Pediatric Anesthesia最新文献

{"title":"Association of Preoperative Inflammatory Markers With Preoperative Anxiety and Emergence Agitation in Children-In Reply.","authors":"Nezahat Merve Ata Soylu, Zehra Hatipoglu, Ersel Gulec, Mediha Turktan, Nurefsan Sadıkoglu, Yusuf Kemal Arslan, Dilek Ozcengiz","doi":"10.1002/pan.70301","DOIUrl":"https://doi.org/10.1002/pan.70301","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888095","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":"Impact of Socioeconomic Deprivation on children's Need for Anesthesia: A Retrospective Analysis of Electronic Health Records From a Tertiary Referral children's Hospital.","authors":"Bryan Atandi, Philip Arnold","doi":"10.1002/pan.70302","DOIUrl":"https://doi.org/10.1002/pan.70302","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic status and geography create healthcare inequalities in children. Geographical areas in the United Kingdom are ranked by deprivation, which confers a higher risk for specific diseases that necessitate procedures under anesthesia.</p><p><strong>Aims: </strong>To examine the relationship between the geographical indices of deprivation and the odds of children presenting for procedures involving anesthesia at a specialist children's referral hospital in Northwest England and Wales, UK.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis linking electronic patient records of patients presenting for anesthesia from 2016 to 2024 to population data. Multivariate mixed-effects logistic regression was conducted for the odds of having a procedure requiring anesthesia.</p><p><strong>Results: </strong>71 613 episodes were included in the final analysis, confined to areas with a higher proportion of children having a procedure at our hospital and only one episode per child in each year. The adjusted odds ratio for having a procedure according to deprivation was 1.15 (95% CI: 1.13-1.17, p < 0.001), with children from a deprived area being more likely to undergo treatment. The odds of undergoing a procedure were higher for most specialities, for children from a deprived area. It was the greatest for dental procedures. When analyzed by the 10 deciles of IMD, the strongest effect was for children from the most deprived areas.</p><p><strong>Conclusion: </strong>Children living in deprived areas are more likely to present for procedures involving anesthesia at our hospital, which serves a large area: Northwest England and Wales. This is true for most specialities. Sensitivity analysis to address study design limitations did not change the general conclusion. Further research is needed to clarify this phenomenon. Our study emphasizes the importance of preventive interventions to reduce inequalities in child health due to socioeconomic deprivation and geography.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881187","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":"Up-and-Down Sequential Allocation Study Comparing the Median Effective Dose of Remimazolam Versus Propofol for Inducing Unconsciousness in Pediatric Patients.","authors":"Yi-Lin Gu, Pei-Pei Liu, Ying Sun, Yan-Ting Wang, Ji-Jian Zheng, Yang Shen","doi":"10.1002/pan.70303","DOIUrl":"https://doi.org/10.1002/pan.70303","url":null,"abstract":"<p><strong>Background: </strong>Remimazolam is a novel ultra-short-acting benzodiazepine used for general anesthesia. Compared with propofol, it offers reversibility with flumazenil and lacks injection pain. However, its optimal bolus dose for anesthesia induction in pediatric patients remains unclear. The aim of this study was to determine the effective dose of remimazolam for loss of consciousness during anesthesia induction in children aged 2 to 14 years.</p><p><strong>Methods: </strong>A prospective, randomized, controlled trial using the Dixon up-and-down sequential design was conducted. It comprised two separate, parallel dose-finding studies, in which a total of fifty children undergoing elective surgery were randomly allocated to receive either remimazolam or propofol for anesthesia induction, respectively. The primary outcome was the ED₅₀ and ED₉₅ of each drug. Secondary outcomes included bispectral index (BIS) values, hemodynamic changes, and adverse events within 5 min after drug administration.</p><p><strong>Results: </strong>The ED₅₀ and ED₉₅ of remimazolam were 0.17 mg/kg (95% CI 0.16-0.19) and 0.26 mg/kg (95% CI 0.23-0.29). Both drugs effectively reduced BIS values, with a significant group-time interaction. Heart rate was more stable in the remimazolam group. No respiratory depression, hypotension, or other serious adverse events were observed in either group.</p><p><strong>Conclusion: </strong>Using a sequential up-and-down design, this study provides the first determination of the ED₅₀ (0.17 mg/kg) of a single intravenous bolus of remimazolam for inducing loss of consciousness in pediatric patients aged 2-14 years. These findings offer a practical dosing reference for remimazolam induction in children.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry: ChiCTR 2200067112.