Pediatric Anesthesia最新文献

{"title":"Error Traps in Infant Spinal Anesthesia.","authors":"Alexander B Froyshteter, Alina Lazar, Ashlee E Holman, Geoff Frawley, Emmett E Whitaker","doi":"10.1111/pan.15132","DOIUrl":"10.1111/pan.15132","url":null,"abstract":"<p><p>Infant spinal anesthesia is a viable alternative to general anesthesia for short procedures below the upper abdomen. It provides a hemodynamically stable anesthetic technique that avoids airway manipulation and associated respiratory complications. Spinal anesthesia allows surgery to be performed without inhaled anesthetic agents or, in certain cases, opioids. This manuscript highlights five preventable perioperative error traps that may occur while performing infant spinal anesthesia with the goal of providing expert clinical guidance for the provision of safe, effective, and efficient spinal anesthesia in pediatric patients.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"598-606"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187555","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":"Oxygenation Practices During General Anesthesia in Pediatric Patients: An International Survey in Europe, USA, Australia, and New Zealand.","authors":"Jan J van Wijk, Sanne E Hoeks, Irwin K M Reiss, Robert Jan Stolker, Lonneke M Staals","doi":"10.1111/pan.15139","DOIUrl":"10.1111/pan.15139","url":null,"abstract":"<p><strong>Aims: </strong>At present, there is a growing body of knowledge regarding the benefits and risks associated with oxygen use in medical practice. In the perioperative period, high fractions of inspiratory oxygen are used during airway management. However, oxygen can have direct toxic effects, as well as systemic effects. In different fields of medicine, protocols exist to limit the use of oxygen, for example, in the intensive care unit and emergency department. However, in pediatric perioperative care, such protocols do not exist. We conducted an international survey among pediatric anesthesiologists to assess their daily practices regarding oxygen use during non-cardiac surgery. The objective of this survey was to determine self-reported perioperative oxygen use across several key areas: the default oxygen settings on anesthesia machines, the prevalence of preoxygenation, the fraction of inspiratory oxygen used intraoperatively, and considerations regarding the intraoperative administration of oxygen.</p><p><strong>Methods: </strong>An online digital survey consisting of up to 21 questions in LimeSurvey was developed and sent to 5667 members of various international pediatric anesthesia societies (ESPA, APAGBI, SPA, SPANZA).</p><p><strong>Results: </strong>A total of 828 responses were received (response rate 15%). The median reported default inspiratory oxygen (FiO₂) value of anesthesia machines was 100% (IQR 30%-100%). Preoxygenation was used by 50% of the respondents, usually with 100% oxygen. 87% of respondents reported to titrate FiO₂ intraoperatively, mainly based on pulse oximetry values. Median standard percentage of oxygen intraoperatively was 35% (IQR 30%-40%).</p><p><strong>Conclusions: </strong>Oxygen administration practices during pediatric anesthesia are hardly regulated. There are opportunities to further limit the use of oxygen. For instance, default settings can be lowered, and intraoperative FiO₂ can be further titrated, mainly based on SpO₂.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"643-648"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249057","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":"The Effectiveness of Bubble-Blowing as a Distraction Technique During Pediatric Intravenous Cannulation: A Randomized Controlled Trial.","authors":"McKenna Postles, Nicholas West, Lindy Moxham, Jenna Ramji, Jade Palm, Christa Morrison, Matthias Görges, James Chen","doi":"10.1111/pan.15138","DOIUrl":"10.1111/pan.15138","url":null,"abstract":"<p><strong>Background: </strong>Intravenous cannulation is a standard but potentially painful procedure. Distraction techniques can alleviate this discomfort by shifting attention from perceived pain. Bubble-blowing is an active distraction technique that combines breathing exercises and play therapy to alleviate pain and anxiety.</p><p><strong>Aims: </strong>To assess the effectiveness of bubble-blowing versus video-watching in reducing pain during and anxiety before pediatric intravenous cannulation.