Pediatric Anesthesia最新文献

{"title":"Reply to: \"Inflammatory Indices and Pediatric Emergence Delirium: Predictive Signal or Statistical Artifact\".","authors":"Serkan Altıparmak, Ayhan Kars, Sara Salcan, Alparslan Koç","doi":"10.1002/pan.70293","DOIUrl":"10.1002/pan.70293","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1481-1482"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796369","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":"A Sedation Protocol for Endoscopic Baton-Plate Adjustment in Neonates With Pierre Robin Sequence.","authors":"Nicolas Leister, Sarah Achterrath, Uwe Trieschmann, Teresa Kruse, Bert Braumann, Volker C Schick","doi":"10.1002/pan.70286","DOIUrl":"10.1002/pan.70286","url":null,"abstract":"<p><strong>Background: </strong>Robin sequence (RS) is characterized by upper airway obstruction leading to life-threatening desaturations in neonates. Procedural sedation in this population presents unique challenges due to anatomical airway anomalies, young patient age, and associated comorbidities. The pre-epiglottic baton-plate (PEBP) procedure is a non-invasive, endoscopically guided intervention that alleviates obstruction, facilitates oral feeding, and promotes mandibular growth. Sedation for PEBP adjustment requires the maintenance of spontaneous respiration while ensuring patient comfort and procedural tolerance.</p><p><strong>Aims: </strong>To compare process characteristics and observed adverse events before and after an institutional change in the sedation regimen and staffing model for endoscopic PEBP adjustment in neonates with RS.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 18 infants undergoing endoscopic PEBP adjustment between December 2012 and June 2025. Cohort I (n = 8) received individualized sedation, most commonly propofol with remifentanil, with variable personnel present. Cohort II (n = 10) received sevoflurane induction followed by ketamine and dexmedetomidine for maintenance, with predefined interdisciplinary staffing including two senior anesthesiologists. Demographic data, sedation regimens, sedation-related adverse events, and airway interventions were compared between groups.</p><p><strong>Results: </strong>All 18 procedures were completed successfully. A total of five sedation-related adverse events occurred, four in Cohort I and one in Cohort II. All events were managed effectively with routine measures. No patient required conversion to general anesthesia or invasive airway management. Procedural duration was significantly shorter in Cohort II. Baseline, lowest intraoperative, and first postoperative oxygen saturation did not differ significantly.</p><p><strong>Conclusions: </strong>Standardization of sedation protocols and procedural workflows was associated with shorter procedure times and fewer observed adverse events; however, the small sample size (n = 8 and n = 10) precludes conclusions regarding safety or causality. In rare, high-risk neonatal procedures, structured and interprofessional approaches may help reduce variability and support reproducible care.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1449-1457"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796389","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":"Suzetrigine for Pediatric Sickle Cell Disease Vaso-Occlusive Crisis: Is There a Role?","authors":"Karla Wyatt-Thompson, Charlotte Walter, Sarah Edwards","doi":"10.1002/pan.70273","DOIUrl":"10.1002/pan.70273","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1473-1474"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707463","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":"Therapeutic Selective Recruitment Using a Bronchial Blocker for Refractory Atelectasis in a Child With Tracheomalacia.","authors":"Yukiko Itokazu, Taiga Ishihara, Ayako Hirai, Gaku Kawamura","doi":"10.1002/pan.70292","DOIUrl":"10.1002/pan.70292","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1471-1472"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796349","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":"EEG-Guided Sevoflurane Anesthesia and Emergence Delirium in Children: A Randomized Controlled Trial.","authors":"Ozlem Kocaturk, Sultan Keles","doi":"10.1002/pan.70279","DOIUrl":"10.1002/pan.70279","url":null,"abstract":"<p><strong>Background: </strong>In pediatric anesthesia, minimum alveolar concentration (MAC) guides inhalational agent dosing but may not accurately reflect anesthetic depth. EEG-guided anesthesia has shown benefits in adults but remains underused in children.</p><p><strong>Aims: </strong>This study aims to evaluate the effect of EEG-guided anesthesia with SedLine on emergence delirium (ED) and sevoflurane dose in behaviorally noncompliant children undergoing dental procedures under general anesthesia.