Pediatric Anesthesia最新文献

{"title":"Prospective Observational Study to Evaluate Post-Operative Urinary Retention With Pediatric Epidural Analgesia.","authors":"Ashish Sam Samuel, Jujju Jacob Kurian, Anita Shirley Joselyn, Susan Jehangir","doi":"10.1002/pan.70223","DOIUrl":"10.1002/pan.70223","url":null,"abstract":"<p><strong>Background and objectives: </strong>Epidural analgesia is an effective analgesic method for children throughout the postoperative phase. The post-operative urinary retention affects the post-operative recovery immensely. Many studies look at post-operative urinary retention in adults who receive epidural analgesia, while there is a paucity of data in children. This is a study that addresses the question of post-operative urinary retention in children in whom epidural analgesia is employed.</p><p><strong>Methodology: </strong>This is a prospective study undertaken in the pediatric surgery department of Christian Medical College in Vellore. Children enrolled in the trial got epidural analgesia both during and after surgery. They weren't catheterized before the surgery. Those who had urinary retention were identified with ultrasound and were catheterized. Data were prospectively collected and analyzed.</p><p><strong>Results: </strong>A total of 157 children participated in this study. Epidural bolus and infusate were either Ropivacaine or Bupivacaine. Sixteen children developed post-operative urinary retention, yielding an overall incidence of 10.2%. Children who were below 2 years of age had no postoperative urinary retention (95% CI: 0.0%-10.9%). Those aged 2 years and above had an incidence of 12.8% (95% CI: 8.0%-19.8%). The likelihood of voiding is 1.15 times higher in children under the age of 2 than in those 2 years and above (Relative Risk (RR): 1.15, 95% CI: 1.07 to 1.23). The incidence of POUR was 13.2% in girls and 7.9% in boys (RR: 1.68, 95% CI: 0.66-4.29, p = 0.270). POUR was observed by 9.6% of the group without the opioid additive and 11.1% of the group with the opioid additive (RR: 0.862, 95% CI: 0.338-2.19). The rate of POUR increased with surgical duration, from 6.1% in procedures < 120 min to 10.8% in procedures with 120 to 180 min and 16.0% in those exceeding 180 min. The bolus used at induction, the Bupivacaine group had 13 out of 124 patients (10.5%) with POUR, and the Ropivacaine group had 3 out of 33 patients (9.1%) with POUR (RR: 1.15, 95% CI: 0.349 to 3.81). The level of epidural placement was not found to be a significant predictor in this study.</p><p><strong>Conclusion: </strong>This study found a rising trend in POUR incidence with age, signifying that older children are more likely to have POUR. This supports a selective, age-guided approach to bladder catheterization in pediatric epidural practice, though larger prospective studies are needed to establish evidence-based thresholds.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1102-1107"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974345","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":"Off-Label Medicine Use in Pediatric Anesthesia-Recommendations of the World Federation of Societies of Anaesthesiologists (WFSA) Paediatric Committee.","authors":"Philippa Lane, Clover-Ann Lee","doi":"10.1002/pan.70226","DOIUrl":"10.1002/pan.70226","url":null,"abstract":"<p><strong>Background: </strong>Off-label medicine use is the administration of a medication in any manner that is not included in the approved package insert for that medication. The off label use of medicines is common in pediatric anesthesia due to the limited number of drugs that are specifically approved for use in children. This is due to the lack of clinical drug trials involving children, resulting in the absence of safety and efficacy data for this population of patients. This may lead to an increased risk of adverse events when these medicines are used in pediatric patients and expose anesthesia practitioners to the risk of litigation.</p><p><strong>Aims: </strong>This paper describes an approach and principles for decision making for anesthesia practitioners around use of medicines in pediatric patients undergoing anesthesia.</p><p><strong>Conclusion: </strong>The decision to use a medication off label should be rational, clinically appropriate and based on a balance of benefit versus risk.