RESUMEN
The objective of this study was to describe the incidence of impaired cerebral autoregulation and to describe the relationship between impaired cerebral autoregulation and outcome after severe pediatric traumatic brain injury (TBI). We prospectively examined cerebral autoregulation in 28 childrenAsunto(s)
Lesiones Encefálicas/fisiopatología
, Encéfalo/fisiopatología
, Circulación Cerebrovascular/fisiología
, Trastornos Cerebrovasculares/fisiopatología
, Homeostasis/fisiología
, Adolescente
, Factores de Edad
, Envejecimiento/fisiología
, Encéfalo/irrigación sanguínea
, Encéfalo/patología
, Lesiones Encefálicas/complicaciones
, Lesiones Encefálicas/diagnóstico
, Arterias Cerebrales/fisiopatología
, Trastornos Cerebrovasculares/diagnóstico
, Trastornos Cerebrovasculares/etiología
, Niño
, Preescolar
, Estudios de Cohortes
, Femenino
, Escala de Consecuencias de Glasgow/estadística & datos numéricos
, Escala de Consecuencias de Glasgow/tendencias
, Humanos
, Masculino
, Valor Predictivo de las Pruebas
, Pronóstico
, Estudios Prospectivos
, Estadística como Asunto
RESUMEN
INTRODUCTION: Little is known about cerebral autoregulation in children. The aim of this study was to examine cerebral autoregulation in children. METHODS: Cerebral autoregulation testing was performed during less than 1 MAC sevoflurane anaesthesia in children (from 6 months to 14 yr) and in adults (18-41 yr). Mean middle cerebral artery flow velocities (V(MCA)) were measured using transcranial Doppler ultrasonography. Mean arterial pressure (MAP) was increased to whichever was greater: 20% above baseline or (i) 80 mm Hg for less than 9 yr, (ii) 90 mm Hg for 9-14 yr, and (iii) 100 mm Hg for adults. Cerebral autoregulation was considered intact if the autoregulatory index was > or =0.4. RESULTS: There were 13 subjects less than 2 yr old (Group 1), 13 subjects 2-5 yr (Group II), 14 subjects 6-9 yr (Group III), 12 subjects 10-14 yr (Group IV), and 12 adults (Group V; control group). All subjects had an autoregulatory index > or =0.4. There was no difference in autoregulatory index between children in Groups I-IV or between children and adults. DISCUSSION: We found no age-related differences in autoregulatory capacity during low-dose sevoflurane anaesthesia. We report no differences in autoregulatory capacity between children and adults.
Asunto(s)
Anestésicos por Inhalación/farmacología , Circulación Cerebrovascular/efectos de los fármacos , Homeostasis/efectos de los fármacos , Éteres Metílicos/farmacología , Adolescente , Adulto , Envejecimiento/fisiología , Análisis de Varianza , Anestesia General , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Circulación Cerebrovascular/fisiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/fisiología , Sevoflurano , Ultrasonografía Doppler TranscranealRESUMEN
BACKGROUND: : There is little information on the limits of cerebral autoregulation and the autoregulatory capacity in children. The aim of this study was to compare dynamic cerebral autoregulation between healthy adolescents and adults. METHODS: : Seventeen healthy volunteers 12-17 years (n = 8) and 25-45 years (n = 9) were enrolled in this study. Bilateral mean middle cerebral artery flow velocities (Vmca; (cm/s)) were measured using transcranial Doppler ultrasonography (TCD). Mean arterial blood pressure (MAP) and end-tidal carbon dioxide were measured continuously during dynamic cerebral autoregulation studies. Blood pressure cuffs were placed around both thighs and inflated to 30 mmHg above the systolic blood pressure for 3 min and then rapidly deflated, resulting in transient systemic hypotension. The change of Vmca to change in MAP constitutes the autoregulatory response, and the speed of this response was quantified using computer model parameter estimation. The dynamic autoregulatory index (ARI) was averaged between the two sides. RESULTS: : Adolescents had significantly lower ARI (3.9 +/- 2.1 vs. 5.3 +/- 0.8; P=0.05), and higher Vmca (75.2 +/- 15.2 vs. 57.6 +/- 15.0; P<0.001) than adults. CONCLUSION: : The autoregulatory index is physiologically lower in normal adolescents 12-17 years of age than in adults.
