RESUMEN
BACKGROUND: The use of cricoid pressure for the possible prevention of regurgitation of gastric contents during induction of anesthesia in both adults and children has been recommended. However, equally important is the technique in possibly preventing insufflation of gas into the stomach. This study was designed to determine the efficacy of cricoid pressure application in preventing gastric gas insufflation in pediatric patients and to determine the airway pressure at which gas entered the stomach (pop-off point). METHODS: Fifty-nine patients, 2 weeks to 8 yr of age, physical status 1-4, scheduled for elective surgery, received an inhalational induction of anesthesia with halothane, N2O, and O2. A single observer used a stethoscope to auscultate over the upper abdomen for any air entry. In study I (without paralysis), the proximal airway pressure was slowly increased by gradually closing the pop-off valve on the anesthesia machine until gas was heard entering the stomach (pop-off point) or until the peak inspiratory pressure (PIP) reached 40 cm H2O. Thereafter, the pressurization procedure was repeated three times, altering the application and removal of cricoid pressure. The same patients were then paralyzed (study II), and the stomach evacuated before commencing an identical pressurization sequence with and without cricoid pressure. RESULTS: Appropriately applied cricoid pressure was 100% effective in preventing gas insufflation into the stomach of all children up to 40 cm H2O PIP with and without paralysis. In addition, paralysis significantly decreased the median pop-off point in any given patient. CONCLUSIONS: Appropriate application of cricoid pressure prevents gastric gas insufflation during airway management via mask up to 40 cm H2O PIP in infants and children. An additional benefit of cricoid pressure occurs in paralyzed patients in whom gastric insufflation occurs at lower inflation pressures.
Asunto(s)
Cartílago Cricoides/fisiología , Reflujo Gastroesofágico/prevención & control , Insuflación , Estómago/fisiología , Anestesia General/efectos adversos , Anestesia General/métodos , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Parálisis/fisiopatología , Respiración Artificial/métodosRESUMEN
A need exists for a safe and effective oral preanesthetic medication for use in children undergoing elective surgical procedures. We evaluated the effectiveness of three different doses of oral midazolam when administered in combination with atropine prior to ambulatory surgery. In this randomized, double-blind, placebo-controlled study, 124 children, ages 1-10 yr, received midazolam, 0.25, 0.50, or 0.75 mg.kg-1 po, and atropine, 0.03 mg.kg-1 po, mixed with apple juice, or a placebo (containing the midazolam vehicle, atropine, and apple juice). A blinded observer noted the child's level of sedation, the quality of separation from parents, and the degree of cooperation with an inhalation induction of anesthesia. Picture-recall was used to assess the amnesic effect of midazolam in children over 5 yr of age. Midazolam 0.75 mg.kg-1 produced significant sedation at 30 min. After procedures lasting an average of 106-113 min, recovery was not prolonged by the oral midazolam-atropine combination. We concluded that oral midazolam 0.5-0.75 mg.kg-1 is an effective preanesthetic medication for pediatric outpatients.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Midazolam/administración & dosificación , Medicación Preanestésica , Administración Oral , Atropina/administración & dosificación , Niño , Conducta Infantil/efectos de los fármacos , Preescolar , Método Doble Ciego , Humanos , Lactante , Recuerdo Mental/efectos de los fármacos , Estudios ProspectivosRESUMEN
Initial studies have suggested that oral transmucosal fentanyl citrate (OTFC) in a dose of 15-20 micrograms/kg may be a safe and effective preanesthetic medication in children and adults, but this has not been demonstrated in a randomized, double-blind fashion. The purpose of this study was to determine in a randomized, double-blind manner, the efficacy of a lollipop containing fentanyl citrate as a preanesthetic medication before surgery in children. Forty health ASA physical status 1 or 2 children 3-12 yr of age were divided randomly and in double-blind fashion into two groups. Group 1 received the lollipop containing OTFC and group 2 received a placebo lollipop. An appropriate size lollipop was chosen so that if the patient received fentanyl, the total dose would be 15-20 micrograms/kg. Anxiety, sedation, and separation scores were assessed preoperatively and ease of induction was rated. Oxygen saturation and respiratory rate were monitored. Time intervals from preanesthetic to induction and from recovery room (PACU) admission to discharge were noted. Recovery room behavior was assessed upon admission and discharge. Complications and the need for postoperative opioids were noted. OTFC produced significantly more sedation and less anxiety compared with that following placebo. Respiratory rate was significantly decreased in the OTFC group, but oxygen saturation was not significantly different between groups. Anxiety and separation scores and the quality of induction were better in the OTFC group. There was a higher incidence of nausea and pruritus in the fentanyl group. OTFC did not prolong the PACU stay.