requiring medical attention. Pediatric emergency physicians and gastroenterologists often encounter nervous and distressed situations, because of children presenting with this condition in the common clinical practice. When determining the appropriate timing and indications for intervention, physicians should consider multiple patient- and FB-related factors. Read More

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https://synapse.koreamed.org/DOIx.php?id=10.5223/pghn.2019.2
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http://dx.doi.org/10.5223/pghn.2019.22.2.132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416381PMC
March 2019
5 Reads

Efficacy and cost savings with the use of a minimal sedation / anxiolysis protocol for intra-articular corticosteroid injections in children with juvenile idiopathic arthritis: a retrospective review of prospectively collected data.

Pediatr Rheumatol Online J 2019 Mar 20;17(1):11. Epub 2019 Mar 20.

Department of Pediatric Anesthesiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue Pittsburgh, Pittsburgh, PA, 15224, USA.

Background: Intra-articular corticosteroid injections (IACI) are frequently used in the treatment of juvenile idiopathic arthritis. There is a paucity of evidence-based research describing methods of pain and anxiety control for this procedure. IACI were mostly performed under general anesthesia for children younger than 13 years old in our institution as of 2014. Read More

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http://dx.doi.org/10.1186/s12969-019-0312-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425704PMC
March 2019
2 Reads

Utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration in children with mediastinal pathology.

Pediatr Pulmonol 2019 Mar 19. Epub 2019 Mar 19.

Division of Pediatric Pulmonology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound with an echobronchoscope-guided fine needle aspiration (EUS-B-FNA) are useful modalities in the evaluation of mediastinal pathologies in adults. However, sparse data are available in children.

Objective: To describe the utility and safety of EBUS-TBNA and EUS-B-FNA in children with mediastinal pathologies of unknown etiology. Read More

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http://dx.doi.org/10.1002/ppul.24313DOI Listing
March 2019
1 Read

Procedural sedation and analgesia practices in the emergency centre.

Afr J Emerg Med 2019 Mar 13;9(1):8-13. Epub 2018 Oct 13.

Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Introduction: Procedural sedation and analgesia allows the clinician to safely and efficiently administer sedation, analgesia, anxiolysis and sometimes amnesia to facilitate the performance of various procedures in the emergency centre. The aim of this study is to determine current sedation practices, common indications and major obstacles in selected emergency centres across Southern Gauteng, South Africa, with a view to improving future standards and practices.

Methods: This was a prospective, questionnaire based, cross-sectional interview of emergency centre managers or their designee of selected private-sector and public-sector hospitals in Southern Gauteng. Read More

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http://dx.doi.org/10.1016/j.afjem.2018.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400002PMC

Sevoflurane sedation for weaning from mechanical ventilation in pediatric intensive care unit.

Minerva Anestesiol 2019 Mar 12. Epub 2019 Mar 12.

Department of Pediatric Surgery and Intensive Care, University Medical Center Ljubljana, Ljubljana, Slovenia.

Background: Light sedation is the prerequisite for weaning from mechanical ventilation. Our aim was to evaluate the technical feasibility and efficacy of sevoflurane delivered by anesthetic conserving device (ACD) for sedation of children during weaning from mechanical ventilation.

Methods: Prospective observational feasibility study in paediatric ICU. Read More

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http://dx.doi.org/10.23736/S0375-9393.19.13077-5DOI Listing
March 2019
1 Read

Nasal foreign bodies in the paediatric emergency department.

Ir J Med Sci 2019 Mar 11. Epub 2019 Mar 11.

Emergency Department, Our Lady's Children's Hospital Crumlin, Drimnagh Road, Dublin 12, Ireland.

Background: Nasal foreign body(-ies) (FB) cause local irritation, inflammation, and mucosal erosion and carry a potential risk of aspiration. The aim is to describe the management of nasal FBs in our Emergency Department (ED).

Method: A retrospective study of 100 sequential suspected nasal FB presentations to a tertiary paediatric ED. Read More

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http://dx.doi.org/10.1007/s11845-019-02000-zDOI Listing
March 2019
2 Reads

Procedural Sedation outside the Operating Room and Potential Neurotoxicity: Analysis of an At-Risk Pediatric Population.

Acad Pediatr 2019 Mar 8. Epub 2019 Mar 8.

Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.

