Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis.

INTRODUCTION: Neonatal and infant anaesthesia are associated with a high risk of perioperative complications. The aim of the current study was to describe those risks in France using the French data from the NECTARINE study. MATERIAL AND METHODS: Data from the French centres that participated to the NECTARINE study were analysed. The primary goal of the study was the description of patients' characteristics, procedures and perioperative management and their comparison with the results of the European NECTARINE study. Secondary outcomes were the description of major perioperative complications and death. RESULTS: Overall, 926 procedures collected in 15 centres (all teaching hospitals) were analysed. Comparison between the French and European NECTARINE cohorts found few differences related to patients' characteristics and procedures. The rate of interventions for critical events (respiratory, haemodynamic, and metabolic) was similar between the two cohorts. Near-infrared spectroscopy monitoring was used in 12% of procedures. Nearly none of the thresholds for these interventions met the published standards. By day 30, complications (respiratory, haemodynamic, metabolic, renal, and liver failure) and death were observed in 14.4% [95% CI 11.6-16.4]% and 1.8% [95% CI 1.1-2.9] of cases, respectively. DISCUSSION: Although the health status of the patients in the French cohort was less severe, procedures, management and postoperative complications and mortality rates were similar to the European cohort. However, thresholds for interventions were often inadequate in both cohorts. Efforts should be undertaken to improve the knowledge and use of new monitoring devices in this population.

Facemask pressure-controlled ventilation in children: what is the pressure limit?

BACKGROUND: In this study, we sought to determine the level of inspiratory pressures allowing adequate and safe ventilation without any risk of gastric insufflation (GI) in children according to age. METHODS: One hundred children, aged 1 day to 16 years, ASA physical status I to II, scheduled for general anesthesia were studied prospectively. After induction of anesthesia, children's lungs were ventilated with pressure-controlled ventilation. The initial inspiratory pressure was 10 cm H(2)O and was increased by steps of 5 cm H(2)O, up to a maximum of 25 cm H(2)O. At each step, GI was detected by epigastric auscultation. The recorded data were age and weight. At each step, the inspiratory pressure, the respiratory rate, the expired tidal volume, the minute ventilation, and the occurrence of GI were also recorded. RESULTS: GI occurred in 78 children. GI occurred in 95% of children younger than 1 year, in 93% of children aged 1 to 5 years, and 56% of children older than 5 years (P = 0.001). The pressure threshold at which GI occurred increased with age: the younger the child, the lower the GI pressure threshold. Tidal volume increased with inspiratory pressure, but at >15 cm H(2)O, tidal volume did not change significantly. CONCLUSION: The inspiratory pressure threshold at which GI can occur depends on age. It is low in infants and increases with age. In most cases, proper ventilation without GI was obtained with an inspiratory pressure

Target-controlled inhalation induction with sevoflurane in children: a prospective pilot study.

BACKGROUND: Target-controlled inhalation induction (TCII) with sevoflurane is becoming possible with new anesthesia platforms. Although TCII has already been performed in adults, it remains to be evaluated in children. METHODS: In a prospective study, we compared TCII using the Felix AInOC anesthetic station (Taema, Anthony, France) to our standard protocol inhalation induction in children scheduled for elective surgery under general anesthesia. After preoxygenation, sevoflurane induction was performed in both groups without priming of the circuit. Sufentanil was administered after venous line placement. RESULTS: In the TCII group, no overdosage or underdosage was observed except in two children where TCII failed owing to high agitation, and the number of adjustments was lower compared with our standard protocol inhalation induction (1(1-2.5[0-5]) vs 6(5-6[4-10]) respectively). Moreover, the delay to obtain target end-tidal sevoflurane concentration was shorter in the TCII group (2(1.6-2.7[1.3-4]) min vs 3.4(2.5-3.8[2.3-6.5]) min respectively). No significant difference in the delay of loss of consciousness or in the conditions for intubation or laryngeal mask placement was observed between the groups. CONCLUSION: The Felix AInOC allows TCII to be performed satisfactorily in children. Manual inhalation induction induced a higher number of adjustments and overdosages.