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1011-1015"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982994","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":"Codeine and Metabolite Concentrations in the Breastfed Neonate.","authors":"Brian J Anderson, Jacqueline A Hannam","doi":"10.1002/pan.70227","DOIUrl":"10.1002/pan.70227","url":null,"abstract":"<p><p>Analgesic effect from codeine is from its metabolite, morphine. Morphine is formed by the O-demethylation of codeine and that enzyme is controlled by the cytochrome P450 2D6. More than 60 alleles in the CYP2D6 gene have been identified. This spectrum of polymorphism can be categorized into four groups: poor (PM), intermediate (IM), normal (NM), and ultra-rapid (UR) metabolizers. Codeine is rarely used in children because of fears that those with the UR genotype may suffer respiratory depression from increased morphine production. There is also concern that postpartum women medicated with codeine and who are UR metabolizers may have enough morphine in breastmilk to cause respiratory depression in a breastfed neonate. A pharmacokinetic compartment model was used to explore this assumption. There are five issues to consider in the pharmacological pathway from maternal ingestion of codeine to neonatal morphine plasma concentration: maternal morphine concentration that is dependent on genotype, milk to plasma concentration ratio, neonatal codeine and morphine exposure from breastmilk, codeine metabolism to morphine in the neonate, and morphine clearance in the neonate. The compartment model confirmed the implausibility of neonatal opioid toxicity from breastfeeding. Currently, short-term maternal use of prescription opioids (other than codeine) is considered safe and infrequently presents a hazard to the newborn. Postpartum women are denied codeine for analgesia and yet predicted neonatal morphine concentrations are lower than 1 μg/L, regardless of genotype. Maternal opioids are used with caution, especially after multiple doses, and neonates younger than 46 weeks postmenstrual age are observed for drowsiness and respiratory depression. The maternal use of codeine requires similar considerations and the current ban on codeine use in postpartum women who are breastfeeding requires review.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1016-1022"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982965","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":"Caudal Anesthesia Patient Education Materials: Comprehensive Analysis of Generative Artificial Intelligence and Traditional Patient Information Leaflets.","authors":"Armanullah Khan, Aritra Kundu, Sourav Saha, Prakash Gondode","doi":"10.1002/pan.70233","DOIUrl":"10.1002/pan.70233","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1153-1155"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148033414","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":"Effects of Perioperative Music Interventions on Emotional Outcomes in Children and Adolescents: A Systematic Review and Meta-Analysis Integrating Developmental Psychology and Music Education Perspectives.","authors":"Yuchen Wen, Jinying Han, Jiayin Gao, Jiaqi Lou, Ziyi Xiang","doi":"10.1002/pan.70239","DOIUrl":"10.1002/pan.70239","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of perioperative music interventions on emotional outcomes (preoperative anxiety, postoperative fear, emergence delirium) and related physiological parameters in children and adolescents undergoing surgery, and to examine potential effect modifiers.</p><p><strong>Methods: </strong>Nine databases were searched from inception to February 2026. Randomized controlled trials comparing music versus no-music control in pediatric surgical patients (≤ 18 years) were included. Risk of bias was assessed with RoB 2.0. Random-effects meta-analyzes were performed for preoperative anxiety, postoperative pain, heart rate, and blood pressure. Subgroup analyzes were conducted for age, music selection method, intervention timing, and surgery type. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>Seventeen RCTs (1871 children) were included. Music significantly reduced preoperative anxiety (SMD = -2.03; 95% CI -3.19 to -0.86; I² = 97%), postoperative pain (SMD = -0.64; 95% CI -1.01 to -0.27; I² = 62%), heart rate (MD = -12.92 bpm; 95% CI -19.07 to -6.77; I² = 88%), and mean arterial pressure (MD = -8.41 mmHg; 95% CI -10.07 to -6.76; I² = 66%). Effects on systolic blood pressure were not significant. Anxiolytic effects were significant in both children (≤ 12 years) and adolescents (≥ 13 years) with no subgroup difference. Self-selected and pre-selected music were both effective. Sensitivity analyzes confirmed robustness. GRADE assessment indicated very low to low certainty of evidence for all outcomes, primarily due to high heterogeneity, risk of bias, and imprecision.</p><p><strong>Conclusions: </strong>Perioperative music was associated with reduced anxiety and pain, but evidence certainty was very low to low. Pending stronger evidence, music may be considered a low-risk adjunct to standard care.