Pediatric Anesthesia最新文献

{"title":"Focused Review of Enhanced Recovery After Abdominal Trauma Surgery in the Pediatric Population and Development of a Pediatric Enhanced Recovery After Trauma Surgery Pathway.","authors":"Robert P Moore, Niharika Singh, Madelyn Wang, Alexandra Tsivitis, Catherine Devitt, Zhaosheng Jin, Ehab Al Bizri, Sunitha M Singh, Helen Hsieh","doi":"10.1111/pan.15074","DOIUrl":"10.1111/pan.15074","url":null,"abstract":"<p><strong>Background: </strong>Traumatic injuries are the leading cause of morbidity and mortality amongst pediatric patients; improving outcomes after pediatric abdominal trauma surgery could be quite impactful. Although enhanced recovery after surgery (ERAS) pathways have been successfully employed in adult trauma patients, there are few studies on pediatric enhanced recovery after abdominal trauma surgery and no consensus post trauma surgery guidelines for children.</p><p><strong>Aims/methods: </strong>A systematic search of the existing literature for pediatric enhanced recovery after trauma surgery pathways was performed by two independent authors. However, no pediatric enhanced recovery after trauma surgery pathways were found. Therefore, we reviewed the pediatric and adult enhanced recovery after trauma surgery literature to identify potential impactful elements of care that could be part of a pediatric pathway.</p><p><strong>Results: </strong>The existing literature supports the incorporation of several elements into pediatric trauma ERAS pathway.</p><p><strong>Conclusion: </strong>We propose a pediatric enhanced recovery after trauma surgery pathway, which highlights several principles of ERAS pathways (multimodal analgesia, goal-directed fluid therapy, early initiation of nutrition, timely administration of antibiotics, avoidance of hypothermia, DVT prophylaxis, the early removal of drains and indwelling catheters, and patient education).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"338-346"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Intrathecal Clonidine as an Adjuvant to Spinal Anesthesia in Infants and Children.","authors":"Grant Heydinger, Eden E Bayer, Catherine Roth, Sibelle Aurelie Yemele Kitio, V Rama Jayanthi, Arlyne Thung, Joseph D Tobias, Giorgio Veneziano","doi":"10.1111/pan.15091","DOIUrl":"10.1111/pan.15091","url":null,"abstract":"<p><strong>Introduction: </strong>Preliminary clinical studies have demonstrated that clonidine is an effective adjuvant to spinal anesthesia in neonates and infants. However, the studies conducted previously have had a limited cohort size of 80-100, potentially limiting an accurate measure of its safety.</p><p><strong>Methods: </strong>The current study retrospectively examines our 5-6-year experience with clonidine as an adjuvant to spinal anesthesia in a large cohort of neonates and infants.</p><p><strong>Results: </strong>The study cohort included 1420 patients ranging in age from newborn to 36 months (median age 7 months). Ninety-five percent of the patients tolerated spinal anesthesia without requiring conversion to general anesthesia, and over 73% of the patients did not require any additional intraoperative sedation. Hypotension (sBP ≤ 60 mmHg) was the most common intraoperative event (17%) with one patient requiring the administration of an anticholinergic agent for bradycardia. No serious intraoperative adverse events were noted. Post Anesthesia Care Unit (PACU) Phase I was bypassed in 75% of cases, and the postoperative admission rate was 7%, with the majority (85%) being planned admissions. Fifty-six patients (4%) returned to the hospital during the first seven postoperative days, primarily for surgical concerns.</p><p><strong>Conclusions: </strong>Based on this retrospective, observational study, clonidine appears to be a safe adjuvant to spinal anesthesia for ambulatory surgical procedures in infants and children. We observed a low incidence of intraoperative and postoperative complications.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"374-379"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) in Adolescents: A Randomized Controlled Trial.","authors":"M Bastianello, M Torre, R Bonfiglio, M G Calevo, L Palomba, P Uva, A Kanapari, G Lorenzoni, N Disma","doi":"10.1111/pan.15090","DOIUrl":"10.1111/pan.15090","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing Pectus Excavatum repair with the minimally invasive approach frequently report severe postoperative pain. The goal of the study is to determine the superiority of cryoanalgesia compared to standard of care for return to normal quality of life.