</p><p><strong>Methods: </strong>In this prospective, randomized controlled trial, 100 children aged 4-10 years were randomized to standard anesthesia guided by MAC and conventional clinical signs (standard group) or EEG-guided anesthesia titrated to SedLine parameters (primary target: PSI 25-50; secondary parameter: SEF 10-15 Hz) (EEG-S group). Primary outcome was ED incidence assessed by the Pediatric Anesthesia Emergence Delirium Scale (PAEDS). Secondary outcomes included mean EtSevo values, postoperative pain, rescue analgesia, nausea/vomiting, recovery time.</p><p><strong>Results: </strong>Median PAEDS scores during the first 120 min postoperatively were significantly lower in the EEG-S group compared with the Standard group (e.g., upon arrival to PACU: 4 [IQR 4] vs. 8 [IQR 4.5]). In addition, the incidence of ED upon arrival in the recovery room was significantly lower in the EEG-S group (17% vs. 43%) and at 10 min postoperatively (17% vs. 37%). The mean end-tidal sevoflurane concentration was statistically lower in the EEG-S group (maintenance EtSevo 1.88 ± 0.25 vs. 1.98 ± 0.20; mean difference = 0.10, 95% confidence interval: 0.006-0.190; p = 0.036). Postoperative FLACC pain scores were also lower in the EEG-S group, representing a potential confounding factor for ED outcomes.</p><p><strong>Conclusion: </strong>EEG-guided anesthesia was associated with lower PAEDS scores and reduced sevoflurane consumption compared with standard management. However, given small EEG-derived differences and potential confounding by postoperative pain, these findings should be interpreted cautiously. Within the applied target ranges, EEG-derived parameters were not independently associated with ED, and specific EEG targets predictive of ED could not be identified.</p><p><strong>Trial registration: </strong>This study was registered (Protocol Registration Receipt NCT06400706/OKocaturk/May 02 2024) at http://www.</p><p><strong>Clinicaltrial: </strong>gov.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1429-1436"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723651","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":"Pre-Extubation Low-Dose Propofol in Pediatric Ear, Nose, and Throat Procedures: A Meta-Analysis With Trial Sequential Analysis.","authors":"Rafaela Silva, Raphaela Mendes, João Mario Borges, Henrique Pivetta, Rafael Miranda, Isabela Alles, Vinicius Oliveira, Steven Staffa, Walid Alrayashi","doi":"10.1002/pan.70277","DOIUrl":"10.1002/pan.70277","url":null,"abstract":"<p><strong>Background: </strong>Post-extubation emergence agitation (EA) is common in pediatric ear, nose, and throat (ENT) procedures and may lead to serious complications.</p><p><strong>Aims: </strong>To assess the efficacy of low-dose propofol administered before extubation, compared with placebo, for preventing EA, using meta-analysis with trial sequential analysis (TSA).</p><p><strong>Methods: </strong>We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) comparing low-dose propofol versus placebo administered before extubation in pediatric ENT procedures. The primary outcomes were laryngospasm, severity of EA, assessed by the Pediatric Anesthesia Emergence Delirium (PAED) scale score, and incidence of EA. Secondary outcomes included post-anesthesia care unit (PACU) length of stay, time to recovery, and time to extubation. Random-effects models were used to pool effect estimates with 95% confidence intervals (CIs). TSA was performed for all outcomes to assess the robustness of the evidence.</p><p><strong>Results: </strong>Ten RCTs were included in the review, of which six (414 pediatric patients) contributed to the meta-analysis. Compared with control, propofol significantly reduced the incidence of EA (risk ratio [RR] = 0.57; 95% CI, 0.42-0.78) and lowered agitation severity (mean difference [MD] = -3.94; 95% CI, -5.74 to -2.13). Time to extubation was slightly longer (MD = 1.8 min; 95% CI, 1.4-2.3), whereas time to recovery (MD = 0.9 min; 95% CI, -1.9 to 3.6) and PACU length of stay (MD = -0.63 min; 95% CI, -3.2 to 1.9) did not differ. TSA confirmed the robustness of the findings for incidence of EA, severity of EA, and time to extubation. However, the certainty of evidence was very low for severity of EA and moderate for EA incidence and time to extubation. Laryngospasm outcomes were not pooled due to substantial heterogeneity.</p><p><strong>Conclusions: </strong>Our findings suggest that pre-extubation propofol probably reduces the incidence of EA in pediatric ENT surgery, supported by moderate-certainty evidence, and may lower EA severity measured by PAED scale scores, for which the certainty of evidence was very low. Propofol was also associated with a slightly longer time to extubation, with no difference in overall recovery time or PACU length of stay.