Objectives: To determine the characteristics of children who met the risk criteria for potential neurotoxicity defined by the US Food and Drug Administration (2016 warning) in a procedural sedation (PS) service.

Study Design: A single center retrospective review of all infants and children aged <3 years receiving PS outside the operating room from 2014 to 2016. Demographics, duration of, and the reason for PS were analyzed. Read More

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http://dx.doi.org/10.1016/j.acap.2019.02.011DOI Listing
March 2019
6 Reads

Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation.

PLoS One 2019 11;14(3):e0213074. Epub 2019 Mar 11.

Health Sciences Graduate Program, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.

Purpose: The optimal sedative regime that provides the greatest comfort and the lowest risk for procedural sedation in young children remains to be determined. The aim of this randomized, blinded, controlled, parallel-design trial was to evaluate the efficacy of intranasal ketamine and midazolam as the main component of the behavioral guidance approach for preschoolers during dental treatment.

Materials And Methods: Children under seven years of age, with caries and non-cooperative behavior, were randomized into three groups: (KMIN) intranasal ketamine and midazolam; (KMO) oral ketamine and midazolam; or (MO) oral midazolam. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213074PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6411109PMC
March 2019
1 Read

Efficacy, pain, and overall patient satisfaction with pediatric upper arm fracture reduction in the emergency department.

Orthop Traumatol Surg Res 2019 Mar 5. Epub 2019 Mar 5.

Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France.

Introduction: Immediate closed reduction and cast immobilization performed under sedation in the emergency room is the mainstay management for most isolated displaced or angulated upper limb fractures in children. We aimed to determine if this approach is safe, effective and if patients, parents and staff are satisfied with this approach.Our working hypothesis was this management provides a high satisfaction rate. Read More

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http://dx.doi.org/10.1016/j.otsr.2018.10.027DOI Listing
March 2019
1 Read

Sedation and Analgesia During Pediatric Burn Dressing Change: A Survey of American Burn Association Centers.

J Burn Care Res 2019 Mar 7. Epub 2019 Mar 7.

Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.

Sedation practices for pediatric burn patients during dressing changes vary between institutions and providers. To better understand current trends in pediatric sedation practice, a survey was conducted among American Burn Association (ABA) members. Questions asked about non-operating room sedation and analgesia practices for burn patients (ages 0-17) having dressing changes in the intensive care unit, inpatient unit, and outpatient clinics. Read More

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http://dx.doi.org/10.1093/jbcr/irz023DOI Listing

Survey of the Current Use of Dexmedetomidine and Management of Withdrawal Symptoms in Critically Ill Children.

J Pediatr Pharmacol Ther 2019 Jan-Feb;24(1):16-21

Objectives: Dexmedetomidine use for sedation in the pediatric intensive care units (PICUs) has increased since its initial US Food and Drug Administration (FDA) approval in adults. However, there is limited evidence to direct providers regarding current usage, dosing, and monitoring for withdrawal symptoms in pediatric patients. This study sought to determine the utilization of dexmedetomidine and management of dexmedetomidine withdrawal symptoms among PICU physicians. Read More

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http://dx.doi.org/10.5863/1551-6776-24.1.16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397011PMC
March 2019
2 Reads

Our Survey Says…Pediatric Procedural Sedation Training Should Not Be a Postscript!

Authors:
Vinay Nadkarni

Pediatr Crit Care Med 2019 Mar;20(3):296-297

Department of Anesthesiology and Critical Care Medicine; and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

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http://dx.doi.org/10.1097/PCC.0000000000001850DOI Listing
March 2019
1 Read

Use of cyproheptadine to stimulate appetite and body weight gain: A systematic review.

Appetite 2019 Jun 27;137:62-72. Epub 2019 Feb 27.

Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.

Objective: A systematic review identifying the use of cyproheptadine (CY) as an appetite stimulant was completed.

Method: Studies of any design exploring the efficacy of CY as an appetite stimulant in all age groups and populations were included. Primary outcomes of studies included were weight gain, appetite stimulation, and/or caloric/nutritional intake increase. Read More

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http://dx.doi.org/10.1016/j.appet.2019.02.012DOI Listing
June 2019
2 Reads

Analgesia, sedation, and delirium in pediatric surgical critical care.

Semin Pediatr Surg 2019 Feb 18;28(1):33-42. Epub 2019 Jan 18.

