Pediatric Anesthesia最新文献

{"title":"Timing Is Everything.","authors":"James Chun-Huang Chen, Katherine Mary Bailey, Victoria Buswell","doi":"10.1111/pan.70036","DOIUrl":"10.1111/pan.70036","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"887-888"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837285","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":"Intraoperative Electromyographic Monitoring in Children Less Than 1 Year of Age.","authors":"Alicia Chaney, Edison E Villalobos, Julie Rice-Weimer, Joseph D Tobias","doi":"10.1111/pan.70043","DOIUrl":"10.1111/pan.70043","url":null,"abstract":"<p><strong>Background: </strong>Despite the potential to improve patient outcomes, quantitative train-of-four (TOF) monitoring has seen limited use in infants and children primarily due to the lack of effective equipment. The current study investigates the feasibility of using an electromyography-based TOF monitor (TetraGraph) in patients < 1 year of age.</p><p><strong>Methods: </strong>Following informed consent, patients < 1 year of age presenting for elective surgery that required use of a non-depolarizing neuromuscular blocking agent were enrolled. The TetraGraph electrodes were positioned on the volar aspect of the forearm over the ulnar nerve to supply neurostimulation. Muscle action potentials were recorded at 20-s intervals from the adductor pollicis muscle throughout surgery until tracheal extubation. Data from the monitor were recorded onto the built-in memory card.</p><p><strong>Results: </strong>The study cohort included 49 patients ranging in age from 30 days to 10 months and in weight from 3.1 to 10.3 kg. Effective monitoring was achieved in all 49 patients in the cohort. Based on our clinical practice, rocuronium was the neuromuscular blocking agent used in all patients. Complete data of neuromuscular recording (baseline to recovery) was obtained in 36 patients, as a complete baseline was not obtained in two patients, and 11 patients either did not receive sugammadex based on clinical need or the sensor was removed prior to recovery. Baseline amplitude for muscle action potential was 6.8 ± 2.2 mV and recovered to 4.7 ± 1.5 mV after reversal of neuromuscular block with sugammadex at completion of the case. The mean baseline TOFr was 99% ± 16.3% and the mean recovered TOFr was 95% ± 10%.</p><p><strong>Conclusion: </strong>In patients > 28 days and < 1 year of age, our preliminary data suggest that electromyography-based TOF monitoring can be used effectively.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"934-939"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963884","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":"Yes, We Need a Drink!","authors":"Benjamin J Blaise","doi":"10.1111/pan.70048","DOIUrl":"10.1111/pan.70048","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"981-982"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006501","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":"Seeking a Viable Alternative: A Prospective, Randomized, Controlled, Double-Blind Non-Inferiority Study of Oral Versus IV Dexamethasone in Children Undergoing Tonsillectomy.","authors":"Melissa Brooks Peterson, Jacob Boyd, Austin Zhu, Samantha Bothwell, Jeremy David Prager","doi":"10.1111/pan.70046","DOIUrl":"10.1111/pan.70046","url":null,"abstract":"<p><strong>Introduction: </strong>Tonsillectomy is associated with a high rate of postoperative nausea and vomiting (PONV), ranging between 40% and 73%, and dexamethasone has been found to have a prophylactic effect on PONV in children undergoing tonsillectomy. In 2020, there was a sudden, severe shortage of intravenous dexamethasone given its role in treating patients with COVID-19. The primary aim of this study was to investigate the viability of an alternative: non-inferiority of oral versus intravenous dexamethasone for preventing PONV. Secondary objectives included pain and surgical complication outcomes.</p><p><strong>Methods: </strong>One hundred twenty-six patients aged 3 to 7 years old undergoing tonsillectomy were prospectively randomized to receive 0.5 mg/kg oral or intravenous dexamethasone (maximum dose 8 mg). PONV data were recorded from the post-anesthesia care unit and post-op day 3 to 5 nursing phone calls. Pain was assessed using the numeric pain scale 0 to 10 or the Faces, Legs, Arms, Crying, Consolability (FLACC) Scale.