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1375-1386"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721433","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":"Inflammatory Indices and Pediatric Emergence Delirium: Predictive Signal or Statistical Artifact?","authors":"Robert Luo, Anupa Parajuli, Aimee Pak, Amir L Butt","doi":"10.1002/pan.70259","DOIUrl":"10.1002/pan.70259","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1479-1480"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382619","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":"Perspectives in Pediatric Ambulatory Anesthesia: Part 1-One Center's 15 Year Evolution in Eligibility, Utilization, Efficiency, and Outcomes.","authors":"Aaron B Low, Jennifer L Chiem, Corrie Casey, Samuel M Vanderhoek, Lynn D Martin","doi":"10.1002/pan.70254","DOIUrl":"10.1002/pan.70254","url":null,"abstract":"<p><strong>Introduction: </strong>Ambulatory surgery has become the dominant model of surgical care in the United States as surgical procedures increasingly shifted from inpatient to outpatient sites of practice. Similar growth in volumes has been observed in pediatric practice. Investigators have highlighted the challenges and opportunities in this current climate, including increasing medical and procedural complexity, difficulties matching pediatric-specific resources to meet the child's perioperative needs and unique risk profile, and limited availability of pediatric ambulatory surgical and anesthesia guidelines of care. Further, they call out the complete lack of pediatric outcomes data to help inform the creation and modification of national care guidelines.</p><p><strong>Methods: </strong>To address these challenges, we chose to complete a comprehensive, single center retrospective review of our process, outcome, and balancing metrics contained in our EMR from our free-standing pediatric ambulatory surgery center (ASC) since its opening in July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EMR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.</p><p><strong>Results: </strong>Patient and procedural acuity increased as the system matured via lower age cutoffs and higher ASA physical status scores. This higher acuity was managed with a dynamic and evolving screening process, resulting in no change in unplanned emergency visit or hospital admissions. The COVID-19 pandemic had profound impacts on ASC operations and case mix, including a temporary closure.</p><p><strong>Discussion: </strong>This retrospective, observational assessment created a detailed picture of our ASC practice changes over time. A pediatric-specific ASC with appropriate patient selection processes, practice guidelines, and clinical expertise successfully mitigated the risk of complications. These results are not generalizable to non-academic, community ambulatory facilities due to the unique characteristics of our pediatric-specific academic center.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1331-1340"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382624","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":"A Pilot and Feasibility Study of a Four-Stage Neurological Staging Framework in Pediatric Tracheal Extubation During Anesthesia Emergence.","authors":"Megumi Okuyama, Katsuhiko Ishibashi, Shiori Nakao, Tomoharu Ukiya, Kohei Takahashi, Taiki Kojima","doi":"10.1002/pan.70270","DOIUrl":"10.1002/pan.70270","url":null,"abstract":"<p><strong>Background: </strong>Postoperative tracheal extubation is a particularly high-risk period in pediatric anesthesia. Because emergence from anesthesia is a complex and complicated process, determining the optimal timing for safe tracheal extubation remains challenging.</p><p><strong>Aims: </strong>To evaluate the feasibility and descriptive characteristics of a four-stage neuroanatomical framework for pediatric anesthesia emergence while providing exploratory incidence estimates of respiratory adverse events across these stages.</p><p><strong>Methods: </strong>Children younger than 7 years undergoing general anesthesia were enrolled. Emergence stratified into four stages, defined by cranial nerve indicators: Stage 1 (Medulla: regular breathing, movement, excluding cough or swallowing); Stage 2 (Pons: tearing or grimacing); Stage 3 (Midbrain: conjugate gaze or eye-opening); and Stage 4 (Cerebrum: purposeful movement). Primary outcomes included feasibility metrics-such as protocol completion, recruitment flow, and data completeness-and successful assignment of emergence stages. Exploratory descriptive statistics summarized the incidence of respiratory adverse events. Risk ratios were calculated to compare the occurrence of respiratory adverse events in intermediate (Stages 2 and 3) and cortical (Stage 4) stages.