Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation.

BACKGROUND: Dexmedetomidine is widely used for non-invasive pediatric procedural sedation. However, the hemodynamic effects of intravenous dexmedetomidine are a concern. There has been a growing interest in the application of intranasal dexmedetomidine as a sedative in children. OBJECTIVE: To investigate the incidence of bradycardia in children undergoing intranasal dexmedetomidine sedation and to identify the associated risk factors. METHODS: Data pertaining to pediatric patients who underwent intranasal dexmedetomidine sedation for non-invasive investigations at the Kunming Children's Hospital between October 2017 and August 2018 were retrospectively analyzed. RESULTS: Out of 9984 children who qualified for inclusion, 228 children (2.3%) developed bradycardia. The incidence of bradycardia in the group that received additional dose of dexmedetomidine was higher than that in the group that did not receive additional dose (9.2% vs 16.7%; P = .003). The incidence of bradycardia in males was higher than that in females (2.6% vs 1.8%; P = .007). On multivariate logistic regression, only male gender showed an independent association with the occurrence of bradycardia (odds ratio 1.48; 95% confidence interval 1.11-1.97; P = .008). CONCLUSIONS: The overall incidence of bradycardia in children after sole use of intranasal dexmedetomidine sedation was 2.3%. Male children showed a 1.48-fold higher risk of bradycardia. However, the blood pressure of the children who developed bradycardia was within the normal range. Simple wake-up can effectively manage bradycardia induced by intranasal dexmedetomidine sedation.

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

OBJECTIVE: This retrospective study evaluated the safety and effectiveness of sevoflurane anesthesia by facemask for magnetic resonance imaging (MRI) scanning among pediatric patients in a high-volume MRI department. METHODS: The medical records of 7129 pediatric patients (median age 12 months, range 4.0-36.0 months) who were administered anesthesia during MRI scanning were reviewed. Anesthesia via 8% and 1.5%-2% sevoflurane was used for induction and maintenance, respectively. All the patients were monitored by anesthetists in the postanesthesia care unit. Vital signs were recorded every 5 minutes. Airway-related adverse events, sevoflurane induction time, MRI scanning time, and recovery time were recorded. Patients were discharged when no complications were found for 10-15 minutes, with Aldrete's score ≥9. RESULTS: After sevoflurane anesthesia, there were 28 severe airway-related adverse events (0.4%, 95% CI: 0.2%-0.5%), and 12 patients had severe respiratory apnea (0.2%, 95% CI: 0.1%-0.2%). The percentage of patients with respiratory apnea was significantly higher in preterm infants compared with term infants (2.4% cf. 0.5%, P = 0.012). Sixteen patients had severe airway obstruction (0.2%, 95% CI: 0.1%-0.3%). CONCLUSION: The major severe airway-related adverse events among pediatric patients associated with sevoflurane anesthesia were respiratory apnea and airway obstruction. The respiratory condition of preterm infants should be monitored carefully when under sevoflurane anesthesia. Overall, sevoflurane is safe and can be used efficiently for pediatric anesthesia in high-volume MRI departments.

Impact of premature rupture of membranes on neonatal complications in preterm infants with gestational age <37 weeks / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of premature rupture of the membrane (PROM) on neonatal complications in premature infants.</p><p><b>METHODS</b>The registration information of 7684 preterm infants with gestational age <37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without (control).</p><p><b>RESULTS</b>The preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group (P<0.05). The 95% confidence interval of the OR value was <1 for mortality, and was >1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus (GDM), gestational period hypertension and 5-min Apgar score <7, the incidences of NEC, ROP and BPD were significantly different between the two groups (P<0.05) with 95% confidence interval of OR value >1, but the mortality rate and incidence of ICH were not significantly different between the two groups (P>0.05).</p><p><b>CONCLUSION</b>PROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.</p>