</p><p><strong>Methods: </strong>This ethically approved, randomized controlled trial assigned 2- to 5-year-old participants to bubble-blowing or video-watching groups during their intravenous cannulations in the medical imaging department. Patients who were non-verbal, did not have an awake intravenous cannulation, received premedication, or had topical anesthetic for < 30 min were excluded. The Face Legs Activity Cry Consolability scale rated pain before, during, and after intravenous cannulation. The modified Yale Preoperative Anxiety-Short Form rated anxiety immediately following parental consent (baseline) and before intravenous cannulation.</p><p><strong>Results: </strong>Data from 120 participants (60 females, median [interquartile range] age 3.8 [2.9-4.4] years) were available. Of these, 105 participants underwent intravenous cannulation and were included in the analysis. Pain scores during intravenous cannulation were 2.0 [0.0-7.0] in the video-watching and 2.0 [0.0-5.0] in the bubble-blowing group; median difference 0.0 (95% confidence interval (CI) -1.0 to 1.0), p = 0.888. Anxiety scores before intravenous cannulation were 36.5 [22.9-63.4] in the video-watching and 27.1 [22.9-52.1] in the bubble-blowing group; median difference 0.0 (95% CI -10.4 to 0.0), p = 0.178. Pain during intravenous cannulation increased in 29/52 (56%) children in the video-watching and 30/53 (57%) in the bubble-blowing group; odds ratio 0.97 (95% CI 0.42-2.24), p > 0.999. Anxiety increased in 27/52 (52%) children in the video-watching and 16/53 (30%) in the bubble-blowing group; odds ratio 2.48 (95% CI 1.04-6.02), p = 0.030.</p><p><strong>Conclusion: </strong>The use of bubble-blowing as a distraction did not significantly reduce pain during or anxiety before IV cannulation compared to video-watching. However, further research is needed to explore whether active distraction techniques could be beneficial for young, neurodiverse, anxious, or fearful children.</p><p><strong>Trials registration: </strong>This study was registered in ClinicalTrials.gov (NCT05899452; June 12, 2023).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"635-642"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249059","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":"Insights From the Child's Perspective-Validation of the English Version of the Pictorial Version of the Quality of Recovery-15 Questionnaire.","authors":"Robert P Moore, Jamie L Romeiser, Maheen Khan, Susannah Oster, Paige Olsen, Karen Li, Ayesha Khan, Helen Hsieh, Eric Noll, Elliott Bennett-Guerrero","doi":"10.1111/pan.15114","DOIUrl":"10.1111/pan.15114","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-reported outcome measures play a key role in efforts to improve the quality and safety of perioperative care. There are no English-language tools to allow children to directly contribute to these efforts. The primary aim of this study was to examine the validity, reliability, acceptability, and feasibility of the use of an English version of the pictorial Quality of Recovery-15 (QoR-15) questionnaire in the context of routine pediatric care.</p><p><strong>Methods: </strong>A prospective observational study was performed including children aged 5-17 years presenting for care at Stony Brook University Hospital. Participants completed the adapted pictorial QoR-15, a VAS pain scoring, and a satisfaction survey before surgery and on Postoperative Day 1. Statistical methods were similar to prior studies that assessed the properties of the QoR-15. Tests were employed to confirm the validity, reliability, and responsiveness of the questionnaire.</p><p><strong>Results: </strong>A total of 253 children conormpleted testing. Mean (SD) preoperative and postoperative QOR-15 scores were 131.9 (±15.4) and 125.7 (±26.4), respectively. Of note, QoR-15 scores could range from a total of 0 to 150. Each question was internally consistent and correlated well with the total QoR-15 score. Construct validity tests demonstrated that the tool was able to differentiate between known determinants of poor recovery, including the duration of surgery (Spearman's Rho = -0.35 [CI = -0.45, -0.23]) and length of recovery unit admission (Spearman's Rho = -0.37 [CI = -0.47, -0.25]). Lower average postoperative QoR-15 scores were recorded in the context of higher levels of postoperative pain, defined by a VAS ≥ 7, confirming discriminative validity. The instrument demonstrated excellent internal consistency, with a Cronbach's raw alpha of 0.92, and a split-half coefficient of 0.85. These results were consistent across a variety of ages.</p><p><strong>Summary: </strong>Our data suggest that the English-language pictorial QoR-15 has good reliability, acceptability, and responsiveness. This suggests that the tool may allow children to contribute to efforts to both improve and better understand pediatric perioperative care.