Pediatric Anesthesia最新文献

{"title":"Anesthetic Considerations in Unvaccinated Pediatric Patients.","authors":"Michael McNally, John McNally","doi":"10.1111/pan.15126","DOIUrl":"10.1111/pan.15126","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"664-665"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombotic Complications of Low-Dose Versus High-Dose Four-Factor Prothrombin Complex Concentrate for Massive Bleeding in Pediatric Cardiovascular Surgery.","authors":"Laura Palacio-Guzmán, Sergio Alzate-Ricaurte, Natalia Plata-Ayala, Andres Pombo-Jiménez, Gustavo Adolfo Cruz-Suarez","doi":"10.1111/pan.15118","DOIUrl":"10.1111/pan.15118","url":null,"abstract":"<p><strong>Introduction: </strong>Major bleeding is a life-threatening complication in pediatric cardiovascular surgery, particularly in neonates and infants with immature coagulation systems and congenital heart defects (CHD). Cardiopulmonary bypass (CPB) exacerbates these risks by depleting coagulation factors and platelets. Four-factor prothrombin complex concentrates (4F-PCC) provide targeted hemostatic correction but carry potential thrombotic risks.</p><p><strong>Methods: </strong>Among 1296 pediatric patients who underwent cardiovascular surgery between January 2018 and April 2024, a retrospective cohort study analyzed 104 patients who received 4F-PCC. Patients were grouped into low-dose (< 35 U/kg) and high-dose (≥ 35 U/kg). Thrombotic complications were evaluated within 15 days after use.</p><p><strong>Results: </strong>The median age was 1 month (IQR: 0-7.5), and 69.23% of patients were male. Common diagnoses included hypoplastic left heart syndrome (14.42%), ventricular septal defect (13.46%), and coarctation of the aorta (12.5%). Frequent procedures included Norwood procedure (14.42%) and ventricular septal defect closure (13.46%). Thrombotic complications occurred in 6.73% overall, with no significant differences between high-dose (5.26%) and low-dose (8.51%) groups (p = 0.698). High-dose 4F-PCC was associated with shorter CPB times (p = 0.007) (Cohen's d 0.537) but higher reintervention rates (57.89% vs. 34.04%; p = 0.015) (Cramér's V 0.118).</p><p><strong>Conclusion: </strong>High-dose 4F-PCC was not associated with increased thrombotic complications. Thrombotic complications in this study were inferior to all-cause thrombotic complications in pediatric cardiovascular surgery of 11%. These findings support 4F-PCC as a viable option for managing severe bleeding in pediatric cardiovascular surgery. Further studies should explore dose optimization and preventive applications.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"619-626"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic Effects of Altering Tidal Volume During Positive Pressure Ventilation in the Fontan Circulation: A Randomized Crossover Trial.","authors":"Manchula Navaratnam, Alexander R Schmidt, Michelle Kaplinski, Elizabeth De Souza, Meaghan J Beattie, Echo V Rowe, Rajesh Punn, Chandra Ramamoorthy","doi":"10.1111/pan.15096","DOIUrl":"10.1111/pan.15096","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Primary determinants of pulmonary blood flow in the Fontan circulation are low transpulmonary gradient and pulmonary vascular resistance (PVR). Changes in intrathoracic pressure during intermittent positive pressure ventilation can influence the transpulmonary gradient, PVR, pulmonary blood flow, and cardiac output. The aim of this study was to evaluate the effect of low (5 mL/kg) versus high (10 mL/kg) tidal volume (V&lt;sub&gt;T&lt;/sub&gt;) ventilation on Fontan circulation hemodynamics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Postoperative patients with a Fontan circulation were enrolled in this single-center, randomized crossover trial. Patients, randomized to group 1 or 2, underwent a ventilation study sequence (baseline ventilation [7 mL/kg], then high V&lt;sub&gt;T&lt;/sub&gt; [10 mL/kg] or low V&lt;sub&gt;T&lt;/sub&gt; [5 mL/kg], then washout ventilation [7 mL/kg], followed by low [5 mL/kg] or high V&lt;sub&gt;T&lt;/sub&gt; [10 mL/kg]) in the operating room at the end of the cardiac surgical procedure. Respiratory, hemodynamic, and transesophageal (TEE) measurements were recorded after 5 min in each ventilation condition. The primary aim of this study was to evaluate the effect of low V&lt;sub&gt;T&lt;/sub&gt; ventilation (5 mL/kg) versus high V&lt;sub&gt;T&lt;/sub&gt; ventilation (10 mL/kg) on transpulmonary gradient (Fontan pressure minus left atrial pressure). The secondary aim was to compare TEE measurements of pulmonary blood flow, stroke volume, and Fontan flow between low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation. We also compared standard hemodynamic and ventilation parameters for all ventilation conditions. Analysis was of paired data, calculating the between-treatment difference within participants across ventilation conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eleven patients were included in the final data analysis with a median [IQR] age of 5 [4, 11] years and weight of 16.3 [13.8, 31.6] kg. The mean (±SD) peak inspiratory pressure during low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation was 15.3 (±2.9) cmH&lt;sub&gt;2&lt;/sub&gt;O and 22.2 (±3.7) cmH&lt;sub&gt;2&lt;/sub&gt;O, respectively (difference -6.9, 95% CI -7.8, -5.9, p &lt; 0.001). The mean airway pressure during low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation was 7.3 ± 0.8 and 8.7 ± 0.9 (difference -1.5, 95% CI -2.1, -0.8, p = 0.001) with a mean inspiratory time of 0.62 (±0.22) s and 1.21 (±0.55) s (difference -0.59, 95% CI -0.84, -0.34, p &lt; 0.001), respectively. During low V&lt;sub&gt;T&lt;/sub&gt; ventilation, the mean Fontan pressure was 13.3 (±1.8) mmHg compared to 12.3 (±2.5) mmHg for high V&lt;sub&gt;T&lt;/sub&gt; ventilation (difference 0.8, 95% CI -0.5, 2.1, p = 0.18). The mean transpulmonary gradient was 7.0 ± 1.3 mmHg compared to 6.8 ± 1.2 mmHg during low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation, respectively (difference 0.2, 95% CI -0.2, 0.6, p = 0.21). We found no significant differences between low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation in TEE measures of pulmonary blood flow, stroke volume, and Fontan flow.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This randomized, crossover pilot trial of Fo","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"607-618"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Prophylactic Use of Antifibrinolytics During Pediatric Non-Cardiac Surgeries on Bleeding and Transfusions: A Systematic Review and Meta-Analysis.","authors":"Katherine Schertz Hickey, Morgan Smith, Oliver Karam, Michelle Demetres, David Faraoni, Vincent Duron, Yeu Sanz Wu, Marianne E Nellis","doi":"10.1111/pan.15137","DOIUrl":"10.1111/pan.15137","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this meta-analysis is to determine the effect of intraoperative tranexamic acid, aminocaproic acid, and aprotinin on bleeding in pediatric surgery.</p><p><strong>Study design: </strong>A literature search was performed for the meta-analysis and systematic review in the following databases from inception until April 2023: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies included patients under 18 years of age, non-cardiac surgery, and administration of antifibrinolytics. Forest plots were used for statistical analysis. Primary outcomes were intraoperative blood loss and intraoperative blood transfusions.</p><p><strong>Results: </strong>One hundred thirty articles met inclusion. Tranexamic acid compared to control resulted in an estimated blood loss of -410.0 mL p-value = < 0.001 for scoliosis surgery, -14.0 mL/kg p-value = < 0.001 for craniofacial surgery, and -21.0 mL p-value < 0.001 for tonsillectomy/adenoidectomy surgery. Aminocaproic acid compared to control resulted in an estimated blood loss of -464.0 mL p-value < 0.001 for scoliosis surgery. Tranexamic acid compared to aminocaproic acid resulted in an estimated blood loss of -391.0 mL p-value < 0.001 for scoliosis surgery. For blood transfusion during craniosynostosis surgery, tranexamic acid compared to control resulted in a mean decrease of -7 mL/kg p-value = 0.010 and aprotinin compared to control resulted in a mean decrease of -20.0 mL/kg p-value < 0.001. The analysis for VRO/VDRO and hip reconstruction did not reach statistical significance.</p><p><strong>Conclusions: </strong>In craniofacial, scoliosis, and tonsillectomy/adenoidectomy surgery, prophylactic administration of tranexamic acid results in lower estimated blood loss. Tranexamic acid and aprotinin are effective for reducing transfusion in craniofacial surgery. For scoliosis surgery, tranexamic acid is more efficacious than aminocaproic acid. More literature is needed to assess the efficacy of tranexamic acid in VRDO/VRO and hip reconstruction surgery and the efficacy of different dosing regimens.