</p><p><strong>Results: </strong>Seventy-two (57.1%) males and 54 (42.9%) females with a mean age of 5.36 years were included in the analysis. Sixty-three (50.0%) patients received oral dexamethasone, and 63 patients received intravenous dexamethasone. Three patients were noted to have nausea in the post-anesthesia care unit, all of whom received oral dexamethasone (2.4%), an absolute risk difference of 4.8% (95% CI 1.6% to 9.5%). Four patients had vomiting in the post-anesthesia care unit, all of whom received oral dexamethasone (3.2%), an absolute risk difference of 6.3% (95% CI 1.6% to 11.1%). Fifteen patients reported nausea and vomiting after discharge; 6/15 (40%) received oral dexamethasone and 9/15 (60%) received intravenous dexamethasone (absolute risk difference -5.4% (95% CI -15.6% to 4.9%)).</p><p><strong>Discussion: </strong>Substituting oral dexamethasone in place of intravenous dexamethasone resulted in a non-inferior rate of PONV for pediatric patients undergoing tonsillectomy. Oral dexamethasone is a reasonable substitute for intravenous dexamethasone, particularly during an immediate, unexpected medication shortage.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"953-961"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016010","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":"The Metabolic Consequences of Citrated Blood Products: Reassessing Transfusion Protocols and Monitoring.","authors":"Allison P Hussin, Danielle R Zabala, Kenichi A Tanaka, Amir L Butt","doi":"10.1111/pan.70035","DOIUrl":"10.1111/pan.70035","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"985-986"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817288","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 Versus Sevoflurane Anesthesia for Acute Postoperative Pain Management in Pediatric Adenotonsillectomy: A Randomized Controlled Trial.","authors":"Zhi-Peng Zhong, Yu Gao, Cheng Fan, Xue Bai, Hao Luo, Lei Zhang, Vivian-Min Yuen, Ying-Yi Xu, Xing-Rong Song, Bi-Lian Li","doi":"10.1111/pan.70047","DOIUrl":"10.1111/pan.70047","url":null,"abstract":"<p><strong>Background: </strong>Pain following pediatric adenotonsillectomy is prevalent, frequently severe, and often inadequately managed. The effectiveness of propofol or sevoflurane anesthesia in acute postoperative pain management is unknown.</p><p><strong>Methods: </strong>We conducted a single-blind, randomized controlled trial to examine the postoperative analgesic effectiveness of propofol or sevoflurane anesthesia. 144 children aged 2-7 years were enrolled and randomly assigned to receive either propofol or sevoflurane anesthesia, with 142 completing the study. The primary outcome was the proportion of acute postoperative pain measured by the Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores > 3 within 24 h between the two groups. Secondary outcomes included postoperative pain assessed by the parent's postoperative pain measure (PPPM) scale and numeric rating scale (NRS) on the 1, 2, 3, 7, and 14 postoperative days, as well as perioperative adverse events.</p><p><strong>Results: </strong>The incidence of acute pain FLACC > 3 within 24 h showed comparable results between both groups (30 of 71 [42.3%] vs. 34 of 71 [47.9%]; odds ratio [OR] = 0.78, 95% confidence interval [CI]: [0.28, 2.18]; p = 0.500). The propofol group demonstrated higher pain scores on postoperative days 2-3, with between-group median differences (ΔNRS at activity = 1, ΔPPPM = 1) below minimal clinically important difference thresholds (ΔNRS > 1, ΔPPPM > 3).</p><p><strong>Conclusions: </strong>The incidence and intensity of acute postoperative pain in the first 24 h after adenotonsillectomy did not differ significantly between pediatric patients who received maintenance anesthesia with propofol or with sevoflurane. The two general anesthesia techniques exhibited comparable clinical efficacy with respect to pain prognosis within 2 weeks.</p><p><strong>Trial registration: </strong>The Chinese Clinical Trial Registry (ChiCTR2300075847, Date of registration: September 3, 2023).