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15 results on '"Valter Sonzogni"'

1. Re: Persistent Pain following Common Outpatient Surgeries in Children: A Multicenter Study in Italy

Author

Bruno Guido Locatelli, Karen Boretsky, Valeria Mossetti, Roberta Nicoletti, Valter Sonzogni, Micol Maffioletti, Rodolfo Lio, Marinella Astuto, Noemi Vicchio, Giorgio Ivani, and David Zurakowski

Subjects
Male, medicine.medical_specialty, Pediatrics, Activities of daily living, Adolescent, Urology, medicine.medical_treatment, Hernia, Inguinal, Pacu, 03 medical and health sciences, 0302 clinical medicine, Anesthesia, Conduction, Risk Factors, 030202 anesthesiology, Surveys and Questionnaires, Prevalence, medicine, Humans, Orchiopexy, Longitudinal Studies, Prospective Studies, Child, Herniorrhaphy, Pain Measurement, Pain, Postoperative, biology, business.industry, Persistent pain, Infant, biology.organism_classification, Anesthesiology and Pain Medicine, Multicenter study, Ambulatory Surgical Procedures, Italy, Child, Preschool, Pediatrics, Perinatology and Child Health, Ambulatory, Orthopedic surgery, Female, Observational study, Chronic Pain, Pediatric anesthesia, business, 030217 neurology & neurosurgery
Abstract

Introduction The prevalence of persistent postsurgical pain in children is over 20% after major surgeries; however, data are scarce on the prevalence, character, and risk factors among children undergoing common ambulatory surgeries. The primary aim of this study was to evaluate the prevalence of persistent pain following pediatric ambulatory surgery at 1, 3, and 6 months. Secondary aims were to identify risk factors and characterize the pain and consequences of persistent postsurgical pain. Methods ASA I-II, ages 1 month to 16 years old, undergoing elective hypospadias repair, herniorraphy, orchiopexy, and orthopedic surgery were enrolled in a prospective, longitudinal, observational study at 3 pediatric centers in Italy. All patients received general plus regional anesthesia. Postoperative pain was evaluated using age appropriate pain scales at 1 and 3 hours. At 1, 3, and 6 months, pain scores were obtained and Parent's Postoperative Pain Measures ( 8 yo) surveys were administered. Results About 350 patients completed the study. The prevalence of pain at 1, 3, and 6 months was 24% (84/350), 6.0% (21/350), and 4.0% (14/350), respectively. Inguinal herniorraphy patients experienced significantly higher pain at all 3-time points; 35.6%, 14.9%, and 9.2%. There was no significant association between mean pain scores >4 in PACU and persistent pain. Pain persisting at 6 months had neuropathic characteristics and frequently interfered with daily activities and sleep. Conclusion Our data support the presence of persistent pain in pediatric patients after common surgeries. Most patients who developed persistent pain at 6 months had pain at 1 month. We recommend questioning at follow-up visit about persistent pain and functional impairment with follow-up until resolution.

Published
2018

2. Apnea after Awake Regional and General Anesthesia in Infants

Author

Jose T D G Van Gool, David M. Polaner, Robyn Stargatt, Girolamo Mattioli, Niall C. T. Wilton, Greg Hammer, J. H M Hagenaars, Marie Backstrom, Davinia E. Withington, John B. Carlin, Navil F. Sethna, Martin Meuller, Val Gebski, Neil McIntosh, Iskra Ivanova, Philip Ragg, Penelope L Hartmann, Cor J. Kalkman, Sulpicio G. Soriano, Stephen R. Hays, Jonathan De Lima, Geoff Frawley, Gaia Giribaldi, Valter Sonzogni, Alessio Pini Prato, Pollyanna Hardy, Britta S von Ungern Sternberg, Sarah J Arnup, Annette J.M. Davis, Anthony Absalom, Ayman I. Eissa, Charles B. Berde, Nicola Disma, Vanessa Young, Giovanni Montobbio, Liam Dorris, Graham Bell, Francesca Izzo, Shilpa Verma, Jurgen C. de Graaff, Jeffery Steiner, Pietro Tuo, Graham Knottenbelt, Martin J. Volkers, Santhanam Suresh, David Costi, Peter A. Stoddart, Britta S. von Ungern-Sternberg, Joss J. Thomas, Koto Furue, Ida Salvo, Anne M. Lynn, Josee Gaudreault, Sandra Numan, Peter Szmuk, Bruno Guido Locatelli, David Field, Robert K. Williams, Pete G. Kovatsis, Katherine J Lee, Rodney W. Hunt, Andy Wolf, Paul S. Myles, Gillian D Ormond, Andrew Davidson, Oliver Bagshaw, Kate Leslie, Frouckje M. Hoekstra, Mary Ellen McCann, Agnes Hunyady, Anthony Chisakuta, Jacki Marmor, David C. Bellinger, Suzette Sheppard, Dick Tibboel, Denisa Haret, Leila Mameli, Neil S. Morton, Lynne G. Maxwell, Andreas H. Taenzer, Joseph P. Cravero, Andrea Wolfler, Magda Khotcholava, Claire Adey, and Brian Kravitz

Subjects
medicine.medical_specialty, business.industry, Incidence (epidemiology), Postmenstrual Age, Apnea, Odds ratio, law.invention, Anesthesiology and Pain Medicine, Randomized controlled trial, law, Anesthesiology, Anesthesia, Medicine, Gestation, medicine.symptom, business, Complication
Abstract

Background:Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia.Methods:Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded.Results:Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature.Conclusions:RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

Published
2015
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3. A novel balanced isotonic sodium solution vs normal saline during major surgery in children up to 36 months: a multicenter RCT

Author

Andrew Davidson, Leila Mameli, Giovanni Montobbio, Nicola Disma, Paola Barabino, Bruno Guido Locatelli, Angela Pistorio, and Valter Sonzogni

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Sodium, Renal function, chemistry.chemical_element, Sodium Chloride, Hypoglycemia, Kidney, Kidney Function Tests, law.invention, Hyperchloremia, Randomized controlled trial, law, medicine, Humans, Organic Chemicals, Saline, business.industry, Infant, Metabolic acidosis, Water-Electrolyte Balance, medicine.disease, Surgery, Glucose, Treatment Outcome, Anesthesiology and Pain Medicine, chemistry, Child, Preschool, Anesthesia, Relative risk, Pediatrics, Perinatology and Child Health, Fluid Therapy, Female, Isotonic Solutions, business
Abstract

Summary Background The use of isotonic electrolytic solutions for the intraoperative fluid management in children is largely recognized, but the exact composition still needs to be defined. Objectives The primary objective of this randomized controlled open trial was to compare the changes in chloride plasma concentration using two intraoperative isotonic fluid regimens (Sterofundin vs normal saline, both added with 1% of glucose) in children undergoing major surgery. Secondary objectives were to compare changes in other electrolytes, renal function, and the occurrence of hypoglycemia. Methods Children aged between 1 and 36 months, scheduled for major surgery, were randomized to receive Sterofundin or saline during the intraoperative time. Children with preoperative electrolyte abnormalities, hemodynamic instability, and severe renal or hepatic dysfunction were excluded. The primary outcome was the Δ of Cl− (Δ = change in plasma concentration between post- and pre-infusion), and secondary outcomes included Δ of other electrolytes and intraoperative hypoglycemia. Results A total of 240 patients were included in the two study sites and randomized to receive Sterofundin plus 1% glucose or normal saline plus 1% glucose, in a open fashion (229 were finally analyzed). Δ of Cl− and Mg++ was statistically less relevant in patients who received intraoperative Sterofundin, and Δ of the other electrolytes was comparable between the two study groups. Relative risk of hyperchloremia was significantly higher when large volumes were infused (over than 46.7 ml·kg−1), regardless of type of crystalloid infused. Hypoglycemia occurred in two of 229 patients. Conclusions Sterofundin is safer than normal saline in protecting young children undergoing major surgery against the risk of increasing plasma chlorides and the subsequent metabolic acidosis.