Texas Children's Hospital, Division of Pediatric Surgery, Department of Surgery, 6701 Fannin Street, Houston, TX 77030, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. Electronic address:

The alleviation of discomfort and distress is an essential component of the management of critically ill surgical patients. Pain and anxiety have multifocal etiologies that may be related to an underlying disease or surgical procedure, ongoing medical therapy, invasive monitors, an unfamiliar, complex and chaotic environment, as well as fear. Pharmacologic and non-pharmacologic therapies have complex risk benefit profiles. Read More

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http://dx.doi.org/10.1053/j.sempedsurg.2019.01.006DOI Listing
February 2019
2 Reads

Preemptive Morphine During Therapeutic Hypothermia After Neonatal Encephalopathy: A Secondary Analysis.

Ther Hypothermia Temp Manag 2019 Feb 26. Epub 2019 Feb 26.

1 Centre for Perinatal Neuroscience, Imperial College London, London, United Kingdom.

Although therapeutic hypothermia (TH) improves outcomes after neonatal encephalopathy (NE), the safety and efficacy of preemptive opioid sedation during cooling therapy is unclear. We performed a secondary analysis of the data from a large multicountry prospective observational study (Magnetic Resonance Biomarkers in Neonatal Encephalopathy [MARBLE]) to examine the association of preemptive morphine infusion during TH on brain injury and neurodevelopmental outcomes after NE. All recruited infants had 3. Read More

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http://dx.doi.org/10.1089/ther.2018.0052DOI Listing
February 2019
2 Reads

Comparison of chloral hydrate and pentobarbital sedation for pediatric echocardiography.

Echocardiography 2019 04 25;36(4):766-769. Epub 2019 Feb 25.

Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York.

Background: In 2013, outpatient use of chloral hydrate (CH) was limited and other alternatives such as oral pentobarbital (PB) were explored to achieve conscious sedation in young children for transthoracic echocardiography (TTE). We aimed to assess efficacy and safety of the two medications.

Methods: Clinical information, from a computerized database, about children who received sedation with either CH or PB for TTE at our center (2008-2015) was reviewed, and the two groups were compared for sedation effectiveness and complications. Read More

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http://dx.doi.org/10.1111/echo.14301DOI Listing

Comparison of sufentanil-midazolam and sevoflurane for anesthesia induction in children undergoing cardiac surgery by real-time hemodynamic and cardiac efficiency monitoring: A prospective randomized study.

Heart Surg Forum 2019 02 18;22(1):E038-E044. Epub 2019 Feb 18.

Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, China.

Background Intravenous sufentanil-midazolam and inhalational sevoflurane are widely used for anesthetic induction in children undergoing cardiac surgery. However, knowledge about their effects on hemodynamics and cardiac efficiency remains limited due largely to the lack of direct monitoring method. We used minimally invasive technique pressure recording analytical method (PRAM) to directly monitor hemodynamics and cardiac efficiency and compared the effects of the two anesthetic regimens in children undergoing ventricular septal defect repair. Read More

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http://dx.doi.org/10.1532/hsf.2037DOI Listing
February 2019
3 Reads

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children.

Paediatr Anaesth 2019 Feb 23. Epub 2019 Feb 23.

Department of Pediatrics, University of Wisconsin, Madison, Wisconsin.

Background: Monitoring of ventilation with capnography or a stethoscope is recommended because the detection of ventilatory abnormalities can be significantly delayed by the use of pulse oximetry alone in patients receiving supplemental oxygen. The aim of this study was to evaluate the diagnostic performance of the pretracheal stethoscope with pulse oximetry and capnography in detecting adverse respiratory events during propofol sedation in nonintubated children. We hypothesized that use of the pretracheal stethoscope would facilitate earlier detection of adverse respiratory events. Read More

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http://dx.doi.org/10.1111/pan.13616DOI Listing
February 2019
3 Reads

3D-printed, externally-implanted, bioresorbable airway splints for severe tracheobronchomalacia.

Laryngoscope 2019 Feb 22. Epub 2019 Feb 22.

Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.

Objectives/hypothesis: To report the clinical safety and efficacy of three-dimensional (3D)-printed, patient-specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia.

Study Design: Case series.