</p><p><strong>Methods: </strong>A randomized, active controlled, parallel groups trial (category IIb medical device) was designed for patients undergoing pectus excavatum repair. Participants were screened from the elective surgical lists at Istituto Gaslini, Genova, Italy, and they all were part of the academic practice setting. Once enrolled, patients were randomly assigned to one of the two study arms: cryoanalgesia vs. standard of care (epidural-based analgesia). The primary outcome was the Pediatric Quality of Life (PedsQL) and the subcomponents (psychosocial and physical health) 14 days after surgery.</p><p><strong>Results: </strong>Protocol was approved by the Ethics Committee (278/2021-DB id 11 421) and conducted between February 2022 and October 2023. Eighty-eight patients were enrolled in the study: forty-five to cryoanalgesia and forty-three in the epidural arm. The PedsQL median (IQR) at the 14th day was 59.8 (48.4, 71.2) vs. 67.9 (58.7, 73.9) (95% CI: 0.46-13; difference 6.5; p = 0.07) with ITT analysis, and 59.8 (48.37, 71.20) vs. 69.02 (58.70, 73.91) (95% CI: 0.82, 14; difference 7.4; p = 0.028) with PP analysis, in the cryoanalgesia and in the standard of care group, respectively. Irrespective of treatment, a significant decrease in both the PedsQL total score and its subcomponents was found. This effect persisted when stratified by treatment: physical health showed a decrease in both arms, while psychosocial health demonstrated a more marked decrease in the standard of care arm (q-value = 0.028), but not in the cryoanalgesia arm (q-value = 0.056).</p><p><strong>Conclusions: </strong>Cryoanalgesia did not improve return to baseline quality of life 2 weeks after surgery. However, it showed to be beneficial in the psychosocial component of the PedsQL scale.</p><p><strong>Trial registration: </strong>NCT05201820.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"347-358"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error Traps in the Intrahospital Transport of Critically Ill and Anesthetized Children.","authors":"Bishr Haydar","doi":"10.1111/pan.15112","DOIUrl":"https://doi.org/10.1111/pan.15112","url":null,"abstract":"<p><p>Intrahospital transport of anesthetized and critically ill children is a routine event that carries myriad risks. Patients with a vast array of conditions are transported between the intensive care unit, procedural and diagnostic imaging suites, emergency department, and other areas. Given this complexity, the range of potential adverse events is large. Improving safety during transport will require a broad and holistic approach. This review will inform pediatric anesthesiologists on the best approach to improve their care and patient safety during transport by identifying common error traps, with both individual- and system-level countermeasures. The error traps include the failure to fully weigh all risks, costs, and benefits associated with transport for a procedure or test; secure appropriate resources for transport and at every destination; provide pertinent information during transfers of care; anticipate physical and physiological changes associated with transport; and execute the plan effectively as a team. Countermeasures include multidisciplinary discussion and resource optimization; use of systematic tools, standardized communication, and checklists to improve processes of care; encouraging the prioritization of a culture of safety around transport; and adapting the team composition and leadership style to suit the specific clinical scenario.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803910","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":"Using a Patient-Reported Outcome (PRO) Questionnaire to Assess Postoperative Care Following Pediatric Outpatient Surgery.","authors":"Hjördis Osk Atladottir, Anne Treschow Phillipsen, Karen Arnt Krøyer, Anne Gade Jensen, Liv Marit Valen Schougaard, Peter Ahlburg","doi":"10.1111/pan.15111","DOIUrl":"https://doi.org/10.1111/pan.15111","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, there has been a marked rise in the incidence of pediatric day surgery across Western countries. As postoperative recovery transitions to the home environment, it is incumbent on healthcare systems to develop methods for patient follow-up and caregiver support.</p><p><strong>Aim: </strong>To describe a method of monitoring the postoperative home treatment of children, as well as giving families appropriate support and guidance.