Published
2014
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4. Perioperative Management of Patients Undergonig Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Author

Claudio Germandi, Maria Rita Melotti, Davide Corbella, Paolo Finazzi, Luca Ansaloni, Valter Sonzogni, Federico Coccolini, and Fausto Catena

Subjects
medicine.medical_specialty, Perioperative management, business.industry, Rehabilitation, Cancer, Physical Therapy, Sports Therapy and Rehabilitation, General Medicine, Perioperative, medicine.disease, Surgery, Intensive care, Ascites, Medicine, Hyperthermic intraperitoneal chemotherapy, Wasting Syndrome, medicine.symptom, business, Cytoreductive surgery, Intensive care medicine
Abstract

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure have demonstrated their efficacy in treating patients with diffused peritoneal carcinomatosis. As a counterpart patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. All these derangements demonstrated to be mild and short-lived in the majority of patients when timely addressed. Anesthesiologists, intensive care physicians and surgeons are involved in providing surveillance and organ support till the patient is effectively weaned after the operation. Moreover they are involved in pain control, metabolic and nutritional support. A malnourished state is common due to wasting syndrome from the tumor, difficult feeding and massive ascites. Lastly physicians need to be aware of the quality of life impact of this procedure.

Published
2014
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5. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Author

Walid Habre, Nicola Disma, Katalin Virag, Karin Becke, Tom G Hansen, Martin Jöhr, Brigitte Leva, Neil S Morton, Petronella M Vermeulen, Marzena Zielinska, Krisztina Boda, Francis Veyckemans, Walter Klimscha, Regina Konecny, Robert Luntzer, Ulrike Morawk-Wintersperger, Franz Neiger, Lydia Rustemeyer, Christian Breschan, Denise Frey, Manuela Platzer, Reinhard Germann, Joachim Oeding, Birgit Stoegermüller, Bernhard Ziegler, Philipp Brotatsch, Anton Gutmann, Gerlinde Mausser, Brigitte Messerer, Wolfgang Toller, Maria Vittinghoff, Gregor Zangl, Natascha Seidel-Ahyai, Christoph Hochhold, Ruth Kroess, Peter Paal, Steven Cnudde, Patricia Coucke, Birgit Loveniers, John Mitchell, David Kahn, Thierry Pirotte, Caroline Pregardien, Marc Coppens, Stefan De Hert, Björn Heyse, Martine Neckebroek, Aliaksandra Parashchanka, Jurgen Van Limmen, Nancy Van Den Eynde, Caroline Vanpeteghem, Piet Wyffels, Michaël Lalot, Jean-Paul Lechat, France Stevens, Sari Casaer, Françoise De Groote, Françoise De Pooter, Andrée De Villé, Marc Gerin, Natalia Magasich, Cristel Sanchez Torres, Denise Van Deenen, Johan Berghmans, Dirk Himpe, Eva Roofthooft, Ellen Joukes, Carine Smitz, Veronique Van Reeth, Christel Huygens, Julie Lauweryns, Karen De Smet, Nadia Najafi, Jan Poelaert, Anne Van de Velde, Veerle Van Mossevelde, Ivan Bekavac, Diana Butkovic, Dubravka Heli Litvic, Ivana Kerovec Soric, Hrvoje Maretic, Djurdjica Moscatello, Ljiljana Popovic, Slobodan Micici, Ivana Stuck Tus, Lada Kalagac Fabris, Tatjana Simurina, Nina Sulen, Gordana Kesic-Valpotic, Dajana Djapic, Jirí Žurek, Lucie Jureckova, Iveta Mackova, Monika Skacel, Stanislava Weinlichova, Jan Divák, Michal Frelich, René Urbanec, Vera Biskupova, Vladimir Mixa, Jana Pavlickova, Arash Afshari, Morten Bøttger, Marguerite B. Ellekvist, Mathias Johansen, Birgitte Ingeborg Madsen, Jens Christian Nilsson, Birgitte MB Schousboe, Nicola G. Clausen, Tom G. Hansen, Nick Phaff Steen, Mari-Liis Ilmoja, Virge Tonise, Juri Karjagin, Reet Kikas, Mika Isohanni, Anniina Lyly, Annika Takala, Johanna Happo, Kai Kiviluoma, Kati Martikainen, Riku Aantaa, Tuula Manner, Sanna Vilo, Catherine Amory, Hugues Ludot, Patricia Lambotte, René Busche, Olivier Jacqmarcq, Corinne Lejus, Julien Corouge, Christian Erb, Delphine Garrigue, Patricia Gillet, Anne Laffargue, Veronique Lambelin, Hélène Le Freche, Daliana Peresbota, Pierre Richart, Jerome Berton, Catherine Chapotte, Laurent Colbus, Thierry Lehousse, Jean Monrigal, Catherine Baujard, Philippe Roulleau, Giuseppe Staiti, Hélène Batoz, Maryline Bordes, Anne Didier, Yann Hamonic, Sylvaine Lagarde, Karine Nouette-Gaulain, François Semjen, Brigitte Zaghet, Jacky Dekens, Axelle Delcuze, Hervé Dupont, Aurélien Legrand, Celine Raffoflandreur, Noémie Audren, Blandine Camus, Marielle Cartal, Chantal Chazelet, Isabelle Davin, Marion Guillier, Luc Desjeux, Claire Larcher, Elodie Grein, Mickeal Leclercq, Roxana Levitchi, Lilica Rosu, Dominique Simon, Aurélien Zang, Anne Migeon, Anne-Charlotte Gagey, Nathalie Bourdaud, Anne-Charlotte Carre, Frédéric Duflo, Jean-Claude Riche, Philippe Robert, Emilie Druot, Olivier Maupain, Gilles Orliaguet, Lucie Sabau, Hanna Taright, Lynn Uhrig, Juliette Verchere-Montmayeur, Lise Debrabant, Clotaire Pilla, Alexandre Podvin, Benjamin Roth, Souhayl Dahmani, Florence Julien-Marsollier, Nada Sabourdin, Bogdan Alexandri, Gilles Brezac, Francois de la Brière, Catherine Hayem, Elizabeth Lhubat, Jean Paul Mission, Charlotte Rémond, Christophe Dadure, Maud Maniora, Anais Marie, Philippe Pirat, Anne-Charlotte Saour, Chrystelle Sola, Claude Ecoffey, Eric Wodey, Christian Adam, Thomas Standl, Ehrenfried Schindler, Tomohiro Yamamoto, Michael Brackhahn, Christoph Bernhard Eich, Holger Guericke, Petra Kindermann, Michael Laschat, Cornel Schink, Frank Wappler, Claudia Hoehne, Natalia Skordou, Johanna Ulrici, Martin Jetzek-Zader, Peter Kienbaum, Tanja Meyer-Treschan, Olaf Picker, Maximilian S. Schaefer, Golo Mielke, Sabine Baethge, Axel Ramminger, Martin Bauer, Matthias Bollinger, José Hinz, Michael Quintel, Sebastian G. Russo, Michael Bauer, Dfominik Geil, Andreas Kortgen, Niels-Peter Preussler, Ulrich Hofmann, Manfred Raber, Doris Reindl, Karin Oppenrieder, Bettina Schierlinger, Jens Roth, Wolfgang Funk, Thomas Fischer, Christian Gernoth, Christina Wiefelspütz, Hauke Volger, Nicole Zederer, Anja Diers, Matthias Huber, Clemens Schorer, Andreas Weyland, Konrad Schwarzkopf, Catharina Grau, Winfried Roth, Rolf Holy, Thomas Mader, Laura Peter, Hauke Supthut, Thomas Kuehhirt, Alexander Milde, Fritz Fiedler, Carsten Isselhorst, Ulrich Grundmann, Alexander Pattar, Jennifer Reinert, Birgit Ehm, Katrin Fritzsche, Ralf Gaebler, Patrick Meybohm, Maximilian Hein, Ines Guzman, Johanna Jokinen, Peter Kranke, Ulrich Goebel, Sarah Harris, Christoph Eisner, Miriam Ochsenreiter, Michael Schoeler, Elke Thil, Richard Ellerkmann, Andreas Hoeft, Claudia Neumann, Stefan Weber, Julia Keilhauer, Jan Kloessing, Michael Schramm, Uwe Trieschmann, Kristina Knauss, Barbara Sinner, Johannes Steinmann, Herbert Koessler, Evagelia Kalliardou, Anna Malisiova, Adelais Tsiotou, Pelagia