Methods: From 2012 to 2018, 15 subjects received 29 splints on their trachea, right and/or left mainstem bronchi. Read More

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http://dx.doi.org/10.1002/lary.27863DOI Listing
February 2019
5 Reads

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

Ann Emerg Med 2019 Feb 16. Epub 2019 Feb 16.

Departments of Pediatrics and Emergency Medicine, University of Minnesota, Minneapolis, MN.

We review the literature in regard to the accuracy, reliability, and feasibility of the Mallampati score as might be pertinent and applicable to emergency department (ED) airway management and procedural sedation. This 4-level pictorial tool was devised to predict difficult preoperative laryngoscopy and intubation, but is now also widely recommended as a routine screening element before procedural sedation. The literature evidence demonstrates that the Mallampati score is inadequately sensitive for the identification of difficult laryngoscopy, difficult intubation, and difficult bag-valve-mask ventilation, with likelihood ratios indicating a small and clinically insignificant effect on outcome prediction. Read More

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http://dx.doi.org/10.1016/j.annemergmed.2018.12.021DOI Listing
February 2019
2 Reads

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement.

JAMA Otolaryngol Head Neck Surg 2019 Feb 14. Epub 2019 Feb 14.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Masschusetts.

Importance: Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation. Read More

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http://dx.doi.org/10.1001/jamaoto.2018.4348DOI Listing
February 2019
3 Reads

Safety and efficacy of a propofol and ketamine based procedural sedation protocol in children with cerebral palsy undergoing botulinum toxin A injections.

PM R 2019 Feb 13. Epub 2019 Feb 13.

Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

Background: Pediatric patients with cerebral palsy (CP) often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. Read More

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http://dx.doi.org/10.1002/pmrj.12146DOI Listing
February 2019
4 Reads

Volumetric Assessment of Pediatric Vascular Malformations Using a Rapid, Hand-Held Three-Dimensional Imaging System.

J Digit Imaging 2019 Apr;32(2):260-268

George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.

The effect of percutaneous, surgical, and medical therapies for vascular malformations (VMs) is often difficult to quantify volumetrically using cross-sectional imaging. Volumetric measurement is often estimated with serial, expensive MRI examinations which may require sedation or anesthesia. We aim to explore whether a portable 3D scanning device is capable of rapid, accurate volumetric analysis of pediatric VMs. Read More

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http://link.springer.com/10.1007/s10278-019-00183-6
Publisher Site
http://dx.doi.org/10.1007/s10278-019-00183-6DOI Listing
April 2019
1 Read

First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis.

Radiology 2019 Apr 12;291(1):170-177. Epub 2019 Feb 12.

From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724.

Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Read More

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http://dx.doi.org/10.1148/radiol.2019181959DOI Listing
April 2019
5 Reads

Clinical Practice Guideline for Emergency Department Procedural Sedation With Propofol: 2018 Update.

Ann Emerg Med 2019 Feb 4. Epub 2019 Feb 4.

Division of Emergency Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA.

We update an evidence-based clinical practice guideline for the administration of propofol for emergency department procedural sedation. Both the unique considerations of using this drug in the pediatric population and the substantial new research warrant revision of the 2007 advisory. We discuss the indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, and adverse events for propofol sedation. Read More

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http://dx.doi.org/10.1016/j.annemergmed.2018.12.012DOI Listing
February 2019
9 Reads

Carbon dioxide versus room air for colonoscopy in deeply sedated pediatric patients: a randomized controlled trial.

Endosc Int Open 2019 Feb 30;7(2):E290-E297. Epub 2019 Jan 30.

Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.

 Use of carbon dioxide (CO ) instead of room air (RA) during colonoscopy in adults revealed significantly less flatulence and abdominal pain in several studies. The objectives of this study were to investigate the effects of CO usage on post-interventional pain, abdominal discomfort, abdominal girth, pCO levels, and narcotic requirement in deeply sedated pediatric patients. A total of 97 children and adolescents aged 4 years to 17 years undergoing colonoscopy were randomized to RA or CO in a prospective, randomized, controlled trial. Read More

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http://dx.doi.org/10.1055/a-0806-7060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353645PMC
February 2019
3 Reads

Necessity of Intracranial Imaging in Infants and Children With Macrocephaly.

Pediatr Neurol 2019 Apr 22;93:21-26. Epub 2018 Nov 22.

