Pediatric Anesthesia最新文献

{"title":"Comparison of Different Neostigmine Doses for Reversal of Cisatracurium-Induced Neuromuscular Block in Children Under Total Intravenous Anesthesia: A Randomized Controlled Trial.","authors":"Antonio J M M Neto, Guilherme L Benette, Letícia C Siqueira, Marian M Santos, Marco A P Costa, Rodrigo L Alves, Eduardo T Moro, Norma S P Módolo","doi":"10.1002/pan.70216","DOIUrl":"https://doi.org/10.1002/pan.70216","url":null,"abstract":"<p><strong>Background: </strong>Neostigmine is widely used to reverse nondepolarizing neuromuscular blockade in children, but the optimal dose under total intravenous anesthesia is uncertain.</p><p><strong>Aims: </strong>The primary aim was to compare the time to full neuromuscular recovery (TOF ratio of 1.0) following administration of neostigmine at doses of 0, 10, 20, and 30 μg/kg in children at a TOF count of 3. Secondary objectives were full reversal within 10 min and adverse events.</p><p><strong>Methods: </strong>This prospective, randomized, double-blind, parallel-group, superiority trial enrolled 120 children (2-10 years; ASA I-II) undergoing tonsillectomy. Participants received 0, 10, 20, or 30 μg/kg neostigmine at a TOF count of 3 measured by quantitative acceleromyography. The primary outcome was the time from TOF count of 3 to full reversal (TOF ratio = 1.0). Secondary outcomes were the proportion of patients achieving full reversal within 10 min and adverse events. Comparisons among active groups used the Kruskal-Wallis test.</p><p><strong>Results: </strong>A total of 118 patients were analyzed. Median [IQR] time to full reversal was 20.2 [14.8-24.1], 14.0 [10.7-16.8], 11.0 [8.2-15.5], and 11.2 [7.9-14.6] min in the 0, 10, 20, and 30 μg/kg groups, respectively. Reversal was significantly slower in the control group compared with all neostigmine doses. However, there was no statistically significant difference among the active doses (Kruskal-Wallis, p = 0.33). At 10 min, full reversal had occurred in 10.7%, 23.3%, 43.3%, and 33.3% of patients in the respective groups. Adverse events were uncommon, occurring in 10 of 118 patients, and consisted exclusively of transient bradycardia and tachycardia, without differences among groups.</p><p><strong>Conclusions: </strong>At TOF count of 3, neostigmine 10-30 μg/kg shortened reversal compared with no reversal, but doses above 10 μg/kg conferred no additional benefit. Quantitative monitoring remains essential, as fewer than half of patients achieved a TOF ratio of 1.0 within 10 min.</p><p><strong>Trial registry: </strong>https://ensaiosclinicos.gov.br/rg/RBR-4xrx2g3.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841407","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":"Dexmedetomidine Maintenance in Pediatric MRI: Age-Dependent Pharmacokinetics Clouds Causal Inference.","authors":"Mason A Thomas, Anupa Parajuli, Amir L Butt, Cassandra R Duncan-Azadi","doi":"10.1002/pan.70209","DOIUrl":"https://doi.org/10.1002/pan.70209","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841403","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 Window to the Stomach-Gastric Ultrasound's Growing Role in Pediatric Anesthesia.","authors":"Ankita Dey, Nagalakshmi Swaminathan, Anju Grewal","doi":"10.1002/pan.70212","DOIUrl":"https://doi.org/10.1002/pan.70212","url":null,"abstract":"<p><p>Gastric ultrasound (GUS) is an evolving Point-of-Care Ultrasound (POCUS) tool whose applicability is being increasingly studied in pediatric anesthesia. The technique evaluates the gastric antrum, in the right lateral decubitus or supine positions to determine the quality and quantity of stomach contents. The Perlas 3-point grading is a semi-quantitative assessment method, which can be applied to pediatric patients as well. GUS may be potentially useful in situations when a child's fasting status is uncertain or gastric emptying is delayed as an adjunct to clinical decision-making. Although quantitative gastric volume estimation models require further validation and large-scale trials are challenging due to the low incidence of aspiration, GUS holds significant promise. Its routine clinical integration demands further robust studies focused on patient-oriented outcomes.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841358","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":"Analysis of Trajectories of Anxiety Behaviors During Induction of Anesthesia in Children With Multiple Encounters: A Secondary Analysis of a Multicenter Retrospective Cohort Study.","authors":"Annie Xin, Allan F Simpao, Timothy Liversedge, Abby V Winterberg, Ari Y Weintraub, James J Thomas, Clyde T Matava","doi":"10.1002/pan.70210","DOIUrl":"https://doi.org/10.1002/pan.70210","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is a significant stressor for children and is associated with negative postoperative outcomes. Although the incidence of difficult inductions during a single anesthetic encounter is well documented, the longitudinal trajectory of anxiety behaviors in children undergoing repeated anesthesia remains poorly characterized. It is unclear whether repeated inductions lead to habituation (reduced difficult inductions) or sensitization (increased difficult inductions).