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1052-1077"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239946","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":"Non-Intubated Spontaneous Ventilation Versus Endotracheal Intubation Anesthesia for Pediatric Thoracoscopic Lung Resection: A Retrospective Propensity-Score-Matched Study-In Reply.","authors":"Ying Chen, Ding Han, Xian Zhang, Yurui Wu, Shoudong Pan, Fuxia Yan","doi":"10.1002/pan.70247","DOIUrl":"10.1002/pan.70247","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1171-1172"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252719","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":"How Culture Enables Practice: Facilitators and Barriers to the Use of Total Intravenous Anesthesia in Pediatric Anesthesia.","authors":"Nicholas West, Eleanor Reimer, Asli E Ozer, Rotem Killam, Matthias Görges","doi":"10.1002/pan.70214","DOIUrl":"10.1002/pan.70214","url":null,"abstract":"<p><strong>Introduction: </strong>Total intravenous anesthesia (TIVA) in children has gained popularity due to potential advantages, including decreased respiratory adverse events, postoperative nausea and vomiting, and emergence agitation. British Columbia Children's Hospital (BCCH) has a reputation for TIVA use, training, and advocacy, including intravenous induction.</p><p><strong>Aim: </strong>To inform practice change and education by exploring how institutional culture impacts TIVA adoption, particularly regarding intravenous cannulation in awake children.</p><p><strong>Methods: </strong>Current and former BCCH anesthesiologists and trainees were surveyed and interviewed about TIVA practices at BCCH and at their current institutions. The survey covered demographics, practice settings, past and current methods for induction and maintenance of anesthesia, factors contributing to technique selection, TIVA barriers and facilitators, and implementation factors. Semi-structured interviews conducted with a subset of participants were analyzed using deductive and inductive thematic analysis.</p><p><strong>Results: </strong>Twenty-six participants completed the survey: 21 attending physicians, 2 fellows, and 3 residents; 58% with < 10 years' and 23% with > 20 years' anesthesia practice. Most participants (92%) practised in an academic setting, caring for a median [interquartile range] 400 [200-500] children annually. Most (96%) indicated their BCCH experience had changed their practice, with a greater effect on using intravenous anesthesia for maintenance than induction. Changes were influenced by a positive experience (77%), supportive environment (42%), and scientific evidence (42%). Choice of anesthetic technique depended on patient factors (89%), institutional expectations (46%), pharmacology (42%), and patient preference (39%), but not parental preference (15%). Interviews with 11 participants focused on intervention bundles to enable success, expectation-setting, family education, equipment and staff availability, and supportive workflows.</p><p><strong>Conclusion: </strong>Training in a TIVA institution can have a profound effect on using TIVA in children and drive changes in anesthetic practice elsewhere. Introducing TIVA requires a supportive culture, appropriate equipment, and the personalization of approaches, and may benefit from understanding factors in change management.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1078-1088"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869318","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 Difficult Laryngoscopy on First-Pass Success and Adverse Events in Pediatric Emergency Department Intubations.","authors":"Tom Solan, Stefan Sabato, Hatem Alkhouri, Michael Dinh, Katie Reeves, Andrew Tagg, Nathan Forsyth, Bernard McCarthy, Eleanor Loughhead, Ben Lawton, Matthew Gorman, Jeremy Furyk, Frances Kinnear, Andrew Brainard, Meredith L Borland, Shane George, Amit Kochar, Simon Craig, Franz E Babl, Elliot Long","doi":"10.1002/pan.70242","DOIUrl":"10.1002/pan.70242","url":null,"abstract":"<p><strong>Background: </strong>Airway management in the Emergency Department (ED) can be challenging, particularly in children. Difficult laryngoscopy reduces first-pass success and increases complications, but pediatric ED data remain limited.