Department of Pediatrics, Sanford USD Medical Center, Sanford Children's Hospital, Sioux Falls, South Dakota; University of South Dakota Sanford School of Medicine, Vermillion, South Dakota. Electronic address:

Background: Macrocephaly is frequently encountered in pediatrics and often leads to imaging. There are no recommendations from the American Academy of Pediatrics or the American College of Radiology providing imaging guidelines for macrocephaly. The goal of this study is to identify risk factors for pathologic macrocephaly and to aid the clinician in identifying patients that would benefit from imaging. Read More

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http://dx.doi.org/10.1016/j.pediatrneurol.2018.10.018DOI Listing
April 2019
2 Reads

Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

J Pediatr Pharmacol Ther 2018 Nov-Dec;23(6):460-465

Objectives: Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. Read More

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http://dx.doi.org/10.5863/1551-6776-23.6.460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336170PMC
January 2019
3 Reads

Cannabinoid toxicity in pediatrics.

Curr Opin Pediatr 2019 Apr;31(2):256-261

Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

Purpose Of Review: The advent of legalized cannabis in multiple regions of the United States has rendered the drug more accessible to pediatric patients. Pediatricians and Pediatric Emergency Medicine Providers face new challenges in counseling both patients and their parents, diagnosing exploratory ingestions of cannabinoids in toddlers, and managing complications of prolonged, heavy cannabis use in adolescents. The purpose of this review article is to provide clinicians a succinct summary of recent literature regarding tetrahydrocannabinol (THC) pharmacokinetics, pharmacodynamics, impacts on development, as well as presentations of acute and chronic toxicity. Read More

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http://Insights.ovid.com/crossref?an=00008480-900000000-9889
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http://dx.doi.org/10.1097/MOP.0000000000000739DOI Listing
April 2019
26 Reads

Factors affecting same-day cancelation of outpatient pediatric oncologic procedural sedation.

Pediatr Hematol Oncol 2018 Aug - Sep;35(5-6):309-315. Epub 2019 Jan 25.

a Department of Pediatrics, Division of Critical Care Medicine , Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston , Atlanta , GA , USA.

Background: Children with cancer undergo serial invasive, painful procedures as a part of their diagnosis, treatment, and surveillance regimens that require procedural sedation (PS). Some may have a delay in their treatment plan due to same-day cancelation (SDC) of the procedure due to issues related to sedation or other factors. The objective of this report was to evaluate the factors resulting in the SDC of hematology and oncology patients in an outpatient pediatric sedation service. Read More

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http://dx.doi.org/10.1080/08880018.2018.1526990DOI Listing
March 2019
4 Reads

Midazolam Dose Optimization in Critically Ill Pediatric Patients With Acute Respiratory Failure: A Population Pharmacokinetic-Pharmacogenomic Study.

Crit Care Med 2019 Apr;47(4):e301-e309

Metrum Research Group, Tariffville, CT.

Objectives: To develop a pharmacokinetic-pharmacogenomic population model of midazolam in critically ill children with primary respiratory failure.

Design: Prospective pharmacokinetic-pharmacogenomic observational study.

Setting: Thirteen PICUs across the United States. Read More

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http://dx.doi.org/10.1097/CCM.0000000000003638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432942PMC
April 2019
4 Reads

Use of ketamine by paediatricians in Italian paediatric emergency departments: a missed opportunity?

Eur J Pediatr 2019 Apr 22;178(4):587-591. Epub 2019 Jan 22.

Department of Pediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.

Procedural sedation and analgesia with ketamine are part of daily practice for children undergoing painful procedures in the paediatric emergency department (ED) of North America. A massive number of studies demonstrate ketamine's safety and efficacy in the hands of trained ED paediatricians, with few severe adverse events (SAEs) recorded. Since there are no data on ketamine's usage in Italian paediatric EDs, we created a survey to examine procedural sedation with ketamine in the EDs of the Italian PIPER (Pain in Paediatric Emergency Room) group, which includes 36 paediatric EDs providing 1. Read More

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http://link.springer.com/10.1007/s00431-019-03320-z
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http://dx.doi.org/10.1007/s00431-019-03320-zDOI Listing
April 2019
9 Reads

Deep Learning Based Attenuation Correction of PET/MRI in Pediatric Brain Tumor Patients: Evaluation in a Clinical Setting.

Front Neurosci 2018 7;12:1005. Epub 2019 Jan 7.

Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark.

