anesthesia-intubation-preadolescent-mouse-pups-for-cardiothoracic

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery

Murine surgical models play an important role in preclinical research. Mechanistic insights into myocardial regeneration after cardiac injury may be ...

The Children’s Hospital at Westmead

University of Sydney

Children suffering supracondylar fractures of the humerus are at risk of vascular compromise, which is currently assessed clinically, although other modalities such as angiography, pulse oximetry, Doppler ultrasound and magnetic resonance angiography have been used. We sought to ascertain whether tissue haemoglobin oxygenation (StO2) measurement could distinguish between patients with and without clinical vascular compromise following supracondylar fractures of the humerus. We prospectively observed StO2 using near-infrared spectroscopy in 29 paediatric patients with supracondylar fractures requiring operative manipulation. The injured and uninjured volar forearm compartments were monitored immediately before and after fracture reduction. The relationship between StO2 in the injured and uninjured limb, and the presence of pre-operative vascular compromise was assessed. Seven out of 29 children presented with vascular compromise. Patients with clinical vascular compromise had significantly lower pre-reduction StO2 (63.5% ± 15%, mean ± standard deviation), compared to those without compromise (80.9% ± 10%). StO2 normalized following surgery in all children with vascular compromise. These improvements in muscle StO2 were associated, in all patients, with the clinical return of pulses and resolution of neurological symptoms if present. StO2 monitoring can identify patients with clinical vascular compromise, can identify the return of adequate perfusion following operative correction of supracondylar fractures, and may be a useful adjunct to clinical assessment. 

Near-infrared spectroscopy for detection of vascular compromise in paediatric supracondylar fractures.

Near-infrared spectroscopy for monitoring renal transplant perfusion.

Traumatic brain injury is a major cause of mortality and morbidity worldwide. It can be worsened by secondary injury particularly with hypoxia or hypotension. Current prehospital guidelines emphasise regular measurement of peripheral oxygen saturation and blood pressure but there is no monitor in use to provide direct information relating to blood flow or oxygen delivery to the brain tissue. This prospective cohort study will assess the utility of near-infrared spectroscopy monitoring in prehospital medicine in demonstrating injury, pathophysiology and associations with long-term functional outcomes.

Study protocol for the PHANTOM study: prehospital assessment of noninvasive tissue oximetry monitoring.

Staying away from the edge - cerebral oximetry guiding blood pressure management.

Peripheral vasodilation is a well-recognized side effect of general anesthesia, and induces changes in the amplitude of the pulse plethysmograph (PPG) waveform. This can be continuously quantitaed using the Perfusion Index (PI), a ratio of the pulsatile to nonpulsatile signal amplitude in the PPG waveform. We hypothesized that the perfusion index would rise with the induction of anesthesia in children, and fall with emergence, and performed a prospective, observational study to test this.

Using a pulse oximeter to determine clinical depth of anesthesia-investigation of the utility of the perfusion index.

Vascular complications following pediatric liver transplantation occur in 8-10% of cases, and no continuous, non-invasive monitoring for this problem exists. Near infrared spectroscopy (NIRS) allows non-invasive, continuous, transcutaneous assessment of hemoglobin oxygenation (StO ) 1-4 cm below the skin surface.

Can transcutaneous near infrared spectroscopy detect severe hepatic ischemia: a juvenile porcine model.

Continuing stories with discontinuity.

Concern over potential neurotoxicity of anesthetics has led to growing interest in prospective clinical trials using potentially less toxic anesthetic regimens, especially for prolonged anesthesia in infants. Preclinical studies suggest that dexmedetomidine may have a reduced neurotoxic profile compared to other conventional anesthetic regimens; however, coadministration with either anesthetic drugs (eg, remifentanil) and/or regional blockade is required to achieve adequate anesthesia for surgery. The feasibility of this pharmacological approach is unknown. The aim of this study was to determine the feasibility of a remifentanil/dexmedetomidine/neuraxial block technique in infants scheduled for surgery lasting longer than 2 hours.

An open label pilot study of a dexmedetomidine-remifentanil-caudal anesthetic for infant lower abdominal/lower extremity surgery: The T REX pilot study.

Hemodynamic monitoring in children with heart disease: Overview of newer technologies.

Intraoperative isoelectric electroencephalography (EEG) has been associated with hypotension and postoperative delirium in adults. This international prospective observational study sought to determine the prevalence of isoelectric EEG in young children during anesthesia. We hypothesized that the prevalence of isoelectric events would be common worldwide and associated with certain anesthetic practices and intraoperative hypotension.

Article	Year
Near-infrared spectroscopy for detection of vascular compromise in paediatric supracondylar fractures. Physiological measurement\| PubMed ID: 24557027	2014
Near-infrared spectroscopy for monitoring renal transplant perfusion. Pediatric nephrology (Berlin, Germany)\| PubMed ID: 25119681	2014
Study protocol for the PHANTOM study: prehospital assessment of noninvasive tissue oximetry monitoring. Scandinavian journal of trauma, resuscitation and emergency medicine\| PubMed ID: 25280485	2014
Staying away from the edge - cerebral oximetry guiding blood pressure management. Paediatric anaesthesia\| PubMed ID: 26053770	2015
Using a pulse oximeter to determine clinical depth of anesthesia-investigation of the utility of the perfusion index. Paediatric anaesthesia\| PubMed ID: 27569026	2016
Can transcutaneous near infrared spectroscopy detect severe hepatic ischemia: a juvenile porcine model. Paediatric anaesthesia\| PubMed ID: 27663858	2016
Continuing stories with discontinuity. Paediatric anaesthesia\| PubMed ID: 28220669	2017
An open label pilot study of a dexmedetomidine-remifentanil-caudal anesthetic for infant lower abdominal/lower extremity surgery: The T REX pilot study. Paediatric anaesthesia\| PubMed ID: 30428151	2019
Hemodynamic monitoring in children with heart disease: Overview of newer technologies. Paediatric anaesthesia\| PubMed ID: 30667124	2019
Isoelectric Electroencephalography in Infants and Toddlers During Anesthesia for Surgery-an International Observational Study. Anesthesiology\| PubMed ID: 35503999	2022

Justin J. Skowno

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