Pediatric Anesthesia最新文献

{"title":"Editor's Picks for the Pediatric Anesthesia Article of the Day: October 2024.","authors":"Melissa Brooks Peterson, Myron Yaster, Justin L Lockman","doi":"10.1111/pan.15062","DOIUrl":"10.1111/pan.15062","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"323-324"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067078","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":"Pharmacokinetic and Physiological Concepts Relevant for Determining Sevoflurane Dose.","authors":"James D Morse, Brian J Anderson","doi":"10.1111/pan.15077","DOIUrl":"10.1111/pan.15077","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"267-269"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189997","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":"Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.","authors":"Kristen K Thomsen, Michael Fritz, Christian Zöllner, Till Kessler, Bernd Saugel, Leonie Schulte-Uentrop","doi":"10.1111/pan.15059","DOIUrl":"10.1111/pan.15059","url":null,"abstract":"<p><strong>Background: </strong>Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.</p><p><strong>Aims: </strong>We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.</p><p><strong>Methods: </strong>This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.</p><p><strong>Results: </strong>150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).</p><p><strong>Conclusion: </strong>TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.</p><p><strong>Trial registration: </strong>German Clinical Trial Register: DRKS00028271.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"310-315"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927588","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":"Mucositis Pain and Its Temporal Relationship to White Cell Count.","authors":"Claire Douglas, James D Morse, Brian J Anderson","doi":"10.1111/pan.15063","DOIUrl":"10.1111/pan.15063","url":null,"abstract":"<p><strong>Background: </strong>Children who have received chemotherapy and/or radiotherapy treatment resulting in neutropenia can suffer painful mucositis. We explored the relationship between pain score and white cell count in children with mucositis due to immunosuppression and assessed the influence of opioid and ketamine analgesia.</p><p><strong>Methods: </strong>Children with mucositis nursed in the pediatric oncology and hematology ward were invited to partake in this observational study following referral to the pediatric pain service for intravenous analgesia. Pain scores, white cell count, neutrophil count, and analgesia requirements were recorded daily until intravenous analgesia was either stopped or transitioned to oral analgesia. Data were analyzed using nonlinear mixed effects models that sought a relationship between white cell count and pain score using a sigmoid maximal effect (E_MAX) model. The impact of analgesic use on pain score was determined. The temporal relationship between white cell count and pain score was characterized by using a delayed effect model with an equilibration half-time.</p><p><strong>Results: </strong>Fifty children were enrolled in the study from January 2022 to December 2023. The equilibration half-time relating the rise in white cell count and pain response was 0.29 days. The initial pain score (estimated in those children already started on treatment with paracetamol and tramadol) was 6.3 (maximum pain 10). The maximum pain reduction was 59% of that initial pain score. Morphine and ketamine further reduced pain; the maximum response for opioids was 38% reduction and that for ketamine was 11%.</p><p><strong>Conclusion: </strong>Pain relief from mucositis is related to an increase in white cell count after a period of severe neutropenia, where white cell count is a surrogate for neutrophil count. There is a delay in analgesic response of approximately 1 day. This analgesic response to increasing white cell count had greater dominance than analgesia achieved using either opioids or ketamine.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"302-309"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932133","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":"Last-Minute Cancellations in Pediatric Ambulatory and Day Surgeries in Italy: Prevalence and Risk Factors.","authors":"Alessandro Vittori, Rajeev S Iyer, Marco Cascella, Riccardo Tarquini, Elisa Francia, Ilaria Mascilini, Cecilia M Pizzo, Franco Marinangeli, Roberto Pedone, Giuliano Marchetti, Sergio G Picardo","doi":"10.1111/pan.15093","DOIUrl":"https://doi.org/10.1111/pan.15093","url":null,"abstract":"<p><strong>Background: </strong>Cancellation of pediatric day and ambulatory surgeries on the day of the procedure poses a significant challenge, impacting hospital resources and patient care. In Italy, ambulatory surgery is defined as a surgical/diagnostic procedure without hospitalization, and day surgery is defined as a surgical/diagnostic procedure with daytime hospitalization.