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Anesthesia Management of Pediatric Victims After the February 6, 2023, Kahramanmaraş Earthquake at a Third-Level
Sengül Özmert1, Melike Demir Işıktekin2, Tuğba Nur Taygurt1
1Department of Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkey.
Insights
Pediatric earthquake survivors need specialized anesthesia. This study identified key time-under-rubble and creatine kinase levels to predict crush syndrome and acute kidney injury in child earthquake victims.
Area of Science:
- Pediatric Anesthesiology
- Disaster Medicine
- Trauma Surgery
Background:
- Earthquakes cause significant devastation, particularly to children who require specialized anesthetic care due to their unique physiology.
- Pediatric earthquake survivors face risks of crush syndrome and acute kidney injury (AKI).
- Establishing predictive cutoff values for these conditions is crucial for effective management.
Purpose of the Study:
- To report on anesthesia techniques and perioperative management of pediatric earthquake victims.
- To determine the time spent under rubble cutoff for crush syndrome development.
- To identify the creatine kinase cutoff value for acute kidney injury in child survivors.
Main Methods:
- Retrospective analysis of 45 pediatric patients (<18 years) who received anesthesia post-February 6, 2023 earthquake.
- Data collected included demographics, Glasgow Coma Scale, time under rubble, injury severity, crush syndrome/AKI status, and laboratory results.
- Anesthesia techniques and airway management strategies were recorded.
Main Results:
- 45 pediatric patients underwent 362 surgical procedures, with extremity injuries being most common.
- Minimal Access Cranial (MAC) technique with sedation and ketamine-based anesthesia was frequently used; nasal O2 and supraglottic airway devices were common for airway management.
- A cutoff of ≥22.5 minutes under debris predicted crush syndrome, and ≥32,029 IU/L of creatine kinase predicted AKI.
Conclusions:
- Findings offer guidance for anesthesia and perioperative care of pediatric earthquake survivors.
- Identified cutoff values can aid in early detection and management of crush syndrome and AKI.
- This study contributes valuable insights for future disaster response involving pediatric populations.
Introduction:
Earthquakes are chaotic events that cause severe physical and psychological devastation. Due to their anatomical and physiological differences and fragile nature, pediatric earthquake survivors require special attention in anesthesia management. This retrospective study aims to share our experiences and anesthesia techniques applied to pediatric earthquake victims in our tertiary care pediatric hospital. Furthermore, the study aimed to determine the time spent under rubble cutoff value for the development of crush syndrome and creatine kinase cutoff value for the development of acute kidney injury in child earthquake victims.
Methods:
Child earthquake victims under the age of 18 who underwent anesthesia in our hospital after the earthquake that occurred on February 6, 2023, were included in this study. Demographic data, Glasgow Coma Scale scores at admission, the time spent under rubble, existing injuries, Injury Severity Score, presence of crush syndrome and acute kidney injury, need for hemodialysis, length of hospital and intensive care unit stay, type of surgical intervention, and preoperative and discharge laboratory results were analyzed. The type of anesthetic agents used and airway management techniques were recorded.
Results:
A total of 45 pediatric earthquake victims underwent 362 surgical interventions. Extremity injuries were more common in our patients. We most frequently administered the MAC technique to our patients using sedation and ketamine-based general anesthesia. For airway management, nasal O2 support (44.0%) and SGA (43.2%) were most commonly used. The mean Injury Severity Score was calculated as 22.18 (95% CI: 19.17-25.18). We found that a cutoff value of ≥ 22.5 min spent under debris strongly predicted the development of crush syndrome, and a creatine kinase cutoff value of ≥ 32 029 IU/L strongly predicted the development of AKI.
Conclusion:
The findings of our study may serve as a guide for anesthesia management and perioperative processes in pediatric earthquake victims in future disaster scenarios.
Trial Registration:
ClinicalTrials.gov identifier: NCT06310265.
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