Pediatric Anesthesia最新文献

{"title":"Harassment and Burnout in Academic Pediatric Anesthesiology.","authors":"K Karisa Walker, Srijaya K Reddy, Nina Deutsch, Rita Agarwal, Nancy L Glass, Franklyn P Cladis","doi":"10.1111/pan.70044","DOIUrl":"10.1111/pan.70044","url":null,"abstract":"<p><strong>Background: </strong>High-profile cases of sexual harassment (SH) have drawn attention to SH in the workplace via the #MeToo movement. Many studies demonstrate SH occurring in medical training and practice. Experiencing SH correlates with long-term personal and professional detrimental effects.</p><p><strong>Aims: </strong>We sought to identify the prevalence of SH among pediatric anesthesiology fellowship program directors (PDs), associate PDs (APDs), and fellows. For comparison, we collected data about exposure to nonsexual harassment (NSH). We assessed the relationship between SH and burnout, characteristics of which overlap with documented ramifications of SH. We hypothesized our participants would report a high rate of SH, which would in turn correlate with higher levels of burnout.</p><p><strong>Methods: </strong>The Maslach Burnout Toolkit (MBT) and a sexual harassment survey were sent to PDs (n = 60) of pediatric anesthesiology fellowships to complete and distribute to APDs and fellows (~221). Results were analyzed using descriptive statistics, Chi-square test, and Fisher's exact test.</p><p><strong>Results: </strong>One hundred and sixty-three physicians completed the surveys: 41 PDs, 13 APDs, and 109 fellows. Twenty-two percent of respondents had experienced SH, 28% had witnessed SH, and 42% had experienced NSH. PDs were more likely to have experienced or witnessed SH or NSH than fellows (p < 0.05). Women were more likely to experience or witness SH. Those who experienced SH were more likely to report depersonalization (p < 0.05). Those who experienced or witnessed NSH were more likely to report emotional exhaustion and depersonalization (p < 0.05). Perpetrators of harassment were reported most commonly to be male surgical attendings.</p><p><strong>Conclusion: </strong>Harassment at work is common and may contribute to burnout among pediatric anesthesiologists. Lower incidence of SH among fellows suggests the work environment may be improving with time, but there is still work to do to ensure a safe environment for pediatric anesthesiologists.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"946-952"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992606","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":"Regulation of Intracuff Pressure by Measurement of the Ratio of Expiratory to Inspiratory Tidal Volumes.","authors":"Kelly Moon, Sibelle Aurelie Yemele Kitio, Julie Rice-Weimer, Joseph D Tobias","doi":"10.1111/pan.70045","DOIUrl":"10.1111/pan.70045","url":null,"abstract":"<p><strong>Introduction: </strong>Endotracheal tube (ETT) cuff pressures that exceed 20-30 cmH₂O may lead to iatrogenic adverse effects such as cough, sore throat, and tracheal edema or more serious complications including tracheal stenosis, recurrent laryngeal nerve injury, and tracheal rupture. The current study evaluates a novel technique, titration of the ratio of expiratory to inspiratory tidal volumes (TV), to regulate intracuff pressure.</p><p><strong>Methods: </strong>This prospective, cross-over trial measured intracuff pressure in a cohort of pediatric patients presenting for general anesthesia with an ETT. Intracuff pressure was measured following adjustment of the expiratory to inspiratory TV to various ratios (1.0, 0.9, and 0.8) by slow removal of air from the ETT cuff.</p><p><strong>Results: </strong>The study cohort included 50 patients with a median age of 12 years. At baseline continuous positive airway pressure (CPAP), the median (IQR) intracuff pressure was 20.4 cmH₂O (13.6, 28.8). The intracuff pressure decreased to 12.2 cmH₂O (10.2, 18.4) at an expired tidal volume (TV_e) to inspired tidal volume (TV_i) ratio of 1, 8.9 cmH₂O (7.4, 10.9) at 0.9, and to 8.2 cmH₂O (6.8, 9.5) at a ratio of 0.8. With both the CPAP method and TVe/TVi ratio of 1, there were cuff pressures greater than 30 cmH₂O (10 with CPAP and 2 with TVe/TVi ratio of 1). With a TVe/TVi ratio of 0.9 or 0.8, there were no cuff pressures greater than 30 cmH₂O.</p><p><strong>Conclusions: </strong>Adjustment of the TVe/TVi may be a more effective means of ensuring that the cuff pressure is in the desired range than other conventionally used clinical techniques such as sealing the airway to a CPAP of 20 cmH₂O.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT02768831.