Chloropoulou, Mpratzou Chrysi, Despoina Iordanidou, Merkourios Ntavlis, Krisztina B Boda, Christilynn Guerin, Janice Irwin, Claire Magner, Solmaz Nakhjavani, Brendan O'Hare, Deborah Galvin, Yosry Jamil, Carlos Lesmes, Yuri Barak, Haran Fisher, Ludmyla Kachko, Jacob Katz, Dmitry Kirilov, Michael Levinzon, Yair Manevich, Konstantin Nekrasov, Elia Peled, Elena Sanko, Dmitri Schmain, Olga Sheinkin, Eliahu Simhi, Alex Tarabikin, Evelina Trabkin, Irena Yagudaev, Yelena Zeitlin, Igor Zunser, Elisabetta Cerutti, Maria Maddalena Schellino, Silvia Valzan, Rosa Lucia Pinciroli, Luciano Bortone, Giorgia Cerati, Fabiana Salici, Leonardo Bussolin, Giuliana Rizzo, Francesca Rossetti, Laura Marchesini, Simonetta Tesoro, Brita De Lorenzo, Fabio Guarracino, Beate Kuppers, Marinella Astuto, Sofia Pitino, Rita Scalisi, Lucia Scordo, Sandra D'Alessandro, Luigi Dei Giudici, Ivano Farinelli, Giuseppe Lofino, Giuliano Marchetti, Sergio Giuseppe Picardo, Simone Reali, Alessandro Vittori, Francesco Antonio Idone, Maria Sammartino, Fabio Sbaraglia, Cinzia Barbera, Michela Bevilacqua, Valeria Cento, Svetlana Kotzeva, Leila Mameli, Giovanni Montobbio, Leandro Passariello, Cinzia Punzo, Rosanna Sileo, Rosanna Viacava, Claudia Volpe, Clelia Zanaboni, Edoardo Calderini, Daniele Genco, Simona Neri, Davide Ottolina, Anna Camporesi, Francesca Izzo, Ida Salvo, Andrea Wolfler, Andrea Sanna, Angela Sciascia, Paolo Stoia, Annamaria Guddo, Maria Lapi, Giorgio Ivani, Annalisa Longobardo, Valeria Mossetti, Dino Pedrotti, Maurizia Grazzini, Luisa Meneghini, Salvatore Metrangolo, Stefania Michelon, Carmelo Minardi, Costanza Tognon, Nicola Zadra, Ilaria Busi, Magda Khotcholava, Bruno Guido Locatelli, Valter Sonzogni, Giusi Starita, Nicole Almenrader, Caterina Aurilio, Pasquale Sansone, Raffaella Albarello, Paolo Bracci, Mariateresa Cecini, Maria Cristina Mondardini, Lorena Pasini, Milo Vason, Gianluca Zani, Roberto Zoppellari, Laura Pistidda, Andrea Cortegiani, Santi Maurizio Raineri, Antigona Hasani, Medita Hashimi, Agris Ancupans, Arta Barzdina, Zane Straume, Anda Zundane, Mikhail Chlopin, Dalia Gestautaite, Laura Lukosiene, Evelina Paliokaite, Ilona Razlevice, Inesa Armoniene, Aurelija Bernotiene, Vidunas Daugelavicius, Ilona Dockiene, Lina Gaidelyte, Nijole Saviciene, Jolita Krikstaponiene, Dominika Sidlovskaite-Baltake, Vladyslav Stasevski, Agne Vaitoskaite, David Gatt, Stephanie Mifsud, Simone Zammit, Celia Allison, Hamid Aslami, Susanne Eberl, Mireille F M van Stijn, Markus F Stevens, Kees Punt, Rob van Osch, Arthur Bauwman, Harm Scholten, Vesna Svircevic, Veronique Adriaens, Maaike Dirckx, Jaap Dogger, Ilse Dons-Sinke, Andreas Machotta, Xavier Moors, Mandana Rad, Lonneke Staals, Anouk van der Knijff - van Dortmont, Caroline van der Marel, Anne Sieben, Tim van der Zwan, Marianne Veldhuizen, David Alders, Wolfgang Buhre, Nicole Engel, Carine Vossen, Ravin Mahadewsing, Patrick Meijer, Volker Gerling, Roelof van der Schatte Olivier, Thea van Doorn, Kristy Vons Mark Hendriks, Sandra Lako, Gert jan Scheffer, Luc Tielens, Marieke Voet, Anthony Absalom, Margot Bergsma, Vera Spanjer, Rob Spanjersberg, Yvette van de Riet, Martin Volkers, Jurgen C. de Graaff, Geranne A.J. Hopman, Teus H. Kappen, J. Hannie, A.M. Megens, Sandra C. Numan, Anton N.J. Schouten, Nigel M. Turner, Désirée B.M. Van Der Werff, Renee T.M. Wensing, Erik Ephraim, Claire Nolte, Tore Reikvam, Ole Fredrik Lund, Lene Skaaden, Kari Marthe Ballovarre, Wenche Bakken Boerke, Guro Grindheim, Pal H H Lindenskov, Anne Beate Solas, Sjur Sponheim, Kyrre Ullensvang, Oddbjorn Viken, Inger Marie Drage, Kasper Gymoese Berthelsen, Bjørn Anders Kroken, Unni Bergland, Miroslaw Pryzmont, Mariola Talalaj, Malgorzata Wasiluk, Dorota Zalewska, Maria Damps, Jadzia Siemek-Mitela, Pawel Wieczorek, Magdalena Juzwa, Jowita Rosada-Kurasinska, Alicja Bartkowska-Sniatkowska, Maciej Cettler, Renata Kopycinska, Iwona Rudewicz, Jaek Sobczyk, Dariusz Wojciechowski, Artur Baranowski, Ewa Basiewicz, Magdalena Mierzewska-Schmidt, Wlodzimierz Retka, Piotr Sawicki, Magdalena Checinska, Magdalena Zurawska, Teresa Leal, Catia Mascarenhas, António Pedro Pina, Maria Joao Susano, Antonio Moniz, Maria Teresa Rocha, Carolina Calvao Santos, M Domingas Patuleia, Ricardo Pereira, Helena Roxo, Rosa Amaral, Isabel Guedes, Cristina Gomes, Marta Gonçalves, Helena Salgado, Maria Santos, Sara Rodrigues, Angela Sa, Elvira Machado, Sandra Pé d'Arca, Manuel Seabra, Ligia Mihaela Gheorghe, Constantin Ivascu, Lucia Moraru-Draghici, Mirela Suvejan, Remus Babici, Kovacs Eniko, Cristiana Hogea, Dubau Mihaela, Daraban Nicoleta, Danut Barbunc, Alina Maria Nistor, Violeta Stefan, Gabriela Catalina Ionescu, Irina Davidescu, Alina Teodora Nastase, Florin Dumitru Rusu, Victoria Badarau, Iulia Cindea, Melania Moscaliuc, Dana Olteanu, Luxita Petrescu, Daniela Ceuca, Irena Galinescu, Rodica Badeti, Alin Capusan, Cosmina Cucui-Cozma, Barbura Popescu, Luminita Cimpeanu, Mihaela-Petronela Birliba, Magdalena Miulescu, Stefania Balamat, Adriana Gurita, Luminita Ilie, Gabriel Mocioiu, Darina Pick, Rodica Sirghie, Radu Tabacaru, Irinel Trante, Lucian Horhota, Daniela Bandrabur, Tudor Ciobanu, Veaceslav Cuciuc, Valentin Munteanu, Valentin Olaru, Corneliu Paiu, Anca Savu, Oana Trifan, Anca Elena Malos, Anton Glazunov, Alexander Ivanov, Evgeny Poduskov, Alexander Popov, Igor Guskov, Alexander Lugovoy, Vladislav Nechaev, Alexey Ovezov, Mikhail Basov, Vladimir Kochkin, Vladimir Lazarev, Dmitri Chizhov, Ivan Ostreikov, Konstantin Tolasov, Ivana Budic, Vesna Marjanovic, Biljana Draskovic, Marina Pandurov, Jovana Simin, Vladimir Dolinaj, Dusanka Janjevic, Ana Mandras, Maja Mircetic, Sladjana Petrovic, Vlatka Rebac, Bojana Slavkovic, Vesna Stevanovic, Ana Velcev, Mirjana Knezevic, Irina Milojevic, Selena Puric, Irena Simic, Marija Stevic, Vladimir Stranjanac, Dusica Simic, Barbora Cabanova, Miloslav Hanula, Andry Grynyuk, Jelena Berger, Uros Cerne, Andraz Nastran, Dejan Pirc, Rok Popic, Spela Stupnik, Paloma Rubio, Cristina del Río, Pilar Benito, Gema Pino, Ignacio Gutierrez, Andrea Gutierrez Valcarcel, Irene León Carsi, Anibal Perez Garcia, Sílvia López Galera, Joan Marco Valls, Laura Ricol Lainez, Andrea Vallejo Tarrat, David Artes, Ester Banus, Luca Chirichiello, Leidy De Abreu, Belen De Josemaria, M Helena Gaitan, Antonio Garces, Juan J Lazaro, Ferran Manen Berga, Dolors Molies, Enric Monclus, Montserrat Navaro, Carmen Pamies, Marina Perelló, Mar Prat, Laura Ribo, M Angeles Sanz, Silvia Serrano, Eva Sola Ruiz, Blanca Anuncia Escontrela Rodríguez, Andrea Maria Gago Martinez, Alberto Martínez Ruiz, Fausto De La Cruz Benito, Gustavo Gabilondo Garcia, Ever Martinez Maldonado, Bryant Noriega, Lara Oller Duque, Alberto Olmos Mendez, Antonio Perez- Ferrer, Francisco