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Background: Laryngospasm is a common and often serious adverse respiratory event encountered during anesthetic care of children. We examined, in a case control design, the risk factors for laryngospasm in children. Material and Methods: The records of 130 children identified as having experienced laryngospasm under general anesthesia were examined. Cases were identified from those prospectively entered into the Mayo Clinic performance improvement database between January 1, 1996 and December 31, 2005. Potential demographic, patient, surgical and anesthetic related risk factors were determined in a 1 : 2 case-control study. Results: No individual demographic factors were found to be significantly associated with risk for laryngospasm. However, multivariate analysis demonstrated significant associations between laryngospasm and intercurrent upper respiratory infection (OR 2.03 P = 0.022) and the presence of an airway anomaly (OR = 3.35, P = 0.030). Among those experiencing laryngospasm during maintenance or emergence, the use of a laryngeal mask airway was strongly associated even when adjusted for the presence of upper respiratory infection and airway anomaly (P = 0.019). Ten patients experienced postoperatively one or more complications whereas only three complications were observed among controls (P = 0.008). No child required cardiopulmonary resuscitation and there were no deaths in either study cohort. Conclusions: In our pediatric population, the risk of laryngospasm was increased in children with upper respiratory tract infection or an airway anomaly. The use of laryngeal mask airway was found to be associated with laryngospasm even when adjusted for the presence of upper respiratory tract infection and airway anomaly.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18859号 / 医博第3970号 / 新制||医||1008(附属図書館) / 31810 / 京都大学大学院医学研究科医学専攻 / (主査)教授 渡邊 直樹, 教授 渡邉 大, 教授 松原 和夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12970号 / 論医博第2103号 / 新制||医||1012(附属図書館) / 32408 / 新制||医||1012 / 京都大学大学院医学研究科医学専攻 / (主査)教授 小池 薫, 教授 三嶋 理晃, 教授 中山 健夫 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DGAM

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In order to further explore the nature of anesthesia-induced unconsciousness and its relationship to nociception, investigators attempted to determine whether mismatch negativity could be detected during general anesthesia and surgery. An auditory odd-ball paradigm designed to elicit mismatch negativity was presented to ten patients during general anesthesia and surgery. Five of the ten also underwent testing in the awake state prior to surgery. Multiple EEG recordings were obtained in each patient and each condition using the BioSemi ActiveTwo 64 EEG electrode system. The anesthetic regime required only that 0.7 MAC of an inhaled agent was administered. Several methods of analysis were utilized to determine whether an MMN response could be identified: visual inspection of ERP waveforms, targeted t-tests, cluster permutation tests, and multivariate pattern analysis. Whereas deviant-related negativity was readily detected in the awake state, deviant-related negativity was not detected during surgery and general anesthesia. Results demonstrate that essential components of the MMN response are abolished during typically conducted general anesthesia even with significant surgical stimulation. These results are consistent with previous research on ERPs and anesthesia. Results cast doubt on the possibility of sensory memory related to intraoperative events. / Thesis / Master of Science (MSc)

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