Pediatric Anesthesia最新文献

{"title":"Effects of Noninvasive Respiratory Support on Ventilation Distribution During Spontaneous Breathing Sedation in Preschool/School-Aged Children: An Electrical Impedance Tomography Study.","authors":"Giovanna Chidini, Tiziana Marchesi, Stefano Scalia Catenacci, Gaetano Florio, Giorgio Conti, Stefano Lanni, Giovanni Filocamo, Francesca Patria, Marta Guerrini, Gregorio Milani, Giacomo Grasselli","doi":"10.1111/pan.15098","DOIUrl":"10.1111/pan.15098","url":null,"abstract":"<p><strong>Background: </strong>Procedural sedation interferes with respiratory dynamics in pediatric patients. It reduces lung compliance, causing the closing volume to exceed the functional residual capacity, which can result in airway collapse, atelectasis, and periods of silent desaturation.</p><p><strong>Aim: </strong>Aims of the study were to clarify the impact of intravenous propofol sedation on ventilation distribution and to evaluate the potential benefits of noninvasive respiratory support (NRS) in restoring the original ventilation distribution pattern by applying the electrical impedance tomography technology.</p><p><strong>Methods: </strong>Single-center physiological randomized crossover study comparing two 20-min steps of NRS delivered as continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) at different time points: (1) spontaneous breathing (SB-1); (2) spontaneous breathing during sedation (SB-2); (3) CPAP during sedation; (4) NIV during sedation; (5) spontaneous breathing after sedation discontinuation (SB-3). Primary endpoint was regional ventilation delay 40% (RVD40%). Secondary outcomes were global index (GI), end-expiratory lung impedance (EELI), and center of ventilation (CoV).</p><p><strong>Results: </strong>Thirteen children were enrolled. RVD40% increased during SB-2 compared to SB-1 (p = 0.014). NIV was effective in reducing it compared to CPAP (p = 0.009) and SB-3 (p = 0.015). NIV was also effective in restoring ventilation homogeneity and lung volume compared to SB-2 by decreasing GI (p = 0.035) and restoring EELI (p = 0.002). During NIV, the center of ventilation increased compared to SB-1 (p = 0.001), SB-2 (p = 0.004), and CPAP (p = 0.004), suggesting that ventilation was shifted toward the ventral areas of the lungs. On the other hand, CPAP was not effective in restoring RVD40, GI, and EELI to SB1 values following the induction of intravenous anesthesia with propofol at SB-2.</p><p><strong>Conclusions: </strong>In this specific ventilatory setting, spontaneous breathing sedation resulted in enhanced ventilation inhomogeneity and a reduction in EELI that could be reversed by NIV but not by CPAP.</p><p><strong>Clinical trials registration: </strong>The trial was registered prior to patient enrollment at Clinicaltrials.gov (NCT05495477; principal investigator: Giovanna Chidini; date of registration: August 10, 2022). Consolidated Standards of Reporting Trials guidelines were followed, and the study was conducted according to the Helsinki 1964 Ethical Declaration Standard, revised in 2008.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"562-572"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677077","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":"Decreasing Opioid Usage in Pediatric Cholecystectomy Through Care Standardization: A Quality Improvement Project Using Enhanced Recovery After Surgery Protocols.","authors":"Rami Karroum, Thomas Wolski, Laurie J Engler, Lenore France, Scott Boulanger, Tarun Bhalla","doi":"10.1111/pan.15103","DOIUrl":"10.1111/pan.15103","url":null,"abstract":"<p><strong>Background: </strong>While enhanced recovery after surgery protocols have been successful in adults, their impact in pediatric surgery is less documented.</p><p><strong>Smart aim: </strong>Reduce opioid use in morphine milligram equivalents by 25% over 32 months through an enhanced recovery after surgery protocol. This period included 5 months dedicated to testing and implementing the protocol, followed by 27 months of full implementation. Process measures ensured adherence, with 30-day readmission rates, pain scores, postoperative nausea and vomiting, pruritus, and hospital length of stay as balancing measures.</p><p><strong>Methods: </strong>Inconsistent perioperative management led to variable opioid use in pediatric laparoscopic cholecystectomy patients at our hospital. A quality improvement project using the Model for Improvement was implemented at a 443-bed pediatric academic hospital. A multidisciplinary enhanced recovery after surgery team implemented perioperative standardizations supported by electronic medical record best practice advisories, monthly educational sessions, and stakeholder engagement.</p><p><strong>Results: </strong>After full enhanced recovery after surgery protocol implementation, morphine milligram equivalents decreased by 27% over 32 months. Mean pain scores decreased from 4.69 (95% CI: 4.32-5.06) pre-enhanced recovery after surgery to 4.10 (95% CI: 3.84-4.36) post-enhanced recovery after surgery. Postoperative nausea and vomiting incidence decreased from 18% (95% CI: 11.7-26.7) to 15% (95% CI: 9.3-23.3), and pruritus incidence declined from 6% (95% CI: 2.8-12.5) to 5% (95% CI: 2.2-11.2). Mean hospital length of stay was 1.37 days (95% CI: 1.33-1.41) pre-enhanced recovery after surgery and 1.34 days (95% CI: 1.30-1.38) post-enhanced recovery after surgery. The 30-day readmission rate remained unchanged, with the sole readmission attributed to constipation.