Reinoso Barbero, Ismael Acevedo Bambaren, Fernando Domínguez, Teresa Franco, Anabel Jiménez, Alicia Melero, Montserrat Feliu, Irene García, Núria Montferrer, Francisca Munar, Cristina Muro, Rosario Nuño, Remel Perera, Erika Schmucker, Glenda Börjesson, Lars Gillberg, Albert Castellheim, Kerstin Sandström, Annette Bauer, Torbjörn Roos, Lars Hedlund, Yann Boegli, Mirko Dolci, Carine Marcucci, Isabelle Spahr-Schopfer, Michel Pellegrini, Malte Book, Loreen Errass, Christine Riggenbach, Mattias Casutt, Martin Hölzle, Thomas Hurni, Jacqueline Mauch, Luciano Anselmi, Irene Anselmi, Alfred Jacomet, Markus Oberhauser, Stephanie Wossner, Angelika Zettl, Thomas Erb, Tomasz Mackiewicz, Helena Simitzes, Yetkin Ozer, Arzu Takil, Zekeriyya Alanoglu, Onat Bermede, K.Sanem Cakar Turhan, Neslihan Alkis, Cigdem Yildirim Guclu, Basak Ceyda Meco, Zehra Hatipoglu, Dilek Ozcengiz, Zekine Begec, Huseyin Ilksen Toprak, Pinar Kendigelen, Ayse Cigdem Tütüncü, Meltem Savran Karadeniz, Tulay Seyhan Ozkan, Nuket Sivrikoz, Mustafa Kemal Arslantas, Ayse Hizal, Gülbin Tore Altun, Tumay Umuroglu, Sibel Baris, Zuleyha Kazak Bengisun, Galyna Goncharenko, Maksym Khrapak, Tetyana Klymenko, Vitaliy Pavlenko, Dmytro Prysiazhniuk, Olga Rudio, Mykhailo Varyvoda, Sergii Vodianytskyi, Ivanna Boryshkevych, Iryna Kyselova, Nikolay Trikash, Andrew Albokrinov, Valentina Perova-Sharonova, Vitaliy Sklyar, Denis Surkov, Amr Abdelaal, Nicola Barber, Sarah Checuti, Leisha Godsiff, Lynch Johanne, Joanna Simpson, Helen Underhill, Rishi Diwan, Nivedita Kelgeri, Nuria Masip, Radha Ravi, Steve Roberts, Annagrazia Cillis, Ritchie Marcus, Federica Merella, David Love, Paolo Baraggia, Victoria Bird, Joseph Hussey, Peter Alderson, Karen Bartholomew, Michael Moncreiff, Sarah Davidson, Alison Hare, Ami Kotecha, Corina Lee, Ganga Liyanage, Shivali Patel, Amee Samani, Mark Abou-Samra, Matthew Boyd, Laurence Hullatt, David Levy, Mark Pauling, Sarah-Jane Sharman, Natalie Smith, John Rutherford, Alison Cavalier, Christie Locke, Frederic Sage, Smita Bapat, Jacinda Hammerschlag, Ioannis Ioannou, Stephanie King, Rachel Pegg, Vishal Salota, Jonathan Sketcher, Muthu Thadsad, Deborah Zeitlin, Ewan Jack, Colin Lang, Samira Ahmed, Reema Ayyash, Francoise Bari, Sarah J Bell, Claire Elizabeth Biercamp, Sandra Briggs, Maria Gabriella Elena Clement, Mark Dalton, Mohamed Ali Eissa Eid, Monica Gandhi, Idse Harmen Herrema, Ranj Khaffaf, Savio Jeng Min Law, Joanna McClintock, Nicholas Ireland, Mohammed Majid Saleem, Fiona Smith, Marc Cohen, Clover-Ann Lee, Lizanne O'Donahue, Alex Powell, Ellen Rawlinson, Aarjan Snoek, Katja Weiss, Hugo Wellesley, Michael Crawford, Mostafa Abdel-Hafiz, Alexandra Day, Balaji Rajamani, Rita Saha, Dave Wright, Lew-Chin Chee, Stephanie Bew, Rachel Homer, Nalini Malarkkan, Juliet Wolfe Barry, Pradeep Angadi, Brid Cagney, Eric De Melo, Elsa Dekker, Emma Helm, Gareth Jones, Kawshala Peiris, William Russell, Patricia Slater, Puja Sodhi, Mike Browning, Trudie Phillips, Rachel Van Hecke, Vimty Muir, Piyush Singh, Tereza Soskova, Craig Cumming, Pamela Farquharson, Karen Pearson, Neil Shaw, Jonathan Whiteside, Emma Whyte, Gordon Byers, Kay Davies, Thomas Engelhardt, Isabella Faliszewski, Graham Johnston, Nils Kaufmann, Zuzana Kusnirikova, Graham Wilson, Peter Carachi, Andrew Makin, Brian Foster, Dariusz Lipczynski, Rebecca Mawer, William Rutherford, David Rogerson, Sarah Rushman, Christopher Taylor, William Tomlinson, Philippa Dix, Tom Woodward, Graham Bell, David Boyle, Marianne Cloherty, Julia Cullen, Pauline Cullen, Ross Fairgrieve, Robert Ghent, Russell Glasgow, Elena 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H, Beate Solas, Anne, Sponheim, Sjur, Ullensvang, Kyrre, Viken, Oddbjorn, Marie Drage, Inger, Gymoese Berthelsen, Kasper, Anders Kroken, Bjørn, Bergland, Unni, Pryzmont, Miroslaw, Talalaj, Mariola, Wasiluk, Malgorzata, Zalewska, Dorota, Damps, Maria, Siemek Mitela, Jadzia, Wieczorek, Pawel, Juzwa, Magdalena, Rosada Kurasinska, Jowita, Bartkowska Sniatkowska, Alicja, Cettler, Maciej, Kopycinska, Renata, Rudewicz, Iwona, Sobczyk, Jaek, Wojciechowski, Dariusz, Baranowski, Artur, Basiewicz, Ewa, Mierzewska Schmidt, Magdalena, Retka, Wlodzimierz, Sawicki, Piotr, Checinska, Magdalena, Zurawska, Magdalena, Leal, Teresa, Mascarenhas, Catia, Pedro Pina, António, Joao Susano, Maria, Moniz, Antonio, Teresa Rocha, Maria, Calvao Santos, Carolina, Domingas Patuleia, M., Pereira, Ricardo, Roxo, Helena, Amaral, Rosa, Guedes, Isabel, Gomes, Cristina, Gonçalves, Marta, Salgado, Helena, Santos, Maria, Rodrigues, Sara, Sa, Angela, Machado, Elvira, Pé d'Arca, Sandra, Seabra, Manuel, Mihaela Gheorghe, Ligia, Ivascu, Constantin, Moraru Draghici, Lucia, Suvejan, Mirela, Babici, Remu, Eniko, Kovac, Hogea, Cristiana, Mihaela, Dubau, Nicoleta, Daraban, Barbunc, Danut, Maria Nistor, Alina, Stefan, Violeta, Catalina Ionescu, Gabriela, Davidescu, Irina, Teodora Nastase, Alina, Dumitru Rusu, Florin, Badarau, Victoria, Cindea, Iulia, Moscaliuc, Melania, Olteanu, Dana, Petrescu, Luxita, Ceuca, Daniela, Galinescu, Irena, Badeti, Rodica, Capusan, Alin, Cucui Cozma, Cosmina, Popescu, Barbura, Cimpeanu, Luminita, Birliba, Mihaela Petronela, Miulescu, Magdalena, Balamat, Stefania, Gurita, Adriana, Ilie, Luminita, Mocioiu, Gabriel, Pick, Darina, Sirghie, Rodica, Tabacaru, Radu, Trante, Irinel, Horhota, Lucian, Bandrabur, Daniela, Ciobanu, Tudor, Cuciuc, Veaceslav, Munteanu, Valentin, Olaru, Valentin, Paiu, Corneliu, Savu, Anca, Trifan, Oana, Elena Malos, Anca, Glazunov, Anton, Ivanov, Alexander, Poduskov, Evgeny, Popov, Alexander, Guskov, Igor, Lugovoy, Alexander, Nechaev, Vladislav, Ovezov, Alexey, Basov, Mikhail, Kochkin, Vladimir, Lazarev, Vladimir, Chizhov, Dmitri, Ostreikov, Ivan, Tolasov, Konstantin, Budic, Ivana, Marjanovic, Vesna, Draskovic, Biljana, Pandurov, Marina, Simin, Jovana, Dolinaj, Vladimir, Janjevic, Dusanka, Mandras, Ana, Mircetic, Maja, Petrovic, Sladjana, Rebac, Vlatka, Slavkovic, Bojana, Stevanovic, Vesna, Velcev, Ana, Knezevic, Mirjana, Milojevic, Irina, Puric, Selena, Simic, Irena, Stevic, Marija, Stranjanac, Vladimir, Simic, Dusica, Cabanova, Barbora, Hanula, Miloslav, Grynyuk, Andry, Berger, Jelena, Cerne, Uro, Nastran, Andraz, Pirc, Dejan, Popic, Rok, Stupnik, Spela, Rubio, Paloma, del Río, Cristina, Benito, Pilar, Pino, Gema, Gutierrez, Ignacio, Gutierrez Valcarcel, Andrea, León Carsi, Irene, Perez Garcia, Anibal, López Galera, Sílvia, Marco Valls, Joan, Ricol Lainez, Laura, Vallejo Tarrat, Andrea, Artes, David, Banus, Ester, Chirichiello, Luca, De Abreu, Leidy, De Josemaria, Belen, Helena Gaitan, M., Garces, Antonio, Lazaro, Juan J, Manen Berga, Ferran, Molies, Dolor, Monclus, Enric, Navaro, Montserrat, Pamies, Carmen, Perelló, Marina, Prat, Mar, Ribo, Laura, Angeles