</p><p><strong>Aims: </strong>To measure the rate and causes of cancellations on the day of the procedure in a tertiary pediatric hospital in Italy.</p><p><strong>Methods: </strong>We collected the data retrospectively from the electronic health record between January 2020 and March 2022 at Ospedale Pediatrico Bambino Gesù in Rome, Italy. The number of case cancellations were captured. The reasons for cancellation were categorized into three different buckets: anesthetic reasons, surgical reasons, and non-adherence to protocol. The reasons under each of these categories were further explored. We analyzed the difference in the rate of last-minute cancellations between ambulatory surgery and day surgeries to examine if different pathways produce different results.</p><p><strong>Results: </strong>A total of 4,600 procedures were scheduled and 183 were canceled (3.9% of total procedures). Surgical reasons contributed to most cancellations (49%), followed by anesthesia reasons (42%) and non-adherence to protocols (9%). Surgical reasons, including the need for post-operative hospitalization, were the primary causes for cancellation, often due to mismatches between pre-operative evaluations and the final decision-making process. Younger patients, particularly those prone to respiratory tract infections, were more likely to experience cancellations. Anesthetic reasons were also a significant factor but less prevalent than surgical ones.</p><p><strong>Conclusions: </strong>Using standardized treatment and diagnosis pathways can reduce the number of canceled procedures and optimize resources. A telephone re-assessment before the procedure and telemedicine can be useful strategies to further reduce the cancellation rate.</p><p><strong>Clinical implications: </strong>The use of pediatric day surgery has significant advantages: minimizing last-minute canceled procedures means increasing patient comfort and reducing healthcare costs. Identifying the causes of cancellations on the day of the procedure allows one to improve the organizational system of the operating room.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625877","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":"Correction to \"Global Pediatric Anesthesia-Anglo West Africa Perspective\".","authors":"","doi":"10.1111/pan.15092","DOIUrl":"https://doi.org/10.1111/pan.15092","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586501","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":"Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) in Adolescents: A Randomized Controlled Trial.","authors":"M Bastianello, M Torre, R Bonfiglio, M G Calevo, L Palomba, P Uva, A Kanapari, G Lorenzoni, N Disma","doi":"10.1111/pan.15090","DOIUrl":"https://doi.org/10.1111/pan.15090","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing Pectus Excavatum repair with the minimally invasive approach frequently report severe postoperative pain. The goal of the study is to determine the superiority of cryoanalgesia compared to standard of care for return to normal quality of life.</p><p><strong>Methods: </strong>A randomized, active controlled, parallel groups trial (category IIb medical device) was designed for patients undergoing pectus excavatum repair. Participants were screened from the elective surgical lists at Istituto Gaslini, Genova, Italy, and they all were part of the academic practice setting. Once enrolled, patients were randomly assigned to one of the two study arms: cryoanalgesia vs. standard of care (epidural-based analgesia). The primary outcome was the Pediatric Quality of Life (PedsQL) and the subcomponents (psychosocial and physical health) 14 days after surgery.</p><p><strong>Results: </strong>Protocol was approved by the Ethics Committee (278/2021-DB id 11 421) and conducted between February 2022 and October 2023. Eighty-eight patients were enrolled in the study: forty-five to cryoanalgesia and forty-three in the epidural arm. The PedsQL median (IQR) at the 14th day was 59.8 (48.4, 71.2) vs. 67.9 (58.7, 73.9) (95% CI: 0.46-13; difference 6.5; p = 0.07) with ITT analysis, and 59.8 (48.37, 71.20) vs. 69.02 (58.70, 73.91) (95% CI: 0.82, 14; difference 7.4; p = 0.028) with PP analysis, in the cryoanalgesia and in the standard of care group, respectively. Irrespective of treatment, a significant decrease in both the PedsQL total score and its subcomponents was found. This effect persisted when stratified by treatment: physical health showed a decrease in both arms, while psychosocial health demonstrated a more marked decrease in the standard of care arm (q-value = 0.028), but not in the cryoanalgesia arm (q-value = 0.056).