</p><p><strong>Conclusion: </strong>Standardizing care through enhanced recovery after surgery protocols effectively reduces opioid use in pediatric laparoscopic cholecystectomy without increasing mean postoperative pain scores, postoperative nausea and vomiting, pruritus, or hospital length of stay.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"527-534"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764582","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":"Sevoflurane Washin With the Dräger Apollo and GE Datex Ohmeda Aisys Workstations in Healthy Children.","authors":"Jerrold Lerman, Ana Maria Restrepo Correa","doi":"10.1111/pan.15106","DOIUrl":"10.1111/pan.15106","url":null,"abstract":"<p><strong>Background: </strong>Sevoflurane is preferred for induction of anesthesia in children because of its rapid wash-in and minimal airway reactivity.</p><p><strong>Aims: </strong>The primary aim of this study was to compare the washin profiles of sevoflurane in children using the Dräger Apollo and Ohmeda Aisys workstations.</p><p><strong>Methods: </strong>Twenty-four healthy children (12 per workstation) scheduled for elective surgery underwent inhalational inductions with 8% sevoflurane and 66% nitrous oxide in this prospective observational study. The inspired and end-tidal sevoflurane concentrations were recorded every 30 for the first 5 min and every minute thereafter until the airway was secured. Primary and secondary outcomes consisted of the derived wash-in metrics during the induction.</p><p><strong>Results: </strong>The end-tidal to inspired ratios of sevoflurane were similar with both workstations. The mean (±SD) inspired sevoflurane concentrations with the Apollo were less than with the Aisys workstation (p < 0.013). The mean (±SD) inspired concentration at 1 min with the Apollo, 6.4% ± 0.4%, was 22% less than that with the Aisys, 7.8% ± 0.67% (mean difference 1.4, 95% CI 0.88 to 1.8, p < 0.0001). The mean (±SD) maximum inspired and expired sevoflurane concentrations during the induction period with the Apollo, 7.2% ± 0.3% and 6.8% ± 0.37%, were 18% and 15% less than those with the Aisys, 8.5% ± 0.4% and 7.8% ± 0.9%, (mean difference 1.3, 95% CI 0.99 to 1.6, p < 0.0001) and (mean difference 1.01, 95% CI 0.41 to 1.6, p < 0.002) respectively. The median (25-75th percentile) time to reach 90% of the maximum inspired concentration during the induction with the Apollo, 1.75 (1-2.4) min was 3.5-fold greater than that with the Aisys, 0.5, 0.5-0.5 min (median difference -1.25, 95% CI -1.5 to -0.5, p < 0.0019).</p><p><strong>Conclusions: </strong>The washing of sevoflurane with the Dräger Apollo workstation is slower, and the maximum sevoflurane concentrations are less in children than with the Ohmeda Aisys workstation.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"535-541"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772894","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":"Pediatric Endotracheal Tube Cuff Management at Altitude: Implications for Aeromedical Retrieval and Other Austere Environments.","authors":"Matthew Desmond, Britta S von Ungern-Sternberg","doi":"10.1111/pan.15123","DOIUrl":"10.1111/pan.15123","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children are sometimes transported via fixed or rotary wing aircraft for medical care. If they are intubated with a cuffed endotracheal tube (ETT), changes in environmental pressure during transport can alter cuff pressure. Cuff management in this setting varies widely by region and by organization. In this historical review, we sought to delineate the evolution of ETT cuff management in children undergoing aeromedical retrieval in order to progress the field toward an optimum strategy in the future.</p><p><strong>Descriptions and conclusions: </strong>Problems with extremely high ETT cuff pressures in adults due to altitude gain were identified by the 1970s. During subsequent decades, this topic was the subject of fervent research and device development, with a relative waning in interest more recently. Children, being transported less frequently and almost always with non-cuffed ETTs, were not included in these research efforts. During a similar epoch, the field of hyperbaric medicine also recognized the issue of ETT cuff pressure changes and almost uniformly changed to cuff insufflation with an incompressible liquid. This was based on cuff pressure measurements and deductive reasoning, rather than on evidence from patient outcome trials. Aeromedical retrieval has not consistently adopted this technique. Further investigation and discussion on an optimum strategy of cuff management in aeromedical transport of children is needed to reach an agreement on best practice.