Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study
Background: Patent ductus arteriosus (PDA) is one of the most common cardiac conditions in preterm infants. Closure of the PDA in symptomatic patients can be achieved medically or surgically. Atropine is commonly administered in general anesthesia as a premedication in this age group but with limite...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-04-01
|
| Series: | Pediatrics and Neonatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957217304345 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850228761673334784 |
|---|---|
| author | Szu-Ling Chang Wen-Li Lin Chien-Hsiang Weng Shye-Jao Wu Hsin-Jung Tsai Shwu-Meei Wang Chun-Chih Peng Jui-Hsing Chang |
| author_facet | Szu-Ling Chang Wen-Li Lin Chien-Hsiang Weng Shye-Jao Wu Hsin-Jung Tsai Shwu-Meei Wang Chun-Chih Peng Jui-Hsing Chang |
| author_sort | Szu-Ling Chang |
| collection | DOAJ |
| description | Background: Patent ductus arteriosus (PDA) is one of the most common cardiac conditions in preterm infants. Closure of the PDA in symptomatic patients can be achieved medically or surgically. Atropine is commonly administered in general anesthesia as a premedication in this age group but with limited evidence addressing the effect of its use. Our study examined the association of the use of atropine as a premedication in PDA ligation and the risk of post-operative respiratory complications. Methods: This retrospective cohort study included 150 newborns who have failed medical treatment for PDA and received PDA ligation during 2008–2012 in a single tertiary medical center. Ninety-two of them (61.3%) received atropine as premedication for general anesthesia while 58 (38.7%) did not. Post-operative respiratory condition, the need of cardiopulmonary resuscitation and the presence of bradycardia were measured. Results: Patients with atropine use were associated with increased odds of respiratory acidosis in both univariate analysis (22.9% vs 7.3%; OR = 3.785, 95% CI = 1.211–11.826, p = 0.022) and multivariate analysis (OR = 4.030, 95% CI = 1.230–13.202, p = 0.021), with an even higher odds of respiratory acidosis in patients receiving both atropine and ketamine. Conclusion: The use of atropine as premedication in general anesthesia for neonatal PDA ligation is associated with higher risk of respiratory acidosis, which worsens with the combined use of ketamine. Key Words: respiratory acidosis, atropine, patent ductus arteriosus, ketamine |
| format | Article |
| id | doaj-art-e45e5072b60b4c1bb2fc8f70a8cfceb1 |
| institution | OA Journals |
| issn | 1875-9572 |
| language | English |
| publishDate | 2018-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj-art-e45e5072b60b4c1bb2fc8f70a8cfceb12025-08-20T02:04:26ZengElsevierPediatrics and Neonatology1875-95722018-04-0159213614010.1016/j.pedneo.2017.04.005Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort studySzu-Ling Chang0Wen-Li Lin1Chien-Hsiang Weng2Shye-Jao Wu3Hsin-Jung Tsai4Shwu-Meei Wang5Chun-Chih Peng6Jui-Hsing Chang7Department of Anesthesia, MacKay Memorial Hospital, Taipei 10449, Taiwan; Department of Anesthesia, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei 11267, TaiwanDepartment of Pediatrics, MacKay Children's Hospital, Taipei 10449, Taiwan; Department of Health Policy and Management, Harvard University School of Public Health, Boston, MA 02115, USANH Dartmouth Family Medicine, Concord Hospital, Concord, NH 03301, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USADivision of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 10449, TaiwanDepartment of Anesthesia, MacKay Memorial Hospital, Taipei 10449, TaiwanDepartment of Pediatrics, MacKay Children's Hospital, Taipei 10449, TaiwanDepartment of Pediatrics, MacKay Children's Hospital, Taipei 10449, TaiwanDepartment of Pediatrics, MacKay Children's Hospital, Taipei 10449, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan; Corresponding author. Department of Pediatrics, MacKay Children's Hospital, No. 92, Sec. 2, Zhongshan N. Road, Taipei 10449, Taiwan.Background: Patent ductus arteriosus (PDA) is one of the most common cardiac conditions in preterm infants. Closure of the PDA in symptomatic patients can be achieved medically or surgically. Atropine is commonly administered in general anesthesia as a premedication in this age group but with limited evidence addressing the effect of its use. Our study examined the association of the use of atropine as a premedication in PDA ligation and the risk of post-operative respiratory complications. Methods: This retrospective cohort study included 150 newborns who have failed medical treatment for PDA and received PDA ligation during 2008–2012 in a single tertiary medical center. Ninety-two of them (61.3%) received atropine as premedication for general anesthesia while 58 (38.7%) did not. Post-operative respiratory condition, the need of cardiopulmonary resuscitation and the presence of bradycardia were measured. Results: Patients with atropine use were associated with increased odds of respiratory acidosis in both univariate analysis (22.9% vs 7.3%; OR = 3.785, 95% CI = 1.211–11.826, p = 0.022) and multivariate analysis (OR = 4.030, 95% CI = 1.230–13.202, p = 0.021), with an even higher odds of respiratory acidosis in patients receiving both atropine and ketamine. Conclusion: The use of atropine as premedication in general anesthesia for neonatal PDA ligation is associated with higher risk of respiratory acidosis, which worsens with the combined use of ketamine. Key Words: respiratory acidosis, atropine, patent ductus arteriosus, ketaminehttp://www.sciencedirect.com/science/article/pii/S1875957217304345 |
| spellingShingle | Szu-Ling Chang Wen-Li Lin Chien-Hsiang Weng Shye-Jao Wu Hsin-Jung Tsai Shwu-Meei Wang Chun-Chih Peng Jui-Hsing Chang Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study Pediatrics and Neonatology |
| title | Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study |
| title_full | Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study |
| title_fullStr | Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study |
| title_full_unstemmed | Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study |
| title_short | Atropine use may lead to post-operative respiratory acidosis in neonates receiving ductal ligation: A retrospective cohort study |
| title_sort | atropine use may lead to post operative respiratory acidosis in neonates receiving ductal ligation a retrospective cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S1875957217304345 |
| work_keys_str_mv | AT szulingchang atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy AT wenlilin atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy AT chienhsiangweng atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy AT shyejaowu atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy AT hsinjungtsai atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy AT shwumeeiwang atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy AT chunchihpeng atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy AT juihsingchang atropineusemayleadtopostoperativerespiratoryacidosisinneonatesreceivingductalligationaretrospectivecohortstudy |