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Zhang Y, Liu C, He X, Tang Z, Guo Q, Huang C. Post-Operative Conversion Aphonia in a Pediatric Patient: A Case Report. Laryngoscope 2023. [PMID: 36810709 DOI: 10.1002/lary.30615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/14/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
We describe an unusual case of post-operative conversion aphonia in a pediatric patient. It indicates the importance of discussing its presentation, and amplifies the need for emotional support in the immediate post-operative period for young patients with heightened anxiety. Laryngoscope, 2023.
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Affiliation(s)
- Yiying Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Chang Liu
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Xin He
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Zhaohui Tang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
| | - Changsheng Huang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
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Russell PSS, Mammen PM, Shankar SR, Viswanathan SA, Rebekah G, Russell S, Earnest R, Chikkala SM. Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis. World J Clin Pediatr 2022; 11:196-205. [PMID: 35433300 PMCID: PMC8985492 DOI: 10.5409/wjcp.v11.i2.196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/27/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emergence delirium (EmD) is a troublesome motoric, emotional, and cognitive disturbance associated with morbidity. It is often misdiagnosed despite being present in a substantial proportion of children and adolescents during emergence from anesthesia.
AIM To evaluate the summary diagnostic accuracy of Pediatric Anesthesia Emergence Delirium Scale (PAEDS) for EmD among children and adolescents.
METHODS Two researchers electronically and hand searched the published literature from May 2004 to February 2021 that evaluated the diagnostic accuracy of PAEDS for EmD among children and adolescents, using appropriate terms. Two independent researchers extracted the diagnostic parameters and appraised the study quality with QUADAS-2. Overall, the diagnostic accuracy of the measures was calculated with the summary receiver operating characteristic curve (SROC), the summary sensitivity and specificity, and diagnostic odds ratio (DOR) for EmD. Various diagnostic cut-off points were evaluated for their diagnostic accuracy. Heterogeneity was analyzed by meta-regression.
RESULTS Nine diagnostic accuracy studies of EmD that conformed to our selection criteria and PRISMA guidelines were included in the final analysis. There was no publication bias. The area under the SROC was 0.97 (95% confidence interval [CI]: 95%-98%). Summary sensitivity and specificity were 0.91 (95%CI: 0.81-0.96; I2 = 92.93%) and 0.94 (95%CI: 0.89-0.97; I2 = 87.44%), respectively. The summary DOR was 148.33 (95%CI: 48.32-455.32). The effect size for the subgroup analysis of PAEDS cut-off scores of < 10, ≥ 10, and ≥ 12 was 3.73, 2.19, and 2.93, respectively; they were not statistically significantly different. The setting of the study and reference standard were statistically significantly related to the sensitivity of PAEDS but not specificity.
CONCLUSION The PAEDS is an accurate diagnostic measure for the diagnosis of EmD among children and adolescents. Further studies should document its clinical utility.
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Affiliation(s)
| | - Priya Mary Mammen
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Satya Raj Shankar
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | | | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Sushila Russell
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Richa Earnest
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
| | - Swetha Madhuri Chikkala
- Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
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Zhang J, Yang M, Dong H, Lu Z. Transient aphasia following general anesthesia in patient undergoing laparoscopic gynecologic surgery: A case report and literature review. Clin Case Rep 2021; 9:634-637. [PMID: 33598216 PMCID: PMC7869373 DOI: 10.1002/ccr3.3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/16/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
Aphasia could be a manifestation of postoperative psychoemotional disorder. Early differential diagnosis is important.