Asunto(s)
Circulación Cerebrovascular/fisiología , Homeostasis/fisiología , Adolescente , Adulto , Envejecimiento/fisiología , Presión Sanguínea/fisiología , Niño , Frecuencia Cardíaca/fisiología , Humanos , Persona de Mediana Edad , Arteria Cerebral Media/fisiología , Valores de ReferenciaRESUMEN
Analgesia for pediatric burn wound care in the outpatient clinic is constrained by time, personnel, and/or monitoring capabilities, yet may improve patient satisfaction and comfort, clinic efficiency, and patient throughput. The ideal analgesic in this increasingly common setting should be palatable, provide potent, rapid, and brief analgesia, and require minimal appropriate monitoring. Using a placebo-controlled, double-blind design we compared oral transmucosal fentanyl citrate (OTFC, approximately 10 microg/kg) and oral oxycodone (0.2 mg/kg) in 22 pediatric outpatient wound care procedures (ages 5-14 years). Pulse oximetry, vital signs, side effects, patient pain scores, and observer scores for cooperation, anxiety, and sedation were recorded. OTFC and oral oxycodone resulted in similar outcome measures and vital signs, and no significant side effects. The taste of OTFC was preferred. We conclude that OTFC and oral oxycodone are safe and effective analgesics in the setting of monitored outpatient wound care in children, and that OTFC offers the advantage of improved palatability.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Quemaduras/complicaciones , Fentanilo/uso terapéutico , Oxicodona/uso terapéutico , Dolor/tratamiento farmacológico , Administración Oral , Adolescente , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Niño , Preescolar , Sedación Consciente , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Fentanilo/administración & dosificación , Fentanilo/efectos adversos , Humanos , Masculino , Mucosa Bucal , Movimiento/efectos de los fármacos , Pacientes Ambulatorios , Oximetría , Oxicodona/administración & dosificación , Oxicodona/efectos adversos , Dolor/etiología , Dimensión del Dolor , Estudios Prospectivos , Respiración/efectos de los fármacos , Resultado del TratamientoRESUMEN
IMPLICATIONS: The effects of inhaled nitric oxide (INO) on cerebrovascular hemodynamics are not well established. We report no adverse cerebral effects with INO therapy in a child with traumatic brain injury.
Asunto(s)
Lesiones Encefálicas/metabolismo , Encéfalo/metabolismo , Circulación Cerebrovascular/efectos de los fármacos , Óxido Nítrico/farmacología , Administración por Inhalación , Niño , Femenino , Humanos , Presión Intracraneal/efectos de los fármacos , Óxido Nítrico/administración & dosificación , Resistencia Vascular/efectos de los fármacosRESUMEN
The authors present the case of an anemic 22-month-old child undergoing lower extremity surgery in whom the lower limit of cerebral autoregulation was shifted to the right.
Asunto(s)
Anemia/complicaciones , Transfusión Sanguínea , Circulación Cerebrovascular , Fracturas del Fémur/cirugía , Accidentes Domésticos , Anestesia General/métodos , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Femenino , Hematócrito , Homeostasis , Humanos , Lactante , Arteria Cerebral Media/diagnóstico por imagen , Monitoreo Intraoperatorio , Respiración Artificial , Ultrasonografía Doppler TranscranealRESUMEN
The authors examined the relationship between fibrin degradation products (FDP) and outcome in children with isolated head injury by reviewing the records of 69 children who met the following criteria: (1) less than 16 years of age; (2) diagnosis of isolated head injury and (3) FDP levels. Outcome was evaluated using the following Glasgow Outcome Scale (GOS): 1 = death; 2 = vegetative state; 3 = functionally impaired; 4 = minimal dysfunction; 5 = premorbid level of functioning. Poor outcome was defined as GOS 1-3. Twenty-nine of 33 patients with FDP > 1000 (g/mL had GOS scores < 4 compared to 4/36 patients (11%) with FDP < 1000 microg/mL (Fisher's Exact Probability Test P < .0001). When stratified by GCS, no other prognosticator of outcome was needed when GCS was < 7 and > 12. In patients with GCS 7-12, however, 4/6 with FDP >1000 microg/mL had a poor outcome and all 12 patients with FDP < 1000 microg/mL had a good outcome (P = .004). The authors conclude that FDP > 1000 microg/mL predicts poor outcome in children with isolated head injury. Fibrin degradation products are a strong independent prognosticator of outcome in children when GCS is between 7 and 12.