</p><p><strong>Methods: </strong>We conducted a secondary analysis of a large multicenter retrospective observational study involving data from six pediatric hospitals between 2019 and 2022. The cohort consisted of children under 18 years of age. The primary outcome was the trajectory of difficult induction, defined as a Child Induction Behavioral Assessment (CIBA) score of 3. Secondary outcomes included mask acceptance and trends in anxiolytic interventions. We employed mixed effects logistic regression models to analyze anxiety trajectories, adjusting for age, parental presence, and behavioral diagnoses. Lorenz curves were used to assess the concentration of anesthetic burden within the population.</p><p><strong>Results: </strong>The study included 102 017 unique patients, of whom 24 564 (24%) underwent multiple encounters. The prevalence of difficult induction remained stable during the initial visits but decreased significantly after the fifth encounter, with the odds of difficult induction decreasing by at least 30% compared to the index visit. This \"learning effect\" was setting-dependent: children aged 1-12 years undergoing Nonoperating room anesthesia (NORA) demonstrated significant habituation, whereas difficult induction rates in the operating room (OR) remained static regardless of visit frequency. Additionally, high-frequency utilizers in NORA settings exhibited a pragmatic shift in anxiolytic strategy, transitioning from pharmacological premedication to increased incidence of parental presence at induction of anesthesia.</p><p><strong>Conclusions: </strong>In this secondary analysis, we found that repeated anesthetic exposure did not inherently lead to sensitization. Instead, children-particularly in NORA settings-exhibited habituation, characterized by decreasing anxiety behaviors over time. This divergence suggests that the less hostile physical environment and absence of surgical pain in NORA facilitate desensitization, whereas the OR environment maintains a higher baseline threat level. Clinicians should consider these distinct trajectories and prioritize environmental adaptations or parental involvement for high-frequency patients.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841362","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":"Reduction of Anesthesiologists' Sevoflurane Exposure During Pediatric Mask Induction With an Additional Scavenger: A Randomized Study.","authors":"Feras Somri, Jalaa Hossein, Mostafa Somri, Ohad Hochman, Luis Gaitini, Edna Efrati, Manuel Á Gómez-Ríos","doi":"10.1002/pan.70205","DOIUrl":"https://doi.org/10.1002/pan.70205","url":null,"abstract":"<p><strong>Background: </strong>Pediatric inhalational induction with a face mask is a well-recognized source of occupational exposure to waste anesthetic gases. Conventional anesthesia machine scavenging systems are ineffective in capturing extra-circuit leaks occurring at the patient-mask interface. Urinary hexafluoroisopropanol (HFIP), a metabolite of sevoflurane, is a sensitive biomarker of systemic exposure.</p><p><strong>Methods: </strong>In this prospective randomized parallel-group study, 20 anesthesiologists performing pediatric mask inductions with sevoflurane in an induction anesthesia room were allocated to work either with or without an additional external active gas scavenger positioned near the patient's face. Urine samples were collected before exposure and the following morning. HFIP concentrations were quantified by chromatography and normalized to creatinine. Between-group comparisons were performed using Welch's t-test, with a Mann-Whitney U test used as a sensitivity analysis.</p><p><strong>Results: </strong>Urinary HFIP concentrations were significantly higher in anesthesiologists working without the additional scavenger compared with those using the scavenging system (mean ± SD: 0.63 ± 0.30 vs. 0.02 ± 0.04 μg/mL; p = 0.002; Cohen's d = 3.19). HFIP was undetectable or near the analytical detection limit in most samples obtained with scavenging. The observed difference corresponded to a very large effect size, indicating a marked reduction in systemic sevoflurane exposure when the additional scavenger was used.</p><p><strong>Conclusions: </strong>Use of an additional external scavenging system during pediatric mask induction was associated with a substantial reduction in anesthesiologists' biological exposure to sevoflurane, as assessed by urinary HFIP. These findings provide biological evidence supporting exposure reduction strategies during pediatric inhalational anesthesia, although the clinical significance of the observed differences remains to be established.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT06487169.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841393","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":"Letter to \"Non-Intubated Spontaneous Ventilation Versus Endotracheal Intubation Anesthesia for Pediatric Thoracoscopic Lung Resection: A Retrospective Propensity Score-Matched Study\".","authors":"Anna Camporesi, Paolo Silvani","doi":"10.1002/pan.70215","DOIUrl":"https://doi.org/10.1002/pan.70215","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841411","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 Neonates and Young Infants: Changes in Clinical Outcomes With Adoption of Routine Video Laryngoscopy in a Single Center Retrospective Cohort.","authors":"Iasha Z Khan, Julia H Nagle, Steven J Staffa, Amira Toivonen, Alisha Suthar, Jennyfer Vallejo, Stephen G Flynn, James M Peyton, Raymond S Park, Pete G Kovatsis, Mary Lyn Stein","doi":"10.1002/pan.70213","DOIUrl":"https://doi.org/10.1002/pan.70213","url":null,"abstract":"<p><strong>Background: </strong>While randomized trials show standard blade video laryngoscopy (SVL) improves first attempt tracheal intubation success in neonates and infants, data on outcomes following adoption in routine clinical practice are limited. We hypothesized that SVL use would increase over time and would be associated with higher first attempt success, fewer difficult intubations, and less hypoxemia during induction.