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Affiliation(s)
- Junbao Zhang
- Department of Anesthesiology and Perioperative MedicineXijing HospitalFourth Military Medical UniversityXi'anChina
| | - Manping Yang
- Department of Anesthesiology and Perioperative MedicineXijing HospitalFourth Military Medical UniversityXi'anChina
| | - Hailong Dong
- Department of Anesthesiology and Perioperative MedicineXijing HospitalFourth Military Medical UniversityXi'anChina
| | - Zhihong Lu
- Department of Anesthesiology and Perioperative MedicineXijing HospitalFourth Military Medical UniversityXi'anChina
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Machovec KA, Ames WA. Recycle: Do It for the Kids. J Cardiothorac Vasc Anesth 2020; 34:3352-3353. [PMID: 32753327 PMCID: PMC7362829 DOI: 10.1053/j.jvca.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022]
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Oh S, Chung J, Baek S, Park YJ. Postoperative expressive aphasia associated with intravenous midazolam administration: a 5-year retrospective case-control study. J Int Med Res 2020; 48:300060520948751. [PMID: 32851907 PMCID: PMC7457656 DOI: 10.1177/0300060520948751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives This study aimed to investigate the epidemiology of intravenous midazolam-induced postoperative expressive aphasia (EA). Methods The incidence rate, risk ratio, and contributing factors to intravenous midazolam-induced postoperative EA were analyzed retrospectively in 6756 orthopedic patients. A telephone interview was conducted with patients with EA after surgery. Results Patients were allocated to either the midazolam group (n = 6178) or no-midazolam group (n = 578). Twelve patients developed EA in the midazolam group, with an incidence of 0.19%, and no patient developed EA in the no-midazolam group. The mean age of EA patients was 70 years, and 92% were women. Among them, 75% received general anesthesia, and the mean dose of midazolam was 1.8 mg. EA was reversed in nine of 12 (75%) patients within 4 minutes of flumazenil administration, and >60 minutes were required to reverse EA in the other three patients (25%). Conclusion Intravenous midazolam administration for preoperative sedation caused transient EA in 0.19% of patients, especially elderly women who received general anesthesia, and EA could be reversed by flumazenil.
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Affiliation(s)
- Saecheol Oh
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihyun Chung
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sujin Baek
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Jung Park
- Department of Anesthesiology and Pain Medicine, Saint Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Escape From Oblivion: Neural Mechanisms of Emergence From General Anesthesia. Anesth Analg 2019; 128:726-736. [PMID: 30883418 DOI: 10.1213/ane.0000000000004006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The question of how general anesthetics suppress consciousness has persisted since the mid-19th century, but it is only relatively recently that the field has turned its focus to a systematic understanding of emergence. Once assumed to be a purely passive process, spontaneously occurring as residual levels of anesthetics dwindle below a critical value, emergence from general anesthesia has been reconsidered as an active and controllable process. Emergence is driven by mechanisms that can be distinct from entry to the anesthetized state. In this narrative review, we focus on the burgeoning scientific understanding of anesthetic emergence, summarizing current knowledge of the neurotransmitter, neuromodulators, and neuronal groups that prime the brain as it prepares for its journey back from oblivion. We also review evidence for possible strategies that may actively bias the brain back toward the wakeful state.
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Sun R, Wang G, Gao X, Wang S. Flumazenil reduces respiratory complications during anesthesia emergence in children with preoperative upper respiratory tract infections. Medicine (Baltimore) 2018; 97:e0516. [PMID: 29703020 PMCID: PMC5944528 DOI: 10.1097/md.0000000000010516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Despite its benignity, upper respiratory infections (URIs) 1 increase the risk of postoperative respiratory complications during the perioperative and postoperative periods. Flumazenil could improve the symptoms of respiratory obstruction.To evaluate the effect of flumazenil on the occurrence of respiratory complications during anesthesia emergence of children with preoperative URI.This was a prospective study of 164 consecutive pediatric patients who underwent strabismus surgery under general anesthesia at the Tianjin Eye Hospital between August 2016 and April 2017. The patients were grouped as: normal airway (N), recent mild URI (I), normal airway and flumazenil (NF), and recent mild URI and flumazenil (group IF) (n = 41/group). An initial dose of flumazenil (0.1 mg) was administrated intravenously to groups IF and NF. The intraoperative and postoperative respiratory complications were recorded by one anesthesiologist unaware of the grouping.All patients underwent surgery uneventfully. The incidence of postoperative respiratory complications in post-anesthesia care unit (PACU) was higher in group I compared with the other 3 groups (IF: 17%; I: 41%; NF: 5%; N: 10%; P = .0147). During the PACU period, significant differences among groups were seen for cough (IF: 15%; I: 20%; NF: 2%; N: 0%; P = .004), secretion (IF: 17%; I: 29%; NF: 5%; N: 7%; P = .007), low oxygen saturation (IF: 12%; I: 32%; NF: 2%; N: 7%; P = .001), and glossocoma (IF: 15%; I: 34%; NF: 10%; N: 32%; P = .015).Respiratory complications during anesthesia emergence were higher in patients with recent preoperative URI compared to patients with healthy airways. Postoperative flumazenil could reduce the incidence of glossocoma.
