Steal the child with a Sleepy wind: Pediatric chair-side general anesthesia

[Anonymous]

 good write up dr sumati bhalla. keep it up

        

[drmithila]

Healthy children under 36 months of age, presenting early childhood caries were randomly assigned to receive protective stabilization plus: combined oral midazolam (0.5 mg/kg) and ketamine (3 mg/kg) (MK), or oral midazolam (1.0 mg/kg) (MS), or no sedative (PS).
The combination of oral midazolam and ketamine is efficacious for guiding the behaviour of children under 3 years old. (International Journal of Paediatric Dentistry)

 

        

[drmithila]

Exposure to common antibacterial chemicals and preservatives found in soap, toothpaste, mouthwash and other personal-care products may make children more prone to a wide range of food and environmental allergies, according to new research from Johns Hopkins Children’s Center.
Results of the NIH-funded study are published online ahead of print June 18 in the Journal of Allergy and Clinical Immunology.
Using existing data from a national health survey of 860 children ages 6 to 18, Johns Hopkins researchers examined the relationship between a child’s urinary levels of antibacterials and preservatives found in many personal-hygiene products and the presence of IgE antibodies in the child’s blood. IgE antibodies are immune chemicals that rise in response to an allergen and are markedly elevated in people with allergies.
"We saw a link between level of exposure, measured by the amount of antimicrobial agents in the urine, and allergy risk, indicated by circulating antibodies to specific allergens," said lead investigator Jessica Savage, M.D., M.H.S., an allergy and immunology fellow at Hopkins.
The researchers caution that the findings do not demonstrate that antibacterials and preservatives themselves cause the allergies, but instead suggest that these agents play a role in immune system development.
The investigators say their findings are also consistent with the so-called hygiene hypothesis, which has recently gained traction as one possible explanation behind the growing rates of food and environmental allergies in the developed world. The hypothesis suggests that early childhood exposure to common pathogens is essential in building healthy immune responses. Lack of such exposure, according to the theory, can lead to an overactive immune system that misfires against harmless substances such as food proteins, pollen or pet dander.
"The link between allergy risk and antimicrobial exposure suggests that these agents may disrupt the delicate balance between beneficial and bad bacteria in the body and lead to immune system dysregulation, which in turn raises the risk of allergies," Savage added.
In the study, those with the highest urine levels of triclosan — an antibacterial agent used in soaps, mouthwash and toothpaste — had the highest levels of food IgE antibodies, and therefore the highest allergy risk, compared with children with the lowest triclosan levels. Children with the highest urinary levels of parabens — preservatives with antimicrobial properties used in cosmetics, food and medications — were more likely to have detectable levels of IgE antibodies to environmental allergens like pollen and pet dander, compared with those with low paraben levels.
The team initially zeroed in on seven ingredients previously shown to disrupt endocrine function in lab and animal studies. These compounds were bisphenol A — found in plastics — and triclosan, benzophenone-3 and propyl, methyl, butyl and ethyl parabens, found in personal-hygiene products and some foods and medications. Interestingly, triclosan and propyl and butyl parabens, all of which have antimicrobial properties, were the only ones associated with increased allergy risk in the current study, the researchers noted.
"This finding highlights the antimicrobial properties of these agents as a probable driving force behind their effect on the immune system," said senior investigator Corinne Keet, M.D., M.S., an allergist at Johns Hopkins Children’s Center.
Children with the highest urine levels of triclosan had nearly twice the risk of environmental allergies as children with the lowest urinary concentrations. Those with highest levels of propyl paraben in the urine had twice the risk of an environmental allergy. Food allergy risk was more than twice as pronounced in children with the highest levels of urinary triclosan as in children with the lowest triclosan levels. High paraben levels in the urine were not linked to food allergy risk.
To clarify the link between antimicrobial agents and allergy development, the researchers are planning a long-term study in babies exposed to antibacterial ingredients at birth, following them throughout childhood.
he research was funded by the National Institutes of Health training grant number T32AI007056-31.
Co-investigators on the research were Elizabeth Matsui, M.D., M.H.S., and Robert Wood, M.D., both of Hopkins.

