Showing papers by "Bruno Bissonnette published in 2007"

Awareness during pediatric anesthesia: what is the position of European pediatric anesthesiologists?

Abstract: Summary Background: The incidence of awareness in the pediatric population is reported as high as 1 : 125 An online survey was conducted about the current perception and practice of members of the British and French pediatric anesthesia societies regarding awareness during general anesthesia Methods: Following the approval of the executive committees of the British and French pediatric anesthesia societies, members with a valid email contact address were invited to participate in a web-based survey Perceived risk factors, use of awareness monitors, pre- and postoperative discussions of awareness as well as personal experience were enquired Results: A total of 302 (51%) responded to the email survey More than 60% indicated that awareness is a problem in pediatric anesthesia with the majority estimating an incidence of 1 : 1000 Almost half (49%) the respondents believe that awareness is age-dependent and 50% are not concerned below 1 month of age More than 86% of respondents do not discuss the risk of awareness with the parents or actively look for awareness despite 27% reporting at least one episode in their practice Intra-operative monitoring almost exclusively consists of clinical signs and endtidal anesthetic concentrations Bispectral index (BIS) monitoring is routinely used by approximately 10% of the surveyed members Conclusions: This survey demonstrates that European pediatric anesthesiologists perceive awareness as a major problem However, none seems to address the issue openly or looks for its presence routinely The vast majority of pediatric anesthesiologists rely almost exclusively on clinical monitoring and endtidal anesthetic concentrations for its detection

The effect of varying continuous propofol infusions on plasma cyclic guanosine 3',5'-monophosphate concentrations in anesthetized children.

Abstract: BACKGROUND The glutamate-nitric oxide-cyclic guanosine 3',5'-monophosphate (cGMP) pathway is potentially an effective target for general anesthetics. Plasma cGMP concentrations are reduced after an increase in predicted plasma propofol concentrations during sedation in healthy adult volunteers. We hypothesized that an increase in measured plasma propofol concentration leads to a reduction in plasma cGMP in anesthetized children. METHODS Eighteen healthy children aged 46.8 (+/-19.6) mo, requiring general anesthesia for lower body surgical procedures were enrolled. After inhaled induction, tracheal intubation and initiation of intermittent positive pressure ventilation, caudal epidural analgesia was performed. Anesthesia was maintained using a continuous propofol infusion adapted from a previously published regimen to achieve predicted propofol plasma concentration of 6, 3, and 1.5 microg/mL after 30, 50, and 70 min, respectively. Samples for propofol and cGMP plasma concentrations were collected and analyzed using high-performance liquid chromatography and an enzyme immunoassay system. RESULTS The plasma cGMP concentrations varied significantly (median [range]) 19.2 [11.8-23.5], 21.3 [14.6-30.8], and 24.9 [15.7-37.8] nmol/L among each predicted plasma propofol concentration, P < 0.0001. The correlation coefficient (r) was -0.62. CONCLUSIONS This study demonstrates that an increase in plasma propofol concentration leads to a decrease in plasma cGMP in healthy children, and could serve as a biochemical marker for depth of propofol anesthesia in children.

Spécificités de la réanimation de l’enfant

Abstract: L’enfant n’est pas un petit adulte. A la naissance, le developpement du systeme nerveux central (SNC) est incomplet et ne sera reellement mature qu’apres la fin de la premiere annee de vie. Ce retard de maturation du SNC est a l’origine de nombreuses differences physiopathologiques et psychologiques.