Taylor JS, Chandler JM, Menendez M, Diyaolu M, Austin JR, Gibson ML, Portelli KI, Caruso TJ, Rodriguez S, Chao SD. Small surgeries, big smiles: using virtual reality to reduce the need for sedation or general anesthesia during minor surgical procedures. Pediatr Surg Int. 2021 Jul 16. doi: 10.1007/s00383-021-04955-6. Epub ahead of print. PMID: 34269867.
Abstract
Purpose: Children often require anesthesia for simple diagnostic and therapeutic procedures. The aim of this study was to evaluate the feasibility of using virtual reality (VR) to reduce sedation in children undergoing minor surgical procedures.
Method: In this prospective, non-randomized clinical trial, pediatric patients at a free-standing children’s hospital undergoing hormone implant placement, removal, or exchange were recruited to use VR and local anesthesia instead of procedural sedation or general anesthesia (GA). Patients were enrolled between November 2017 and March 2020, and were compared to historic controls who underwent similar procedures without VR between April 2016 and February 2020. Primary outcome measure was successful procedure completion without sedation or GA. Secondary measures included assessments of pain, fear and anxiety, patient compliance, procedural and recovery times.
Results: Twenty-eight patients underwent 29 procedures with VR. Hormone implants (72%), removals (7%), or exchanges (21%) were completed without GA, sedation or IV placement. Procedure lengths and pain scores were similar between VR patients and historic controls, but recovery times were significantly shorter in VR patients (18 vs 65 min, p < 0.001). Participant satisfaction scores were high, with 95% recommending VR to others.
Conclusions: VR is a feasible alternative to sedation or GA for select pediatric patients undergoing minor surgical procedures.
Full text access for Children’s and Emory users.
Urfali S, Urfali B, Sarac ET, Koyuncu O. Safety and Complications of Sedation Anesthesia during Pediatric Auditory Brainstem Response Testing. ORL J Otorhinolaryngol Relat Spec. 2021 Jul 12:1-5. doi: 10.1159/000517156. Epub ahead of print. PMID: 34252904.
Abstract
Objective: The auditory brainstem response (ABR) test has been widely used in childhood. Although it is a painless procedure, sedation can be needed in pediatric patients. Thus, this study aimed to evaluate safety and complications of sedation anesthesia applied in pediatric patients during ABR testing.
Methods: Medical records of 75 children who underwent ABR testing between 2018 and 2020 were evaluated retrospectively in terms of applicability, safety, and complications of sedation anesthesia.
Results: The ages ranged from 3 to 9 (mean 6.2) years. Comorbidity was detected in 20% (n = 15); 3 had multiple comorbidities, and the most common comorbidity was Down syndrome (4%). The drugs used in sedation anesthesia were midazolam in 81.3% (n = 61), a combination of propofol and ketamine in 14.7% (n = 11), and only propofol in 4% (n = 3) of the patients. An additional drug use was needed in 44% (n = 33). The mean procedure time was 40 (range 30-55) min. The mean anesthesia duration was 45 (range 35-60) min. The mean recovery time was 10 (range 5-15) min. Complications related to anesthesia developed in 4 (5.33%) of the patients; respiratory distress, agitation, cough, and nausea-vomiting were seen in one of the patients, respectively. Complications like bradycardia and respiratory or cardiac arrest were not seen at all.
Conclusions: The complication rate of sedation anesthesia performed during ABR testing of pediatric patients is quite low. It may be more beneficial to use combinations of sedation drugs instead of using a single sedation drug. Although sedation anesthesia appears to be safe in general, the potentially life-threatening complications of sedative agents should be remembered, especially in children who have comorbidities.
Full text access for Children’s and Emory users.
Roy CF, Turkdogan S, Nguyen LHP, Yeung J. Procedural Sedation in Minor Procedure Rooms for Pediatric Myringotomy and Tympanostomy: A Quality Improvement Initiative. Otolaryngol Head Neck Surg. 2021 May 4:1945998211011066. doi: 10.1177/01945998211011066. Epub ahead of print. PMID: 33940993.
Abstract
Objective: Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion.
Methods: As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications.
Results: Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting.
Discussion: Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety.
Implications for practice: This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.
Full text access for Children’s and Emory users.
Hammon DE, Pearsall K, Smith NM, McBride AS, Bass AL, Tooze JA, McLean TW. Eutectic Mixture of Lidocaine and Prilocaine Decreases Movement and Propofol Requirements for Pediatric Lumbar Puncture During Deep Sedation: A Randomized, Placebo-Controlled, Double Blind Trial. J Pediatr Hematol Oncol. 2021 Apr 21. doi: 10.1097/MPH.0000000000002169. Epub ahead of print. PMID: 33885035.
Abstract
Deep sedation/general anesthesia is commonly used in pediatric oncology patients undergoing lumbar puncture (LP). Propofol is often used for sedation, with or without a narcotic. We hypothesized that eutectic mixture of lidocaine and prilocaine (EMLA) would allow for lower cumulative doses of propofol and less movement. We performed a prospective, randomized, double blind, placebo-controlled trial in children undergoing sedation for LP. Standard initial weight-based doses of propofol and fentanyl were administered, with either EMLA cream or a placebo cream applied topically. The primary outcome was the total dose of propofol administered to each patient. We also tracked patient movement and complications. Twenty-seven patients underwent 152 LPs. Patients randomized to EMLA cream (n=75) were significantly more likely to receive a lower dose of propofol (2.94 mg/kg, SE=0.25, vs. 3.22 mg/kg, SE=0.19; P=0.036) and to not require additional propofol doses (probability 0.49, SE=0.08 vs. 0.69, SE=0.06; P=0.001) compared with patients randomized to placebo cream (n=77). In addition, patients with EMLA cream were significantly less likely to demonstrate minor or major movement. EMLA cream results in less movement and less propofol administration in pediatric oncology patients undergoing sedation for LP.
Full text access for Children’s and Emory users.
pedzzzz.com 
Leave a comment