 

        

[drsushant]

Young children with allergies to milk and egg experience reactions to these and other foods more often than researchers had expected, a study reports. The study also found that severe and potentially life-threatening reactions in a significant number of these children occur and that some caregivers are hesitant to give such children epinephrine, a medication that reverses the symptoms of such reactions and can save lives.
"This study reinforces the importance of doctors, parents and other caregivers working together to be even more vigilant in managing food allergy in children," said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
The study results appear online in the June 25 issue of Pediatrics and are the latest findings from the Consortium of Food Allergy Research (CoFAR), a network established by NIAID to conduct clinical trials, observational studies and basic research to better understand and treat food allergy.
The research is part of an ongoing CoFAR observational study that enrolled 512 infants aged 3 to 15 months who at study entry were allergic to milk or egg, or who were likely to be allergic, based on a positive skin test and the presence of moderate-to-severe eczema, a chronic skin condition. The investigators are carefully following these children to see whether their allergies resolve or if new allergies, particularly peanut allergy, develop. The study is ongoing at research hospitals in Baltimore; Denver; Durham, N.C.; Little Rock, Ark.; and New York City.
CoFAR investigators advised parents and caregivers to avoid giving their children foods that could cause an allergic reaction. Study participants also received an emergency action plan, describing the symptoms of a severe allergic reaction to food and what to do if a child has one, along with a prescription and instructions on how to give epinephrine if a severe reaction occurred.
Data compiled from patient questionnaires and clinic visits over three years showed that 72 percent of the children had a food-allergic reaction, and that 53 percent of the children had more than one reaction, with the majority of reactions being to milk, egg or peanut. This translated into a rate of nearly 1 food-allergic reaction per child per year. Approximately 11 percent of the reactions were classified as severe and included symptoms such as swelling in the throat, difficulty breathing, a sudden drop in blood pressure, dizziness or fainting. Almost all of the severe reactions were caused by ingestion of the allergen rather than inhalation or skin contact.
In only 30 percent of the severe reactions did caregivers administer epinephrine, a drug that alleviates the symptoms of severe reactions by increasing heart rate, constricting blood vessels and opening the airways. Investigators found that caregivers did not give children epinephrine for a number of reasons: the drug was not available, they were too afraid to administer it, they did not recognize the symptoms as those of an allergic reaction, or they did not recognize the reaction as severe.
"This study documenting the natural history of allergic reactions to three of the major food allergens in pre-school children provides important new information for parents, caregivers and health care workers because of the large number of children involved and the rigorous follow-up," said Daniel Rotrosen, M.D., director of the NIAID Division of Allergy, Immunology and Transplantation, which oversees CoFAR. "The findings not only reveal that food-allergic reactions occur at a much higher rate in young children than we thought, they also suggest that more vigilance and increased use of epinephrine is needed."
Almost 90 percent of allergic reactions to egg, milk or peanut occurred after a child accidentally ate the food. The reasons for the accidental exposures included caregivers misreading food labels, not checking a food for an allergen, and unintentionally allowing a food allergen to come into contact with other foods (cross-contamination).
The study also found that approximately 11 percent of allergic reactions to egg, milk or peanut occurred after a caregiver — most often a parent — provided a child the allergenic food intentionally.
"Intentional exposures to allergenic food are typically reported in teenagers, who tend to take more risks or who might be embarrassed about their food allergy," says David Fleischer, M.D., the lead study author. "What is troubling is that in this study we found that a significant number of young children received allergenic foods from parents who were aware of the allergy."
CoFAR investigators are exploring possible reasons for these intentional exposures, but they speculate that it could reflect parents’ at-home tests to determine if children have outgrown the food allergy. Because giving children allergenic foods could possibly result in life-threatening reactions, such testing should only be conducted under the direct supervision of a health care professional trained in performing food challenges. The study findings reinforce the importance of caregivers working closely with their doctors to understand how to effectively manage a child’s food allergy.

