Pediatric Anesthesia最新文献

{"title":"Evaluation of the Pediatric Regional Anesthesia Time-Out Checklist: A Simulation Study.","authors":"Anna Clebone, Brian Duggar, Tessa N Mandler, Barbara K Burian, Melissa M Masaracchia, David Polaner","doi":"10.1111/pan.15069","DOIUrl":"10.1111/pan.15069","url":null,"abstract":"<p><strong>Introduction: </strong>The Society for Pediatric Anesthesia Quality and Safety Committee developed the Pediatric Regional Anesthesia Time-Out Checklist, consisting of 14 safety items intended to be reviewed by an anesthesia team prior to a regional anesthetic. Primarily, we hypothesized that use of this Checklist would increase the number of safety items performed compared with no checklist, evaluating the usefulness of this tool. Secondarily, we hypothesized that, after checklist training, subjects would show better clinical judgment by electing to perform a regional anesthetic in scenarios in which no programmed error existed and electing to not perform a regional anesthetic in scenarios in which a programmed error did exist.</p><p><strong>Methods: </strong>Each anesthesia attending/trainee pair participated in 12 different randomized video-recorded medium-fidelity regional anesthesia simulation scenarios, receiving checklist training after half of the scenarios had been completed by each pair. In four of the scenarios, subjects were expected to decline to perform the regional anesthetic because of an error programmed into the scenario. Two errors consisted of a maximum dose of local anesthetic given by the surgeon immediately prior to the planned regional anesthetic and two errors consisted of coagulation issues prior to neuraxial block (1 with a low platelet count and 1 receiving low molecular weight heparin). Scenarios were scored for the number of safety items identified and performed by the subjects. Additionally, the team's choice to perform the regional anesthetic or abort was recorded.</p><p><strong>Results: </strong>One-hundred and thirty-two scenarios were performed by 22 physicians. A greater number of safety items were completed after training on the Pediatric Regional Anesthesia Time-Out Checklist, for each of 11 individual groups and when data from all groups was pooled, p < 0.001, 95% CI (0.33, 0.41). Overall, 78% of safety items studied were performed after checklist training compared to 41% of safety items performed prior to training. The team's choice to perform or abort the regional anesthetic occurred as expected more often (92% of scenarios) after Checklist training, compared to before checklist training (77% of scenarios), t = 3.41; p = 0.001, 95% CI (0.03, 0.27). Teams chose to perform the regional anesthetic despite a programmed error in three scenarios (0.05%) prior to Checklist training and no scenarios (0%) after Checklist training.</p><p><strong>Conclusion: </strong>Pediatric Regional Anesthesia Time-Out Checklist training led to an increased number of safety items performed prior to a simulated anesthetic.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"430-438"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143040736","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":"Anesthetic-Sparing Effect of Dexmedetomidine During Total Intravenous Anesthesia for Children Undergoing Dental Surgery: A Randomized Controlled Trial-In Reply.","authors":"Victor C L Lee, Randa Ridgway, Nicholas C West, Matthias Görges, Simon D Whyte","doi":"10.1111/pan.15109","DOIUrl":"10.1111/pan.15109","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"485-486"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743507","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":"Correction to \"Global Pediatric Anesthesia-Anglo West Africa Perspective\".","authors":"","doi":"10.1111/pan.15092","DOIUrl":"10.1111/pan.15092","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"487"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586501","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":"Supervision of Pediatric Anesthesia After-Hours: A Survey of Pediatric Anesthetists in Australia and New Zealand.","authors":"Steven Cai, Fiona Taverner","doi":"10.1111/pan.15068","DOIUrl":"10.1111/pan.15068","url":null,"abstract":"<p><strong>Background: </strong>After-hours pediatric anesthesia may pose increased risks, with a heightened potential for sudden cardio-respiratory decline. While mortality rates are low in Australia and New Zealand, critical events and morbidity occur more frequently and present ongoing challenges. However, little is known about how trainees are supervised during these high-risk periods.</p><p><strong>Methods: </strong>An anonymized online survey of members of the Society for Pediatric Anesthesia in New Zealand and Australia (SPANZA) was conducted to explore supervising anesthetists attitudes towards after-hours supervision. The survey examined the influence of patient age, medical history, trainee experience, and surgery type on supervision practices.</p><p><strong>Results: </strong>Respondents identified age and physical status as key risk factors but reported providing less direct supervision than recommended by international studies, especially for non-complex surgeries in healthy children. Trainee experience was a significant factor in supervision decisions.</p><p><strong>Conclusion: </strong>Pediatric anesthetists in Australia and New Zealand recognize major risk factors but tend to supervise more remotely after-hours. Further research is needed to evaluate the effects of these supervision practices on outcomes.