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875354","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":"Respiratory Events and Procedure Interruptions During Pediatric Bronchoscopy and Suspension Laryngoscopy: A Secondary Analysis Comparing Dexmedetomidine and Remifentanil-Based Anesthesia.","authors":"Clyde T Matava, Brenda Nkonge, Martina Bordini, Julia M Olsen, Jennifer M Siu, Jason Macartney, Nikolaus E Wolter, Evan J Propst","doi":"10.1002/pan.70250","DOIUrl":"10.1002/pan.70250","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1159-1161"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278246","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":"Impact of Institutional Protocol on Urinary Catheter Outcome Measures in Orthopedic Children Treated With Epidural Analgesia.","authors":"Idan Katz, Tomer Talmy, Dor Barami, Tal S Beckmann, Barry Danino, Yotam Lior, Margaret Ekstein","doi":"10.1002/pan.70218","DOIUrl":"10.1002/pan.70218","url":null,"abstract":"<p><strong>Background: </strong>Epidural analgesia is commonly used for pain control after major lower-limb orthopedic surgery in children, but it is associated with a risk of postoperative urinary retention. Consequently, urinary catheters are often placed and left in situ for the full duration of epidural analgesia, despite the potential risks of prolonged catheterization, including discomfort, ward reinsertion, and urinary tract infection.</p><p><strong>Aims: </strong>To assess the impact of implementing a standardized institutional urinary catheter management protocol on postoperative urinary catheter outcomes in children less than age 18 years, undergoing major lower-limb orthopedic surgery with postoperative epidural analgesia.</p><p><strong>Methods: </strong>Single-center, retrospective, observational study on children who met the above criteria in the study period before (1/2019-6/2021) and after (7/2021-7/2023) initiation of a urinary catheter management protocol. The protocol mandated intra-operative urinary catheter placement and early removal on postoperative day 1, while continuing epidural analgesia as long as 5 days.</p><p><strong>Results: </strong>A total of 93 children were included in this study: 47 before and 46 after initiation of the protocol. Demographic data were similar. Children treated according to the new protocol required significantly fewer ward urinary catheter insertions (2.2% vs. 19.1% respectively, p = 0.003) and had significantly faster removal of urinary catheter (1 [1-1] vs. 3 [2-3] days, p < 0.001) without subsequent urinary catheter insertion despite similar epidural analgesia duration. There was no difference in occurrence of urinary tract infection.</p><p><strong>Conclusions: </strong>Implementation of a standardized institutional urinary catheter management protocol, mandating intraoperative catheter placement and removal on postoperative day 1, despite ongoing epidural analgesia, was associated with reduced urinary catheter duration and fewer postoperative ward catheter insertions in pediatric patients undergoing major lower-limb orthopedic surgery.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1089-1095"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942334","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":"Role of Angiotensin II as a Vasoactive Agent to Treat Distributive Shock With a Focus on Preliminary Data in Pediatric-Aged Patients.","authors":"Shinya Ito, Kevin Spellman, Sarah Khan, Joseph D Tobias","doi":"10.1002/pan.70237","DOIUrl":"10.1002/pan.70237","url":null,"abstract":"<p><p>In pediatric-aged patients, distributive (vasoplegic) shock is commonly caused by sepsis, anaphylaxis, or the humoral/immunologic response following cardiopulmonary bypass. In general, the first-line vasoactive agent for children is epinephrine or norepinephrine. In cases of fluid-refractory shock requiring escalating doses of catecholamines, adjunct therapies such as vasopressin, hydrocortisone, hydroxycobalamin-ascorbic acid, and methylene blue may be introduced. In 2017, the FDA approved a synthetic human angiotensin II (AT-II) infusion preparation for treating adult patients with refractory vasodilatory shock. The following educational review examines the role of AT-II as a vasoactive agent in the treatment of distributive shock with a focus on pediatric patients. A systematic search of the literature was performed to identify key publications regarding the therapeutic use of AT-II for the treatment of distributive shock in adult and pediatric patients. Prospective studies in adult patients demonstrate the efficacy of AT-II to treat refractory vasodilatory shock when escalating doses of conventional vasoactive agents (norepinephrine ≥ 0.2-0.3 μg/kg/min) have failed. In these scenarios, AT-II has been added as the third or fourth medication. There are limited trials evaluating AT-II as the primary agent for vasodilatory shock in adults. The majority of studies have shown an improvement in mean arterial pressure (MAP); however, there has been limited impact on long-term survival. Pediatric evidence to date has included 5 case reports and two larger retrospective case series encompassing a total of 44 patients. Although AT-II was generally effective in increasing the MAP, given the non-randomized and non-prospective nature of these studies, information regarding the impact on long-term outcomes is not available. Both adult and pediatric reports have outlined the potential utility of AT-II in treating vasodilatory shock as primarily a rescue agent when conventional vasoactive agents fail or dose requirements escalate. To date, evidence-based medicine demonstrates an increase in MAP with the ability to wean other vasoactive agents. The current studies do not appear to uniformly and clearly define a survival benefit. Future studies should focus on the potential survival impact of this novel vasoactive agent, further define dosing strategies, and more clearly outline its role as a primary agent or when other vasoactive agents fail.