</p><p><strong>Method: </strong>We developed and implemented an electronic patient-reported outcome (PRO) questionnaire, designed to assist parents in assessing and managing pediatric postoperative care at home following day surgery. We present questionnaire response rates, reasons for nonresponse, and the frequency and causes of postdischarge contact with the hospital.</p><p><strong>Results: </strong>Since its implementation in 2020, our PRO questionnaire has captured postoperative home-care data from 530 families. The questionnaire facilitated the identification of 157 families requiring additional postoperative support following discharge. The primary postoperative complication identified was pain, with nausea and vomiting being less frequently reported as isolated concerns.</p><p><strong>Conclusion: </strong>We have found the use of a postdischarge electronic questionnaire helpful in the postoperative care and provision of timely guidance to families.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Error Traps\" in Pediatric ERAS.","authors":"Megan A Brockel, Melissa Brooks Peterson, Kyle O Rove","doi":"10.1111/pan.15113","DOIUrl":"https://doi.org/10.1111/pan.15113","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788373","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":"Sevoflurane Washin With the Dräger Apollo and GE Datex Ohmeda Aisys Workstations in Healthy Children.","authors":"Jerrold Lerman, Ana Maria Restrepo Correa","doi":"10.1111/pan.15106","DOIUrl":"https://doi.org/10.1111/pan.15106","url":null,"abstract":"<p><strong>Background: </strong>Sevoflurane is preferred for induction of anesthesia in children because of its rapid wash-in and minimal airway reactivity.</p><p><strong>Aims: </strong>The primary aim of this study was to compare the washin profiles of sevoflurane in children using the Dräger Apollo and Ohmeda Aisys workstations.</p><p><strong>Methods: </strong>Twenty-four healthy children (12 per workstation) scheduled for elective surgery underwent inhalational inductions with 8% sevoflurane and 66% nitrous oxide in this prospective observational study. The inspired and end-tidal sevoflurane concentrations were recorded every 30 for the first 5 min and every minute thereafter until the airway was secured. Primary and secondary outcomes consisted of the derived wash-in metrics during the induction.</p><p><strong>Results: </strong>The end-tidal to inspired ratios of sevoflurane were similar with both workstations. The mean (±SD) inspired sevoflurane concentrations with the Apollo were less than with the Aisys workstation (p < 0.013). The mean (±SD) inspired concentration at 1 min with the Apollo, 6.4% ± 0.4%, was 22% less than that with the Aisys, 7.8% ± 0.67% (mean difference 1.4, 95% CI 0.88 to 1.8, p < 0.0001). The mean (±SD) maximum inspired and expired sevoflurane concentrations during the induction period with the Apollo, 7.2% ± 0.3% and 6.8% ± 0.37%, were 18% and 15% less than those with the Aisys, 8.5% ± 0.4% and 7.8% ± 0.9%, (mean difference 1.3, 95% CI 0.99 to 1.6, p < 0.0001) and (mean difference 1.01, 95% CI 0.41 to 1.6, p < 0.002) respectively. The median (25-75th percentile) time to reach 90% of the maximum inspired concentration during the induction with the Apollo, 1.75 (1-2.4) min was 3.5-fold greater than that with the Aisys, 0.5, 0.5-0.5 min (median difference -1.25, 95% CI -1.5 to -0.5, p < 0.0019).</p><p><strong>Conclusions: </strong>The washing of sevoflurane with the Dräger Apollo workstation is slower, and the maximum sevoflurane concentrations are less in children than with the Ohmeda Aisys workstation.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772894","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing Opioid Usage in Pediatric Cholecystectomy Through Care Standardization: A Quality Improvement Project Using Enhanced Recovery After Surgery Protocols.","authors":"Rami Karroum, Thomas Wolski, Laurie J Engler, Lenore France, Scott Boulanger, Tarun Bhalla","doi":"10.1111/pan.15103","DOIUrl":"https://doi.org/10.1111/pan.15103","url":null,"abstract":"<p><strong>Background: </strong>While enhanced recovery after surgery protocols have been successful in adults, their impact in pediatric surgery is less documented.</p><p><strong>Smart aim: </strong>Reduce opioid use in morphine milligram equivalents by 25% over 32 months through an enhanced recovery after surgery protocol. This period included 5 months dedicated to testing and implementing the protocol, followed by 27 months of full implementation. Process measures ensured adherence, with 30-day readmission rates, pain scores, postoperative nausea and vomiting, pruritus, and hospital length of stay as balancing measures.