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"940-945"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006417","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":"Editor's Picks for the Pediatric Anesthesia Article of the Day: December 2024.","authors":"Melissa Brooks Peterson, Justin L Lockman, Myron Yaster","doi":"10.1111/pan.70025","DOIUrl":"https://doi.org/10.1111/pan.70025","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":"35 11","pages":"987-988"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239325","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":"Regional Anesthesia in Resource-Constrained Settings: A Chance to Ameliorate Pediatric Perioperative Care.","authors":"Madeeha Rasheed, Mohsin Nazir","doi":"10.1111/pan.70000","DOIUrl":"10.1111/pan.70000","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"983-984"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326416","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":"Airway Management in Children Undergoing Cleft Lip or Cleft Palate Surgery: An 8-Year Retrospective Analysis of 274 Cases.","authors":"Johannes Feyrer, Andrea Irouschek, Tobias Golditz, Joachim Schmidt, Rainer Lutz, Marco Kesting, Andreas Moritz","doi":"10.1111/pan.70038","DOIUrl":"10.1111/pan.70038","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Orofacial malformations, especially when associated with syndromes, may complicate airway management in children. However, only a few studies have addressed the airway management in children undergoing cleft lip and/or palate surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To report on perioperative airway management and complications in children undergoing cleft lip or palate surgery over an 8-year retrospective period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective analysis of patients younger than 2 years of age who underwent surgery for cleft lip or palate at the Department of Oral and Cranio-Maxillofacial Surgery of a German university hospital between 2016 and 2023. The study assessed patient demographics, airway management techniques, airway management difficulties, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the observation period, 274 cases were included. Difficult laryngoscopy occurred in 16 cases (6%). Direct laryngoscopy failed in five cases (1.9%), leading to successful video-laryngoscopic intubation. There was a noticeable higher incidence of difficult laryngoscopy (16.7% vs. 5.3%) and failed direct laryngoscopy (11.1% vs. 1.2%) in cleft patients with a syndrome association. In eight cases (2.9%) with an expected difficult airway, a primary hybrid technique was used for intubation due to a proven syndromic disorder. Airway complications were significantly more common in patients associated with a syndromic disorder (40.7% vs. 23.5%; p = 0.049, φ = 0.12).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Airway management in children undergoing cleft lip or palate surgery presents unique challenges, with an increased incidence of difficult and failed direct laryngoscopy and a significantly higher rate of complications in patients with a syndromic disorder. Video laryngoscopy and, if a difficult airway is anticipated, a hybrid technique for intubation is a safe and effective approach to airway management in these patients. However, the postextubation period can be very challenging, particularly in patients with associated syndromes. Epinephrine inhalation may prevent reintubation and ventilated admission to the intensive care unit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Cleft lip and palate significantly complicate airway management, especially in infants with syndromic conditions. It was already known that these children are at higher risk for difficult intubation and respiratory complications. The new findings of this study, analyzing 274 procedures in children under 2 years, found that the hybrid technique (video laryngoscopy combined with flexible bronchoscopy) is highly effective for anticipated difficult airways and highlights the importance of an individualized, stepwise approach to ensure safe anesthesia in cleft surgery. Additionally, the study identified a higher incidence of postextubation stridor, particularly in syndromic patients, pointing to the need for tailored postoperative ","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"925-933"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859523","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":"Anesthesia Management of Pediatric Victims