Sanz, M., Serrano, Silvia, Sola Ruiz, Eva, Anuncia Escontrela Rodríguez, Blanca, Maria Gago Martinez, Andrea, Martínez Ruiz, Alberto, De La Cruz Benito, Fausto, Gabilondo Garcia, Gustavo, Martinez Maldonado, Ever, Noriega, Bryant, Oller Duque, Lara, Olmos Mendez, Alberto, Perez Ferrer, Antonio, Reinoso Barbero, Francisco, Acevedo Bambaren, Ismael, Domínguez, Fernando, Franco, Teresa, Jiménez, Anabel, Melero, Alicia, Feliu, Montserrat, García, Irene, Montferrer, Núria, Munar, Francisca, Muro, Cristina, Nuño, Rosario, Perera, Remel, Schmucker, Erika, Börjesson, Glenda, Gillberg, Lar, Castellheim, Albert, Sandström, Kerstin, Bauer, Annette, Roos, Torbjörn, Hedlund, Lar, Boegli, Yann, Dolci, Mirko, Marcucci, Carine, Spahr Schopfer, Isabelle, Pellegrini, Michel, Book, Malte, Errass, Loreen, Riggenbach, Christine, Casutt, Mattia, Hölzle, Martin, Hurni, Thoma, Mauch, Jacqueline, Anselmi, Luciano, Anselmi, Irene, Jacomet, Alfred, Oberhauser, Marku, Wossner, Stephanie, Zettl, Angelika, Erb, Thoma, Mackiewicz, Tomasz, Simitzes, Helena, Ozer, Yetkin, Takil, Arzu, Alanoglu, Zekeriyya, Bermede, Onat, Cakar Turhan, K. Sanem, Alkis, Neslihan, Yildirim Guclu, Cigdem, Ceyda Meco, Basak, Hatipoglu, Zehra, Ozcengiz, Dilek, Begec, Zekine, Ilksen Toprak, Huseyin, Kendigelen, Pinar, Cigdem Tütüncü, Ayse, Karadeniz, Meltem Savran, Seyhan Ozkan, Tulay, Sivrikoz, Nuket, Kemal Arslantas, Mustafa, Hizal, Ayse, Tore Altun, Gülbin, Umuroglu, Tumay, Baris, Sibel, Kazak Bengisun, Zuleyha, Goncharenko, Galyna, Khrapak, Maksym, Klymenko, Tetyana, Pavlenko, Vitaliy, Prysiazhniuk, Dmytro, Rudio, Olga, Varyvoda, Mykhailo, Vodianytskyi, Sergii, Boryshkevych, Ivanna, Kyselova, Iryna, Trikash, Nikolay, Albokrinov, Andrew, Perova Sharonova, Valentina, Sklyar, Vitaliy, Surkov, Deni, Abdelaal, Amr, Barber, Nicola, Checuti, Sarah, Godsiff, Leisha, Johanne, Lynch, Simpson, Joanna, Underhill, Helen, Diwan, Rishi, Kelgeri, Nivedita, Masip, Nuria, Ravi, Radha, Roberts, Steve, Cillis, Annagrazia, Marcus, Ritchie, Merella, Federica, Love, David, Baraggia, Paolo, Bird, Victoria, Hussey, Joseph, Alderson, Peter, Bartholomew, Karen, Moncreiff, Michael, Davidson, Sarah, Hare, Alison, Kotecha, Ami, Lee, Corina, Liyanage, Ganga, Patel, Shivali, Samani, Amee, Abou Samra, Mark, Boyd, Matthew, Hullatt, Laurence, Levy, David, Pauling, Mark, Sharman, Sarah Jane, Smith, Natalie, Rutherford, John, Cavalier, Alison, Locke, Christie, Sage, Frederic, Bapat, Smita, Hammerschlag, Jacinda, Ioannou, Ioanni, King, Stephanie, Pegg, Rachel, Salota, Vishal, Sketcher, Jonathan, Thadsad, Muthu, Zeitlin, Deborah, Jack, Ewan, Lang, Colin, Ahmed, Samira, Ayyash, Reema, Bari, Francoise, Bell, Sarah J, Elizabeth Biercamp, Claire, Briggs, Sandra, Gabriella Elena Clement, Maria, Dalton, Mark, Ali Eissa Eid, Mohamed, Gandhi, Monica, Harmen Herrema, Idse, Khaffaf, Ranj, Jeng Min Law, Savio, Mcclintock, Joanna, Ireland, Nichola, Majid Saleem, Mohammed, Smith, Fiona, Cohen, Marc, Lee, Clover Ann, O'Donahue, Lizanne, Powell, Alex, Rawlinson, Ellen, Snoek, Aarjan, Weiss, Katja, Wellesley, Hugo, Crawford, Michael, Abdel Hafiz, Mostafa, Day, Alexandra, Rajamani, Balaji, Saha, Rita, Wright, Dave, Chee, Lew Chin, Bew, Stephanie, Homer, Rachel, Malarkkan, Nalini, Wolfe Barry, Juliet, Angadi, Pradeep, Cagney, Brid, De Melo, Eric, Dekker, Elsa, Helm, Emma, Jones, Gareth, Peiris, Kawshala, Russell, William, Slater, Patricia, Sodhi, Puja, Browning, Mike, Phillips, Trudie, Van Hecke, Rachel, Muir, Vimty, Singh, Piyush, Soskova, Tereza, Cumming, Craig, Farquharson, Pamela, Pearson, Karen, Shaw, Neil, Whiteside, Jonathan, Whyte, Emma, Byers, Gordon, Davies, Kay, Engelhardt, Thoma, Faliszewski, Isabella, Johnston, Graham, Kaufmann, Nil, Kusnirikova, Zuzana, Wilson, Graham, Carachi, Peter, Makin, Andrew, Foster, Brian, Lipczynski, Dariusz, Mawer, Rebecca, Rutherford, William, Rogerson, David, Rushman, Sarah, Taylor, Christopher, Tomlinson, William, Dix, Philippa, Woodward, Tom, Bell, Graham, Boyle, David, Cloherty, Marianne, Cullen, Julia, Cullen, Pauline, Fairgrieve, Ro, Ghent, Robert, Glasgow, Russell, Gordeeva, Elena, Harden, Alison, Hivey, Sarah, Jerome, Kevin, Mckee, Lesley, Morton, Neil, Pribul, Vicky, Sinclair, John, Steiner, Maria, Steward, Heather, Sweeney, Lorraine, Thomson, Wendy, Whiteside, Jeanette, Dalton, Andrew, Ross, Mark, Smith, Carolyn, Allen, Claire, Anders, Nicola, Barlow, Victoria, Bassett, Mike, Darwin, Leanne, Davison, Rachel, Diacono, Jacque, Hobbs, Amy, Hutchinson, Adel, Lomas, Bernadette, Lonsdale, Hannah, Nasser, Leila, Oshan, Vimmi, Patel, Pradip, Raistrick, Christopher, Scott Warren, Victoria, Talbot, Laura, Wai, Carolynn, Childs, Sophie, Dickinson, Matthew, Bloomfield, Tom, Garrioch, Sweyn, Watson, Karen, Gaynor, Jame, Harrison, Richard, Lee, Juliette, Blythe, Elizabeth, Dorman, Teresa, Eissa, Ayman, Ellwood, Jame, Gooch, Ingrid, Hearn, Robert, Hodgetts, Vanessa, John, Robert, Kirton, Christine, Ladak, Nadia, Morgan, Judith, Plant, Nina, Shepherd, Elizabeth, Short, Judith, Stack, Charle, Steel, Simon, Taylor, Matthew, Thomas, Deborah, Wilson, Catharine, Wilson Smith, Elaine, Bradbury, Carol L., Hussain, Nageena, Mayell, Antonia, Mesbah, Ahmed, Qureshi, Arif, Vaidyanath, Chandra, Geary, Tim, Hawksworth, Chri, Parasuraman, Tamaraichelvi, Perry, Nicole, Banerjee, Indrani, Barr, Katharine, Butler, Patrick, Davies, Jack, Flewin, Lisa, Gande, Richard, Montague, Jame, Plumb, Jame, Pratt, Thoma, Sutherland, Paul, Vail, Hannah, Wilkins, Andrew, Hunter, Catherine, Russell, Susan, Thomas, Alun, Mifsud, Mark, Strachan, Dominic, Plichon, Benoit, Harlet, Pierre, Child and Adolescent Psychiatry / Psychology, Morawk-Wintersperger, Ulrike, Seidel-Ahyai, Natascha, Lechat, Jean-Paul, Kesic-Valpotic, Gordana, Ilmoja, Mari-Lii, Nouette-Gaulain, Karine, Gagey, Anne-Charlotte, Carre, Anne-Charlotte, Riche, Jean-Claude, Verchere-Montmayeur, Juliette, Julien-Marsollier, Florence, Saour, Anne-Charlotte, Jetzek-Zader, Martin, Meyer-Treschan, Tanja, Preussler, Niels-Peter, Sidlovskaite-Baltake, Dominika, van Stijn, Mireille F M, Dons-Sinke, Ilse, van der Knijff - van Dortmont, Anouk, Hopman, Geranne A.J., Megens, A.M., Schouten, Anton N.J., Van Der Werff, Désirée B.M., Wensing, Renee T.M., Lindenskov, Pal H H, Siemek-Mitela, Jadzia, Rosada-Kurasinska, Jowita, Bartkowska-Sniatkowska, Alicja, Mierzewska-Schmidt, Magdalena, Moraru-Draghici, Lucia, Cucui-Cozma, Cosmina, Birliba, Mihaela-Petronela, Perez- Ferrer, Antonio, Spahr-Schopfer, Isabelle, Cakar Turhan, K.Sanem, Perova-Sharonova, Valentina, Abou-Samra, Mark, Sharman, Sarah-Jane, McClintock, Joanna, Lee, Clover-Ann, Abdel-Hafiz, Mostafa, Chee, Lew-Chin, McKee, Lesley, Scott-Warren, Victoria, and Wilson-Smith, Elaine

