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Mari-Liis Ilmoja SA Tallinna Lastehaigla
22052015
Perioperative anaesthetic morbidity in children a database of 24 165 anaesthetics
over a 30-month period
I Murat I Constant H Maudhuy
Pediatric Anesthesia Vol 142 158-166 2004
24165
anaesthesias
724 adverse events
311000
53 respiratory
Risk factors infancy
higher ASA status ENT
surgery
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 JC1 Paediatr Anaesth 2015
35190 anesteesiat
1214 ebasoodsat juhtumit
so 34 1000
465 hingamisteedega seotud
Riskifaktorid ASA III-IV alla 1-aastased erakorralised protseduurid
Prospective study
1092009 ndash 31082010
4660 anaesthesias
No cardiac surgery (except PDA ligation)
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
20
40
60
80
100
120
No
of
pa
tie
nts
Respiratory events 64
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
5
10
15
20
25
30
35
40
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
sept oct nov dec jan feb mar apr may june july aug
Respiratory infections and adverse events
inf
AE
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Risk factors for adverse events ASA status III-V
ASA III-IV OR 798 (95CI 538 ndash 1184)
0
20
40
60
80
100
120
140
160
AE per 1000 anaesthesias
I-II
III-V
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Perioperative anaesthetic morbidity in children a database of 24 165 anaesthetics
over a 30-month period
I Murat I Constant H Maudhuy
Pediatric Anesthesia Vol 142 158-166 2004
24165
anaesthesias
724 adverse events
311000
53 respiratory
Risk factors infancy
higher ASA status ENT
surgery
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 JC1 Paediatr Anaesth 2015
35190 anesteesiat
1214 ebasoodsat juhtumit
so 34 1000
465 hingamisteedega seotud
Riskifaktorid ASA III-IV alla 1-aastased erakorralised protseduurid
Prospective study
1092009 ndash 31082010
4660 anaesthesias
No cardiac surgery (except PDA ligation)
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
20
40
60
80
100
120
No
of
pa
tie
nts
Respiratory events 64
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
5
10
15
20
25
30
35
40
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
sept oct nov dec jan feb mar apr may june july aug
Respiratory infections and adverse events
inf
AE
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Risk factors for adverse events ASA status III-V
ASA III-IV OR 798 (95CI 538 ndash 1184)
0
20
40
60
80
100
120
140
160
AE per 1000 anaesthesias
I-II
III-V
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
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 JC1 Paediatr Anaesth 2015
35190 anesteesiat
1214 ebasoodsat juhtumit
so 34 1000
465 hingamisteedega seotud
Riskifaktorid ASA III-IV alla 1-aastased erakorralised protseduurid
Prospective study
1092009 ndash 31082010
4660 anaesthesias
No cardiac surgery (except PDA ligation)
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
20
40
60
80
100
120
No
of
pa
tie
nts
Respiratory events 64
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
5
10
15
20
25
30
35
40
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
sept oct nov dec jan feb mar apr may june july aug
Respiratory infections and adverse events
inf
AE
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Risk factors for adverse events ASA status III-V
ASA III-IV OR 798 (95CI 538 ndash 1184)
0
20
40
60
80
100
120
140
160
AE per 1000 anaesthesias
I-II
III-V
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Prospective study
1092009 ndash 31082010
4660 anaesthesias
No cardiac surgery (except PDA ligation)
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
20
40
60
80
100
120
No
of
pa
tie
nts
Respiratory events 64
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
5
10
15
20
25
30
35
40
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
sept oct nov dec jan feb mar apr may june july aug
Respiratory infections and adverse events
inf
AE
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Risk factors for adverse events ASA status III-V
ASA III-IV OR 798 (95CI 538 ndash 1184)
0
20
40
60
80
100
120
140
160
AE per 1000 anaesthesias
I-II
III-V
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
0
20
40
60
80
100
120
No
of
pa
tie
nts
Respiratory events 64
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
0
5
10
15
20
25
30
35
40
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
sept oct nov dec jan feb mar apr may june july aug
Respiratory infections and adverse events
inf
AE
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Risk factors for adverse events ASA status III-V