</p><p><strong>Results: </strong>Of the 174 patients screened, 89 completed the protocol. Overall, 153 patients provided consent (91.6% consent rate). The overall data capture rate was 58.2% (89/153), while the worksheet processing rate-adjusted for protocol-ineligible cases, such as those with supraglottic airway use-was 73.2% (112/153). Among the 89 patients analyzed, there were no missing data for key variables, and stage assignment was achieved in all cases. Respiratory adverse events were observed in 16.9% of children; descriptive analysis showed an event rate of 25.0% during Stage 2, 25.0% during Stage 3, and 11.6% during Stage 4.</p><p><strong>Conclusions: </strong>While stage assignment was possible among captured cases, the predefined data capture targets were not met. This pilot study successfully identified key workflow and feasibility barriers, which establish a foundation for refining protocols in the upcoming multicenter ExPEDIA registry.</p><p><strong>Trial registration: </strong>Clinical Trial Registration: jRCT 1030250099.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1409-1416"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550183","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":"Psychometric Evaluation of the Turkish Version of the Induction Compliance Checklist in Children Undergoing Mask Anesthesia.","authors":"Yesim Andiran Senayli, Nida Kiyici, Sevgi Ulusoy Tangul, Cevdet Yardimci, Mehmet Kara, Atilla Senayli, Zeev N Kain","doi":"10.1002/pan.70290","DOIUrl":"10.1002/pan.70290","url":null,"abstract":"<p><strong>Background: </strong>Many children undergoing anesthesia commonly exhibit distress behaviors such as anxiety, crying, and physical resistance. Assessment of this behavior is important as it could lead to postoperative behavioral changes and delayed recovery.</p><p><strong>Aim: </strong>The aim of this study was to evaluate the content validity, construct validity, internal consistency, and inter-observer reliability of the Turkish version of the Induction Compliance Checklist (ICC), which was developed to assess compliance behaviors in children during anesthesia induction.</p><p><strong>Methods: </strong>The study was planned as a prospective observational study. Following translation of the original ICC, content validity was examined using the Davis technique with the opinions of 10 experts. Next, Turkish ICC was applied simultaneously and independently by three independent observers during mask induction to 184 children (ASA I-III) aged 1-7 years undergoing anesthesia and surgery. Inter-observer reliability was evaluated with Intraclass Correlation Coefficient (ICC) and Fleiss Kappa/Gwet's AC1; internal consistency with KR-20 and McDonald's omega; and construct validity with single-factor confirmatory factor analysis (WLSMV). Item analysis was performed with a tetrachoric correlation matrix, floor and ceiling effects.</p><p><strong>Results: </strong>Content validity was excellent (I-CVI 0.90-1.00, S-CVI≈0.99). Inter-observer reliability for the total score was excellent: InCC (1, 2) = 0.92 (95% CI: 0.90-0.94), InCC (2, 3) = 0.97 (95% CI: 0.96-0.98). At the item level, Gwet's AC1 values ranged from 0.81 to 0.97, while Kappa values were generally 0.75-0.90 except for M11. Internal consistency was at an acceptable level with KR-20 0.49-0.52 and McDonald's omega 0.66-0.82. These results are low due to the floor effect caused by premedication. Confirmatory factor analysis moderately supported the single-factor structure (best fit in Observer Surgeon: CFI = 0.927, TLI = 0.907). High floor effect was prominent especially in rarely observed severe behaviors (M7-M11); strong correlation was observed between M9-M10 (0.89-0.94).</p><p><strong>Conclusions: </strong>Following rigorous analysis, we found that the Turkish ICC is a reliable and valid tool that can assess children's compliance behaviors during pediatric anesthesia induction. Excellent inter-observer agreement and high content validity support its suitability for clinical and research use. The Turkish Induction Compliance Checklist is a reliable and valid measurement tool in the Turkish pediatric population. It can contribute to standardized evaluation of child behaviors during anesthesia induction and help improve the quality of perioperative care.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1458-1466"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796407","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}