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"424-429"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009427","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":"Historical Development and Experience of Day Surgery in China: From the Perspective of Anesthesiologists.","authors":"Jiangrong Luo, Chunbao Xie, Dan Fan","doi":"10.1111/pan.15078","DOIUrl":"10.1111/pan.15078","url":null,"abstract":"<p><strong>Background: </strong>Day surgery has become the main mode of surgery in American and European countries, but it is still in the early stage in developing countries due to the limitation of medical technology and the backward management concept. At present, day surgery accounts for more than 60% of elective surgery in many countries in Europe and North America and more than 85% in countries such as the United Kingdom and the United States. There are 8469 ambulatory surgery centers in the United States in 2023. In China, the first ambulatory surgery center was established in 2001. In 2018, more than half of the tertiary hospitals (high-level hospitals) in China carried out day surgery, of which 639 hospitals set up ambulatory surgery centers; the proportion of day surgery in elective surgery increased to 12.8%. The annual number of day surgeries exceeded 1.25 million. In 2022, our hospital established an ambulatory surgery center managed by anesthesiologists. Day surgery requires anesthesiologists to participate in the whole process of patient management from preoperative preparation to postoperative recovery. The establishment of ambulatory surgery centers managed by anesthesiologists is of great significance to China, developing countries, and the whole world.</p><p><strong>Objectives: </strong>So this study aimed to review the development of day surgery in China, combine Chinese government policy evolution, summarize the management model of Chinese ambulatory surgery centers, guide the establishment of ambulatory surgery centers in low- and middle-income countries, and highlight and analyze the advantages of anesthesiologist-managed ambulatory surgery centers as distinct from other physician-managed ones.</p><p><strong>Discussion: </strong>We call on anesthesiologists, other physicians, surgeons, nurses, and health system managers around the world to promote efficient, low-cost day surgery in developing countries and thereby increase access to surgical treatment for the world's poor.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"412-423"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374539","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":"Incidence, Risk Factors, and Outcomes of Non-Extubation in the Operating Room Following Elective Pediatric Neurosurgery-A Prospective Observational Study.","authors":"Amruta Nirale, Suparna Bharadwaj, Sangeetha R Palaniswamy, Dhaval P Shukla, Dhritiman Chakrabarti, Kamath Sriganesh","doi":"10.1111/pan.15095","DOIUrl":"10.1111/pan.15095","url":null,"abstract":"<p><strong>Background: </strong>Studies on non-extubation after elective pediatric neurosurgery are limited. As non-extubation can contribute to adverse patient outcomes, there is a need to understand this problem better. We aimed to assess the incidence, risk factors, and impact of non-extubation in the operating room (OR) after elective pediatric neurosurgery.</p><p><strong>Methods: </strong>This was a single-center, prospective, observational study conducted at a university hospital from February 2022 to November 2023 after ethics approval and study registration. We included patients aged below 18 years undergoing elective neurosurgery under general anesthesia. Non-extubation was defined as retention of the tracheal tube before leaving the OR. Data collected included age, gender, body mass index, American Society of Anesthesiologists (ASA) physical status, neurosurgical diagnosis, surgical procedure, comorbidities, presence of preoperative lower cranial nerve palsy, Cormack-Lehane grade, surgery duration, patient position, intraoperative complications, transfusion of blood products and colloids, fluid balance, neurological decline, in-hospital mortality, and durations of postoperative stay in the intensive care unit (ICU) and hospital.</p><p><strong>Results: </strong>A total of 738 children were included in the study. The incidence of non-extubation was 13.01% (96/738). The predictors of non-extubation were higher ASA grade (odds ratio [OR] 2.86, 95% confidence interval [CI] 1.78-4.69, p < 0.001), preoperative lower cranial nerve palsy (OR 2.35, CI 1.23-4.43, p = 0.010), prolonged surgery (OR 1.45, CI 1.26-1.68, p < 0.001), occurrence of intraoperative complications (OR 4.89, CI 2.69-8.89, p < 0.001), and higher intraoperative blood transfusion rates (OR 2.46, CI 1.37-4.5, p = 0.002). Non-extubation in the OR was associated with postoperative neurological deterioration, higher in-hospital mortality, and prolonged ICU and hospital stay.</p><p><strong>Conclusions: </strong>A significant proportion of children are not extubated immediately after elective pediatric neurosurgery. Higher ASA grade, lower cranial nerve palsy, prolonged surgery, intraoperative complications, and higher blood transfusion increase the risk of delayed extubation. Non-extubation in the OR is associated with poor postoperative outcomes of neurological decline, in-hospital mortality, and longer duration of hospital stay.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"454-459"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649837","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":"Availability and Practice Patterns of Videolaryngoscopy and Adaptation of Apneic Oxygenation in Pediatric Anesthesia: A Cross-Sectional Survey of Pediatric Anesthesiologists.","authors":"Wenyu Bai, Prabhat Koppera, Yuan Yuan, Graciela Mentz, Bridget Pearce, Megan Therrian, Paul Reynolds, Sydney E S Brown","doi":"10.1111/pan.15079","DOIUrl":"10.1111/pan.15079","url":null,"abstract":"<p><strong>Background: </strong>Videolaryngoscopy (VL) and apneic oxygenation are highly recommended and increasingly used in pediatric anesthesia practice; yet, availability, use in recommended clinical settings (e.g., neonates, airway emergencies, and out-of-operating-room tracheal intubation), and the association of VL availability with how pediatric anesthesiologists define difficult intubation have not been explored.