 

        

[drsnehamaheshwari]

 Successful sedation in dentistry does not end when the patient departs the practice. Children, in particular, are sensitive to sedation, and as childhood caries rates remain high, the need for sedation will also persist.

Researchers from the department of pediatric dentistry at Louisiana State University Health Sciences Center (LSUHSC) School of Dentistry noticed the dearth of data about children’s response to sedation after they have left the practice where the dental procedure took place. In a study published in Anesthesia Progress, the researchers compared the adverse events experienced by children administered meperidine and hydroxyzine versus midazolam eight hours and 24 hours after sedation (Summer 2013, Vol. 60:2, pp. 54-59).

Their results could help set expectations and inspire advice for parents as they prepare to take their children home.

"Sleeping in the car during the ride back home was observed in half of the sedated children in this study," wrote Priyanshi Ritwik, an associate professor in the department of pediatric dentistry, and colleagues. "This has the risk of airway obstruction."

The researchers also observed different reactions to the sedatives they compared. "Vomiting was seen in children sedated with meperidine and hydroxyzine but not in the children sedated with midazolam," they noted. "Prolonged sleep at home was significantly higher in the children sedated with meperidine and hydroxyzine." And most adverse effects were likely to occur in the first eight hours, although some took up to 24 hours to manifest.

 

The drive home

Sedatives often last longer than the duration of the dental appointment. Consequently, the trip home from the dental practice can be a hazardous one, involving vomiting or worse.

"It is critical to know the effects of these medications beyond the time spent by the child in the dental office, so that parents can be appropriately cautioned about the expected effects and how to distinguish them from any potential emergencies that may lead to airway obstruction," the researchers explained.

During a three-month period, the researchers called the parents of children undergoing sedation at LSUHSC who were willing to participate in a survey eight hours and 24 hours after the procedure. The children included in the study were generally healthy and sedated due to acute situational anxiety.

The eight-hour questionnaire asked predominantly "yes" or "no" questions about complaints of pain, vomiting, snoring, or sleeping in the car on the way home, sleeping at home arousability, irritability, the ability to eat and drink, the need for medications at home, and the need for additional medical care after the appointment. The questions at the 24-hour mark were similar.

The parents of 46 children participated in the study; 40 were sedated with a combination of meperidine and hydroxyzine while the remaining six were sedated with midazolam. In the former group, 16 children reported pain after eight hours and seven of them said it persisted at the 24-hour mark. Only two children in this group had a fever. One child in the midazolam group reported pain in the first eight hours and one child had a fever. There was no statistical difference in the proportion of patients experiencing pain (p = 0.647) or fever (p = 0.349) based on which sedative they were given.

Three children given meperidine and hydroxyzine vomited within eight hours of sedation; none from the midazolam group did. Half of the children from both groups slept in the car after departure. Of those who slept in the car, 13 from the meperidine-hydroxyzine group and one child from the midazolam group had a ride of less than 30 minutes to get home. Five children from the former group and one from the latter had a ride of more than 30 minutes.

"All children in the meperidine and hydroxyzine group exhibited prolonged sleep at home in the eight- to 24-hour period," the researchers noted. "Five children (13%) were difficult to wake up in this time period." In the other group, 67% of the children exhibited prolonged sleep and one of them was difficult to rouse.

The researchers noted that sleeping during the car ride home has the potential for airway obstruction because the children may tilt their head down to their chest. "It is, therefore, important to ask parents to bring another responsible adult to accompany their child in the car when planning sedations for pediatric patients," they concluded.

        

[Guru Hospital]

The thread was usefull.
For child Anasthesia it should be accomplished by a proffesional.

        

[Author]

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