</p><p><strong>Clinical implications: </strong>There is no existing English-language tool to allow children to describe the quality of their perioperative experience. This is a key gap in efforts to both understand and improve pediatric care.</p><p><strong>New information added by this study: </strong>This study demonstrates the validity, reliability, acceptability, and feasibility for the use of an English pictorial Quality of Recovery questionnaire.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"627-634"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985979","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":"Looking Into the Future of Pediatric Oxygenation Management: Challenges in Implementing Novel Monitoring Methods.","authors":"Jacob Karlsson, Justin Skowno","doi":"10.1111/pan.70013","DOIUrl":"https://doi.org/10.1111/pan.70013","url":null,"abstract":"<p><p>In this editorial, we use the Oxygen Reserve Index (ORI) as an example to discuss the challenges of implementing novel monitoring methods in pediatric anesthesia from both a technical and physiological angle. Challenges with implementing methods originally intended and validated for use in adults are also examined.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643137","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":"Hydromorphone Versus Fentanyl-Based Induction of Anesthesia for Postoperative Pain and Emergence Delirium in Children Undergoing Strabismus Surgery: A Randomized, Double-Blind Comparative Study.","authors":"Qiyuan Huang, Yongwei Su, Xiaohui Sun, Ruihao Zhou, Zhao Xu, Yang Chen, Xuejiao Bai, Guo Chen, Tao Zhu","doi":"10.1111/pan.70012","DOIUrl":"https://doi.org/10.1111/pan.70012","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the effects of hydromorphone and fentanyl-based induction of anesthesia for immediate postoperative analgesia in pediatric patients.</p><p><strong>Patients and methods: </strong>This was a prospective, double-blind, randomized controlled trial. 186 preschool children aged 3 to 7 years old scheduled for strabismus surgery were randomized to receive hydromorphone 0.02 mg/kg (hydromorphone group; n = 80) or fentanyl 3 μg/kg (fentanyl group; n = 80). The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) pain score at extubation. Secondary outcomes included the incidence of postoperative emergence delirium (ED), the proportion of subjects who received rescue analgesia, Ramsay sedation scores, heart rate, mean arterial pressure, and SpO₂ in post-anesthesia care unit, and perioperative adverse events.</p><p><strong>Results: </strong>From November 10, 2020, to May 26, 2022,186 patients at West China Hospital were enrolled, 153 (37.5% male) of whom received administration of fentanyl (n = 76) or hydromorphone (n = 77). The hydromorphone group showed lower FLACC pain scores at the time of extubation (median [IQR], hydromorphone vs. fentanyl, 0 [0-0] vs. 0 [0-1], Mann-Whitney U = 2457.0, Z = -2.469, p = 0.014). The incidence of ED in the hydromorphone group was statistically lower than that in the fentanyl group (75.3% vs. 93.4%, p = 0.004, relative risk and 95% CI was 0.8 (0.7, 0.9)). Other secondary outcomes were comparable between the two groups.</p><p><strong>Conclusion: </strong>Hydromorphone administration during induction may improve postoperative pain control and reduce the incidence of ED in PACU after pediatric strabismus surgery.</p><p><strong>Trial registration: </strong>This study was registered at the Chinese Clinical Trials Register (www.chictr.org.cn) (number: ChiCTR2000039555, date of registration: 31/10/2020).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601151","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":"Outcomes of Nasotracheal Versus Orotracheal Intubation in Neonates After Cardiopulmonary Bypass Surgery: A Retrospective Cross-Sectional Analysis.","authors":"Peggy Vogt, Laura Downey, Michelle E Gleason, Lily D Dresner, Shanelle Clark, Subhadra Shashidharan, Justin Long","doi":"10.1111/pan.70010","DOIUrl":"https://doi.org/10.1111/pan.70010","url":null,"abstract":"<p><strong>Background: </strong>Institutions variably utilize oral (OI) versus nasal intubation (NI) for neonatal cardiac surgery. The proposed advantages of NI include a lower rate of endotracheal tube (ETT) dislodgement, decreased sedation requirements, and improved oral feeding. However, NI carries an additional risk of pressure injury and increased technical difficulty.