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Jim Van Os - One of the best experts on this subject based on the ideXlab platform.
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post hoc revision of the Pediatric Anesthesia emergence delirium rating scale clinical improvement of a bedside tool
Minerva Anestesiologica, 2012Co-Authors: Roos J Blankespoor, N Janssen, Jim Van Os, Anton M H Wolters, Jan N M SchieveldAbstract:BACKGROUND Pediatric delirium (PD) is a severe neuropsychiatric disorder often seen at the Pediatric intensive care unit (PICU). The Pediatric Anesthesia Emergence Delirium (PAED) scale assesses five behavioral items on a five-level severity scale, and is easily applicable in children. However, the five-level severity scales are rather arbitrarily anchored and subjective. This study aimed to pilot a practical and clinical improvement of the PAED by condensing the five-level scales of the five behavioral items to a more objectively anchored two- and three-point scale. METHODS Post-hoc analysis of routine data in an eight-bed PICU in a tertiary university hospital. 144 critically ill, non-electively admitted patients, aged 1-18 years, were included between November 2006 and February 2010. Scales of the five PAED-items were condensed post-hoc from five to two- and three levels of severity. Five scale properties were analyzed: 1) internal consistency; 2) item-total score correlations; 3) inter-rater agreement; 4) sensitivity and specificity; and 5) discriminative diagnostic ability. RESULTS Three-level PAED-items post-hoc displayed Cronbach's alpha of 0.86, and mean item-total score correlation was 0.71 (range 0.60 to 0.79). Inter-rater agreement was high (0.90). The most optimal cut-off was 8 (sensitivity=100%, specificity=96.7%) with an area under the curve (AUC) of 0.98. Likelihood ratio for a positive test result (LR+) was 30.3. CONCLUSION A three-level severity scale for the five PAED-items may be optimal to diagnose PD. Further prospective research is required to determine whether a revised PAED has adequate psychometric properties and is applicable across different clinical settings.
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on the utility of diagnostic instruments for Pediatric delirium in critical illness an evaluation of the Pediatric Anesthesia emergence delirium scale the delirium rating scale 88 and the delirium rating scale revised r 98
Intensive Care Medicine, 2011Co-Authors: N Janssen, Eva Y L Tan, Marian Staal, Eveline P C J Janssen, Piet L J M Leroy, Richel Lousberg, Jim Van OsAbstract:Purpose Delirium is a poor-prognosis neuropsychiatric disorder. Pediatric delirium (PD) remains understudied, particularly at Pediatric intensive care units (PICU). Although the Pediatric Anesthesia Emergence Delirium (PAED) scale, the Delirium Rating Scale (DRS-88), and the Delirium Rating Scale-Revised (DRS-R-98) are available, none have been validated for use in PICU settings. The aim of the present study was to investigate the use of the DRS/PAED instruments as diagnostic tools for PD in the PICU.
Norma Sueli Pinheiro Modolo - One of the best experts on this subject based on the ideXlab platform.
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laryngeal mask airway versus other airway devices for Anesthesia in children with an upper respiratory tract infection a systematic review and meta analysis of respiratory complications
Anesthesia & Analgesia, 2018Co-Authors: Ana Lygia R De Carvalho, Leandro Gobbo Braz, Roberto Bezerra Vital, Carlos Cezar Sousa Lira, Igor Barreira Magro, Patricia T S Sato, Lais Helena Navarro E Lima, Norma Sueli Pinheiro ModoloAbstract:There is an association between upper respiratory tract infection (URTI) and an increased incidence of perioperative respiratory adverse events (PRAEs), which is a major risk for morbidity during Pediatric Anesthesia. The aim of the present study was to compare the risk of PRAEs among different airw
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emergence agitation in Pediatric Anesthesia current features
Jornal De Pediatria, 2008Co-Authors: Leopoldo Muniz Da Silva, Leandro Gobbo Braz, Norma Sueli Pinheiro ModoloAbstract:Objective: Postoperative agitation in children is a well-documented clinical phenomenon with incidence ranging from 10% to 67%. There is no definitive explanation for this agitation. Possible causes include rapid awakening in unfamiliar settings, pain (wounds, sore throat, bladder distension, etc.), stress during induction, hypoxemia, airway obstruction, noisy environment, Anesthesia duration, child’s personality, premedication and type of Anesthesia. The purpose of this paper is to discuss the possible causes of postoperative agitation in children, providing a foundation for better methods of identifying and preventing this problem.