Subjects
Male, Pediatrics, Health Status, OPERATING-ROOM, Respiratory Tract Diseases, CHILDREN, 0302 clinical medicine, REGIONAL ANESTHESIA, Postoperative Complications, 030202 anesthesiology, CARDIAC-ARREST, Medicine, General anaesthesia, Prospective Studies, Prospective cohort study, Child, Intraoperative Complications, COMPLICATIONS, ddc:617, Incidence (epidemiology), Mortality rate, musculoskeletal, neural, and ocular physiology, Incidence, Age Factors, Hospitals, Europe, Cardiovascular Diseases, Child, Preschool, RESPIRATORY ADVERSE EVENTS, Female, Clinical Competence, Cohort study, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, macromolecular substances, Anesthesia, General, Drug Hypersensitivity, 03 medical and health sciences, MORBIDITY, Journal Article, Humans, business.industry, Infant, Newborn, Infant, 030208 emergency & critical care medicine, Perioperative, nervous system, PROSPECTIVE COHORT, Relative risk, RISK-FACTORS, Observational study, Human medicine, Nervous System Diseases, business, SYSTEM
Abstract

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p

Published
2017
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6. Anesthetics considerations in peritonitis

Author

Valter Sonzogni, Pietro Brambillasca, Micol Maffioletti, Luca F. Lorini, Davide Corbella, Alberto Benigni, Pietro, B, Alberto, B, Micol, M, Valter, S, Lorini, F, and Davide, C

Subjects
medicine.medical_specialty, Perioperative medicine, APACHE II, business.industry, Mortality rate, Peritonitis, Early goal-directed therapy, Early warning score, medicine.disease, Health evaluation, Medicine, anesthesia peritonitis, business, Intensive care medicine, Abdominal surgery
Abstract

Peritonitis remains an illness with a significant mortality rate in surgery. Age, male sex, and the inability to control the source are associated with greater mortality. Anesthesia and perioperative medicine should aim to stop the increase in metabolic debt in the pre-surgical phase and to provide metabolic steering during surgery. Early goal directed therapy (EGDT) is still the mandatory cornerstone of management, presented here in several different versions, depending on the monitoring system available in the local clinical environment. The discharge from the operating room to a proper clinical setting must be based on a suitable scoring system, such as APACHE II (acute physiology and chronic health evaluation). Clinical surveillance, when the patient is on the ward, has to be governed for a period using a nursing score like the modified early warning score. Antimicrobial therapy, as well as appropriate timing of administration is both important. Analgesia, locoregional whenever possible, is also an important tool for preventing complications, which occur mainly during the postoperative period, and most frequently in the first month.

Published
2017

7. The impact of perioperative transfusion of blood products on survival after pediatric liver transplantation

Author

P. Brambillasca, Sabrina Buoro, Anna Falanga, Sergio Vedovati, Luigi Naldi, V. Corno, F. Lorusso, Federico Lussana, T Barbui, A. Benigni, Michele Colledan, Mirco Nacoti, Valter Sonzogni, Simone Cazzaniga, and Ezio Bonanomi

Subjects
Transplantation, medicine.medical_specialty, business.industry, Proportional hazards model, medicine.medical_treatment, Hazard ratio, Retrospective cohort study, Perioperative, Liver transplantation, Surgery, Blood product, Blood Component Transfusion, Internal medicine, Pediatrics, Perinatology and Child Health, Medicine, business, Survival analysis
Abstract

Intraoperative transfusion of red blood cells (RBC) is associated with adverse outcome after LT in adult patients. This relationship in pediatric patients has not been studied in depth, and its analysis is the scope of this study. Forty-one variables associated with outcome, including blood product transfusions, were studied in a cohort of 243 pediatric patients undergoing a cadaveric LT between 2002 and 2009 at the General Hospital of Bergamo. Multivariate stepwise Cox proportional hazards models were adopted with adjustment by propensity scores to minimize factors associated with the use of blood products. Median age at transplant was 1.37 yr. In uni- and multivariate analyses, perioperative transfusion of FFP and RBC was an independent risk factor for predicting one-yr patient and graft survival. The effect on one-yr survival was dose-related with a hazard ratio of 3.15 for three or more units of RBC (p = 0.033) and 3.35 for three or more units of FFP (p = 0.021) when compared with 1 or no units transfused. The negative impact of RBC and FFP transfusion was confirmed by propensity score-adjusted analysis. These findings may have important implications for transfusion practice in the LT pediatric recipients.

