Serious airway‐related adverse events with sevoflurane anesthesia via facemask for magnetic resonance imaging in 7129 pediatric patients: A retrospective study

Huang, Lei; Li, Chao; Tang, Miao; Liu, Ling; Ying, Pu Yan; Han, Peng Xiao; Xu, Bo

doi:10.1111/pan.13601

Cited by 11 publications

(7 citation statements)

References 16 publications

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“…Sevoflurane anesthesia provides higher success rates (92% vs. 80%) and faster onset and recovery, but a higher incidence of emergence delirium than propofol anesthesia in children undergoing MRI [70,76]. Major airway-related adverse events such as respiratory apnea and severe airway obstruction occurred in 0.4% of children, while preterm infants are at higher risk compared to term infants after sevoflurane anesthesia for MRI [81]. Positive pressure ventilation with endotracheal intubation or LMA may result in more extensive atelectasis in children after MRI compared to spontaneous ventilation in children receiving sevoflurane-based anesthesia [78,82].…”

Section: ) Propofolmentioning

confidence: 99%

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Jung

2020

Yeungnam Univ J Med

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The prevalence of magnetic resonance imaging (MRI) for diagnosing and monitoring a wide range of disease in children continues to expand with the efficacy benefit of providing high-resolution images of tissue anatomy and quantitative function and the safety advantage of a lack of ionizing radiation [1,2]. Aspects of MRI scans such as loud noises, confined bore of the magnet, and the required immobility to prevent motion artifacts are the causes of anxiety and barriers to successful performance of the procedure in children younger than 6 years and those at any age with development delay, claustrophobia, or involuntary movements or con-The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infants or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

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Section: ) Propofolmentioning

confidence: 99%

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Jung

2020

Yeungnam Univ J Med

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“…However, our previous clinical observation found that airway adverse events such as holding breath and coughing were easy to occur during the resuscitation of sevoflurane anesthesia in children (Li J, et al, 2013). Similarly, a recent study also reported that the incidence of adverse airway events in premature infants under sevoflurane anesthesia was higher than that in normal infants, which may be related to airway immaturity (Lei H, et al, 2019). The above studies suggest that in special conditions, such as very low concentrations of sevoflurane are not sufficient to produce protective effects or airway is immature, the nociceptive effect may return to the dominant role, resulting in a series of airway adverse events.…”

Section: Discussionmentioning

confidence: 90%

The expanded effects of sevoflurane on the nervous system: the harmful effect of residual concentration of sevoflurane on the respiratory system through neurogenic inflammation

Wang¹,

Zhang²,

Zhou³

et al. 2021

Ibrain

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Background Neurogenic inflammation caused by sevoflurane may not only limite to the nervous system, but also expand to the respiratory system. The purpose of this study was to investigate the expression changes of transient receptor potential vanilloid 1 (TRPV1), neurokinin A (NKA), neurokinin B (NKB), calcitonin gene related peptide (CGRP) and substance P (SP) in 14, 21 and 42‐day‐old rats after inhaling 0.4% sevoflurane, in order to evaluate whether the residual sevoflurane be harmful to the respiratory system through neurogenic inflammation. Methods The anesthetic inhalation device was designed to allow 14, 21 and 42‐day‐old rats inhale 0.4% sevoflurane, while rats in the control group inhaled 40% O2 for 1h. Rats in the antagonist group inhaled 0.4% sevoflurane or 40% O2 for 1 h after Capsazepine (CPZ) pretreatment. The expression of TRPV1 in lung tissue was detected by western blot, and the expression of NKA, NKB, CGRP and SP in trachea was detected by immunohistochemistry. Results After inhaling 0.4% sevoflurane, the expression of TRPV1 in lung tissue of 14 and 21‐day‐old rats was significantly higher than that of the control group, as well as increased the expression of CGRP and SP in the trachea of 14‐day‐old rats and NKA, NKB, CGRP and SP in the trachea of 21‐day‐old rats. CPZ pretreatment could antagonize these effects. Conclusion Residual sevoflurane during resuscitation of inhalation anesthesia could induce neurogenic inflammation by activating TRPV1, which damaged to the developing respiratory system, but has no significant effect on the respiratory system in adulthood.

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“…Our results show a higher incidence of total anesthesia-related AEs than previously described in literature for pediatric procedural sedation or anesthesia. 36 Most of the reports are based on retrospective data analysis 37,38 or voluntary self-reporting 39,40 and focus on serious AEs requiring immediate interventions. 36,40 These aspects might lead to underestimation of total AEs.…”

Section: Discussionmentioning

confidence: 99%

Needleless inhaled anesthesia with sevoflurane: Advantages of a simplified approach for children with spinal muscular atrophy undergoing intrathecal administration of nusinersen

Salerno

Picconi

Genovese

et al. 2023

Pediatric Anesthesia

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Background: Intrathecal nusinersen administration, a fundamental step in the treatment of spinal muscular atrophy, is challenging in children. Aims:This retrospective monocentric analysis of prospectively collected data evaluated the feasibility of needleless general anesthesia exclusively with sevoflurane, without imaging guidance, for children undergoing nusinersen administration in a 24-month period.Methods: Clinical data included demographics, type of spinal muscular atrophy, presence and severity of scoliosis. Primary outcome was defined by the number of predefined sentinel adverse events related to anesthesia. Secondary outcomes were assessed by duration of the procedure, number of lumbar puncture attempts, and number of failures. Other measures included number and type of moderate, minor and minimal adverse events, as well as number and type of puncture-related adverse events.Results: 116 patients (mean age: 8.7 (SD 6.9) years; with scoliosis: 49.1%) underwent 250 lumbar punctures; two cases of prolonged desaturation, considered as sentinel adverse events, (0.8%) were recorded during anesthesia (primary outcome). None of the patients underwent orotracheal intubation nor required an unplanned admission in the Pediatric Intensive Care Unit. No patient required an unplanned or prolonged hospitalization after the procedure. Mean number of puncture attempts was 1.6 (SD 1.3), and mean duration of the procedure was 14.1 (SD 8.3) minutes. No failure in the drug administration occurred (secondary outcomes). Conclusion:In this single-center experience, needleless general anesthesia with inhaled sevoflurane without imaging guidance has been shown to be feasible for children with spinal muscular atrophy undergoing lumbar puncture for nusinersen administration.

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Serious airway‐related adverse events with sevoflurane anesthesia via facemask for magnetic resonance imaging in 7129 pediatric patients: A retrospective study

Cited by 11 publications

References 16 publications

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

The expanded effects of sevoflurane on the nervous system: the harmful effect of residual concentration of sevoflurane on the respiratory system through neurogenic inflammation

Needleless inhaled anesthesia with sevoflurane: Advantages of a simplified approach for children with spinal muscular atrophy undergoing intrathecal administration of nusinersen

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