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Collection: Attention deficit and hyperactivity disorder
Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by inattention, hyperactivity, and impulsivity. It is most commonly diagnosed in childhood, with a male predominance (approximately 2-3:1), though symptoms often persist into adulthood. Global prevalence is estimated at ~5-7% in children and ~2-3% in adults. Meta-analyses show ADHD is primarily genetic with 70–80% heritability.
Anesthesia issues
1. Medication considerations
   • Stimulants (methylphenidate, amphetamines)
     • May increase sympathetic tone (tachycardia, hypertension, arrhythmias)
     • Possible attenuation of response to indirect-acting vasopressors (e.g. ephedrine, metaraminol); prefer direct-acting agents (phenylephrine, epinephrine)
     • Withdrawal or omission perioperatively may cause fatigue, irritability, behavioural instability.
     • Possible altered anaesthetic requirements; stimulants may increase MAC slightly, though evidence is inconsistent.
   • Non-stimulants (atomoxetine, guanfacine, clonidine) - α2-agonists (guanfacine, clonidine) can potentiate sedation and hypotension.
     
2. Behavioural and perioperative management
   • Difficulty with preoperative cooperation and anxiolysis (may need structured preparation, early anxiolytic use, or parental presence in paediatrics); Increased anxiety or agitation in unfamiliar environments.
   • Impulsivity may increase risk of perioperative non-adherence (e.g. fasting rules, device removal).
   • Higher risk of emergence agitation or delirium, especially in children.
   • May display increased postoperative anxiety, irritability, or oppositional behaviour
   • Pain perception and reporting may be inconsistent, complicating assessment and analgesia planning.
3. Comorbidities
   • High association with anxiety, depression, and substance use disorders (impact on anaesthetic planning and perioperative risk)
   • Sleep disturbances common, may complicate recovery and pain management
  Daniel Jolley
pearl
1
Acetaminophen use during pregnancy was not associated with children's risk of autism, ADHD, or intellectual disability in sibling control analysis.
Ahlqvist VH, Sjöqvist H, Dalman C et al. Acetaminophen Use During Pregnancy and Children's Risk of Autism, ADHD, and Intellectual Disability. JAMA. 2024 Apr 9; 331 (14): 120512141205-1214.
  Daniel Jolley
pearl
1
"According to the current scientific evidence, in utero exposure to acetaminophen is unlikely to confer a clinically important increased risk of childhood ADHD or ASD."
Damkier P, Gram EB, Ceulemans M et al. Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autism Spectrum Disorder. Obstet Gynecol. 2025 Feb 1; 145 (2): 168176168-176.
  Daniel Jolley
pearl
1
Prophylactic phenylephrine infusion is superior to bolus dosing in avoiding maternal hypotension in women receiving neuraxial anaesthesia for caesarean section, although is also associated with more hypertension and bradycardia.
Garg H, Narayanan V, Khanna P et al. Comparison of Phenylephrine Bolus and Infusion Regimens on Maternal and Fetal Outcomes During Cesarean Delivery: A Systematic Review and Meta-Analysis. Anesth. Analg. 2024 Dec 1; 139 (6): 114411551144-1155.
  Daniel Jolley
pearl
1
Higher fresh gas flows during TIVA reduce costs without increasing environmental impact compared to low-flow techniques.
Zhong G, Abbas A, Jones J et al. Environmental and economic impact of using increased fresh gas flow to reduce carbon dioxide absorbent consumption in the absence of inhalational anaesthetics. Br J Anaesth. 2020 Nov 1; 125 (5): 773778773-778.
  Daniel Jolley
pearl
1
Large Lanuguage Models may outperform physicians on diagnostic tasks, but simply providing access to AI tools does not improve doctors' diagnostic reasoning without effective integration.
Goh E, Gallo R, Hom J et al. Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial. JAMA Netw Open. 2024 Oct 1; 7 (10): e2440969e2440969.
  Daniel Jolley
pearl
1
When suitable for the surgery, using an LMA instead of ETT may reduce postoperative atelectasis by allowing faster airway placement and requiring less muscle relaxation.
Liu B, Wang Y, Li L et al. The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial. J Clin Anesth. 2024 Nov 1; 98: 111564111564.
  Daniel Jolley
pearl
1
General anaesthesia, particularly with optimised ventilation strategies (either HFJV or HFLTV), appears to improve AF ablation outcomes through enhanced catheter stability.
Ford P, Cheung AR, Khan MS et al. Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review. J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 275427602754-2760.
  Daniel Jolley
pearl
1
Intraopertive autonomic blockade reduces remifentanil consumption during laparoscopic sleeve gastrectomy.
Daes J, Pantoja R, Luquetta J et al. Impact on Anesthetic Agent Consumption After Autonomic Neural Blockade as Part of a Combined Anesthesia Protocol: A Randomized Clinical Trial. Anesth. Analg. 2024 Sep 1; 139 (3): 581589581-589.
  Daniel Jolley
pearl
1
Dexamethasone is the most effective adjuvant for prolonging local anaesthetic infiltration, likely superior to dexmedetomidine, clonidine, NSAIDs, opioids and magnesium.
Schubert AK, Wiesmann T, Wulf H et al. The analgetic effect of adjuvants in local infiltration analgesia - a systematic review with network meta-analysis of randomized trials. J Clin Anesth. 2024 Oct 1; 97: 111531111531.
  Daniel Jolley