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"913-924"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016101","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":"The Effect of a Caregiver Preparation Video (Take5) on Child Anxiety During Anesthetic Induction: A Randomized Controlled Trial.","authors":"Erin Brown, Krittika Vongkiatkajorn, Vanessa Rich, Justin Kenardy, Alexandra Donaldson, Rebecca Paterson, Cameron Graydon, Paul Lee-Archer","doi":"10.1111/pan.70006","DOIUrl":"10.1111/pan.70006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A general anesthetic can be an anxiety-provoking experience, and children who experience perioperative anxiety are more likely to have negative outcomes such as emergence delirium, increased analgesic requirements, and maladaptive behaviors. Parental presence at the induction of anesthesia can help reduce anxiety; however, only if the parent does not feel anxious themselves and can support their child in a positive way. The aim of this study was to test the efficacy of a short preparation video aimed at caregivers prior to the child's induction of anesthesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a randomized controlled trial of the Take5 video compared to standard care. The Take5 video was developed by pediatric anesthetists, child psychologists and a consumer panel of parents of children who had lived experience of surgery and anesthesia. The Take5 video is a 5-min, animated video that prepares caregivers for what to expect during the anesthetic induction. It also provides the caregiver with suggested behaviors that will positively support the child during the induction and psychological coping strategies to manage personal distress. Participants were randomized to the standard preparation group or the intervention group, which consisted of standard preparation plus the caregiver being shown the Take5 video in the preoperative waiting area prior to accompanying their child to the operating room. The primary outcome was child anxiety at induction measured using the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes were caregiver procedural behavior, child postoperative pain, emergence delirium, time to discharge, caregiver satisfaction and caregiver and child psychological wellbeing at 3 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One-hundred children and their caregivers were recruited to the trial. There was good to excellent inter-rater reliability with all of the observer scales (intraclass correlation coefficient = 0.81 for the mYPAS-SF). For the primary outcome of child anxiety at induction of anesthesia, there was good evidence for no difference between groups. For the secondary outcomes, the video intervention did not show any effect on parental behavior. There was a statistically significant difference in pain scores between groups, with children in the control group rated as having more pain on the Faces, Legs, Activity, Cry and Consolability (FLACC) scale (mean difference 0.6, 95% CI 0.04-1.16, p = 0.037). There was no difference shown in any of the other secondary outcomes including emergence delirium, time to discharge or caregiver satisfaction. There were also no differences in any of the 3-month psychological wellbeing outcomes: Child health-related quality of life, child behavioral difficulties or parent depression and anxiety scores. Despite this, in semistructured interviews, caregivers reported the video to be acceptable and beneficial, but many would have pre","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"904-912"},"PeriodicalIF":1.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507328","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":"Prospective National Audit of the Anesthetic Management of Children With Long QT Syndrome.","authors":"Tim Murphy, Georgia Spentzou, Alistair Hustig, Yssela Erquiaga, Jennifer Haden, Jenny Shortland","doi":"10.1111/pan.70067","DOIUrl":"https://doi.org/10.1111/pan.70067","url":null,"abstract":"<p><strong>Background: </strong>It is recognized that the perioperative anesthetic management of children with long QT syndrome may be complex, as they are at risk of life-threatening arrhythmias such as ventricular tachycardia, torsades des pointes, ventricular fibrillation, or severe bradycardia. There is uncertainty regarding the incidence of complications as well as which techniques might be acceptable or preferable in this group of patients.</p><p><strong>Aims: </strong>In collaboration with the Congenital Cardiac Anesthesia Network, we conducted a prospective audit of the anesthetic management, complications, and outcomes of children with long QT syndrome.</p><p><strong>Methods: </strong>Following receipt of ethics committee approval and an extensive process of communication within the Congenital Cardiac Anesthesia Network and elsewhere, over approximately a two-year period in the United Kingdom we prospectively collected fully anonymized data relating to the anesthetic management of children with long QT syndrome using an online secure reporting portal.