Pediatric Anesthesia最新文献

{"title":"Impact of Video Distraction on Anxiety During Anesthesia Induction in Pediatric Patients Premedicated With Midazolam: A Randomized Controlled Trial.","authors":"Armin Sablewski, Thorben Jacobi, Sebastian Walter, Hiltrud Muhle, Christian Kandzia, Asita Fazel, Andreas Meinzer, Dithild-Angelika Melchior, Amke Caliebe, Michael Kalab, Tobias Becher, Ingmar Lautenschläger","doi":"10.1111/pan.15105","DOIUrl":"10.1111/pan.15105","url":null,"abstract":"<p><strong>Background: </strong>Midazolam is commonly used and effective in reducing preoperative anxiety in children. Nonpharmacological interventions, such as video distraction, are also well established for alleviating preoperative anxiety in pediatric patients, particularly those treated in ambulatory settings.</p><p><strong>Aims: </strong>To explore whether video distraction during anesthesia induction provides additional anxiety reduction in children premedicated with midazolam.</p><p><strong>Methods: </strong>In this prospective randomized controlled trial, children aged 2-10 years scheduled for elective noncardiac surgery were premedicated with midazolam and randomly assigned to either a video group (n = 54) or a control group (n = 51). In the video group, videoclips were displayed as a distraction prior to anesthesia induction, while the control group received standard care. Anxiety was measured using the short form of the modified Yale Preoperative Anxiety Scale (mYPAS-SF). The primary endpoint was the change in mYPAS-SF scores between transfer to the operating theater and anesthesia induction (ΔmYPAS-SF). Secondary endpoints included emergence delirium, postoperative pain, and compliance during anesthesia induction. Character traits were assessed.</p><p><strong>Results: </strong>There was no additional anxiety reduction in the video group compared to the control group. The change in mYPAS-SF scores (median [interquartile range]) was 4.2 (-2.1, 16.7) in the control group and 4.16 (-2.1, 7.0) in the video group (p = 0.246). Similarly, there were no significant differences between the groups regarding compliance during anesthesia induction, emergence delirium, or postoperative pain. Compliance during anesthesia induction, emergence delirium, and postoperative pain was similar between the groups. Additional anxiety reduction through video distraction was observed in children with pronounced anxiety traits, including \"General Phobia,\" \"Separation,\" \"Panic,\" and the overall \"Total Phobia\" score.</p><p><strong>Conclusion: </strong>In our study, video distraction did not result in additional anxiety reduction in children premedicated with midazolam prior to anesthesia induction in a hospital setting. Certain children with specific personality traits may still benefit from this intervention.</p><p><strong>Trial registration: </strong>Registry: German Clinical Trial Register; Registration number: DRKS00025411; Principal investigator's name: Armin Sablewski; Date of registration: February 15, 2022; https://drks.de/search/en/trial/DRKS00025411.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"542-551"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772891","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":"Perioperative Intravenous Lidocaine Infusion Therapy as an Adjunct to Multimodal Analgesia for Adolescent Idiopathic Scoliosis Surgical Correction: A Double-Blind Randomized Controlled Trial.","authors":"Jessica Luo, Nicholas West, Samantha Pang, Aanisah Golam, Erin Adams, Matthias Görges, Roxane R Carr, Firoz Miyanji, Gillian R Lauder","doi":"10.1111/pan.15124","DOIUrl":"10.1111/pan.15124","url":null,"abstract":"<p><strong>Background: </strong>Posterior spinal instrumentation and fusion is a common surgical correction for adolescent idiopathic scoliosis. Preventative multimodal analgesia, including opioids, is required to minimize postoperative pain, but opioids are associated with dose-dependent side effects that may disrupt recovery.</p><p><strong>Aims: </strong>We hypothesized that the addition of 48-h perioperative intravenous lidocaine therapy to a multimodal analgesia regimen would reduce morphine utilization.</p><p><strong>Method: </strong>We conducted a double-blinded randomized controlled trial in 10-19 years old, ASA I-III, undergoing single-stage scoliosis correction. Participants were randomly allocated to the Intervention group (intravenous lidocaine 1 mg kg^-1 bolus at anesthesia start, followed by 2 mg kg^-1 h^-1 infusion for 8 h, followed by 1 mg kg^-1 h^-1 for 40 h) or Control (normal saline). Participants received standardized perioperative multimodal analgesia, including a postoperative morphine infusion with titration rules protocolized to self-reported pain scores. The primary outcome was 48-h morphine utilization; secondary outcomes were median and worst pain scores, and times to first stand, first walk > 15 steps, urinary catheter removal, termination of morphine infusion, and hospital discharge.</p><p><strong>Results: </strong>Data were available from 38 participants: 32 (84%) female; median (IQR) age 16.3 (14.9-17.2) years, with curve magnitude (Cobb angle) 62 (56-70) degrees. The 48-h morphine utilization did not differ between groups: Intervention median (IQR) 0.86 (0.73-1.05) mg kg^-1 versus Control 1.00 (0.77-1.18) mg kg^-1; median difference -0.11 (95% CI -0.30 to 0.13) mg kg^-1; p = 0.264. There were similarly no differences in morphine utilization at 12, 24, or 36 h or any secondary outcome, except the first postoperative pain score: Intervention 3/10 (1.75-5) versus Control 5/10 (3-7); median difference -2 (95% CI 0 to -3); p = 0.035. Three cases with mild symptoms of suspected local anesthetic systemic toxicity were observed in the Intervention group.