Mari-Liis Ilmoja SA Tallinna Lastehaigla 22.05.2015
24,165 anaesthesias 724 adverse events; 31:1000 53% respiratory Risk factors: infancy, higher ASA status, ENT surgery Perioperative anaesthetic morbidity in children: a database of 24 165 anaesthetics over a 30-month period I Murat, I Constant, H Maud'huy Pediatric Anesthesia, Vol 14:2, 158-166, 2004
35190 anesteesiat 1214 ebasoodsat juhtumit s.o. 34 : 1000 46,5% hingamisteedega seotud Riskifaktorid: ASA III-IV, alla 1-aastased, erakorralised protseduurid Anesthesia-related critical incidents in the perioperative period in children; a proposal for an anesthesia-related reporting system for critical incidents in children. de Graaff JC 1, Paediatr Anaesth 2015
Prospective study 1.09.2009 31.08.2010 4660 anaesthesias No cardiac surgery (except PDA ligation) Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care, 2010
No of patients 120 100 80 Respiratory events 64% 60 40 20 0 Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care, 2010
45000 40000 35000 30000 25000 20000 15000 10000 5000 Respiratory infections and adverse events 40 35 30 25 20 15 10 5 inf AE 0 sept oct nov dec jan feb mar apr may june july aug 0 Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care, 2010
Risk factors for adverse events: ASA status III-V AE per 1000 anaesthesias 160 140 120 100 80 60 40 20 0 I-II III-V ASA III-IV OR 7,98 (95%CI 5,38 11,84) Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care, 2010
Risk factors for adverse events: age < 1 year 140 AE per 1000 anaesthesias 120 100 80 60 40 20 resp cardiac vomiting CNS medication other regional 0 < 1 mo 1mo-1 yr 1-5 yr 6-12 yr > 12 yr Age < 1 year OR 3,87 (95%CI 2,72 5,39) Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care, 2010
APRICOT: Anaesthesia PRactice In Children Observational Trial: European prospective multicenter observational study: Epidemiology of severe critical events NECTARINE: NEonate-Children audit of Anaesthesia practice IN Europe. Epidemiology of morbidity and mortality in neonatal anaesthesia: A European prospective multicentre observational audit of practice
Käitumuslikud ja autonoomsed vastused valule Maksa ensüümsüsteemid ja ravimite metabolism Ravimite ja nende metaboliitide renaalne kliirens Ravimite omastamise ja ümberjaotumise vanuselised aspektid Ravimite famakodünaamika vanuselised aspektid Nasr V, Davis J; Pediatric Research 2015
Opiaatide toime hingamissüsteemile Opiaatretseptorite, transporterite ja teiste ensüümsüsteemide geneetiline polümorfism erinev vastus anesteesia ravimitele Neuronite tundlikkus apoptoosi suhtes nii ravimid kui haigusseisundid Hemodünaamika muutused üld-, spinaal või epiduraalanalgeesias Hormonaalne vastus haigusele või kirugiale Ravimite koostoime Nasr V, Davis J; Pediatric Research 2015
GAS study sevofluraan vs spinaalanalgeesia songa operatsiooniks
NMDA glutamaat retseptorite inhibeerimine Ketamiin, N2O GABA retseptorite aktivatsioon Neuroapoptoos Neurokognitiivne defitsiit Bensodiasepiinid, barbituraadid, propofool, sevofluraan Anesthetics and sedatives: Toxic or protective for the developing brain? C Ward, A Loepke Pharmacological Research, 2011, 271-274
7 p rotid Midasolaam+N2O+isofluraan 6 tundi Tulemused: widespread apoptotic neurodegeneration in the developing brain, deficits in hippocampal synaptic function, persistent memory/learning impairments. Jevtovic-Todorovic et al. J. Neurosci. 2003
Gleich S, Nemergut M, Flick R Curr Opin Anesthesiol 2013
Gleich S, Nemergut M, Flick R Curr Opin Anesthesiol 2013
1. How does the anesthetic exposure in preclinical studies compare with pediatric anesthesia practice? 2. Is the maturational state of the brain in experimental models comparable to that of patients undergoing pediatric anesthesia? 3. Are there any detectable clinical markers of neurodegeneration in children after exposure to anesthetics? Loepke A, et al; ANESTHESIA & ANALGESIA, 2008
Concurrent noxious stimulation with CFA attenuates ketamine-induced caspase-3 activation Concurrent noxious stimulation attenuates ketamine-induced increase in cyclin D1 expression. Data are presented as mean ± SE. CFA = complete Freund's adjuvant; KET = ketamine. Liu J, et al; Anesthesiology, 2012 Date of download: 5/21/2015 Copyright 2015 American Society of Anesthesiologists. All rights reserved.
Shih J, et al; Anesthesiology. 2012
I have no wish, nor the skill, to embark upon a philosophical discussion of the meaning of 'causation'. Meeting January, 1965
Gleich S, Nemergut M, Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s.1976 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700 Flick R, et al; Pediatrics 2011
Hazard ratio: Korstnapühkija ja skrootumi vähk 200 Salitsülaadid ja Reye sündroom 26 Kõhuli magamine ja SIDS 12,6 Gleich,2013; Bell 1965
Anesthetic-related neurotoxicity in young children Gleich et al. Curr Opin Anesthesiol 2013, 26:340 347
Summary Although the evidence from nonhuman primates and humans is overtly concerning, it lacks clinical verification. There are, at present, no data that would dictate a change in clinical practice in the anesthetic management of infants and children. Anesthetic-related neurotoxicity in young children Gleich et al. Curr Opin Anesthesiol 2013, 26:340 347
Anesteesia tüsistuste esinemissagedus Eestis on võrreldav teiste riikidega Anesteesia mõju arenevale ajule vajab täpsustamist