Abstract:In this study, we did not find a significant increase in metabolic stress, measured by serum lactate. Using propofol for short-duration procedural sedation may not carry similar risks for propofol infusion syndrome to those for long-duration/high-dose infusion therapy.
“…There is no evidence that propofol induces neurotoxicity in humans [27], and the propofol related lypid syndrome, that is more likely to appear in pediatric population, occurs in high doses exceeding 4 mg/bw/h administered for over 24 hours [28]. Younger children are more resistant to the respiratory depressant effects of the Propofol and special care for children with associated autoimmune disorders is needed [29] Propofol is the most effective drug for intravenous monitored anesthesia care sedation in children undergoing spinal anesthesia [30].…”
Sevoflurane (2,2,2-trifluoro-1-[trifluoromethyl]ethyl fluoromethyl ether or C4H3F7O), with a molar mass 200.055 g/mol, also called fluoromethyl, is a highly fluorinated methyl isopropyl ether with general anesthetic property, available for clinical practice for about 30 years. Sevoflurane is a sweet-smelling, non-flammable and it is used for induction and maintenance of general anesthesia. Together with desflurane, it is replacing isoflurane and halothane in modern anesthesiology. Propofol (2,6-diisopropylphenol or C12H18O), with a molar mass 178.271g/mol is an alkylphenol derivative formulated for induction and maintenance (in some cases) of general anesthesia, sedation and hypnosis and acting as an intravenous anaesthetic drug, having largely replaced sodium thiopental because recovery from propofol is more rapid and clear.
“…There is no evidence that propofol induces neurotoxicity in humans [27], and the propofol related lypid syndrome, that is more likely to appear in pediatric population, occurs in high doses exceeding 4 mg/bw/h administered for over 24 hours [28]. Younger children are more resistant to the respiratory depressant effects of the Propofol and special care for children with associated autoimmune disorders is needed [29] Propofol is the most effective drug for intravenous monitored anesthesia care sedation in children undergoing spinal anesthesia [30].…”
Sevoflurane (2,2,2-trifluoro-1-[trifluoromethyl]ethyl fluoromethyl ether or C4H3F7O), with a molar mass 200.055 g/mol, also called fluoromethyl, is a highly fluorinated methyl isopropyl ether with general anesthetic property, available for clinical practice for about 30 years. Sevoflurane is a sweet-smelling, non-flammable and it is used for induction and maintenance of general anesthesia. Together with desflurane, it is replacing isoflurane and halothane in modern anesthesiology. Propofol (2,6-diisopropylphenol or C12H18O), with a molar mass 178.271g/mol is an alkylphenol derivative formulated for induction and maintenance (in some cases) of general anesthesia, sedation and hypnosis and acting as an intravenous anaesthetic drug, having largely replaced sodium thiopental because recovery from propofol is more rapid and clear.
“… I - There were 69 severe adverse events (SAEs) (1.1 %) and 86 patients (1.4 %) required intervention. - SAEs - OR for propofol 5,6; OR for ketamine and fentanyl 6.5, both with p < 0.05 Indra S et al (2017) 46 50 children (2–18 years; mean age of 9 years) Prospective longitudinal study 2 mg/kg (1−9 mg/kg) to evaluate whether sedation of short-term procedures in children with propofol is related to propofol infusion syndrome (PIS) measured by serum lactate. - The mean propofol dose per patient was 8.2 mg/kg II - The highest measured lactate value was 1.8 mmol/L.…”
“…Bei einer Kurzzeitapplikation von Propofol über 40 min und einer Dosis von durchschnittlich 8,2 mg/kgKG traten keine relevanten Laktatspiegel bei Kindern auf [12]. Das Risiko eines PRIS bei kurzdauernden Kinderanästhesien z.…”
ZusammenfassungDas pädiatrische Emergence Delir rückt aufgrund der Debatte um Neurotoxizität von Anästhetika bei kleinen Kindern erneut in den Fokus. Die 2017 von der Europäischen Gesellschaft für Anästhesiologie (ESA) publizierte Leitlinie zu Prävention und Therapie kann eine sinnvolle Unterstützung der klinischen Tätigkeit sein. Insbesondere die zügige und konsequente Behandlung von Schmerzen bei kleinen Kindern und die konsequente Diagnose eines pädED mittels validierter Skale ermöglicht es- dank der Verbreitung von patient data management systemen- in Zukunft eine reelle Inzidenz des pädEDs anzugeben. In der Prävention des pädED liegt der Schwerpunkt auf der Reduktion der präoperativen Angst der Kinder, egal, ob dies durch ein auf das Kind fokussierte Kinderanästhesieteam zusammen mit den Eltern, Musik, Clowns, smartphones/tablets oder eine medikamentöse Prämedikation erzielt wird. Medikamentöse pädED-Prophylaxe durch perioperative Anwendung von alpha-2-Agonisten und die Verwendung von Propofol als Ausleitungsbolus oder TIVA erscheint gleichzeitg sinnvoll. Postoperativ ermöglicht eine ruhige Aufwachumgebung ein entspanntes delirfreies Aufwachen. Postanästhesiologische Visiten mit strukturiertem Erfassen von Veränderungen des kindlichen Verhaltens respektive schriftliche Fragebögen werden in Zukunft Auskunft über das pädED auf den Normalstationen geben. Strukturierte Nachbefragungen im Verlauf werden auch die Erfassung postoperativen unerwünschten Verhaltensänderungen und deren möglichen Zusammenhang zum pädED ermöglichen.
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