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1029-1040"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205463","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":"Intraoperative Cardiac Events During Pediatric Cardiac Magnetic Resonance Imaging Under Anesthesia: A Retrospective Cohort Study.","authors":"Theodora Wingert, Justine Liang, Kelly Feldman, Amelie Delaporte, Christine Nguyen-Buckley, Tristan Grogan, Alexandre Joosten, John Paul Finn, Ihab Ayad","doi":"10.1002/pan.70249","DOIUrl":"10.1002/pan.70249","url":null,"abstract":"<p><strong>Background: </strong>Children with congenital heart disease (CHD) frequently undergo cardiac magnetic resonance imaging (MRI) under anesthesia. Although these procedures lack surgical stimulus, patients remain physiologically vulnerable, and the incidence of perioperative cardiovascular instability in this setting is poorly defined. We aimed to determine the incidence and predictors of intraoperative cardiac events during pediatric cardiac MRI using a recently proposed composite framework of intraoperative cardiovascular instability.</p><p><strong>Methods: </strong>This single-center retrospective cohort study analyzed patients ≤ 18 years undergoing cardiac MRI under anesthesia from 2013 to 2025. The primary outcome was intraoperative cardiac events, defined as ≥ 5 cumulative minutes with mean arterial pressure > 2 standard deviations below age- and sex-adjusted reference values, vasopressor administration, or severe adverse cardiac events. Multivariable logistic regression identified independent predictors. Thirty-day mortality was evaluated descriptively.</p><p><strong>Results: </strong>Among 330 cases, intraoperative cardiac events occurred in 29.7% (98/330). Hypotension was most common (24.2%), followed by vasopressor administration (9.7%); no severe adverse cardiac events were observed. Thirty-day mortality was 1.8% (6/330). Independent predictors included increasing age (OR 1.13 per year, 95% CI: 1.04-1.21), and higher-acuity preoperative location, including neonatal intensive care unit (ICU) (OR 4.42, 95% CI: 1.86-10.52) and pediatric ICU (OR 4.84, 95% CI: 1.91-12.26). Sensitivity analyses demonstrated consistent findings across model specifications.</p><p><strong>Conclusions: </strong>Intraoperative cardiac events, primarily hypotension of unknown significance, were common during pediatric cardiac MRI under anesthesia; no severe adverse cardiac events occurred. Our findings highlight the physiologic complexity of this population and support the need for thoughtful perioperative risk stratification and management.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1143-1152"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278278","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":"Processed EEG Monitoring During Pediatric Procedural Sedation: Correlation Between the Narcotrend Index and the Pediatric Sedation State Scale.","authors":"Hendryk Schneider, Daniel Matheisl, Martin Kuntz, Hans Fuchs","doi":"10.1002/pan.70245","DOIUrl":"10.1002/pan.70245","url":null,"abstract":"<p><strong>Background: </strong>Objective assessment of sedation depth in children undergoing procedural sedation while maintaining spontaneous breathing and protective reflexes can be challenging. Processed electroencephalogram (pEEG) monitoring systems such as the Narcotrend monitor may provide continuous information regarding the depth of sedation. The aim of this study was to investigate the correlation between the Narcotrend Index (NI) and the Pediatric Sedation State Scale (PSSS) during procedural sedation with propofol and fentanyl in children.</p><p><strong>Methods: </strong>Children and adolescents aged 6 months to 17 years undergoing procedural sedation with propofol and fentanyl in the procedure room of a pediatric intensive care unit were included. Sedation depth was assessed using the Narcotrend monitor and the Pediatric Sedation State Scale. Spearman's rank correlation coefficient was calculated to evaluate the relationship between the NI and PSSS.</p><p><strong>Results: </strong>A total of 311 paired measurements (NI and PSSS) from 29 patients were analyzed. Spearman's rank correlation analysis demonstrated a moderate to good correlation between the NI and PSSS (r = 0.61; 95% CI 0.54-0.68; p < 0.0001). The median NI corresponding to the desired deep sedation level (PSSS 2) was 39 (IQR 30-50), with a 95% confidence interval for the median of 36-42.</p><p><strong>Conclusion: </strong>The Narcotrend Index demonstrated an acceptable correlation with the Pediatric Sedation State Scale. Processed EEG monitoring using the Narcotrend Index may therefore represent a useful adjunct to clinical monitoring for avoiding both over-sedation and inadequate sedation in children, particularly for less experienced sedation providers.</p><p><strong>Trial registration: </strong>German Clinical Trials Register: DRKS00033129.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1126-1131"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259114","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":"Response: Codeine in Breast Milk: Minimal Transfer, Still Risky for Neonates.","authors":"Brian J Anderson, Jacqueline A Hannam","doi":"10.1002/pan.70244","DOIUrl":"10.1002/pan.70244","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1167-1168"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252672","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":"Intraoperative Lidocaine Infusion Therapy and Neurophysiological Monitoring in Adolescents Undergoing Idiopathic Scoliosis Correction: A Supplemental Analysis of a Prospective Study.","authors":"Katherine L Mason, Tabrez Hussein, Miku Wake, Nicholas West, Gillian Lauder","doi":"10.1002/pan.70243","DOIUrl":"10.1002/pan.70243","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1156-1158"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271872","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}