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"668-683"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Outcomes for Children With Cardiomyopathy Undergoing Noncardiac Procedures.","authors":"Jia Liu, Robert Przybylski, Mikaela J Mari, Carine Foz, Ryan L Kobayashi, Dominic Abrams, Viviane G Nasr","doi":"10.1111/pan.15120","DOIUrl":"10.1111/pan.15120","url":null,"abstract":"<p><strong>Background: </strong>Pediatric cardiomyopathy is rare with an estimated annualized incidence of just over 1 per 100 000 children. However, many of these children have systemic disorders underlying their cardiomyopathy, including RASopathies, muscular dystrophies, and inborn errors of metabolism, and thus may require noncardiac procedural interventions or diagnostic studies. There is a paucity of data about the rate and nature of periprocedural complications and outcomes in this patient population.</p><p><strong>Aims: </strong>This study aims to describe children with cardiomyopathy undergoing procedures or diagnostic studies requiring anesthesia, and their perioperative outcomes.</p><p><strong>Methods: </strong>We performed a single-center retrospective cohort study using each procedural event as the unit of analysis. Perioperative (intraoperative and 72 h postoperatively) data and outcomes were recorded. Logistic regression was used to identify risk factors for adverse events.</p><p><strong>Results: </strong>We identified 98 patients who underwent a total of 231 procedures. There were 26 total adverse events (11%), including four major adverse events (involving three distinct patients). ASA-PS class 4 status was associated with an increased likelihood of any adverse event, and all the patients who experienced major adverse events had moderate or greater left ventricular dysfunction.</p><p><strong>Conclusions: </strong>Anesthesia in children with cardiomyopathy is associated with a low (< 2%), but notable, rate of major adverse events. The risk of major adverse events appears to be highest in children with marked left ventricular dysfunction and was often associated with respiratory events in our cohort.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"649-656"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of EEG-Derived Wavelet Index for End-Tidal Sevoflurane in Pediatric Anesthesia: A Prospective, Single-Blind Study.","authors":"Jing Jiang, Yinzhi Dan, Yue Huang, Jijian Zheng, Kan Zhang","doi":"10.1111/pan.15127","DOIUrl":"10.1111/pan.15127","url":null,"abstract":"<p><strong>Background: </strong>Processed electroencephalogram is able to assess the depth of anesthesia. EEG-derived wavelet index (WLi) is a novel indicator derived from EEG on the basis of wavelet analysis.</p><p><strong>Aims: </strong>We primarily tested whether WLi can reflect changes in end-tidal sevoflurane (sevo_ET) in pediatric patients, especially during the transition from awake status to 0.6 MAC. We then explored the concentration-effect relationship between sevo_ET and WLi and tested the effect of age on WLi.</p><p><strong>Methods: </strong>This prospective, single-blind study was performed at a tertiary care hospital affiliated with Shanghai Jiao Tong University School of Medicine, China. WLi and BIS were measured in 40 pediatric patients aged 6 months to 6 years who underwent elective surgeries after sevo_ET was maintained at 2.0, 1.3, and 0.6 age-adjusted MAC in stepwise decrements.</p><p><strong>Results: </strong>WLi and BIS had comparable performance in predicting the transition of anesthesia status from awake to sevo_ET at 0.6 MAC and from 1.3 to 2.0 MAC. In contrast to BIS, WLi exhibited a plateau effect and failed to predict the transition from 0.6 to 1.3 MAC. The indicator-specific performance of prediction was supported by their concentration-effect relationships, with EC₅₀ of 0.38 MAC for WLi and 0.95 MAC for BIS. Further, we found that the WLi values between individuals were independent of age.</p><p><strong>Conclusions: </strong>WLi can reflect the transition of anesthesia status from light to moderate sedation, and the plateau effect might indicate adequate depth of anesthesia during deeper sedation and general anesthesia.