Pediatric Anesthesia最新文献

{"title":"Measurement of Airway Length in Neonates Using Fiberoptic Bronchoscopy.","authors":"Faruk Cicekci","doi":"10.1002/pan.70136","DOIUrl":"10.1002/pan.70136","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1475-1476"},"PeriodicalIF":1.6,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053321","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":"Correlation of Neuron-Specific Enolase and S100ß Protein Levels, Inflammatory Cytokines, and Neurological Injury in Children Undergoing Cardiopulmonary Bypass.","authors":"Mark Twite, Aris Sophocles, Zhaoxing Pan, Robert Friesen","doi":"10.1002/pan.70332","DOIUrl":"https://doi.org/10.1002/pan.70332","url":null,"abstract":"<p><strong>Background: </strong>The systemic inflammatory response syndrome to cardiopulmonary bypass (CPB) affects all organ systems including the brain. Perioperative brain injury in children with congenital heart disease is often clinically silent in the acute perioperative period and may not be detected until patients are older. The plasma biomarkers neuron-specific enolase (NSE) and S100ß protein show potential for detecting neurological injury in the perioperative period.</p><p><strong>Objectives: </strong>The three objectives of this study were to examine the correlation of NSE and S100ß protein levels with inflammatory cytokines, parameters of CPB, and the development of neurological injury in the intensive care unit following cardiac surgery in children.</p><p><strong>Methods: </strong>50 children undergoing cardiac surgery with CPB had blood samples drawn at three time points: after induction of anesthesia, 30 min post-CPB, and 24 h post-CPB. Blood samples were analyzed for NSE, S100ß, and the inflammatory cytokines IL-6, IL-8, and IL-10. Data were collected on CPB durations and neurological injury diagnosed in the postoperative period.</p><p><strong>Results: </strong>NSE and S100ß increased significantly following bypass and correlated with increases of IL-6, IL-8, and IL-10. There was a significant positive correlation of NSE and S100ß with duration of CPB, and of S100ß with duration of aortic cross clamp. Three patients suffered neurological insult. These patients had greater levels of NSE during the post-CPB period (p = 0.02) and S100ß at 24 h post-CPB (p = 0.02) than patients without neurological deficits.</p><p><strong>Conclusion: </strong>The positive correlation between NSE, S100ß, inflammatory cytokines, and neurological deficits suggests that the systemic inflammatory response to CPB may contribute to neurological injury and that NSE and S100ß may be useful tools to detect neurological injury following CPB.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228431","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 Evolution of Anesthesia for Congenital Heart Disease.","authors":"Kirsten C Odegard, Katherine L Zaleski, Viviane G Nasr","doi":"10.1002/pan.70331","DOIUrl":"https://doi.org/10.1002/pan.70331","url":null,"abstract":"<p><p>This educational review describes the historical development of pediatric congenital cardiac anesthesia and its expanding role in the care of patients with congenital heart disease (CHD). Over the past eight decades, the specialty has evolved from an era in which few congenital heart defects were surgically treatable and perioperative mortality was high to one in which survival into adulthood is expected for most children with CHD. This transformation has been driven by parallel advances in surgical techniques, cardiopulmonary bypass technology, myocardial protection, monitoring, intensive care, and anesthetic management. From the first successful patent ductus arteriosus ligation in 1938 to the development of fetal cardiac interventions and the many major technological and scientific advances of the late twentieth and early twenty-first centuries, anesthesiologists have played a pivotal role in improving the care of patients with CHD. As survival has improved, the population of adults and elderly patients living with repaired or palliated CHD has grown, and the specialty's focus has expanded beyond reducing perioperative mortality to improving lifelong outcomes. Today, congenital cardiac anesthesiologists are integral members of multidisciplinary teams responsible for perioperative risk assessment, hemodynamic optimization, neuroprotection, coagulation management, mechanical circulatory support, and enhanced recovery. The history of the specialty highlights the importance of multidisciplinary collaboration and continued scientific progress in improving patient safety, recovery, and long-term outcomes.