Pediatric Anesthesia最新文献

{"title":"Is NRfit \"Fit\" for Caudal.","authors":"Jennifer Coe, Su Ying Ong, Alastair Baxter","doi":"10.1111/pan.15041","DOIUrl":"10.1111/pan.15041","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"178-179"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625691","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":"Caudal block, high flow oxygen insufflation and dexmedetomidine sedation for inguinal hernia surgery in infants-A prospective evaluation of an alternative anesthesia technique.","authors":"Fiona J Taverner, Laura L Burgoyne, Ross Scott-Weekly, Benjamin F van der Griend, Cheryl S L Chooi, Sanjeev Khurana, Susan R Humphreys, Shalem Lemaqz, Scott Morris, Claire T Roberts, Britta S von Ungern-Sternberg","doi":"10.1111/pan.15040","DOIUrl":"10.1111/pan.15040","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair is the most common operation in infants, with well recognized anesthetic and perioperative risks. The aim was to investigate if the combination of caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is suitable for infants undergoing inguinal hernia surgery.</p><p><strong>Methods: </strong>A prospective multicenter international study was performed in three centers in Australia and New Zealand. Fifty infants less than 64 weeks post-menstrual age undergoing inguinal hernia surgery were enrolled. Exclusion criteria were any condition that contraindicated the use of the anesthesia technique. The technique included intravenous dexmedetomidine with a loading dose of 1-2 mcg/kg over 10 min and maintenance of 0.2-3 mcg/kg/h, high-flow nasal oxygen insufflation 2 L/kg/min with an oxygen blender, and a caudal block using 1 mL/kg 0.2% ropivacaine. The primary outcome was the successful completion of surgery without conversion to general anesthesia.</p><p><strong>Results: </strong>Completion of surgery with the technique was successful in 41/50 (82%) infants. Care was provided by 22 anesthesiologists and 11 surgeons. Infants had a low incidence of intraoperative complications, including apnea [1 (2.4%)], bradycardia [2 (4.9%)], hypotension [2 (4.9%)], and desaturation [1 (2.4%)]. Postoperative complications included apnea [3 (7.3%)], bradycardia [3 (7.3%)], hypotension [3 (7.3%)], desaturation [4 (9.8%)]. No infants were intubated in the first 24 h postoperatively.</p><p><strong>Conclusion: </strong>Caudal block, high-flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is a potential alternative to general anesthesia for infant inguinal hernia surgery with a low rate of complications in this small cohort of infants.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"147-154"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605955","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":"Measurement Properties of the Pediatric Anesthesia Emergence Delirium Scale: A Confirmatory Factor Analysis-Based Study.","authors":"Jenny Ringblom, Ingrid Wåhlin, Marie Proczkowska, Laura Korhonen, Kristofer Årestedt","doi":"10.1111/pan.15046","DOIUrl":"10.1111/pan.15046","url":null,"abstract":"<p><strong>Background: </strong>Emergence delirium is a well-known and common problem in children recovering from anesthesia. The five-item Pediatric Anesthesia Emergence Delirium scale is one of the most commonly used instruments for assessing this condition, but the scale has been questioned regarding its latent structure, i.e., whether its items cover just one underlying construct. It has been suggested that the scale's first three items might identify emergence delirium better than the last two.</p><p><strong>Aim: </strong>The aim of this study was to evaluate the measurement properties of the Pediatric Anesthesia Emergence Delirium scale with a focus on its latent structure and cutoff scores, using appropriate statistical methods for ordinal data.</p><p><strong>Methods: </strong>A total of 350 children under 7 years of age, undergoing adenoidectomy, with or without additional tonsillotomy or minor procedures like paracentesis, tongue-tie release, or cerumen removal, were enrolled in the study. At the recovery unit, emergence delirium and pain were registered.</p><p><strong>Results: </strong>The confirmatory factor analyses demonstrated that the two-factor model, including emergence delirium-specific behaviors (first three items) and emergence delirium-nonspecific behaviors (last two items), established an excellent model fit according to the χ² goodness-of-fit statistics, Root Mean Square Error of Approximation, Comparative Fit Index, Tucker-Lewis Index, and Standardized Root Mean Square Residual. The ordinal alpha of 0.98 and the ordinal omega of 0.96 supported the internal consistency reliability of the emergence delirium-specific behaviors. The convergent validity was supported due to a strong correlation between emergence delirium-nonspecific behaviors and the Face, Legs, Activity, Cry, and Consolability scale. The receiver-operating characteristic curve analyses resulted in two tentative cutoff scores for emergence delirium-specific behaviors¸ ≥ 6 and ≥ 8.</p><p><strong>Conclusion: </strong>The Pediatric Anesthesia Emergence Delirium scale's first three items are a more valid and reliable measure of emergence delirium than its original five items.