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Inhalation agents in pediatric anaesthesia - an update
1Women and Children's Hospital of Buffalo, SUNY, Strong Memorial Hospital, University of Rochester, Rochester, New York, USA. jerrold.lerman@gmail.com
Insights
Recent studies highlight inhaled anesthetics like sevoflurane and desflurane for pediatric care. Medications can manage emergence delirium, but caution is advised for children with Duchenne
Area of Science:
- Pediatric Anesthesiology
- Inhalational Anesthetics
- Clinical Pharmacology
Background:
- Inhaled anesthetics are crucial for pediatric anesthesia.
- Emergence delirium and specific patient conditions pose challenges.
- Recent advancements offer improved safety and efficacy.
Purpose of the Study:
- To review recent publications on inhaled agents in children.
- To discuss their implications for clinical practice.
- To highlight safety considerations and emerging techniques.
Main Methods:
- Literature review of recent publications.
- Analysis of clinical findings related to inhaled anesthetics.
- Discussion of pharmacologic interventions and monitoring.
Main Results:
- Clonidine, dexmedetomidine, ketamine, and nalbuphine aid in managing emergence delirium.
- Bispectral index monitoring reveals unique findings with different agents.
- Sevoflurane and desflurane require careful use in Duchenne muscular dystrophy patients due to risks of hyperkalemia and myocardial depression.
- Desflurane offers faster recovery in pediatric patients.
- Single-breath inductions with sevoflurane are effective for rapid anesthesia induction in older children.
Conclusions:
- Sevoflurane and desflurane present ongoing challenges in pediatric anesthesia.
- Emergence delirium can be managed with specific medications.
- Caution is essential when using inhaled agents in children with Duchenne muscular dystrophy.
- Rapid recovery with desflurane and efficient induction with sevoflurane are notable advancements.
Purpose Of Review:
To present the most recent publications on inhaled agents in children and their implications for clinical care.
Recent Findings:
The roles of clonidine, dexmedetomidine, ketamine and nalbuphine in the treatment of emergence delirium after sevoflurane and desflurane are discussed. Bispectral index monitoring has generated several curious findings in children. Halothane consistently produced higher Bispectral index readings than equi-minimum-alveolar-concentration multiples of ether anesthetics. Bispectral index readings increased as the sevoflurane concentration increased beyond 3%. Inhalation agents may cause two serious complications when administered to children with Duchenne's muscular dystrophy: hyperkalemia in younger children and myocardial depression in adolescents. Recovery after desflurane anesthesia is more rapid than with the other ether anesthetics in infants and children. Single-breath inductions are of interest in children >6 years for rapid anesthesia induction.
Summary:
Sevoflurane and desflurane continue to challenge our abilities to anesthetize children safely and efficiently. Although transient emergence delirium after insoluble agents is a problem, several medications may be used to attenuate it. Inhaled agents must be used with caution in children with Duchenne's muscular dystrophy as hyperkalemia may occur in young males and myocardial depression in adolescents. Rapid recovery after desflurane and single-breath inductions with sevoflurane continue to fascinate clinicians.
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