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224699","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":"Resilience Through Connection: A Group Coaching Framework for Women Anesthesiologists in the Women's Empowerment and Leadership Initiative (WELI).","authors":"Nina Deutsch, Rachel Schwartz, Najla Shilleh, Hanna Van Pelt, Jennifer Lee, Laura Berenstain, Rebecca Margolis, Malgorzata Lutwin-Kawalec, Erek Ostrowski, Viviane G Nasr","doi":"10.1002/pan.70330","DOIUrl":"https://doi.org/10.1002/pan.70330","url":null,"abstract":"<p><strong>Background: </strong>Women anesthesiologists face unique challenges that threaten their well-being and retention. This includes high rates of imposter phenomenon, higher rates of attrition compared to male colleagues, and high rates of suicide. While group coaching is increasingly recognized as a developmental modality to foster growth in complex work environments, gaps remain in understanding how group coaching supports women who face imposter syndrome or how effective this modality is for women anesthesiologists.</p><p><strong>Aims: </strong>This study examines the impact of a pilot group coaching intervention that focused on addressing imposter syndrome in women anesthesiologists participating in the Women's Empowerment and Leadership Initiative (WELI).</p><p><strong>Methods: </strong>Fifteen women pediatric anesthesiologists, split across two groups, took part in seven monthly group coaching sessions. A post-coaching survey was then conducted in which participants were asked about their experiences before and after group coaching. Eight of the participants volunteered to participate in semi-structured interviews about their experiences. Qualitative data were coded using an inductive thematic analysis approach.</p><p><strong>Results: </strong>The survey showed that following group coaching, participants demonstrated an increase in self-reported compassion and acceptance of others. They also reported learning more about themselves and how to amend their own behavior in helpful ways compared to pre-intervention. Two overarching themes emerged: a sense of community (fueled by psychological safety, validation, shared experience, and addressing imposter syndrome through the group coaching) and tools gained (including clearer priorities, work/life integration, and proactive social support).</p><p><strong>Conclusions: </strong>Results of this pilot intervention suggest group coaching programs for anesthesiologists have the potential to build resilience in the current work environment, thereby benefiting not only individuals but the anesthesiology workforce as a whole.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224675","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":"Perceptions of Intra-Operative EEG Brain Monitoring During Pediatric Anesthesia Among Children and Parents: An Exploratory Cross-Sectional Survey.","authors":"Kah Hau Luke Chua, Teddy Fabila, Neyziel Mardo, Choon Looi Bong","doi":"10.1002/pan.70329","DOIUrl":"https://doi.org/10.1002/pan.70329","url":null,"abstract":"<p><strong>Background: </strong>Electroencephalography (EEG) monitoring during pediatric anesthesia may improve perioperative safety by optimizing anesthetic titration and reducing adverse outcomes. However, little is known about patient and caregiver perceptions regarding this technology and its implementation into routine anesthesia care.</p><p><strong>Aims: </strong>This study evaluates perceived importance, utility, and extent of reassurance provided by intra-operative EEG monitoring among pediatric patients and their parents. Secondary aims include identifying concerns surrounding general anesthesia (GA), concerns surrounding EEG monitoring, cost and willingness to pay, and sociodemographic and medical factors shaping these attitudes.</p><p><strong>Methods: </strong>We conducted an exploratory cross-sectional survey at a tertiary pediatric hospital in Singapore between July 2022 and September 2025. Respondents were parents of children aged 1-18 years and children aged 12-18 scheduled for elective procedures under general anesthesia. A 16-item anonymized questionnaire assessed perceptions of intra-operative EEG monitoring, concerns about anesthesia, and attitudes regarding the cost of EEG monitoring.</p><p><strong>Results: </strong>Of 400 respondents (100 children, 300 parents), 83.5% rated intra-operative brain monitoring as \"very\" or \"quite\" important and 93% reported feeling more reassured by its use. Children were most concerned about intraoperative awareness and failure to awaken, whereas parents were most concerned about anesthetic side effects and dosage. Parents with higher education and whose children had prior anesthetic exposure reported greater reassurance from EEG monitoring. Cost was the leading concern regarding EEG monitoring, particularly among parents from families residing in public housing. Despite this, most parents (75%) and children (59%) expressed willingness to pay for EEG monitoring.