</p><p><strong>Conclusions: </strong>We found no evidence to support the adjunctive use of 48-h perioperative intravenous lidocaine therapy in adolescents undergoing scoliosis correction in which effective multimodal analgesia was adopted.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04069169.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"552-561"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041553","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":"Development and Evaluation of an Electronic Health Record-Generated Clinical Coverage Scoring System Compared to Human Decision-Making in Pediatric Surgical Patients: A Single Center Experience.","authors":"Pornswan Ngamprasertwong, Annie R Amin, Jiwon Lee, Lili Ding, Bobby R Das, Ali I Kandil, Theerawich Likitabhorn, Michelle Coleman, Simran Venkatraman, Sarah Wilhelm, Ekanong Sutthipongkiat, Veronica O Busso","doi":"10.1111/pan.15110","DOIUrl":"10.1111/pan.15110","url":null,"abstract":"<p><strong>Background: </strong>Surgical Patients in tertiary care centers can be healthy or extremely ill with comorbidities, and procedures vary from simple to difficult and complicated. High-acuity cases, or those involving anesthesia and procedural complexities, require specific anesthesia staff arrangements, specific nursing team assignments, and additional support staff. These cases are identified manually, and there is no ready-to-use scoring system to stratify high-acuity, complex pediatric surgical patients.</p><p><strong>Aims: </strong>We aim to develop an electronic medical record-generated rule-based clinical coverage scoring system to identify high-acuity, complex cases and compare its accuracy with human performance.</p><p><strong>Methods: </strong>In this quality improvement project, an automated scoring system using rule-based clinical criteria was designed and implemented in a quaternary children's hospital. These rules were based on patient characteristics, procedure and anesthetic complexity, and the patient's acute condition. The cases with clinical coverage scores higher than zero were compared to those manually identified as high-acuity, complex cases by the anesthesia clinical directors and operating room charge nurses. The accuracy was reported using sensitivity, specificity, PPV, NPV, accuracy, and F-1 scores.</p><p><strong>Results: </strong>There were 10 761 pediatric surgical cases during the study period (April 7-September 8, 2023). 1450 (13.5%) cases were manually identified as high-acuity, complex cases, while the automated system identified 1906 (17.7%) cases. The accuracy of the automated scoring system improved over time. Eventually, it became better than manual identification with 95.86% (94.48%-97.24%) sensitivity, 99.84% (99.71%-99.98%) specificity, 99.35% (98.78%-99.92%) PPV, 98.97% (98.62%-99.32%) NPV, and 99.04% (98.62%-99.47%) accuracy by the end of the study period. The most impactful interventions were removing canceled cases and adding procedure codes to the rules for automated scores.</p><p><strong>Conclusion: </strong>EHR-generated clinical coverage scores can reliably replace manual reviews of high-acuity, complex pediatric surgical patients. This tool can guide clinical decision-making in real time.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"511-519"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764584","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":"In This Issue August 2025.","authors":"","doi":"10.1111/pan.70007","DOIUrl":"https://doi.org/10.1111/pan.70007","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476157","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":"Harnessing Generative Artificial Intelligence in Pediatric Anesthesia: Enhancing Learning, Patient Care, and Family Communication.","authors":"Asad Siddiqui, Vikas N O'Reilly-Shah, Allan F Simpao, Hannah Lonsdale","doi":"10.1111/pan.70005","DOIUrl":"https://doi.org/10.1111/pan.70005","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476156","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":"Propofol: A Medication That Changed Pediatric Anesthesia Practice.","authors":"Brian J Anderson, L Ignacio Cortinez","doi":"10.1111/pan.70001","DOIUrl":"10.1111/pan.70001","url":null,"abstract":"<p><p>The introduction of propofol changed our understanding of pediatric anesthesia pharmacology, research approaches for intravenous drug study, and led to infusion pump development for the maintenance phase of anesthesia. The story of propofol development provides a blueprint for other intravenous drug development. The introduction of the target concentration strategy based on pharmacokinetic-pharmacodynamic and covariate understanding is central to total intravenous anesthesia techniques and is best exemplified by propofol. While use of the EEG to gauge depth of anesthesia preceded the propofol era, processed EEG signals enabled description of the relationship between propofol plasma concentration and effect, advancing propofol use and safety. Clinical need drove the characterization of propofol pharmacokinetics and concentration effect relationships in children. Subsequently, study in populations such as neonates, the critically ill, and children with obesity explored covariate influences. Target-controlled infusions also required an appreciation of effect site concentrations and time delays, and drug interactions such as those between propofol and opioids. Supraglottic airway use in children paralleled propofol use because greater depression of pharyngeal and laryngeal reactivity was noted with propofol than seen than with thiopental. Environmental concerns with the carbon footprint of inhalational agents may yet see infusions assume dominance for maintenance anesthesia.