Positron emission tomography (PET) imaging is a useful tool for assisting in correct differentiation of tumor progression from reactive changes. O-(2-18F-fluoroethyl)-L-tyrosine (FET)-PET in combination with MRI can add valuable information for clinical decision making. Acquiring FET-PET/MRI simultaneously allows for a one-stop-shop that limits the need for a second sedation or anesthesia as with PET and MRI in sequence. Read More

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http://dx.doi.org/10.3389/fnins.2018.01005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330282PMC
January 2019
5 Reads

Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee.

J Pediatr Gastroenterol Nutr 2019 04;68(4):595-606

Section of Pediatric Gastroenterology, Hepatology and Nutrition; Baylor College of Medicine, Texas Childrens Hospital; Houston, Texas.

Pediatric gastrointestinal endoscopy has been established as safe and effective for diagnosis and management of many pediatric gastrointestinal diseases. Nevertheless, certain patient and procedure factors should be recognized that increase the risk of intra- and/or postprocedural adverse events (AEs). AEs associated with endoscopic procedures can broadly be categorized as involving sedation-related physiological changes, bleeding, perforation, and infection. Read More

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http://dx.doi.org/10.1097/MPG.0000000000002277DOI Listing
April 2019
8 Reads

The impact of a quality improvement project to standardize pain, agitation, and withdrawal assessments on the use of morphine and midazolam in the Pediatric Intensive Care Unit.

Paediatr Anaesth 2019 Apr 22;29(4):322-330. Epub 2019 Feb 22.

Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Quebec, Canada.

Background: This study aims to assess the impact of a quality improvement initiative to increase assessments of pain, agitation, and iatrogenic withdrawal syndrome, on the use of sedative and analgesic medication in a pediatric intensive care unit.

Methods: This is a retrospective pre and post, observational, quality improvement study conducted in an 18-bed medical-surgical-cardiac, tertiary intensive care unit. We included patients consecutively admitted from October 1 to March 31 (pre-period 2015-2016, post-period 2016-2017) who were mechanically ventilated beyond 48 hours. Read More

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http://dx.doi.org/10.1111/pan.13591DOI Listing
April 2019
4 Reads

An improved ultra-high-performance liquid chromatography-tandem mass spectrometric method for the quantitation of dexmedetomidine in small volume of pediatric plasma.

Biomed Chromatogr 2019 Jan 21:e4487. Epub 2019 Jan 21.

Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.

Dexmedetomidine (Dex), a highly selective α -adrenergic agonist, is used primarily for the sedation and anxiolysis of adults and children in the intensive care setting. A sensitive and selective assay for Dex in pediatric plasma was developed by employing ultra-high-performance liquid chromatography-tandem mass spectrometry with d4-Dex as an internal standard. Dex was extracted from 0. Read More

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http://dx.doi.org/10.1002/bmc.4487DOI Listing
January 2019
3 Reads

Efficacy and Safety of Fentanyl in Combination with Midazolam in Children on Mechanical Ventilation.

J Korean Med Sci 2019 Jan 7;34(3):e21. Epub 2019 Jan 7.

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Background: To evaluate the efficacy and safety of fentanyl for sedation therapy in mechanically ventilated children.

Methods: This was a double-blind, randomized controlled trial of mechanically ventilated patients between 2 months and 18 years of age. Patients were randomly divided into two groups; the control group with midazolam alone, and the combination group with both fentanyl and midazolam. Read More

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http://dx.doi.org/10.3346/jkms.2019.34.e21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335121PMC
January 2019
4 Reads
1.253 Impact Factor

Continuous Deep Sedation and Euthanasia in Pediatrics: Does One Really Exclude the Other for Terminally Ill Patients?

J Med Philos 2019 Jan;44(1):50-70

University of Basel, Basel, Switzerland.

Debates on morally acceptable and lawful end-of-life (EOL) practices in pediatrics were reignited by the recent amendment in Belgian law to allow euthanasia for minors of any age who meet the criteria for capacity. Euthanasia and its legalization in pediatrics are often opposed based on the availability of aggressive palliative sedation. For terminally ill patients, this type of sedation is often identified as continuous and deep sedation until death (CDS). Read More

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https://academic.oup.com/jmp/article/44/1/50/5289341
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http://dx.doi.org/10.1093/jmp/jhy033DOI Listing
January 2019
7 Reads