</p><p><strong>Results: </strong>90 episodes of anesthesia for cardiac/cardiological (44) and non-cardiac (46) procedures were reported in 81 patients, with a median age of 6 years and a median weight of 22 kg. 59% were male. In 57 patients (70%), the diagnosis of long QT syndrome had been confirmed by genotyping. Where available, the QTc on a preoperative ECG ranged from 340 to 650 milliseconds. 14 patients had a history of previous out-of-hospital cardiac arrest, and 18 patients had an in situ cardiac pacing/defibrillation system. Three patients had a previous history of major complications under anesthesia, including ventricular tachycardia or ventricular fibrillation. Three patients experienced a significant complication, including intermittent atrioventricular block, ventricular tachycardia, changes in QRS morphology on the electrocardiograph, and bradycardia necessitating cardiopulmonary resuscitation. Both intravenous and inhalational agents were used perioperatively. No patient required unplanned admission to an intensive care unit. In every case, the patient was anesthetized by a consultant.</p><p><strong>Conclusions: </strong>This complex group of patients has a significant complication rate under general anesthesia. Perioperative management of such patients should be delivered by experienced anesthetists, and in the majority of cases, it is appropriate for this to take place in centers where there is relevant additional cardiological expertise.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280828","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":"On Table Extubation After Heart Surgery in Children, Infants and Neonates.","authors":"Philip Arnold, Tim Murphy","doi":"10.1111/pan.70065","DOIUrl":"https://doi.org/10.1111/pan.70065","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275552","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 Quality Improvement Initiative to Improve Early Postoperative Pain Outcomes After Tonsillectomy in Children.","authors":"Alfonso Ernesto Albornoz, Lara Navarro, Julia Mallen, Sophie O'Halloran, Simon Denning, Clyde Matava, Sharon L Cushing, Nikolaus E Wolter, Conor Mc Donnell, Maisie Tsang","doi":"10.1111/pan.70062","DOIUrl":"https://doi.org/10.1111/pan.70062","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative opioid use during pediatric tonsillectomy is commonly avoided to reduce the risk of postoperative respiratory adverse events (PRAEs). Avoidance of perioperative opioids may contribute to increased early postoperative pain, which can result in patients receiving rescue doses of opioids in the postanesthesia care unit (PACU).</p><p><strong>Aims: </strong>The aim of this project was to reduce moderate to severe pain in PACU for pediatric tonsillectomy/adenotonsillectomy patients by 50% within 12 months.</p><p><strong>Methods: </strong>Pilot data was collected on the intraoperative care and PACU pain outcomes of patients between June 2018 and June 2020. A six-item toolkit was designed, then implemented from April 2021, with identical data points collected for comparison. Postintervention patients were categorized into toolkit compliance groups: (1) Standard of care (< 5 of 6 items delivered), (2) Partial Toolkit (5 of 6 items delivered), and (3) Toolkit (100% adherence). Statistical process control charts were used for data analysis.</p><p><strong>Results: </strong>Data was collected for 420 patients. Baseline data reported 65.8% of patients experienced moderate-severe pain in PACU. In the first 12 months of toolkit implementation (2021-2022), the incidence of moderate to severe pain decreased to 47.1% in the 100% adherence group (28% reduction). In subsequent years (2022-2024), this measure decreased further to 31% (53% reduction overall). Pretoolkit, 69% of patients received rescue opioids in PACU. In the first 12 months of toolkit implementation (2021-2022), the incidence of rescue opioids in PACU decreased to 35% in the 100% toolkit adherence group (49% reduction). From 2022 to 2024, this decreased to 45% (35% reduction).</p><p><strong>Conclusion: </strong>Through the implementation of the tonsillectomy toolkit, we helped reduce early postoperative pain by 28% in the first year. Continued data collection showed the intervention to be sustainable and delivered subsequent decreases in moderate to severe pain by a factor of 53%. These improvements were achieved without increasing PRAEs, postoperative nausea/vomiting incidence, or PACU length of stay.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233160","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}