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"155-162"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751427","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":"Interruption of oral hypoglycemic agents before pediatric surgery.","authors":"Anthony M-H Ho, Melinda Fleming, Joanna M Dion, Glenio B Mizubuti","doi":"10.1111/pan.15038","DOIUrl":"10.1111/pan.15038","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"181-182"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569229","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":"Optimizing the anesthetic care of patients with aromatic l-amino acid decarboxylase deficiency.","authors":"Megha K Kanjia, Edmund H Jooste, Melissa Illig, Jennifer Neifeld Capps, Christoph Eisner, Shou Zen Fan, Jerzy Lenarczyk, Rafał Wojdacz","doi":"10.1111/pan.15025","DOIUrl":"10.1111/pan.15025","url":null,"abstract":"<p><p>Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare autosomal recessive disorder that results in a lack of the monoamine neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine. Patients present with a wide spectrum of symptoms, including motor and autonomic dysfunction, hypotonia, and developmental delay, often before the age of one. Until recently, treatment options were limited to symptom control, but the recent approval of the first gene therapy for AADC deficiency in Europe and the UK has provided an alternative to treating symptoms for this disease. Eladocagene exuparvovec is a one-time gene therapy, administered bilaterally to the putamen by magnetic resonance imaging-guided stereotactic neurosurgery. While administration of the gene therapy itself is minimally invasive, the anesthetic management of patients with AADC deficiency is challenging due to the absence of sympathetic regulation secondary to the lack of adrenergic neurotransmitters. Optimal anesthetic management requires an understanding of the complex and heterogeneous nature of the disease. Hemodynamic instability, temperature dysregulation, and hypoglycemia are of primary concern, but there are also challenges regarding intravenous access and airway management. A thorough preoperative assessment is essential and should be guided by the patient's history. Advanced planning is necessary regarding the timing of the procedure schedule and operative plan; meticulous preparation, simulation for the operating room, as well as communication with all perioperative staff members, are crucial. Intraoperatively, utmost care must be taken to protect the skin, maintain body temperature, and to prepare for inotropic and/or glycemic support as needed. Postoperative intensive care management is necessary for consideration of postoperative extubation and provision of supportive care. With careful planning, preparation, and vigilance, patients with AADC deficiency can safely undergo anesthesia.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"99-106"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11701947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471860","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":"Does cognitive aid app design influence the speed of actions during a critical event?: A simulation study.","authors":"Brady Still, Anna Clebone","doi":"10.1111/pan.15037","DOIUrl":"10.1111/pan.15037","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"175-177"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605972","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":"Clinical Impact of Specific Extraocular Muscle Manipulation and the Oculocardiac Reflex on Postoperative Vomiting in Pediatric Strabismus Surgery: A Multicenter, Observational Study.","authors":"Taiki Kojima, Yusuke Yamauchi, Takashi Fujiwara, Soichiro Obara, Aya Sueda, Riku Takahashi, Sayuri Yasuda, Hiroshi Kitoh","doi":"10.1111/pan.15047","DOIUrl":"10.1111/pan.15047","url":null,"abstract":"<p><strong>Background: </strong>Strabismus surgery, which is commonly performed in children, poses a high risk of postoperative vomiting. The current anesthesia guidelines for the prevention of postoperative vomiting in children are based on heterogeneous populations involving different types of surgery, and risk factors for postoperative vomiting in, specifically, the pediatric strabismus surgery population are unclear. Moreover, the effects of manipulating the deeply attached extraocular muscles and the oculocardiac reflex on this risk remain inconclusive.</p><p><strong>Aim: </strong>To evaluate the associations among inferior oblique muscle manipulation, the oculocardiac reflex, and postoperative vomiting in children with retrospectively collected data.</p><p><strong>Methods: </strong>The study had a multicenter retrospective cross-sectional design and was conducted at three institutions (two tertiary-care children's hospitals and one pediatric-adult mixed community hospital). It included children aged < 18 years and without major comorbidities undergoing strabismus surgery. The primary exposure was inferior oblique muscle manipulation during surgery. The outcome of interest was postoperative vomiting or antiemetic medication usage within 24 h postsurgery or by discharge.</p><p><strong>Results: </strong>Among 3152 children postoperative vomiting occurred in 108/795 (13.6%) children with and 227/2357 (9.6%) without inferior oblique muscle manipulation (unadjusted odds ratio, 1.57; 95% confidence interval, 1.21-2.05; p = 0.001). Multilevel logistic regression analysis, adjusting for potential confounders and surgeon-related variance, revealed that inferior oblique muscle manipulation (adjusted odds ratio, 1.58; 95% confidence interval, 1.15-2.18; p = 0.005), but not the oculocardiac reflex (adjusted odds ratio, 1.06; 95% confidence interval, 0.76-1.48; p = 0.73), was associated with postoperative vomiting after adjusting for confounders.</p><p><strong>Conclusions: </strong>Stronger preventive measures against postoperative vomiting are recommended in healthy children undergoing strabismus surgery with inferior oblique muscle manipulation. Additionally, inferior oblique muscle manipulation should be considered a potential confounder in future related studies. However, the oculocardiac reflex was not associated with postoperative vomiting in pediatric strabismus surgery.