</p><p><strong>Aims: </strong>Our primary aims were to report first attempt success and incidence of difficult intubation. Secondary aims included evaluation of temporal trends in SVL use and association of modifiable factors with hypoxemia at induction.</p><p><strong>Methods: </strong>Following IRB approval, we retrospectively reviewed anesthetics with tracheal intubation for noncardiac procedures in neonates and infants < 2 months of age at our institution from August 2012 to May 2024. Group comparisons were made using Fisher's exact test or the Chi-square test. Trends over time were analyzed using the Cochran-Armitage test of trend. Multivariable logistic regression identified factors independently associated with airway outcomes.</p><p><strong>Results: </strong>First attempt tracheal intubation success was 80.4% (2994/3724); incidence of difficult intubation was 5.0% (186/3724). Hypoxemia at induction occurred in 5.5% (205/3724), and airway-related cardiac arrest occurred in 0.2% (6/3724). First attempt success increased over time, paralleling increased SVL use. SVL use was associated with increased odds of first attempt success (85.9%,1381/1607 SVL vs. 76.2%,1613/2117 direct laryngoscopy (DL), aOR 1.77 95% CI 1.48, 2.12, p < 0.001) and decreased odds of difficult intubation (3.1%, 49/1607 SVL vs. 6.5%, 137/2117 DL, aOR 0.47, 95% CI 0.33, 0.66, p < 0.001). Each additional intubation attempt was strongly associated with hypoxemia at induction.</p><p><strong>Conclusions: </strong>We found clinically important improvements in first attempt tracheal intubation over time. These changes occurred in the context of increased SVL use in conjunction with other practice changes in airway management. We advocate routine SVL use in neonates and young infants with the goal of minimizing the number of intubation attempts, a key target for reducing hypoxemia at induction.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819294","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":"Arachnoid Cyst During Caudal Block: USG To the Rescue.","authors":"Amrit Kaur, Sunaakshi Puri, Poonam Motiani, Mukul Kumar Jain","doi":"10.1002/pan.70208","DOIUrl":"https://doi.org/10.1002/pan.70208","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819357","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":"Ultrasound Versus MRI for Pediatric Tracheal Diameter Measurement: A Science Letter.","authors":"Frédéric Anthony Paul Brillouet","doi":"10.1002/pan.70143","DOIUrl":"10.1002/pan.70143","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"571-572"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166196","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":"Determining Parental Attitudes Toward Day of Surgery Consent for Research.","authors":"Monica Caldeira-Kulbakas, Carolyne Pehora, R J Williams, Lipika Soni, Katherine L Taylor","doi":"10.1002/pan.70151","DOIUrl":"10.1002/pan.70151","url":null,"abstract":"<p><strong>Background: </strong>Satisfying ethical principles of voluntary consent within workflow constraints can be challenging, particularly for anesthesia research, where patients are met on the day of surgery. For parents, the added burden of being a surrogate decision maker may impact willingness to be approached for research on the day of surgery. Our aims were to determine parental attitudes to day of surgery approach for research consent and if study type had any influence.</p><p><strong>Methods: </strong>We iteratively developed a questionnaire using stakeholder interviews regarding day of surgery approach for research consent. Particular attention was given to (a) research study designs, (b) previous research experience, and (c) types of surgeries. Participants were stratified according to a child's age, child's previous surgical experience, and any family research experience. Enrolment continued until saturation was reached. Interviews were transcribed and analyzed for themes. The final questionnaire included questions designed to determine parental perceptions of the appropriateness of the same day approach, and whether ethical principles would be satisfied if approached on the day of surgery. The second section presented a series of scenarios describing different study types designed to determine if studies with increasing levels of perceived risk would impact parental perception.</p><p><strong>Results: </strong>Most parents reported that this approach would satisfy ethical principles for voluntary informed consent. Study type was not a determinant except for RCTs, where only half felt a day of surgery approach would be appropriate. The most cited reason for reluctance for RCTs was insufficient time to review details. Parents of younger children (61.1% infants, 56.2% toddlers) were more likely to prefer an alternative time of approach compared to teenagers (36%).</p><p><strong>Conclusions: </strong>The results of this study are reassuring for pediatric researchers, identifying majority acceptance for day of surgery research consent approaches for most studies. We identified subgroups who preferred alternative timing for approach. Alternate strategies are advised to target these subgroups.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04613505.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"560-566"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147308836","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}