</p><p><strong>Aims: </strong>The goal of this study was to evaluate whether NI was associated with decreased risk of ETT dislodgement or improved feeding outcomes versus OI.</p><p><strong>Methods: </strong>We performed a single center, retrospective, cross-sectional study of neonates intubated in the operating room undergoing cardiopulmonary bypass surgery from 2018 to 2020. Primary outcomes were unplanned extubation and oral feeding at discharge. Secondary outcomes included hospital length of stay, duration of intubation, otolaryngology (ENT) consult, skin breakdown related to the ETT, postoperative sedation medications, and adverse anesthesia induction events. Chi-squared and Fisher's exact tests were used for categorical data and Wilcoxon rank-sum tests for continuous data. Unadjusted results were calculated using univariate regressions. Adjusted results were calculated using linear mixed effect models and logistic regressions. Continuous outcomes were log transformed, and results adjusted for weight and surgeon. p < 0.05 was statistically significant.</p><p><strong>Results: </strong>Of the 179 patients, 49.8% (n = 89) were OI and 50.2% (n = 90) were NI. There was no difference in unplanned extubation, length of hospital stay, length of intubation, complications during induction, or percentage of exclusively oral feeding at the time of transfer from the intensive care unit or discharge from the hospital. There was a statistically significant difference in skin breakdown related to the ETT, where 89% of breakdown occurred in the NI group (p = 0.045, OR = 0.12, 95% CI [0.01, 0.65]). Sedation administration between the groups was similar.</p><p><strong>Conclusions: </strong>NI was not associated with improved exclusive oral feeding at discharge for neonatal cardiac surgical patients and may be associated with an increased risk of pressure injury in this single center, retrospective, cross-sectional study.</p><p><strong>Clinical implications: </strong>Several studies have investigated practice patterns and potential benefits of nasal intubation (NI) versus oral intubation (OI) in neonates undergoing cardiac surgical procedures; however, there is wide variation in national practice standards and unclear effects on postoperative feeding outcomes. At our high-volume cardiac center, we implemented a nasal intubation program for neonates as a quality improvement initiative. We found that NI was not associated with decreased risk of peri-operative unplanned extubation nor improved oral feeding outcomes at the time of hospital discharge.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591940","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":"Anesthesia for Endoscopic Strip Craniectomy Repair: A Single-Center Retrospective Cohort Study.","authors":"Kira Achaibar, Holly Graham, Shammi Kakad, Karolina Wloch, Nu Owase Jeelani, Greg James, A H Dulanka Silva, Juling Ong, Simon Eccles, David Dunaway, Pamela Cupples, Sally Wilmshurst, Kar-Binh Ong, Usman Ali","doi":"10.1111/pan.70008","DOIUrl":"https://doi.org/10.1111/pan.70008","url":null,"abstract":"<p><strong>Background and objective: </strong>Endoscopic strip craniectomy is a minimally invasive surgical technique offered to infants for craniosynostosis repair. We examine our institution's experience with infants undergoing this surgery with respect to perioperative physiological parameters, transfusion rates, complications, and length of hospital stay.</p><p><strong>Methods: </strong>We performed an observational retrospective review of all infants undergoing endoscopic strip craniectomy at Great Ormond Street Hospital, UK from 2019 to 2024. Data were collected via the digital health record system EPIC (Epic Systems Corporation [2023], USA) and analyzed in Microsoft Excel.</p><p><strong>Results: </strong>One hundred and eleven patients were included in the study undergoing single or multicranial suture repair: metopic (n = 67), unicoronal (n = 27), sagittal (n = 9), frontosphenoidal (n = 2), bicoronal (n = 4), and multisuture (n = 2). We present a mean age of 4.4 months (±1.05 SD), weight 6.95 kg (±1.05 SD), male (n = 66) population predominance, and ASA score from 1 to 3. Surgical procedure time was 73 min (±23 SD) across all sutures, with multisuture repair requiring a longer operative time of 96 min (±15 SD). The overall red cell transfusion rate was 1 in 5 children, with a higher incidence in those undergoing metopic suture repair (18/67, 26%). Mean preoperative and postoperative hemoglobin in the single suture repair group was 114 g/L (±11 g/L SD) and 87 g/L (±13 g/L SD) resulting in a mean reduction in hemoglobin of 26 g/L (±15 g/L SD). Mean preoperative and postoperative hemoglobin in the bilateral or multisuture repair group was 118 g/L (±7.17 g/L SD) and 85.5 g/L (±14.29 g/L SD) resulting in a mean reduction in hemoglobin of 35 g/L (±15 g/L SD). One hundred and six infants (95%) were discharged on Day 1 postoperatively, and no children required high dependency care. Complications reported were inadvertent extubation on positioning (n = 2), laryngospasm (n = 1), and a minor transfusion reaction (n = 1).