ASA III-IV OR 798 (95CI 538 ndash 1184)
0
20
40
60
80
100
120
140
160
AE per 1000 anaesthesias
I-II
III-V
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
0
5
10
15
20
25
30
35
40
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
sept oct nov dec jan feb mar apr may june july aug
Respiratory infections and adverse events
inf
AE
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Risk factors for adverse events ASA status III-V
ASA III-IV OR 798 (95CI 538 ndash 1184)
0
20
40
60
80
100
120
140
160
AE per 1000 anaesthesias
I-II
III-V
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Risk factors for adverse events ASA status III-V
ASA III-IV OR 798 (95CI 538 ndash 1184)
0
20
40
60
80
100
120
140
160
AE per 1000 anaesthesias
I-II
III-V
Ilmoja ML Baltic Congress of Anesthesiology and Intensive Care 2010
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Age lt 1 year OR 387 (95CI 272 ndash 539)
Risk factors for adverse events age lt 1 year
0
20
40
60
80
100
120
140
lt 1 mo 1mo-1 yr 1-5 yr 6-12 yr gt 12 yr
AE per 1000 anaesthesias
resp
cardiac
vomiting
CNS
medication
other
regional
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
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
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Kaumlitumuslikud ja autonoomsed vastused valule
Maksa ensuumluumlmsuumlsteemid ja ravimite metabolism
Ravimite ja nende metaboliitide renaalne kliirens
Ravimite omastamise ja uumlmberjaotumise vanuselised aspektid
Ravimite famakoduumlnaamika vanuselised aspektid
Nasr V Davis J Pediatric Research 2015
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Opiaatide toime hingamissuumlsteemile
Opiaatretseptorite transporterite ja teiste ensuumluumlmsuumlsteemide geneetiline poluumlmorfism erinev vastus anesteesia ravimitele
Neuronite tundlikkus apoptoosi suhtes ndash nii ravimid kui haigusseisundid
Hemoduumlnaamika muutused uumlld- spinaal votildei epiduraalanalgeesias
Hormonaalne vastus haigusele votildei 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
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
GAS study sevofluraan vs spinaalanalgeesia songa operatsiooniks
NMDA glutamaat
retseptorite
inhibeerimine
Ketamiin N2O
GABA retseptorite
aktivatsioon
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
NMDA glutamaat
retseptorite
inhibeerimine
Ketamiin N2O
GABA retseptorite
aktivatsioon
Bensodiasepiinid
barbituraadid
propofool sevofluraan
Neuroapoptoos
Neurokognitiivne
defitsiit
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 memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
7 p rotid Midasolaam+N2O+isofluraan 6 tundi Tulemused widespread apoptotic neurodegeneration in the
developing brain deficits in hippocampal synaptic function persistent memorylearning impairments
Jevtovic-Todorovic et al J Neurosci 2003 bull
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
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 amp ANALGESIA 2008
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Date of download 5212015 Copyright copy 2015 American Society of Anesthesiologists All rights reserved
Concurrent noxious stimulation
attenuates ketamine-induced increase in
cyclin D1 expression Data are
presented as mean plusmn SE CFA =
complete Freunds adjuvant KET =
ketamine
Liu J et al Anesthesiology 2012
Concurrent noxious stimulation with
CFA attenuates ketamine-induced
caspase-3 activation
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Shih J et al Anesthesiology 2012
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Meeting January 1965
I have no wish nor the skill to embark upon a philosophical discussion of the meaning of causation
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Gleich S Nemergut M Flick R Curr Opin Anesthesiol 2013
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Mayo Clinic 8548 last(s1976 ndash 1982 ) Anesteesia alla 2 aasta vanuses 350 vs 700
Flick R et al Pediatrics 2011
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Gleich 2013 Bell 1965
Hazard ratio
Korstnapuumlhkija ja skrootumi vaumlhk ndash 200
Salitsuumllaadid ja Reye
suumlndroom ndash 26
Kotildehuli magamine ja SIDS ndash 126
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Anesthetic-related neurotoxicity in young children Gleich et al Curr Opin Anesthesiol 2013 26340ndash347
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
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
Anesteesia tuumlsistuste esinemissagedus Eestis on votilderreldav teiste riikidega
Anesteesia motildeju arenevale ajule vajab taumlpsustamist