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Affiliation(s)
- Ruiqiang Sun
- Cinical College of Ophthalmology, Tianjin Medical University
| | - Guolin Wang
- General Hospital of Tianjin Medical University, Tianjin, China
| | - Xuesong Gao
- Cinical College of Ophthalmology, Tianjin Medical University
| | - Shuzhen Wang
- Cinical College of Ophthalmology, Tianjin Medical University
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Effects of γ-Aminobutyric Acid Type A Receptor Modulation by Flumazenil on Emergence from General Anesthesia. Anesthesiology 2017; 125:147-58. [PMID: 27111534 DOI: 10.1097/aln.0000000000001134] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transitions into conscious states are partially mediated by inactivation of sleep networks and activation of arousal networks. Pharmacologic hastening of emergence from general anesthesia has largely focused on activating subcortical monoaminergic networks, with little attention on antagonizing the γ-aminobutyric acid type A receptor (GABAAR). As the GABAAR mediates the clinical effects of many common general anesthetics, the authors hypothesized that negative GABAAR modulators would hasten emergence, possibly via cortical networks involved in sleep. METHODS The authors investigated the capacity of the benzodiazepine rescue agent, flumazenil, which had been recently shown to promote wakefulness in hypersomnia patients, to alter emergence. Using an in vivo rodent model and an in vitro GABAAR heterologous expression system, they measured flumazenil's effects on behavioral, neurophysiologic, and electrophysiologic correlates of emergence from isoflurane anesthesia. RESULTS Animals administered intravenous flumazenil (0.4 mg/kg, n = 8) exhibited hastened emergence compared to saline-treated animals (n = 8) at cessation of isoflurane anesthesia. Wake-like electroencephalographic patterns occurred sooner and exhibited more high-frequency electroencephalography power after flumazenil administration (median latency ± median absolute deviation: 290 ± 34 s) compared to saline administration (473 ± 186 s; P = 0.042). Moreover, in flumazenil-treated animals, there was a decreased impact on postanesthesia sleep. In vitro experiments in human embryonic kidney-293T cells demonstrated that flumazenil inhibited isoflurane-mediated GABA current enhancement (n = 34 cells, 88.7 ± 2.42% potentiation at 3 μM). Moreover, flumazenil exhibited weak agonist activity on the GABAAR (n = 10 cells, 10.3 ± 3.96% peak GABA EC20 current at 1 μM). CONCLUSIONS Flumazenil can modulate emergence from isoflurane anesthesia. The authors highlight the complex role GABAARs play in mediating consciousness and provide mechanistic links between emergence from anesthesia and arousal.
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Shin YH, Lee SH, Kim DY. Risperidone in a child with untractable emergency delirium: a case report. Korean J Anesthesiol 2016; 69:623-626. [PMID: 27924205 PMCID: PMC5133236 DOI: 10.4097/kjae.2016.69.6.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/27/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
A 6-year-old boy was scheduled for thoracic magnetic resonance imaging under deep sedation with midazolam 1.8 mg and propofol 100 µg/kg/min via intravenous injection. He showed emergence delirium in the post-anesthesia care unit. The staff attempted to calm him by administering flumazenil as an antidote for midazolam, propofol for further sedation, and meperidine. However, this was not successful. A psychiatrist recommended the use of antipsychotics. Administration of risperidone led to immediate resolution of the boy's symptoms and relaxed him. The use of antipsychotic drugs is not common for anesthesiologists, but should be considered for treating uncontrolled emergence delirium after anesthesia.
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Affiliation(s)
- Young Hee Shin
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Yoon Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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