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"657-663"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a Patient-Reported Outcome (PRO) Questionnaire to Assess Postoperative Care Following Pediatric Outpatient Surgery.","authors":"Hjördis Osk Atladottir, Anne Treschow Phillipsen, Karen Arnt Krøyer, Anne Gade Jensen, Liv Marit Valen Schougaard, Peter Ahlburg","doi":"10.1111/pan.15111","DOIUrl":"10.1111/pan.15111","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, there has been a marked rise in the incidence of pediatric day surgery across Western countries. As postoperative recovery transitions to the home environment, it is incumbent on healthcare systems to develop methods for patient follow-up and caregiver support.</p><p><strong>Aim: </strong>To describe a method of monitoring the postoperative home treatment of children, as well as giving families appropriate support and guidance.</p><p><strong>Method: </strong>We developed and implemented an electronic patient-reported outcome (PRO) questionnaire, designed to assist parents in assessing and managing pediatric postoperative care at home following day surgery. We present questionnaire response rates, reasons for nonresponse, and the frequency and causes of postdischarge contact with the hospital.</p><p><strong>Results: </strong>Since its implementation in 2020, our PRO questionnaire has captured postoperative home-care data from 530 families. The questionnaire facilitated the identification of 157 families requiring additional postoperative support following discharge. The primary postoperative complication identified was pain, with nausea and vomiting being less frequently reported as isolated concerns.</p><p><strong>Conclusion: </strong>We have found the use of a postdischarge electronic questionnaire helpful in the postoperative care and provision of timely guidance to families.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"590-597"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flipping the Conditional: Why We Are Probably Wrong About Probabilities.","authors":"David Sidebotham, Tim Dare","doi":"10.1111/pan.15133","DOIUrl":"10.1111/pan.15133","url":null,"abstract":"<p><p>Flipping the conditional is an error of reasoning that occurs when we inadvertently transpose the terms in a conditional probability. A conditional probability arises when the probability of an event occurring (e.g., a positive test result) depends on another event being true (e.g., the presence of a disease). The ordering of terms in a conditional probability is crucially important, and the consequences of transposing the terms can be severe. The error of reasoning is most easily entertained when events are very rare. Flipping the conditional explains why we sometimes misinterpret clinical and diagnostic tests and also underpins a phenomenon known as the \"prosecutor's fallacy\". Flipping the conditional occurs when we confuse the sensitivity of a diagnostic test with the positive predictive value. The prosecutor's fallacy involves confusing the probability a person is guilty given the evidence with the probability of the evidence given they are guilty. Perhaps the best-known example of the prosecutor's fallacy is that of UK solicitor Sally Clark, who in 1990 was convicted of murdering her two infant sons. Recently, the prosecutor's fallacy has again been in the news, with respect to the statistical evidence presented at the trial of UK nurse, Lucy Letby. In this article, we define the concept of conditional probability and discuss some examples of flipping the conditional that are relevant to pediatric anesthesia and to medical evidence presented at trial.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"584-589"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia Delivery in Humanitarian Context: Lessons From the Front Line.","authors":"Rodrigo Lopez-Barreda","doi":"10.1111/pan.15108","DOIUrl":"10.1111/pan.15108","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"666-667"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fontan Enigma: Ventilating Between Lows and Highs.","authors":"Mona Momeni, Thierry Detaille","doi":"10.1111/pan.15131","DOIUrl":"10.1111/pan.15131","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"582-583"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}