</p><p><strong>Conclusions: </strong>Cryoanalgesia did not improve return to baseline quality of life 2 weeks after surgery. However, it showed to be beneficial in the psychosocial component of the PedsQL scale.</p><p><strong>Trial registration: </strong>NCT05201820.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542844","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":"Safety of Intrathecal Clonidine as an Adjuvant to Spinal Anesthesia in Infants and Children.","authors":"Grant Heydinger, Eden E Bayer, Catherine Roth, Sibelle Aurelie Yemele Kitio, V Rama Jayanthi, Arlyne Thung, Joseph D Tobias, Giorgio Veneziano","doi":"10.1111/pan.15091","DOIUrl":"https://doi.org/10.1111/pan.15091","url":null,"abstract":"<p><strong>Introduction: </strong>Preliminary clinical studies have demonstrated that clonidine is an effective adjuvant to spinal anesthesia in neonates and infants. However, the studies conducted previously have had a limited cohort size of 80-100, potentially limiting an accurate measure of its safety.</p><p><strong>Methods: </strong>The current study retrospectively examines our 5-6-year experience with clonidine as an adjuvant to spinal anesthesia in a large cohort of neonates and infants.</p><p><strong>Results: </strong>The study cohort included 1420 patients ranging in age from newborn to 36 months (median age 7 months). Ninety-five percent of the patients tolerated spinal anesthesia without requiring conversion to general anesthesia, and over 73% of the patients did not require any additional intraoperative sedation. Hypotension (sBP ≤ 60 mmHg) was the most common intraoperative event (17%) with one patient requiring the administration of an anticholinergic agent for bradycardia. No serious intraoperative adverse events were noted. Post Anesthesia Care Unit (PACU) Phase I was bypassed in 75% of cases, and the postoperative admission rate was 7%, with the majority (85%) being planned admissions. Fifty-six patients (4%) returned to the hospital during the first seven postoperative days, primarily for surgical concerns.</p><p><strong>Conclusions: </strong>Based on this retrospective, observational study, clonidine appears to be a safe adjuvant to spinal anesthesia for ambulatory surgical procedures in infants and children. We observed a low incidence of intraoperative and postoperative complications.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542847","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":"Opioid-Free Anesthesia for a Child With Patau Syndrome With External Oblique Intercostal Fascial Plane Blocks.","authors":"Dhari Alrashed, Sinead Harte, Brano Mislovic","doi":"10.1111/pan.15052","DOIUrl":"10.1111/pan.15052","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"249-250"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786394","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":"Error Traps in Developing a Pediatric Enhanced Recovery After Surgery (ERAS) Program.","authors":"Christian M Taylor, Emily L Weisberg, Nichole M Doyle, Todd A Glenski","doi":"10.1111/pan.15042","DOIUrl":"10.1111/pan.15042","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) pathways have been shown to improve patient outcomes, increase patient satisfaction, and decrease costs. First created and implemented in the adult population, these pathways are now commonplace and continue to expand in the pediatric realm. While there are many proven benefits to ERAS pathways, there continue to be challenges to their proper implementation and long-term success. This article aims to explore common challenges in pediatric ERAS development and implementation, along with strategies to avoid potential pitfalls. Key themes include departmental and institutional support, stakeholder engagement, awareness of pathways, data management and dissemination, and long-term maintenance including Plan-Do-Study-Act (PDSA) cycles. Pathway development teams should be aware of these considerations and potential pitfalls, and focusing on them can promote long-term success for a well-designed pathway.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"199-206"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693328","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}