</p><p><strong>Methods: </strong>Inconsistent perioperative management led to variable opioid use in pediatric laparoscopic cholecystectomy patients at our hospital. A quality improvement project using the Model for Improvement was implemented at a 443-bed pediatric academic hospital. A multidisciplinary enhanced recovery after surgery team implemented perioperative standardizations supported by electronic medical record best practice advisories, monthly educational sessions, and stakeholder engagement.</p><p><strong>Results: </strong>After full enhanced recovery after surgery protocol implementation, morphine milligram equivalents decreased by 27% over 32 months. Mean pain scores decreased from 4.69 (95% CI: 4.32-5.06) pre-enhanced recovery after surgery to 4.10 (95% CI: 3.84-4.36) post-enhanced recovery after surgery. Postoperative nausea and vomiting incidence decreased from 18% (95% CI: 11.7-26.7) to 15% (95% CI: 9.3-23.3), and pruritus incidence declined from 6% (95% CI: 2.8-12.5) to 5% (95% CI: 2.2-11.2). Mean hospital length of stay was 1.37 days (95% CI: 1.33-1.41) pre-enhanced recovery after surgery and 1.34 days (95% CI: 1.30-1.38) post-enhanced recovery after surgery. The 30-day readmission rate remained unchanged, with the sole readmission attributed to constipation.</p><p><strong>Conclusion: </strong>Standardizing care through enhanced recovery after surgery protocols effectively reduces opioid use in pediatric laparoscopic cholecystectomy without increasing mean postoperative pain scores, postoperative nausea and vomiting, pruritus, or hospital length of stay.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764582","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":"Metabolic Alkalosis in the Pediatric Cardiac Intensive Care Unit-A Prospective Observational Study.","authors":"Diana Thomas, Suneel P Raman, Baiju S Dharan","doi":"10.1111/pan.15104","DOIUrl":"https://doi.org/10.1111/pan.15104","url":null,"abstract":"<p><strong>Background: </strong>Metabolic alkalosis in pediatric patients following cardiac surgery warrants a comprehensive study. Newer methods of arterial blood gas (ABG) assessment can offer more insights into the mechanisms behind such derangement.</p><p><strong>Objective(s): </strong>To study the incidence of metabolic alkalosis in postsurgical infants admitted to the pediatric cardiac intensive care unit and analyze factors associated with its development and its effect on prognosis.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Tertiary care teaching hospital in India during 2020-2021.</p><p><strong>Patients: </strong>One hundred four infants < 1 year of age undergoing elective cardiac surgery and who required more than 6 h of postoperative mechanical ventilation were included. Infants on preoperative mechanical ventilation or with metabolic alkalosis were excluded.</p><p><strong>Main outcome measures: </strong>Incidence of metabolic alkalosis and causative preoperative, intraoperative, and postoperative factors were studied along with their morbidity profile.</p><p><strong>Results: </strong>Metabolic alkalosis was detected in 23 (22.1%) subjects. In group MA (who developed metabolic alkalosis), 73.9% of infants belonged to risk adjustment for congenital heart surgery-1 (RACHS-1) category 3 and above (p = 0.009). They also had longer cardiopulmonary bypass time (200.04 ± 83.35 min vs. 144.59 ± 64.77; 95% confidence interval of the difference in means [23, 87.9]), longer cross-clamp time (119.78 ± 63.12 min vs. 84.95 ± 48.8; 95% CI [10.4, 59.3]), greater application of modified ultrafiltration (MUF) (91.3% vs. 60.5%, p = 0.005), and larger volume of MUF removed (60 (44.4, 70) ml kg^-1 vs. 44.44 (32.9, 54.3), p = 0.003). Partitioning of base excess showed similar standard base excess due to free water (SBE_FW) (MA -0.18 ± 0.94 vs. No MA 0.25 ± 1.1; confidence interval of the difference in means [-0.95, 0.09]) and due to chloride (SBE_Cl) (MA -5.7 ± 4.8 vs. No MA -5.18 ± 5.05; 95% CI [-2.9, 1.8]) in both groups. A longer period of ventilation, intensive care unit stay, and hospital stay were found in group MA.</p><p><strong>Conclusion: </strong>This prospective study on postcardiotomy infants revealed a much lower incidence of metabolic alkalosis than historical data. Physicochemical analysis of the blood samples for mechanisms underlying metabolic alkalosis found that its development is not entirely dependent on overt volume depletion or significant chloride loss. The administration of chloride-containing solutions appears to mitigate both the occurrence and severity of metabolic alkalosis.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764588","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}