thiopental and Child-Behavior-Disorders

There are few published data comparing the psychological effects of intravenous (i.v.) and inhalation methods of anaesthesia induction in children. In the present study, we compared perioperative anxiety and postoperative behavioural changes in children undergoing standardized i.v. induction with thiopental and inhalation induction with sevoflurane for routine ear, nose and throat surgery.. Children were randomly assigned to receive inhalation induction with sevoflurane or i.v. induction with thiopental. Anxiety was assessed on arrival, at induction and 30 min after transfer to the recovery room using a four-point scale. The incidence of postoperative behavioural disturbances was determined using a postoperative questionnaire.. Significantly more children were anxious during induction in the i.v. group than in the inhalation group [23 of 50 (46%) versus 5 of 50 (10%); P = 0.0001]. Mean induction time was shorter (5.6 versus 7.0 min; P = 0.0001) and recovery time longer (30.5 versus 10.4 min; P = 0.0001) in the i.v. group compared with the inhalation group. Problematic behavioural changes were reported in the first 2 weeks after surgery in nine of 32 children (28%) in the i.v. group and 16 of 34 (48%) children in the inhalation group (P = 0.13).. Although children were more anxious during i.v. induction than inhalation induction, there was no difference in the incidence of behavioural disturbances in the first 2 weeks postoperatively.

Topics: Adolescent; Anesthesia Recovery Period; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Anxiety; Child; Child Behavior Disorders; Child, Preschool; Female; Humans; Infant; Intraoperative Period; Male; Methyl Ethers; Otorhinolaryngologic Surgical Procedures; Parents; Postoperative Complications; Preoperative Care; Sevoflurane; Surveys and Questionnaires; Thiopental

To determine the success rate, safety and complications using a standard protocol and trained nurses to provide sedation for MRI under the supervision of a radiologist.. Nurses were trained to provide sedation via a standard protocol for pediatric patients undergoing diagnostic MRI. Oral chloral hydrate (80-100 mg x kg(-1)) was used for children less than 18 mo of age. Older children received either 1-6 mg x kg(-1) pentobarbital i.v., with or without 1-2 microg x kg x hr(-1) fentanyl, or 25 mg x kg(-1) thiopental pr. Sedation was defined as successful if it allowed completion of the MRI without image distorting patient movement. The records of 572 MRIs performed on 488 pediatric patients (mean age 5+/-4 yr; age 2 mo-14 yr) from 1991 to July 1995 were reviewed to determine the success rate and complications using the sedation program.. Most, 91.8% (525/572), of the MRIs were successfully completed in 445 patients. The reasons for failure were inadequate sedation (45, 95.7%) and coughing (2, 4.2%). The failure rate was much higher before 1994 (38/272, 14%) than after (9/300, 3%; P<0.0001). Failure was more common if rectal thiopental was used (23/172, 14%) than intravenous pentobarbital (19/256, 7.4%; P<0.05). The failure rate was also high in patients with a history of a behavioural disorder (10/59, 17%). There were no deaths or unexpected admissions as a result of the sedation program.. A high success rate can be achieved as experience is gained using a standard protocol and trained nurses to sedate children for MRI.

Topics: Administration, Rectal; Adolescent; Age Factors; Anesthesia, General; Anesthesiology; Anesthetics, Intravenous; Child; Child Behavior Disorders; Child, Preschool; Chloral Hydrate; Cough; Education, Nursing; Fentanyl; Humans; Hypnotics and Sedatives; Infant; Magnetic Resonance Imaging; Movement; Phenobarbital; Prognosis; Safety; Thiopental