Published
2012
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8. Analgesic effectiveness of caudal levobupivacaine and ketamine

Author

L. Monia, B. Rossi, Serge Kaplanian, Pablo Ingelmo, Angelica Spotti, Geoff Frawley, Valter Sonzogni, and Bruno Guido Locatelli

Subjects
Male, medicine.medical_specialty, medicine.drug_class, Sedation, Analgesic, Motor Activity, Drug Administration Schedule, Double-Blind Method, Abdomen, Humans, Medicine, Ketamine, Anesthetics, Local, Child, Levobupivacaine, Pain Measurement, Bupivacaine, Analgesics, Anesthetics, Dissociative, Pain, Postoperative, Dose-Response Relationship, Drug, business.industry, Local anesthetic, Ropivacaine, Infant, Anesthetics, Combined, Surgery, Anesthesiology and Pain Medicine, Child, Preschool, Anesthesia, Urologic Surgical Procedures, Female, medicine.symptom, business, Anesthesia, Caudal, Surgical incision, medicine.drug
Abstract

Background Ketamine is used increasingly in paediatric anaesthetic practice to prolong the action of a caudal block. This study was designed to determine if adding S(+)-ketamine 0.5 mg kg −1 allows a lower concentration of levobupivacaine to be used for caudal anaesthesia without loss of clinical effectiveness. Methods One hundred and sixty-four children (ASA I or II) aged 3 months–6 yr were randomly allocated to receive 1 ml kg −1 of levobupivacaine 0.15% with 0.5 mg kg −1 S(+)-ketamine (Group 1), levobupivacaine 0.175% with 0.5 mg kg −1 S(+)-ketamine (Group 2), or levobupivacaine 0.2% (Group 3) by the caudal route. Pain, motor block, sedation, and requirement for postoperative analgesia were assessed up to 6 h after operation. Results There was no significant difference between the groups in effectiveness at first surgical incision. Significantly lower analgesic requirements were reported in Group 2 compared with Group 3 at wakeup, 180 and 360 min after operation. Time to first rescue analgesia was longer in Group 2 compared with Group 1 or 3. Kaplan–Meier survival analysis of analgesia free time demonstrated a significant advantage of Group 2 over Groups 1 and 3 (log rank P =0.05). The incidence of postoperative motor block was not significantly different between the groups. No excess sedation or dysphoric reactions were observed in the ketamine groups. Conclusions The addition of 0.5 mg kg −1 S(+)-ketamine to levobupivacaine 0.175% for caudal analgesia for lower abdominal and urological surgery is significantly more effective in providing postoperative analgesia than levobupivacaine 0.15% with 0.5 mg kg −1 S(+)-ketamine or levobupivacaine 0.2%.

Published
2008
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9. Preoperative Consideration in Common Pathological and Nonpathological Conditions

Author

Marinella Astuto, Barbara Rosina, Fabio Borrometi, Simonetta Baroncini, Marina Sammartino, Elisabetta Lampugnani, Emre Sahillioglu, G Serafini, Costanza Tognon, Rita Sonzogni, Tiziana Tondinelli, Valter Sonzogni, Giovanni Mangia, Carlotta Rossi, Nicola Zadra, Andrea Gentili, Luisa Meneghini, Cristina Ceschin, Simonetta Tesoro, C. Minardi, Pablo Ingelmo, Luciano Bortone, Giovanni Montobbio, and Francesca Pinzoni

Subjects
medicine.medical_specialty, business.industry, Evidence-based medicine, medicine.disease, Preoperative care, Bronchopulmonary dysplasia, Bronchial hyperresponsiveness, medicine, Heart murmur, Clinical significance, medicine.symptom, Elective Surgical Procedure, Intensive care medicine, business, Asthma
Abstract

Background: The preoperative assessment involves the process of evaluating the patient’s clinical condition, which is intended to define the physical status classification, eligibility for anesthesia, and the risks associated with it, thus providing elements to select the most appropriate and individualized anesthetic plan. We obtained evidence concerning pediatric preoperative evaluation on specific conditions and clinical problems: upper respiratory infections, asthma and bronchial hyperresponsiveness, bronchopulmonary dysplasia, allergies, heart murmurs, and vaccination. We produce a set of recommendations, with emphasis on the level of evidence, clinical relevance, and the risk/benefit ratio.

Published
2016
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10. Congenital heart disease and pediatric liver transplantation: Complications and outcome

Author

Valter Sonzogni, Diego Manzoni, Bruno Carrara, Carlo D’Ercole, and Angelica Spotti

Subjects
Heart Defects, Congenital, Male, medicine.medical_specialty, Time Factors, Heart disease, medicine.medical_treatment, Hemodynamics, Liver transplantation, Coronary Angiography, Postoperative Complications, Prevalence, Humans, Medicine, Intraoperative Complications, Retrospective Studies, Transplantation, business.industry, Incidence, Incidence (epidemiology), Retrospective cohort study, medicine.disease, Liver Transplantation, Surgery, Survival Rate, Treatment Outcome, surgical procedures, operative, Italy, El Niño, Echocardiography, Child, Preschool, Pediatrics, Perinatology and Child Health, Female, business, Complication, Liver Failure, Follow-Up Studies, Cohort study
Abstract

Mild and moderate CHD in infants do not always need surgical correction but possibly augment the operative risk of patients with ESLD undergoing OLT. The aim of this study is to assess the intraoperative and post-operative complications and evaluate the outcome of these patients. The records of 196 patients were reviewed retrospectively in a cohort study, 50 CHD were found in 36 patients undergoing 41 OLT procedures. The prevalence of CHD during pediatric OLT was 18%. Our data identified no significant differences between the two groups of patients, regarding hypotension, desaturation, acidosis, and bleeding during the procedure. Post-operatively, no differences were observed in the hemodynamic, respiratory, and renal systems as no differences were detected for graft failure, surgical complications, infection, and rejection rates. Mortality is comparable in the two groups as are re-transplantation and recovery rates. The above mentioned results indicate that minor cardiac defects do not significantly influence the operative risk of these patients.

Published
2007
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11. Caudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double-blind, randomized, controlled trial

Author

Pablo Ingelmo, Chiara Gattoni, Monia Lorini, Gloria N. Sora, Alberto Cadisco, Valter Sonzogni, Roberto Fumagalli, Bruno Guido Locatelli, Ingelmo, P, Locatelli, B, Sonzogni, V, Gattoni, C, Cadisco, A, Lorini, M, Sora, G, and Fumagalli, R

Subjects
Male, medicine.medical_specialty, Cauda Equina, medicine.drug_class, Analgesic, Motor Activity, law.invention, Randomized controlled trial, children, law, medicine, Humans, Anesthesia, Ropivacaine, Child, Levobupivacaine, Bupivacaine, propofol, Local anesthetic, business.industry, Infant, medicine.disease, Amides, Surgery, Inguinal hernia, Anesthesiology and Pain Medicine, Child, Preschool, Pediatrics, Perinatology and Child Health, Female, Propofol, business, medicine.drug
Abstract

Summary Background : We hypothesized that without the analgesic effects of volatile anesthetics, caudal 0.20% ropivacaine would be less effective during surgical stimulation than 0.20% bupivacaine or 0.20% levobupivacaine. This trial was designed to examine whether the combination of a caudal block with 0.20% ropivacaine and i.v. anesthesia resulted in reduced analgesic efficacy during surgery compared with caudal 0.20% levobupivacaine or 0.20% bupivacaine in children. Methods : Ninety ASA I–II children between 1 and 7 years old, scheduled for inguinal hernia repair or orchidopexy under propofol anesthesia were randomized to receive a caudal block with 1 ml·kg−1 of 0.2% bupivacaine, 0.2% ropivacaine or 0.2% levobupivacaine. The primary outcome measure of the study was the clinical efficacy of the caudal block during surgery. Secondary outcome measures were postoperative pain relief and residual motor blockade. Results : Four children were excluded and 86 were analyzed. The proportion of children with effective caudal block during surgery was significantly higher in children receiving levobupivacaine (26/28) or bupivacaine (27/29) compared with patients receiving ropivacaine (21/29) (P = 0.03). There were no significant differences among groups in the analgesic onset time (P = 0.1), incidence of residual motor blockade (P = 0.4), number of patients requiring analgesia after operation or in the time from caudal injection to the first administration of analgesic medication (P = 0.3). Conclusions : Combined with propofol anesthesia, 0.2% levobupivacaine and 0.2% bupivacaine are more effective than 0.2% ropivacaine for caudal use in children undergoing inguinal hernia repair or orchidopexy.