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"504-510"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036995","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":"Maintaining Privacy During the Intrahospital Transport of Anesthetized Children.","authors":"Kevin Finbarr McCarthy","doi":"10.1111/pan.15125","DOIUrl":"10.1111/pan.15125","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"577-578"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976207","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":"Authorship and Its Virtues.","authors":"Tim Dare","doi":"10.1111/pan.15119","DOIUrl":"10.1111/pan.15119","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"494-496"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037024","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":"Documentation of Core Temperature in Pediatric Patients Undergoing General Anesthesia: A Quality Improvement Initiative to Increase Compliance.","authors":"Alexandra C Cates, Bradley J Curtis, Christy J Crockett","doi":"10.1111/pan.15099","DOIUrl":"10.1111/pan.15099","url":null,"abstract":"<p><strong>Background: </strong>Children's body composition makes them highly susceptible to heat loss, which is further amplified by anesthetic-induced inhibition of thermoregulatory control. Perioperative hypothermia can lead to adverse outcomes, thus highlighting the importance of core temperature monitoring for pediatric patients undergoing general anesthesia. We launched and completed a quality improvement (QI) initiative at our institution starting in February 2023, with the SMART aim to increase the percentage of pediatric patients in our dental OR who receive a documented core temperature in the anesthetic record from 10% to 60% by October 2023.</p><p><strong>Methods: </strong>We referenced the Standards for Quality Improvement Reporting Excellence guidelines and used the Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We tested 5 interventions between February and October 2023. These included an educational email to all anesthesia professionals, a posted sign in the OR, a Morbidity and Mortality Conference regarding core temperature monitoring, and the development of an integrated pop-up reminder to measure core temperature in our electronic healthcare record.</p><p><strong>Results: </strong>With this QI initiative, the percentage of pediatric patients undergoing general anesthesia for more than an hour in our dental OR with documented core temperature monitoring increased from 10% to 60% by October 2023, and to 90% by January 2024.</p><p><strong>Conclusions: </strong>We successfully increased compliance with standard ASA monitoring guidelines. By January 2024, 90% of pediatric patients undergoing general anesthesia for more than an hour in our dental OR had documented core temperature monitoring in the anesthetic record.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"520-526"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663873","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 the Intrahospital Transport of Critically Ill and Anesthetized Children.","authors":"Bishr Haydar","doi":"10.1111/pan.15112","DOIUrl":"10.1111/pan.15112","url":null,"abstract":"<p><p>Intrahospital transport of anesthetized and critically ill children is a routine event that carries myriad risks. Patients with a vast array of conditions are transported between the intensive care unit, procedural and diagnostic imaging suites, emergency department, and other areas. Given this complexity, the range of potential adverse events is large. Improving safety during transport will require a broad and holistic approach. This review will inform pediatric anesthesiologists on the best approach to improve their care and patient safety during transport by identifying common error traps, with both individual- and system-level countermeasures. The error traps include the failure to fully weigh all risks, costs, and benefits associated with transport for a procedure or test; secure appropriate resources for transport and at every destination; provide pertinent information during transfers of care; anticipate physical and physiological changes associated with transport; and execute the plan effectively as a team. Countermeasures include multidisciplinary discussion and resource optimization; use of systematic tools, standardized communication, and checklists to improve processes of care; encouraging the prioritization of a culture of safety around transport; and adapting the team composition and leadership style to suit the specific clinical scenario.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"497-503"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803910","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":"The Right Team for the Job: Dynamic, Data-Driven Acuity Scoring in Pediatric Perioperative Care.","authors":"Allan F Simpao, Jessica A Berger, Clyde T Matava","doi":"10.1111/pan.15116","DOIUrl":"10.1111/pan.15116","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"492-493"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022970","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":"Risk Analysis of Unplanned Extubation and Inadvertent Endobronchial Intubation During Pediatric Cleft Palate and Lip Repair.","authors":"Jordan I Gaelen, Johna Joseph, Alexander B Froyshteter, Noopur Gangopadhyay, Jennifer L McGrath, Eric C Cheon","doi":"10.1111/pan.15121","DOIUrl":"10.1111/pan.15121","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"573-576"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026293","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}