Shobha Malviya - One of the best experts on this subject based on the ideXlab platform.
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Anesthesia for the child with an upper respiratory tract infection still a dilemma
Anesthesia & Analgesia, 2005Co-Authors: Alan R. Tait, Shobha MalviyaAbstract:One of the most controversial issues in Pediatric Anesthesia has revolved around the decision to proceed with Anesthesia and surgery for the child who presents with an upper respiratory tract infection (URI). In the past, doctrine dictated that children with URIs have their surgery postponed until t
Jerrold Lerman - One of the best experts on this subject based on the ideXlab platform.
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Development and psychometric evaluation of the Pediatric Anesthesia emergence delirium scale.
Anesthesiology, 2004Co-Authors: Nancy Sikich, Jerrold LermanAbstract:Background: Emergence delirium has been investigated in several clinical trials. However, no reliable and valid rating scale exists to measure this phenomenon in children. Therefore, the authors developed and evaluated the Pediatric Anesthesia Emergence Delirium (PAED) scale to measure emergence delirium in children. Methods: A list of scale items that were statements describing the emergence behavior of children was compiled, and the items were evaluated for content validity and statistical significance. Items that satisfied these evaluations comprised the PAED scale. Each item was scored from 1 to 4 (with reverse scoring where applicable), and the scores were summed to obtain a total scale score. The degree of emergence delirium varied directly with the total score. Fifty children were enrolled to determine the reliability and validity of the PAED scale. Scale validity was evaluated using five hypotheses: The PAED scale scores correlated negatively with age and time to awakening and positively with clinical judgment scores and Post Hospital Behavior Questionnaire scores, and were greater after sevoflurane than after halothane. The sensitivity of the scale was also determined. Results: Five of 27 items that satisfied the content validity and statistical analysis became the PAED scale: (1) The child makes eye contact with the caregiver, (2) the child’s actions are purposeful, (3) the child is aware of his/her surroundings, (4) the child is restless, and (5) the child is inconsolable. The internal consistency of the PAED scale was 0.89, and the reliability was 0.84 (95% confidence interval, 0.76 ‐ 0.90). Three hypotheses supported the validity of the scale: The scores correlated negatively with age (r 0.31, P < 0.04) and time to awakening (r 0.5, P < 0.001) and were greater after sevoflurane Anesthesia than halothane (P < 0.008). The sensitivity was 0.64. Conclusions: These results support the reliability and validity of the PAED scale.
Doralina L. Anghelescu - One of the best experts on this subject based on the ideXlab platform.
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Emergence Delirium in Pediatric Anesthesia
Pediatric Drugs, 2017Co-Authors: Arthura D. Moore, Doralina L. AnghelescuAbstract:Emergence delirium (ED) is a complex of perceptual disturbances and psychomotor agitation that occurs most commonly in preschool-aged children in the early postanesthetic period. The incidence of ED varies between 10 and 80% in children and is perceived as a troublesome clinical situation by 42% of Pediatric anesthesiologists. Although these events are often short lived, they increase the risk of self-injury and delayed discharge, require additional nursing staff and can increase medical care costs, all of which are causes for concern. The prevalence of ED has increased with the introduction and growing use of sevoflurane and desflurane, two low-solubility inhalational anesthetics. These agents promote early arousal post anesthetic, which contributes to ED. Physiological factors, pharmacological factors, the type of procedure, the anesthetic agent administered, painful stimuli, and various patient factors can all contribute to ED and thus need to be considered. Recent literature debates the cause–effect relationship between ED and pain, suggesting that they often occur concurrently but are sometimes independent findings. The consistent relation between ED and sevoflurane-based Anesthesia has guided many studies to investigate its incidence compared with using other anesthetic techniques or various adjuncts. The risk of ED is lowest when propofol is used as a single-agent anesthetic compared with sevoflurane-based anesthetics. Adjunctive agents can be rated in the following order of most effective to least effective interventions: dexmedetomidine, fentanyl, ketamine, clonidine, and propofol bolus at the end of sevoflurane-based Anesthesia. This review summarizes the factors that may predict ED and provides an intervention algorithm to guide effective prevention and treatment.