Document Detail


Anesthetic technique and postoperative outcome in preterm infants undergoing PDA closure.
MedLine Citation:
PMID:  20237487     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To describe the various anesthetic techniques used for surgical closure of PDA in premature infants at the Montreal Children's Hospital and assess their impact on postoperative outcome.
STUDY DESIGN: The charts of all preterms who underwent PDA ligation during a 21-month period were reviewed for preoperative status, intraoperative anesthetic management and postoperative outcome. We determined the associations between independent variables and two postoperative outcome variables: unstable postoperative respiratory course (UPRC) and hypotension.
RESULT: The mean weight at surgery of the 33 infants was 1.031±0.29 kg. All infants, but one, received intraoperative opioids. Eight patients presented UPRC. Mean fentanyl doses were 5.3±2.6 mcg kg(-1) for patients with UPRC vs 22.6±16.6 mcg kg(-1) for patients without UPRC (P=0.004). Applying the receiver-operator characteristic curve (ROC), 10.5 mcg kg(-1) of fentanyl was established as the dose that discriminated and identified patients who experienced UPRC. The postnatal and postmenstrual age of the patient, birthweight, current weight, ventilator settings preoperatively, previous courses of indomethacin, sex and preoperative creatinine, were not correlated with the dose of fentanyl equivalent used. Logistic regression did not show a relationship between any of the previously mentioned factors and receiving a fentanyl equivalent of >10.5 mcg kg(-1). The only factor associated with the total fentanyl equivalent dose (as a continuous variable) or receiving <10.5 mcg kg(-1) (as a dichotomous variable) was the identity of the anesthetist involved, P<0.001.
CONCLUSION: We conclude that the use of at least 10.5 mcg kg(-1) of fentanyl equivalent as a component of the anesthetic regimen for surgical closure of a PDA in premature infants, avoids an unstable postoperative respiratory course.
Authors:
A Janvier; J L Martinez; K Barrington; J Lavoie
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Publication Detail:
Type:  Journal Article     Date:  2010-03-18
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  30     ISSN:  1476-5543     ISO Abbreviation:  J Perinatol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-29     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  677-82     Citation Subset:  IM    
Affiliation:
Department of Neonatology, Ste Justine Hospital, Cote St Catherine, Montreal, Quebec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, General*
Anesthetics, Intravenous / administration & dosage*
Ductus Arteriosus, Patent / surgery*
Female
Fentanyl / administration & dosage*
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / surgery*
Logistic Models
Male
ROC Curve
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anesthetics, Intravenous; 437-38-7/Fentanyl

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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