</p><p><strong>Methods: </strong>We conducted a prospective, observational study of pediatric intubations recorded in the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) between 2012 and 2025, including 25 Pediatric Research in Emergency Departments International Collaborative (PREDICT) sites. The primary outcome was the incidence of difficult laryngoscopy. Secondary outcomes were the impact of difficult laryngoscopy on First-Pass Success (FPS) and adverse events. The main exposure variable was laryngoscopic grade, defined as difficult when a Cormack-Lehane Grade 3 or 4 view was encountered on the first attempt. Patient, procedural, and operator characteristics were assessed as potential confounders.</p><p><strong>Results: </strong>Of 946 pediatric ED intubations recorded across 55 sites (including 25 PREDICT pediatric sites) between 2012 and 2025, 865 were included in the analysis after exclusion of cases with missing laryngoscopic grade. The median age was 3.5 years. Difficult laryngoscopy (Cormack-Lehane grade 3-4) was observed in 65 cases (7.5%). FPS was significantly lower in patients with a difficult view compared with those with a non-difficult view (41.5% vs. 87.9%; OR 0.10, 95% CI 0.06-0.17). Adverse events were more frequent in the difficult-view group, including hypoxaemia (38.5% vs. 11.5%; OR 4.81, 95% CI 2.79-8.29) and esophageal intubation (15.4% vs. 1.3%; OR 14.36, 95% CI 5.73-35.98).</p><p><strong>Conclusion: </strong>Difficult laryngoscopy in pediatric ED intubations is relatively infrequent but associated with reduced FPS and increased complications. These findings emphasize the importance of ongoing quality improvement and may help inform training and escalation strategies. Continued registry participation is valuable to capture these low-frequency events and better understand their consequences.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1117-1125"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259149","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":"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":"10.1002/pan.70215","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1169-1170"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460453/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Complete Blood Count-Derived Inflammation Indices and Emergence Delirium in Children Undergoing Adenotonsillectomy.","authors":"Serkan Altıparmak, Ayhan Kars, Sara Salcan, Alparslan Koç","doi":"10.1002/pan.70219","DOIUrl":"10.1002/pan.70219","url":null,"abstract":"<p><strong>Background: </strong>Emergence delirium (ED) is a common postoperative complication in the pediatric population. Although the pathophysiology of ED has not been fully elucidated, an association has been suggested between inflammation and the development of the condition.</p><p><strong>Aims: </strong>The aim of this study was to investigate the associations between the development of ED and preoperative inflammatory indices, primarily the systemic immune inflammation index (SII) and the pan-immune inflammation value (PIV) calculated from complete blood count parameters in pediatric patients undergoing adenoidectomy or adenotonsillectomy.</p><p><strong>Methods: </strong>This prospective study was conducted with children aged 3-12 years who underwent adenoidectomy or adenotonsillectomy at our hospital. Preoperative inflammatory indices were calculated from complete blood count parameters, including the SII (platelet × neutrophil/lymphocyte), PIV (platelet × neutrophil × monocyte/lymphocyte), neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and platelet-to-monocyte ratio (PMR). ED was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale, while the Face, Legs, Activity, Cry, Consolability (FLACC) scale was used to minimize confounding by postoperative pain. Statistical analyses included receiver operating characteristic (ROC) curve analysis and multivariable logistic regression to assess the association between inflammatory indices and emergence delirium.</p><p><strong>Results: </strong>ED occurred in 32 out of 99 patients (32.3%). SII exhibited an AUC of 0.850 with a cut-off value of 412 (sensitivity 81.3%; specificity 86.6%). PIV exhibited an area under the curve of 0.883, with a cut-off value of 289 (sensitivity 75.0%; specificity 92.5%). In the univariable analysis, operative time, SII, and PIV were significantly associated with ED. In the multivariable analysis, operative time, SII and PIV were significantly associated with ED.</p><p><strong>Conclusions: </strong>SII and PIV values derived from routine complete blood count parameters were observed to be associated with the development of ED in pediatric patients undergoing adenotonsillectomy and may provide useful insights into the potential role of systemic inflammation in the pathophysiology of such delirium.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1096-1101"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942337","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}