After the February 6, 2023, Kahramanmaraş Earthquake at a Third-Level Hospital.","authors":"Sengül Özmert, Melike Demir Işıktekin, Tuğba Nur Taygurt, Sema Civelek, Tuba Bayir, Rabia Bayar, Süleyman Arif Bostancı, Niyazi Erdem Yaşar","doi":"10.1111/pan.70039","DOIUrl":"10.1111/pan.70039","url":null,"abstract":"<p><strong>Introduction: </strong>Earthquakes are chaotic events that cause severe physical and psychological devastation. Due to their anatomical and physiological differences and fragile nature, pediatric earthquake survivors require special attention in anesthesia management. This retrospective study aims to share our experiences and anesthesia techniques applied to pediatric earthquake victims in our tertiary care pediatric hospital. Furthermore, the study aimed to determine the time spent under rubble cutoff value for the development of crush syndrome and creatine kinase cutoff value for the development of acute kidney injury in child earthquake victims.</p><p><strong>Methods: </strong>Child earthquake victims under the age of 18 who underwent anesthesia in our hospital after the earthquake that occurred on February 6, 2023, were included in this study. Demographic data, Glasgow Coma Scale scores at admission, the time spent under rubble, existing injuries, Injury Severity Score, presence of crush syndrome and acute kidney injury, need for hemodialysis, length of hospital and intensive care unit stay, type of surgical intervention, and preoperative and discharge laboratory results were analyzed. The type of anesthetic agents used and airway management techniques were recorded.</p><p><strong>Results: </strong>A total of 45 pediatric earthquake victims underwent 362 surgical interventions. Extremity injuries were more common in our patients. We most frequently administered the MAC technique to our patients using sedation and ketamine-based general anesthesia. For airway management, nasal O₂ support (44.0%) and SGA (43.2%) were most commonly used. The mean Injury Severity Score was calculated as 22.18 (95% CI: 19.17-25.18). We found that a cutoff value of ≥ 22.5 min spent under debris strongly predicted the development of crush syndrome, and a creatine kinase cutoff value of ≥ 32 029 IU/L strongly predicted the development of AKI.</p><p><strong>Conclusion: </strong>The findings of our study may serve as a guide for anesthesia management and perioperative processes in pediatric earthquake victims in future disaster scenarios.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06310265.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"969-976"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963916","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":"Preoperative Virtual Reality for Pediatric Patients Undergoing General Anesthesia: A Meta-Analysis of Randomized Controlled Trial.","authors":"Difang Zhao, Ting Tian, Shuguang Jin","doi":"10.1111/pan.70016","DOIUrl":"10.1111/pan.70016","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pediatric patients undergoing general anesthesia often face stress responses, anesthetic challenges, and delayed recovery. Virtual reality has emerged as a promising non-pharmacological intervention, though its effectiveness varies across studies. This meta-analysis evaluates the effects of preoperative virtual reality interventions on various outcomes in pediatric patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for randomized controlled trials with intention-to-treat analysis comparing preoperative virtual reality interventions with standard care in pediatric patients undergoing general anesthesia. Primary outcomes included preoperative anxiety (Modified Yale Preoperative Anxiety Scale, change in Modified Yale Preoperative Anxiety Scale) and compliance during anesthesia induction (Induction Compliance Checklist). Secondary outcomes included preoperative fear (Children's Fear Scale), procedural behavior (Procedural Behavior Rating Scale), postoperative pain (Face, Legs, Activity, Cry, Consolability scale, Wong-Baker FACES Pain Rating Scale), postoperative delirium (Pediatric Anesthesia Emergence Delirium scale), and parental satisfaction. Data were analyzed using Review Manager 5.4.1, with results presented as weighted mean differences and odds ratios with 95% confidence intervals. Certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation) were also assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twelve RCTs were included. Compared to the control group, the virtual reality group had lower Modified Yale Preoperative Anxiety Scale scores (weighted mean difference: -12.69, 95% confidence interval: -16.17 to -9.20, p &lt; 0.001, low evidence), greater change in Modified Yale Preoperative Anxiety Scale scores (weighted mean difference: -9.54, 95% confidence interval: -12.98 to -6.10, p &lt; 0.001, low evidence), lower Induction Compliance Checklist scores (weighted mean difference: -1.67, 95% confidence interval: -2.02 to -1.32, p &lt; 0.001, low evidence), lower Children's Fear Scale scores (weighted mean difference: -2.30, 95% confidence interval: -2.54 to -2.07, p &lt; 0.001, moderate evidence), lower Procedural Behavior Rating Scale scores (weighted mean difference: -1.00, 95% confidence interval: -1.12 to -0.88, p &lt; 0.001, moderate evidence), lower Face, Legs, Activity, Cry, Consolability scale scores (weighted mean difference: -0.26, 95% confidence interval: -0.35 to -0.18, p &lt; 0.001, moderate evidence), lower Wong-Baker FACES Pain Rating Scale scores (weighted mean difference: -0.44, 95% confidence interval: -0.61 to -0.28, p &lt; 0.001, moderate evidence), and higher parental satisfaction scores (weighted mean difference: 0.68, 95% confidence interval: 0.59 to 0.77, p &lt; 0.001, moderate evidence). For categorical Induction Compliance Checklist, the virtual reality group showed significantly more perfect scores (odds ratio: 3.53, 95% confi","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"889-903"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691181","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":"Safe Selection: A Multi-Center Analysis of Exclusion Criteria in Pediatric Ambulatory Surgery Centers.","authors":"Vasili Chernishof, Sameh Nour, Shiu-Yi Emily Chen, Yu Bin Na, Laura Prichett, Samuel M Vanderhoek","doi":"10.1111/pan.70037","DOIUrl":"10.1111/pan.70037","url":null,"abstract":"<p><strong>Background: </strong>In the United States, over a quarter of outpatient pediatric procedures take place in ambulatory surgery centers (ASCs). Previous studies have identified substantial variability in clinical staffing, pediatric-specific training, and policy development among ASCs that provide pediatric care.</p><p><strong>Aims: </strong>To characterize and compare the exclusion criteria currently used in ASCs affiliated with pediatric hospital systems across the continental United States.</p><p><strong>Methods: </strong>In this descriptive study, we solicited exclusion guidelines from the 30 largest pediatric hospitals representing each geographic region in the continental United States. Additionally, we surveyed each institution regarding the physical configuration of its ambulatory surgery center, as well as the availability of ancillary site support and the center's proximity to the parent institution.</p><p><strong>Results: </strong>While there was general consistency in excluding children with a history of congenital heart disease, pulmonary conditions, and difficult airway, we found considerable heterogeneity in minimum age thresholds, obesity criteria, and recent respiratory infection. Additionally, there was variation in ambulatory surgery center proximity to its parent institution, resources available at the facility, and capacity for extended observation beyond same-day discharge.</p><p><strong>Conclusions: </strong>These findings highlight the need for standardized, evidence-based guidelines that balance consistency with site-specific flexibility to ensure safe and efficient care for pediatric patients in ambulatory surgery settings.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"962-968"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855955","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":"Editor's Picks for the Pediatric Anesthesia Article of the Day: April 2025.","authors":"Melissa Brooks Peterson, Justin L Lockman, Myron Yaster","doi":"10.1111/pan.70022","DOIUrl":"https://doi.org/10.1111/pan.70022","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":"35 11","pages":"989-990"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239331","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":"Repeated Exposure to Anesthesia Short-Course Training of Non-Physician Anesthesia Providers and the Incidence of Intraoperative Hypoxemia in a Low-Resource Hospital in Tanzania.","authors":"Simon Ponthus, Amina Omari, Selerina Tesha, Silas Msangi, Lionel Dumont","doi":"10.1111/pan.70002","DOIUrl":"10.1111/pan.70002","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"977-980"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333694","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}