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340340","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":"Repeated Exposure to Anesthesia Short-Course Training of Non-Physician Anesthesia Providers and the Incidence of Intraoperative Hypoxemia in a Low-Resource Hospital in Tanzania.","authors":"Simon Ponthus, Amina Omari, Selerina Tesha, Silas Msangi, Lionel Dumont","doi":"10.1111/pan.70002","DOIUrl":"10.1111/pan.70002","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333694","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":"Regional Anesthesia in Resource-Constrained Settings: A Chance to Ameliorate Pediatric Perioperative Care.","authors":"Madeeha Rasheed, Mohsin Nazir","doi":"10.1111/pan.70000","DOIUrl":"https://doi.org/10.1111/pan.70000","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326416","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":"Evaluation of Modified Fasting Protocols to Shorten Fasting Time Before Sedation in Children: A Prospective Randomized Noninferiority Trial.","authors":"Eunah Cho, Jinyoung Song, June Huh, I-Seok Kang, Hyun Ju Kim, In Young Youn, Hyebin Lee, Ji Hee Kwak","doi":"10.1111/pan.15142","DOIUrl":"https://doi.org/10.1111/pan.15142","url":null,"abstract":"<p><strong>Backgrounds: </strong>Guidelines for fasting before procedural sedation aim to prevent pulmonary aspiration and are primarily targeted for deep sedation. Our study explored whether a shortened fasting protocol is noninferior to the standard protocol by comparing gastric contents evaluated by ultrasound.</p><p><strong>Methods: </strong>Pediatric patients aged < 3 years, scheduled for elective transthoracic echocardiography under sedation, were randomly allocated to a standard group (4-h fasting) or a modified group (4-h fasting for solid and 1-h fasting for water). Gastric ultrasound was performed to evaluate cross-sectional area (CSA) in supine and right lateral decubitus positions (RLDP), with the upper body elevated at 45°. The primary outcome was the CSA-RLDP (CSA_{RLDP 45}). A noninferiority test was performed applying the delta (Δ) of 2.1.</p><p><strong>Results: </strong>The noninferiority test showed that the modified fasting protocol was noninferior to the standard fasting protocol in terms of CSA_{RLDP 45}, with a mean difference (95% confidence interval) of 0.16 (-0.55 to 0.87) within the noninferiority range of delta.</p><p><strong>Conclusion: </strong>The modified fasting protocol was noninferior to the standard in pediatric patients undergoing sedation for transthoracic echocardiography, as assessed by gastric ultrasound.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05810532.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326415","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 Perioperative Quality Improvement: Case Studies in Positive Deviance Using Real-World Data.","authors":"Aaron B Low, Jill R Maresh, Terri Jarvi, Jennifer Esser, Terrance Rawson, Nicolas Fernandez, Jennifer L Chiem, Rachel M Feldman, John V Hale, Paul A Merguerian, Timothy A Lander, Lynn D Martin","doi":"10.1111/pan.15143","DOIUrl":"https://doi.org/10.1111/pan.15143","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare quality/safety efforts frequently carry negative themes. This 'find and fix' method typically highlights little about the presence but rather the absence of quality and safety. Positive deviance (PD) is an approach that instead focuses on spreading success rather than eliminating errors. We describe four PD case studies from two pediatric health systems where procedural quality outcomes were improved.</p><p><strong>Methods: </strong>Utilizing common continuous quality improvement methods, multidisciplinary teams assessed and improved clinical processes. AdaptX (Seattle, WA), a software solution that allows clinicians to extract continuously updated, aggregated health data from EMRs, was used to analyze data using statistical process control methods. Funnel charts identified PD providers for key processes. The team leader interviewed, observed, and documented their practice. Team members tested these new processes in clinical practice utilizing Plan-Do-Study-Act (PDSA) cycles. The team monitored real-time data to guide each PDSA cycle decision. Once finalized, the team disseminated this new best practice standard across the staff.</p><p><strong>Results: </strong>Reduction in surgical prep time yielded a sustained 35% increase in monthly procedure volumes. Gastroenterology anesthesia improvements coupled with a second procedural room led to a sustained 74% increase in monthly case counts. Improvements in Post-Anesthesia Care Unit duration and on-time performance reduced case durations, staff overtime, and increased operational capacity. Balance measures were unchanged.</p><p><strong>Discussion: </strong>These PD methods successfully improved the timeliness of procedural processes and capacity without adverse impacts on other quality measures. Real-time, democratized access to data made finding PD providers easy and eased the spread of this practice, facilitating sustained improvement in outcomes. This approach aligns with clinicians' desire to provide the best care, thus enhancing staff engagement.</p><p><strong>Conclusions: </strong>The PD approach improved procedural efficiency in two unique and unaffiliated pediatric healthcare systems. Future efforts will focus on PD beyond the procedural domain and in additional healthcare institutions.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317576","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}