</p><p><strong>Conclusion: </strong>Endoscopic strip craniectomy is a well-established minimally invasive surgical technique. Anesthesia for this procedure is typically performed in young infants who may be at greater risk of perioperative anesthetic complications and clinically significant blood loss and blood transfusion. We report a > 20% transfusion rate in our infant cohort mostly with metopic repairs.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575968","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":"Confidence and Competence in Provision of Pediatric Anesthesia in the United Kingdom and Ireland-A National Survey From the Association of Paediatric Anaesthetists of Great Britain and Ireland.","authors":"Shivan Kanani, Laurence Hulatt","doi":"10.1111/pan.70003","DOIUrl":"https://doi.org/10.1111/pan.70003","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567648","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":"Effects of Noninvasive Respiratory Support on Ventilation Distribution During Spontaneous Breathing Sedation in Preschool/School-Aged Children: An Electrical Impedance Tomography Study.","authors":"Giovanna Chidini, Tiziana Marchesi, Stefano Scalia Catenacci, Gaetano Florio, Giorgio Conti, Stefano Lanni, Giovanni Filocamo, Francesca Patria, Marta Guerrini, Gregorio Milani, Giacomo Grasselli","doi":"10.1111/pan.15098","DOIUrl":"10.1111/pan.15098","url":null,"abstract":"<p><strong>Background: </strong>Procedural sedation interferes with respiratory dynamics in pediatric patients. It reduces lung compliance, causing the closing volume to exceed the functional residual capacity, which can result in airway collapse, atelectasis, and periods of silent desaturation.</p><p><strong>Aim: </strong>Aims of the study were to clarify the impact of intravenous propofol sedation on ventilation distribution and to evaluate the potential benefits of noninvasive respiratory support (NRS) in restoring the original ventilation distribution pattern by applying the electrical impedance tomography technology.</p><p><strong>Methods: </strong>Single-center physiological randomized crossover study comparing two 20-min steps of NRS delivered as continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) at different time points: (1) spontaneous breathing (SB-1); (2) spontaneous breathing during sedation (SB-2); (3) CPAP during sedation; (4) NIV during sedation; (5) spontaneous breathing after sedation discontinuation (SB-3). Primary endpoint was regional ventilation delay 40% (RVD40%). Secondary outcomes were global index (GI), end-expiratory lung impedance (EELI), and center of ventilation (CoV).</p><p><strong>Results: </strong>Thirteen children were enrolled. RVD40% increased during SB-2 compared to SB-1 (p = 0.014). NIV was effective in reducing it compared to CPAP (p = 0.009) and SB-3 (p = 0.015). NIV was also effective in restoring ventilation homogeneity and lung volume compared to SB-2 by decreasing GI (p = 0.035) and restoring EELI (p = 0.002). During NIV, the center of ventilation increased compared to SB-1 (p = 0.001), SB-2 (p = 0.004), and CPAP (p = 0.004), suggesting that ventilation was shifted toward the ventral areas of the lungs. On the other hand, CPAP was not effective in restoring RVD40, GI, and EELI to SB1 values following the induction of intravenous anesthesia with propofol at SB-2.</p><p><strong>Conclusions: </strong>In this specific ventilatory setting, spontaneous breathing sedation resulted in enhanced ventilation inhomogeneity and a reduction in EELI that could be reversed by NIV but not by CPAP.</p><p><strong>Clinical trials registration: </strong>The trial was registered prior to patient enrollment at Clinicaltrials.gov (NCT05495477; principal investigator: Giovanna Chidini; date of registration: August 10, 2022). Consolidated Standards of Reporting Trials guidelines were followed, and the study was conducted according to the Helsinki 1964 Ethical Declaration Standard, revised in 2008.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"562-572"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677077","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}