Published
2006

12. Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children

Author

V. Gatti, Bruno Guido Locatelli, Angelica Spotti, Pablo Ingelmo, S. Di Marco, Alberto Zanella, Valter Sonzogni, Roberto Fumagalli, Locatelli, B, Ingelmo, P, Sonzogni, V, Zanella, A, Gatti, V, Spotti, A, Di Marco, S, and Fumagalli, R

Subjects
Male, Amide, medicine.medical_specialty, medicine.drug_class, Movement, Analgesic, law.invention, Double blind, Randomized controlled trial, Double-Blind Method, law, Abdomen, medicine, Humans, Ropivacaine, Anesthetics, Local, MED/41 - ANESTESIOLOGIA, Levobupivacaine, Pain Measurement, Bupivacaine, Pain, Postoperative, business.industry, Local anesthetic, Infant, Amides, Surgery, Anesthesiology and Pain Medicine, Caudal route, Anesthesia, Anesthesia Recovery Period, Female, business, Anesthesia, Caudal, medicine.drug, Human
Abstract

BACKGROUND: The rationale for replacing racemic bupivacaine with the s-enantiomers levobupivacaine and ropivacaine is to provide a wider margin of safety with the same analgesic efficacy and less postoperative motor block. In a randomized, double-blind, phase III, controlled trial we compared the caudal administration of levobupivacaine 0.25% and ropivacaine 0.25% with bupivacaine 0.25% in children. METHODS: Ninety-nine ASA I-II children less than 10 yr old scheduled for elective sub-umbilical surgery were randomized to receive caudal block with bupivacaine 0.25%, ropivacaine 0.25% or levobupivacaine 0.25%. The primary outcome of the study was the clinical efficacy of the caudal block during the operation. Secondary outcome measures were analgesic onset time, pain relief after the operation and residual motor blockade. RESULTS: The proportion of children with effective analgesia during the operation was similar among groups. There were no significant differences in the analgesic onset time of the caudal block. Bupivacaine produced a significant incidence of residual motor block compared with levobupivacaine or ropivacaine at wake-up (P

Published
2005

13. Hemolytic uremic syndrome: A fatal outcome after kidney and liver transplantation performed to correct factor H gene mutation

Author

Valter Sonzogni, Sara Bucchioni, Giuseppe Remuzzi, Ezio Bonanomi, Aurelio Sonzogni, Marina Noris, Bruno Gridelli, Alessandro Bertani, Michele Colledan, Norberto Perico, Piero Ruggenenti, Paola Bettinaglio, Jeffrey L. Platt, Remuzzi, G, Ruggenenti, P, Colledan, M, Gridelli, B, Bertani, A, Bettinaglio, P, Bucchioni, S, Sonzogni, A, Bonanomi, E, Sonzogni, V, Platt, J, Perico, N, and Noris, M

Subjects
Graft Rejection, Hemolytic anemia, medicine.medical_specialty, Thrombotic microangiopathy, medicine.medical_treatment, Mutation, Missense, Liver transplantation, Transplant, Kidney, Gastroenterology, Fatal Outcome, Internal medicine, medicine, Humans, Immunology and Allergy, Hemolytic uremic syndrome, Pharmacology (medical), Complement Activation, Kidney transplantation, Transplantation, business.industry, Factor H, Infant, Exons, medicine.disease, Kidney Transplantation, Liver Transplantation, Complement system, Perfusion, medicine.anatomical_structure, Liver, Complement Factor H, Reperfusion Injury, Hemolytic-Uremic Syndrome, Immunology, Female, Endothelium, Vascular, Heparitin Sulfate, business, Liver Failure, Kidney disease
Abstract

Factor H-associated hemolytic uremic syndrome (HUS) is a genetic form of thrombotic microangiopathy characterized by deficient factor H (HF-1) levels/activity and uncontrolled complement activation. The disorder mostly leads to end-stage renal disease and often recurs after kidney transplantation. We previously demonstrated that in a child with HF-1-associated HUS a simultaneous kidney and liver transplantation restored the defective HF-1 with no recurrence of the disease in the transplanted kidney. Here we describe a second childhood case of HF-1-associated HUS treated by combined kidney and liver transplant and complicated by a fatal, primary non-function of the liver graft. Graft hypoperfusion during surgery triggered ischemia/reperfusion changes and complement activation. Conceivably, as a result of defective complement regulatory potential, massive shedding of vascular heparan sulfates was documented in the transplanted liver. This might have impaired the physiological thromboresistance of vascular endothelium ending with widespread microvascular thrombosis and infarction. This case indicates that more fundamental research is needed before combined liver and kidney transplant is considered an option for children with HF-1-associated HUS.

Published
2005

14. Transplantation for acute liver failure in children

Author

Marco Spada, Domenico Pinelli, M Guizzetti, Sergio Vedovati, A Bertani, M. Zambelli, M. Giovanelli, Bruno Gridelli, G. Maldini, Silvia Riva, Michele Colledan, V. Corno, Valter Sonzogni, Alessandro Lucianetti, Pinelli, D, Spada, M, Lucianetti, A, Riva, S, Guizzetti, M, Giovanelli, M, Maldini, G, Corno, V, Sonzogni, V, Vedovati, S, Bertani, A, Zambelli, M, Gridelli, B, and Colledan, M

Subjects
survival rate, medicine.medical_specialty, age distribution, Waiting Lists, medicine.medical_treatment, Liver transplantation, surgical technique, Group B, body weight, liver graft, Medicine, Humans, controlled study, human, comparative study, conference paper, donor, Retrospective Studies, Transplantation, child, clinical article, liver transplantation, business.industry, recipient, Liver Diseases, liver failure, Liver failure, Infant, Newborn, Patient survival, Liver Failure, Acute, infant, Surgery, Treatment Outcome, El Niño, Italy, priority journal, Waiting list, Treatment modality, Child, Preschool, adolescent, business, hospitalization
Abstract

We reviewed the clinical data of 30 children-hospitalized for acute liver failure in the last 6 years. Ten patients were not listed for liver transplantation OLTX. Their clinical conditions gradually improved and they are all alive without deficit. Among 20 patients listed, 15 underwent urgent OLTX. Two children died on the waiting list and three were suspended from waiting list after few days because of improvement. Survival according to age class was analyzed dividing the patients into two groups: A, age 1 year or less versus B, age between 1 and 16 years. The patient survival was 86% at 6 months and 61% both at 1 and 2 years. Survival at 6 months and 1 and 2 years was 88%, 67%, and 45% for the patients in group A and 83%, 83%, and 83% for the patients in group B (P = NS). Observing graft-to-recipient weight ratio and donor-to-recipient weight ratio most patients received an optimal sized graft. The split-liver technique is considered the preferred method of liver transplantation even in the pediatric patients with acute liver failure; especially in the setting of a cooperative system in which all livers that are suitable for split-liver transplantation are shared between centers. In order to have the best chance for survival, children with acute liver failure should be referred as soon as possible to an highly specialized pediatric liver transplantation center that can offer all the treatment modalities that are currently available.

Published
2005

15. Video-Assisted Thoracoscopic Extended Thymectomy in Myasthenic Children

Author

Angelica Spotti, Ilaria Busi, Lorenzo Novellino, Alberto Benigni, Rita Sonzogni, Valter Sonzogni, and Magda Khotcholava

Subjects
Weakness, medicine.medical_specialty, medicine.medical_treatment, lcsh:Medicine, Pediatrics, Article, Fentanyl, law.invention, pediatric anesthesia, Desflurane, law, Medicine, video assisted thoracoscopic extended thymectomy, myasthenia gravis, business.industry, lcsh:R, lcsh:RJ1-570, lcsh:Pediatrics, Perioperative, myasthenic children, medicine.disease, Neuromuscular monitoring, Intensive care unit, Myasthenia gravis, Surgery, Thymectomy, Anesthesia, myasthenia gravis, video assisted thoracoscopic extended thymectomy, myasthenic children, pediatric anesthesia, medicine.symptom, business, medicine.drug
Abstract

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.

Published
2013
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