Background

Pneumopericardium is a rare air-leak syndrome caused by abnormal presence of air in the pericardial space, with potentially high risk of morbidity and mortality. Clinically, it can be divided in non-tension and tension pneumopericardium, the latter resulting in a decreased cardiac output and circulatory failure. Scant data are available on non-traumatic tension pneumopericardium in non-ventilated patients.

Objectives

To describe a case of tension pneumopericardium and review the pertinent literature.

Methods

Case report and review of the literature (Pubmed search) of non-traumatic and non-ventilated pneumopericardium in children.

Results

Case: A 2-month-old infant developed cardiac tamponade due to tension pneumopericardium 11 days after cardiac surgery. The prompt treatment with pericardium drainage resolved the critical clinical conditions.

Literature review: 55 cases of pneumopericardium retrieved, a minority of which were tension pneumopericardium (17/55, 30.9%). Patients with tension pneumopericardium were predominantly males 12/16 (75.0%) with a mean age of 4.8 years. Most of the patients with non-tension pneumopericardium were children (21/38, 55.3%); patients with tension pneumopericardium were mainly newborns (6/17, 35.3%). The etiologies are reported in Figure 1. Conservative treatment was performed in all cases of non-tension pneumopericardium and pericardiocentesis in all other cases. Overall, the majority of the patients survived (41/51, 80.3%); with a lower survival rate among patients with tension pneumopericardium (62.5% vs 88.6%).

Conclusion

Pneumopericardium is a rare condition with a higher mortality rate in patients with tension pneumopericardium which requires immediate diagnosis and treatment. In non-ventilated patients tension pneumopericardium presents in younger ages, especially in patients with a history of surgery and leukemia.

Background

Electroencephalogram (EEG) is difficult to be performed in children with behavioural disorders without sedation. Dexmedetomidine, a safe highly selective α2-agonist sedative, does not affect EEG results.

Objectives

To evaluate the efficacy and safety of sedation with dexmedetomidine for EEG recordings in children with behavioural disorders.

Methods

Prospective observational study on children with behavioural disorders who had to undergo an EEG at the paediatric hospital in Padova, Italy. A bolus of dexmedetomidine (2 mcg/kg over 10 min) was administered, followed by an infusion (1-2 mcg/kg/h). The bolus could be repeated up 3 times to reach the target level of sedation assessed by the Pediatric Sedation State Scale. Vital signs (including EtCO2) were recorded before, during and after the procedure until complete recovery. EEG recording quality, and caregivers’ opinion on the quality of sedation and quality of sleep at home was assessed.

Results

For this preliminary study 13 patients were enrolled. Efficacy was 100%. Mean total dose of dexmedetomidine was 3,24±0,95 mcg/kg. Adequate sedation was achieved within 12±8,7 minutes. Time to first awakening was 24±25.5 minutes and to complete recovery 65±50 minutes. Adverse effects (hypotension, bradycardia) were reported in 6 patients and classified as “minor” requiring no intervention. EEG recording quality was good or excellent in 100% of patients. Parents referred an excellent quality of the procedure and a low incidence of sleep disorders.

Conclusion

Dexmedetomidine showed an excellent efficacy and good safety profile for EEG recording. More data are needed to confirm our preliminary findings.

Background

Children’s poor compliance during imaging requiring prolonged immobilization, such as MRI, often requires the use of sedative drugs. Dexmedetomidine is a high selective α2-agonist sedative drug, which can be used for this purpose.

Objectives

To evaluate the effectiveness, safety and feasibility of dexmedetomidine for sedation during MRI in non-cooperative children, providing additional data on the most appropriate dosage and time of administration.

Methods

This is a prospective observational study conducted at the paediatric hospital of Padua, Italy, including uncooperative children who had to undergo a brain MRI. Dexmedetomidine iv loading dose of 2 mcg/kg in 10 minutes (up to 3 times) was administered, followed by continuous infusion at 1-2 mcg/kg/h. Level of sedation (Pediatric Sedation State Scale), vital signs (including EtCO2), adverse effects and quality of MRI were recorded.

Results

Twenty-eight children were enrolled. Efficacy was 96.4%. Mean total dose was 3.44±2 mcg/kg. Adequate sedation was achieved within 10 minutes in 71.4%, time to first awakening was 23.8±31.5 minutes and to complete recovery 92.7±57.8 minutes. Adverse effects were haemodinamic and reported in 6 patients: all of them were classified as “minor” according to SIVA score and required no intervention. No respiratory adverse events were recorded. MRI quality was excellent (76.5%) or good (23.5%).

Conclusion

Dexmedetomidine showed a high efficacy and good safety profile for MRI sedation at the dosage regimen used. More data are needed to further validate our preliminary findings.