Anesthesia Concerns and Questions - Mothering Forums

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#1 of 7 Old 07-27-2009, 10:29 PM - Thread Starter
 
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My two year old son is scheduled for eye surgery in August.

Anyone knowledgeable regarding the side-effects (long and short) of anesthesia?

The best medications for preoperative sedation (e.g. midazolam, ketamine, chloral hydrate, brevital, etc.)?

Any of these meds. contraindicated for asthma, autism spectrum disorders, possible mitochondrial disorder, allergies, diabetes type I?

Any chance of anesthesia aggravating any of the above conditions?

Chances of seizure disorder following anesthesia especially in a spectrum child?

Thanks so much! I'm grateful for any information.
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#2 of 7 Old 07-27-2009, 10:44 PM
 
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In-patient or out-patient? An anesthesiologist would consult with you beforehand. I wouldn't do general anesthesia outpatient.


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#3 of 7 Old 07-28-2009, 11:04 PM - Thread Starter
 
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Outpatient. I'm thinking the same thing. I was going to request that he be kept in-patient for 24 hours following the surgery.
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#4 of 7 Old 07-29-2009, 10:10 AM
 
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Quote:
Originally Posted by DoratheExplora View Post
Outpatient. I'm thinking the same thing. I was going to request that he be kept in-patient for 24 hours following the surgery.
Ok, outpatient, not in office with "conscious sedation"?

Outpatient with a medical facility (rather than dental office), they'll do a work-up before hand. It'll be ok. I just wouldn't do in-office sedation. Any outpatient medical facility will have personnel trained in ACLS and have proper medical equipment.

If you don't mind my question, what is the surgery? I have had a couple of major surgeries as outpatient and no problems. It is non-standard and unnecessary to stay overnight afterwards, unless has acute respiratory issue. Then you'd postpone until well. Asthma should be ok, unless compromised with active respiratory illness, imo.

The diabetes you already manage with insulin and monitoring, nothing otherwise would be done. It sounds like you are very knowledgable. I *would* take TWO adults with you to monitor him in the car on the ride home. That is the most respiratory risk situation. And I'd prefer Versed. We used nasal Versed with our son at age 5. It is easily reversed, unlike Chloral Hydrate. I would NOT agree to it, personally. I can get you documentation, if you are interested.




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#5 of 7 Old 07-29-2009, 10:06 PM - Thread Starter
 
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WuWei: Eye surgery. It is an outpatient surgery center.

Yes! Could you get me info. on it? Thanks so much!
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#6 of 7 Old 07-30-2009, 12:01 AM
 
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The concern, imo, is less the choice of sedation as the degree of medical management of conscious or unconscious sedation.

There is a medical article in the "Files" section of Very Young Kids Teeth about in sedation risks called "CONSCIOUS SEDATION.doc ". The degree of responsiveness of the patient is the defining variable. In hospital/out-patient, it is required that (1-2) licensed anesthesiologist along with multiple personnel certified in ACLS (Advanced Cardiac Life Support) are present and available during general anesthesia.

I was a critical care nurse, so understood the measures required for conscious sedation in hospital. Oxygen saturation, oxygen supplementation, IV access, emergency drugs for respiratory compromised incidents are available in an outpatient setting.

The dangers of Chloral Hydrate are covered in that article. Chloral Hydrate is highly associated with children's deaths. Plain and simple, no way would I give this to my child when he is not under constant medical observation with oxygen saturation measurement. But, the respiratory depression effects can be lethal. This drug is even contra-indicated for sedation dentistry for children due to its risks.

I investigated the clinical research related to sedation dentistry for our son. Here are some of the studies. The studies evaluate the risks of chloral hydrate for children, in a controlled and monitored setting.

Adverse Sedation Events in Pediatrics: Analysis of Medications Used for
Sedation:
http://f1.grp.yahoofs.com/v1/8DxqSliz68FHFLqWQErwbsITpFtJoHjJ94FN2_XoB_2SICu0Hn j\
jcV4BNmpG_okuMJDodvZyvDlJT3LJdh9b3NR7R-dpdRMl/Literature%20on%20Sedation%20/Adve\
rse%20Sedation%20Events%20-%20Analysis%20of%20Medication.pdf


Sedation of anxious children undergoing dental treatment.pdf:
http://f1.grp.yahoofs.com/v1/8DxqSsSGkiJHFLqW_4jjQePzUfaRXo5Ym1OMRKXexD_ea3QA9E 0\
JAHzedu4IovHVz1X0pXLifn_UN0Wm22AoA_YqZQZYuUBw/Literature%20on%20Sedation%20/Seda\
tion%20of%20anxious%20children%20undergoing%20dent al%20treatment.pdf


Sedation disasters in pediatrics and concerns for office based practice:
http://f1.grp.yahoofs.com/v1/8DxqSpeMZhxHFLqWBJjPSFpZ7PyEBuEN4bQkfNgDXv1oQlbi-iu\
ptOJMh6BfCf9ardnCAIxJvksX83hfLM4jGRCRuxWy6G49/Literature%20on%20Sedation%20/seda\
tion.pdf

The ability to proscribe and measure the dose accurately is critical due to the different liver metabolism of children by age. The half-life and peak effects are different than in adults. Multiple children have died after taking chloral hydrate before dental treatments due to the respiratory depression effect.

Additionally, it has a risk of carcinogenicity:
http://aappolicy.aappublications.org...trics;92/3/471

http://www.drugs.com/cons/chloral-hydrate.html

http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/\
CPS-%20
(General%20Monographs-%20C)/CHLORAL%20HYDRATE.html

This link does not even provide for dosing administration of syrup for children, by non-professionals. The risk of mis-measuring is too great! The syrup is only to be administered by a professional in an observed environment.
http://drugspedia.net/prep/41291.html

All in all, the post-procedure respiratory risks of Chloral Hydrate are unnecessary and unpredictable, in an outpatient setting, when you are going home afterward, imo. Versed has a short half-life and is much easier to manage. It comes po or nasally. We avoid artificial colors and flavors, so chose the nasal dosage route. It worked great!


ETA: is the surgery essential 'now'. I would wait until optimal timing (no illness for four weeks, no recent vaccinations or out of town respiratory exposures, limited allergen exposures, etc.). Generally, summer, rather than winter is optimal, with less 'flu/cold season' concerns, however.


HTH,

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#7 of 7 Old 08-04-2009, 11:08 PM - Thread Starter
 
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Wow. Thanks so much for the info. I really appreciate it.
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