</p><p><strong>Conclusions: </strong>Pediatric patients and parents viewed intra-operative EEG monitoring as important and reassuring, and expressed willingness to support its implementation despite cost concerns. These findings suggest that families are unlikely to be a major barrier to EEG adoption and highlight the need for clinician- and system-level strategies to integrate EEG monitoring into family-centered pediatric anesthesia care.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195896","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":"Wrong-Site Regional Blocks: A Study From Wake Up Safe.","authors":"Angela C Lee, Amanda Townsend Redding, Md Sohel Rana, Jayant K Deshpande, Eugenie Heitmiller","doi":"10.1002/pan.70326","DOIUrl":"https://doi.org/10.1002/pan.70326","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183429","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 Ethics Framework for Last-Minute Pediatric Refusal of Anesthesia Induction.","authors":"J Patrick Haltom, Amy S Martin, Hugo Wellesley","doi":"10.1002/pan.70328","DOIUrl":"https://doi.org/10.1002/pan.70328","url":null,"abstract":"<p><p>Induction of anesthesia is one of the most distressing moments for pediatric patients during their perioperative experience. They may consequently refuse induction at the last minute. Anesthesia providers are then placed in a challenging ethical dilemma: they must seek to gain the child's cooperation, force the child to undergo induction using restraint, or delay the case. In the moment, it can be difficult to parse the relevant clinical and ethical factors to determine the most appropriate course of action. The purpose of this perspective paper is to provide a clinical ethics framework to support anesthesia provider decision making during instances of last-minute pediatric refusal of anesthesia induction. Three prominent pediatric ethics concepts support this framework, including the harm principle, best interests, and emerging autonomy. This framework uses the criteria of (1) urgency of intervention, (2) decision-making ability of the patient, and (3) harms to the patient from a forced induction. Each of these criteria is discussed in depth as it relates to last-minute pediatric refusal. Case illustrations are provided to demonstrate the clinical utility of this framework in everyday practice.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171022","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":"Intrathecal Hydromorphone Dosing for Adolescent Spinal Fusion: A Prospective Dose-Escalation Study.","authors":"Kathryn S Handlogten, Lindsay L Warner, A Noelle Larson, Todd A Milbrandt, Anthony A Stans, Emmanouil Grigoriou, Darrell R Schroeder, David O Warner","doi":"10.1002/pan.70325","DOIUrl":"https://doi.org/10.1002/pan.70325","url":null,"abstract":"<p><strong>Background: </strong>Intrathecal opioids are widely used for postoperative analgesia in pediatric spine surgery, but optimal dosing remains undefined. We evaluated the relationship between intrathecal hydromorphone (ITH) dose, analgesia, and adverse effects in adolescents undergoing posterior spinal fusion (PSF).</p><p><strong>Methods: </strong>In this single-center, prospective, blinded dose-escalation study using a biased-coin up-down sequential allocation design, patients aged 10-17 years undergoing PSF received ITH starting at 3.5 mcg kg^-1, with dose adjustments based on analgesic response (range 2.0 to 7 mcg kg^-1 with a maximum of 400 mcg). The primary outcome was maximum postoperative pain within 18 h. Secondary outcomes included pain burden (area under the curve), 24-h systemic opioid consumption (oral morphine equivalents [OME], excluding ITH), adverse effects, supplemental diazepam use, and rescue opioid use. Associations between dose and outcomes were assessed using Spearman correlation and logistic regression.</p><p><strong>Results: </strong>Twenty-seven patients completed the study. The median ITH dose received was 5.5 mcg kg^-1 (IQR, 3.5-7.0), with a median absolute dose of 370 mcg (IQR, 180-400). No significant association was observed between ITH dose and maximum pain (r = 0.16, p = 0.41), pain burden (r = 0.32, p = 0.10), or 24-h OME (r = 0.13, p = 0.52). ITH dose was not significantly associated with the time to rescue opioid (HR = 1.24; 95% CI 0.68-2.25; p = 0.485) or diazepam (HR = 1.10; 95% CI 0.72-1.71; p = 0.655). Adverse respiratory events occurred at doses > 5 mcg kg^-1 without improved analgesia.</p><p><strong>Conclusions: </strong>Increasing ITH dose was not associated with improved analgesia or change in supplemental opioid or diazepam use. Doses > 5 mcg kg^-1 were associated with adverse respiratory effects. These findings support conservative dosing strategies and underscore the need to define the minimum effective dose in pediatric populations.