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"163-174"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11701950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755400","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":"Pediatric Awake Craniotomy: An Educational Review.","authors":"Maria Nabil Henry, Maryam N Shahin, Ian Stevens, Jessica Calvert, Dana Dharmakaya Colgan, Michael Vega, Kelly Collins","doi":"10.1111/pan.15075","DOIUrl":"https://doi.org/10.1111/pan.15075","url":null,"abstract":"<p><strong>Background: </strong>Awake craniotomies with functional cortical mapping are performed to minimize post-operative deficits from the resection of lesions adjacent to eloquent cortex. The procedure is well-established in the adult patient population and is increasingly applied to well-selected pediatric patients. A review of recent literature demonstrated that the most commonly reported anesthetic techniques were \"asleep-awake-asleep\" protocols that relied on propofol, remifentanil, or fentanyl.</p><p><strong>Main article: </strong>This educational review discusses the unique challenges that face the anesthesiology and neurosurgical teams when working with the pediatric population. To further illustrate pediatric-specific considerations, a case of a 9-year-old boy who underwent a resection of a large left peri-rolandic ependymoma is presented, including his multidisciplinary pre-operative, intra-operative, and post-operative care.</p><p><strong>Conclusion: </strong>Awake craniotomies can safely be performed in the pediatric population with appropriate patient sel7ection, planning, and a multi-disciplinary approach.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075283","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":"Design considerations for development of cuffed endotracheal tube for small airways.","authors":"Seamus Maguire, Daniel Wade, James Curley, Sean Morris","doi":"10.1111/pan.15033","DOIUrl":"10.1111/pan.15033","url":null,"abstract":"<p><p>Endotracheal tubes (ETTs) are life-supporting devices that are designed to maintain a patent airway in patients who are unable to sustain an airway due to illness or injury. Patients with small airways, such as neonates and pediatrics, have unique structural and functional features, making it essential that ETT design considers and executes on these particular needs. Though uncuffed ETTs have historically been preferred for patients younger than eight years of age, advances in cuffed ETT design and construction can be utilized to manufacture ETTs that are optimized for the smallest, most fragile airways. The purpose of this article is to discuss certain design features of cuffed ETTs in respect to small airways.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"91-98"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668570","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":"Factors associated with the use of regional anesthesia for calcaneal osteotomy in pediatric patients: A single-center, retrospective cohort study.","authors":"Benjamin Y Andrew, Kayla E Pfaff, Sarah Jooste, Lisa M Einhorn","doi":"10.1111/pan.15030","DOIUrl":"10.1111/pan.15030","url":null,"abstract":"<p><strong>Background: </strong>Despite known disparities in pediatric perioperative outcomes, few studies have examined factors associated with the use of regional anesthesia for pediatric orthopedic surgery.</p><p><strong>Aims: </strong>This investigation aimed to determine if minority and developmental disability status were associated with the allocation of peripheral nerve blocks in calcaneal osteotomy.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective study of records of patients <18 years who underwent calcaneal osteotomy from 2013 to 2023. Regional technique was classified into three groups: popliteal-sciatic single-shot block, popliteal-sciatic catheter, and no block. Patients were classified as either nonminority (white, non-Hispanic) or minority. Developmental disability status was defined based on medical history and classified as binary. Anesthesiologists were classified as \"regional\" or \"nonregional\" based on clinical expertise. A Bayesian hierarchical multinomial model with random intercepts for patients and surgeons was used to investigate the association of minority status, developmental disability, and anesthesiologist expertise with block selection.</p><p><strong>Results: </strong>We analyzed 287 cases in 225 patients; of these, 55% occurred in minority patients and 28% occurred in patients with developmental disability. Catheters were placed in 45% of cases, single shot blocks in 41%, and no block in 14%. Minority and nonminority patients had a similar likelihood of receiving of any block. Patients with developmental disability had a -22% absolute difference of receiving any block (95% credible interval [-38%, -7%]) compared to those without developmental disability (55% vs. 77%), an effect primarily driven by a lower rate of catheter placement in these children. Regional anesthesiologists were more likely to place catheters (23% absolute increase; 36% vs. 13%) and more likely to perform any block in children with developmental disability (30% absolute increase; 67% vs. 37%) than nonregional anesthesiologists.</p><p><strong>Conclusions: </strong>Decision-making surrounding the placement of regional anesthesia techniques is complex. In this study, developmental disability status and anesthesiologist experience were associated with a difference in the use of regional anesthesia in patients undergoing calcaneal osteotomy.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"107-117"},"PeriodicalIF":1.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625687","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}