</p><p><strong>Method: </strong>An electronic survey was distributed to the members of several international pediatric anesthesia societies to examine the availability and practice patterns of VL and to explore the criteria used to define a difficult tracheal intubation in children in the context of VL.</p><p><strong>Results: </strong>The response rate was 12.9%. VL was reported to be \"most likely available\" in main pediatric operating rooms and offsite locations 93% and 80.1% of the time, respectively. Fifty-seven percent of participants would select VL first when anticipating a difficult tracheal intubation; nearly 30% of respondents would choose direct laryngoscopy first and VL as a backup in this scenario. One-third of subjects would select VL as their first choice for nonoperating room (non-OR) emergency tracheal intubation and for premature or newborn infants, regardless of anticipated difficulty with intubation. Thirty percent of subjects reported using apneic oxygenation during difficult laryngoscopy. Institutional VL availability was not associated with how providers defined difficult tracheal intubation.</p><p><strong>Conclusion: </strong>VL is highly available, but the adoption of VL and apneic oxygenation for managing difficult tracheal intubation was lower than expected, given recent recommendations by pediatric anesthesia societies. There was heterogeneity in how difficult intubation was defined, resulting in a possible patient safety risk.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"460-468"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189987","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":"\"Error Traps\" in Pediatric ERAS.","authors":"Megan A Brockel, Melissa Brooks Peterson, Kyle O Rove","doi":"10.1111/pan.15113","DOIUrl":"10.1111/pan.15113","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"410-411"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788373","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":"Last-Minute Cancellations in Pediatric Ambulatory and Day Surgeries in Italy: Prevalence and Risk Factors.","authors":"Alessandro Vittori, Rajeev S Iyer, Marco Cascella, Riccardo Tarquini, Elisa Francia, Ilaria Mascilini, Cecilia M Pizzo, Franco Marinangeli, Roberto Pedone, Giuliano Marchetti, Sergio G Picardo","doi":"10.1111/pan.15093","DOIUrl":"10.1111/pan.15093","url":null,"abstract":"<p><strong>Background: </strong>Cancellation of pediatric day and ambulatory surgeries on the day of the procedure poses a significant challenge, impacting hospital resources and patient care. In Italy, ambulatory surgery is defined as a surgical/diagnostic procedure without hospitalization, and day surgery is defined as a surgical/diagnostic procedure with daytime hospitalization.</p><p><strong>Aims: </strong>To measure the rate and causes of cancellations on the day of the procedure in a tertiary pediatric hospital in Italy.</p><p><strong>Methods: </strong>We collected the data retrospectively from the electronic health record between January 2020 and March 2022 at Ospedale Pediatrico Bambino Gesù in Rome, Italy. The number of case cancellations were captured. The reasons for cancellation were categorized into three different buckets: anesthetic reasons, surgical reasons, and non-adherence to protocol. The reasons under each of these categories were further explored. We analyzed the difference in the rate of last-minute cancellations between ambulatory surgery and day surgeries to examine if different pathways produce different results.</p><p><strong>Results: </strong>A total of 4,600 procedures were scheduled and 183 were canceled (3.9% of total procedures). Surgical reasons contributed to most cancellations (49%), followed by anesthesia reasons (42%) and non-adherence to protocols (9%). Surgical reasons, including the need for post-operative hospitalization, were the primary causes for cancellation, often due to mismatches between pre-operative evaluations and the final decision-making process. Younger patients, particularly those prone to respiratory tract infections, were more likely to experience cancellations. Anesthetic reasons were also a significant factor but less prevalent than surgical ones.</p><p><strong>Conclusions: </strong>Using standardized treatment and diagnosis pathways can reduce the number of canceled procedures and optimize resources. A telephone re-assessment before the procedure and telemedicine can be useful strategies to further reduce the cancellation rate.</p><p><strong>Clinical implications: </strong>The use of pediatric day surgery has significant advantages: minimizing last-minute canceled procedures means increasing patient comfort and reducing healthcare costs. Identifying the causes of cancellations on the day of the procedure allows one to improve the organizational system of the operating room.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"439-445"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625877","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":"Anaesthetic-Sparing Effects of Dexmedetomidine in Children Receiving Total Intravenous Anaesthesia.","authors":"Robert J Starr, Le Roux Jacobs, Craig Lyons","doi":"10.1111/pan.15076","DOIUrl":"10.1111/pan.15076","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"483-484"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190021","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}