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128330","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":"Pediatric Preassessment Service Evaluation Across the South Thames Pediatric Network.","authors":"William Fry, Natasha Woodman, Laura Snow, Samantha Black","doi":"10.1002/pan.70321","DOIUrl":"https://doi.org/10.1002/pan.70321","url":null,"abstract":"<p><strong>Background: </strong>Pediatric preassessment services across the United Kingdom remain variably developed and inconsistently funded when compared to adult care. There has been little systematic evaluation of pediatric preassessment models across regions or networks. The aim is to evaluate the quality of pediatric preassessment within the South Thames Pediatric Network (STPN). By engaging families across a large, multi-organizational network, this questionnaire collated evidence to inform local and national service improvement, promote equitable access and enhance patient experience for children.</p><p><strong>Methods: </strong>A cross-sectional, questionnaire-based service evaluation was conducted across hospitals within the STPN over a four-month period. Eligible participants were guardians of pediatric patients scheduled for elective procedures under general anesthesia. Questions were informed by national guidance (APAGBI and RCoA) to ensure adherence to current standards of pediatric perioperative care.</p><p><strong>Results: </strong>403 responses were collected from 18 hospitals. Telephone consultation was the most common and preferred preassessment modality. 79% of respondents were satisfied with the explanation of anesthetic risks, despite just 46% receiving the RCoA infographic. Health promotion advice was offered to 35%. 70% were asked about anxiety and only 9% were not reassured about these anxieties. For children with additional needs, 95% felt the healthcare professional listened to their individual needs. Overall satisfaction was high; 85% felt the preassessment suitably prepared them for surgery.</p><p><strong>Discussion: </strong>This evaluation supports the effectiveness and acceptability of pediatric preoperative assessment, with high overall satisfaction within STPN. Pediatric preassessment provides a crucial opportunity to make an individualized plan, particularly for children with additional needs, who are overrepresented compared with the general population. Addressing anxiety, standardizing information provision, modality choice, and communication gaps helps bridge the divide with adult practice and further optimize perioperative care for children and families.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112171","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":"Perioperative Characteristics and Outcomes of Home-Ventilated Children Undergoing Non-Cardiac Surgery in the Pediatric NSQIP Database.","authors":"Jia Liu, Amber C Bausley, Robert J Graham","doi":"10.1002/pan.70324","DOIUrl":"https://doi.org/10.1002/pan.70324","url":null,"abstract":"<p><strong>Background: </strong>Due to advancements in medicine and technology, there is a growing population of children with chronic respiratory failure that requires long-term mechanical ventilation (LTV). These patients commonly have a high degree of medical complexity and often require surgical intervention.</p><p><strong>Aims: </strong>This study seeks to describe the perioperative characteristics, surgical interventions, and postoperative outcomes for pediatric patients with long-term ventilation (LTV)-dependence via tracheostomy undergoing elective non-cardiac surgery.</p><p><strong>Methods: </strong>A retrospective cohort analysis was performed using the Pediatric National Surgical Quality Improvement Program (NSQIP) database from 2019 to 2023. Pediatric patients with LTV undergoing elective non-cardiac surgeries were identified. Demographic data, medical comorbidities, surgical characteristics, and postoperative outcomes were analyzed.</p><p><strong>Results: </strong>We identified 1291 pediatric patients with home tracheostomy and ventilation requirements undergoing elective non-cardiac surgery. There were no reported intraoperative cardiac arrests or unplanned loss of secure airway amongst all patients for the years this data was available (2019-2023). There were major postoperative adverse events in five patients (0.4%) who experienced cardiac arrest requiring CPR and three patients (0.2%) who experienced 30-day mortality. There was an overall rate of 12% (n = 153) for 30-day readmission, of which 81% (n = 124) were unplanned.</p><p><strong>Conclusions: </strong>Although children dependent on LTV have high medical complexity, serious postoperative adverse events are rare following elective surgery.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112139","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}