Pediatric Anesthesia最新文献

{"title":"Comparison of Methylprednisolone and Dexamethasone in Their Interaction With Sugammadex in Pediatric Patients: A Randomized Controlled Trial.","authors":"Mustafa Büyükcavlak, Yasin Tire, Mehmet Sarı, Cansu Çiftci","doi":"10.1002/pan.70322","DOIUrl":"https://doi.org/10.1002/pan.70322","url":null,"abstract":"<p><strong>Background: </strong>Sugammadex may interact with steroidal compounds; however, comparative clinical data on different peri-operative corticosteroids in children are limited. This randomized controlled trial primarily aimed to compare the effect of methylprednisolone and dexamethasone, administered at clinically equivalent glucocorticoid doses, on sugammadex-mediated reversal time of rocuronium-induced neuromuscular block in children. Secondary aims were to compare extubation time, postoperative nausea, pain, and adverse events related to upper airway oedema between groups.</p><p><strong>Methods: </strong>Sixty children undergoing adenotonsillar surgery were randomized 1:1:1 to receive methylprednisolone 1 mg kg^-1, dexamethasone 0.2 mg kg^-1, or no corticosteroid (control). Neuromuscular monitoring followed the Good Clinical Research Practice in pharmacodynamic studies of neuromuscular blocking agents standards. The primary endpoint was the rocuronium reversal time: interval from the sugammadex bolus at train of four count = 2 to a normalized train of four ratio of 0.9. Extubation time (interval from the sugammadex bolus at a train of four count = 2 until tracheal extubation); severity scores for postoperative pain and nausea; and frequency of adverse events related to upper airway oedema were the secondary endpoints. Between-group comparisons used one-way ANOVA or Welch's ANOVA for normally distributed data and the Kruskal-Wallis test for non-normally distributed data, with Bonferroni-corrected post hoc pairwise comparisons.</p><p><strong>Results: </strong>The study population had a mean ± SD age, weight, and height of 7.9 ± 2.0 years, 30.0 ± 9.3 kg, and 129.0 ± 11.0 cm, respectively, with comparable demographic and baseline profiles across groups. Reversal time was longer with methylprednisolone (mean ± SD: 82.8 ± 16.1 s) than with dexamethasone (63.4 ± 13.4 s) and control (56.1 ± 13.7 s) (p < 0.001). Extubation time showed a similar pattern. Postoperative nausea-vomiting, pain scores, and the overall incidence of adverse events did not differ significantly between groups.</p><p><strong>Conclusions: </strong>At clinically equivalent glucocorticoid doses, methylprednisolone was associated with longer sugammadex-mediated reversal and extubation time than dexamethasone and control, while postoperative pain, nausea scores, and adverse event rates were comparable between the groups. These findings indicate that the corticosteroid selected for peri-operative use may influence the efficacy of sugammadex-mediated reversal in children.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT07175623.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113271","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":"Response to the Letter on Esketamine and Tracheal Extubation Time.","authors":"Munder Lateiresh, Alhasan Altayf, Muhammed Elhadi","doi":"10.1002/pan.70323","DOIUrl":"https://doi.org/10.1002/pan.70323","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112128","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":"Perianesthetic Complications in Genetic Mitochondrial Disease: A Review of Case Reports.","authors":"Brittany M Johnson, Simon C Johnson","doi":"10.1002/pan.70257","DOIUrl":"10.1002/pan.70257","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Genetic mitochondrial diseases (GMDs) are a large group of genetically and clinically heterogeneous disorders caused by defects in genes encoding mitochondrial components. GMDs are grouped into named syndromes based on clinical presentation, for example, Leigh syndrome (LS). Surgical interventions are often required in GMDs, necessitating the use of general anesthesia (GA). Some GMD animal models show both a marked reduction in anesthetic concentrations necessary for sedation and toxic sequelae resulting from anesthetic exposures. Hypersensitivity to sedation by anesthetic agents, most notably volatile anesthetic agents (VAs), occurs in a subset of GMD patients, and some evidence suggests toxicities are also present. Reported complications of anesthesia in GMD are varied, including minor metabolic changes, acceleration of underlying disease, and death. The potential toxicity of anesthetics in the setting of GMDs has recently been underscored by deaths among pediatric and young adult patients of Venezuelan descent putatively linked to a specific mitochondrial DNA haplotype. Interpretation of clinical findings is limited by the lack of a thorough review of case reports for anesthetic exposures in GMD patients. Here, we provide a comprehensive review of published case reports for GMD patients undergoing anesthetic exposures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using search terms \"anesthesia mitochondrial disease,\" \"anesthesia mitochondrial disease case report,\" and \"anesthesia Leigh syndrome\" we identified case reports published up to May 2025. Non-English articles were translated and included where possible. Only reports of GMD patients undergoing GA with total intravenous anesthesia (TIVA) or VAs containing outcome information were included, totaling 148 cases from 123 reports. We examined relationships between complications and GA type, clinical diagnosis, perianesthetic drugs, procedure length and type, and general demographics. We performed a narrative review of clinical and pre-clinical literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall complication rate was significantly higher in VA versus TIVA cases (42% vs. 18%, Fisher's exact p-value **p = 0.0022), as was rate of severe complications (*p = 0.01). Encephalomyelopathies, including LS, were overrepresented among cases resulting in death. Complication rate has remained relatively stable over time. Sex and age were not associated with significant differences in complication rate. Complication rate varied significantly by procedure type, and severe complications were associated with procedure length. While not statistically significant, older VAs had higher complication rates than newer VAs. Similarly, older neuromuscular blockade agents may be less safe than newer drugs. N&lt;sub&gt;2&lt;/sub&gt;O and ketamine were notably safe among drugs used in TIVA procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Available case-report data support the notion that GMD patients are at increas","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1217-1230"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397393","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":"Contextualizing Opioid Consumption After Ambulatory Surgery in Adolescents.","authors":"Cornelius B Groenewald, Jennifer A Rabbitts, Amber N Borucki, Rita Agarwal, Chiara Sabatti, Tonya M Palermo, Andrew H Rogers","doi":"10.1002/pan.70282","DOIUrl":"10.1002/pan.70282","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1327-1328"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722201","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":"Monitoring Neuromuscular Block in Infants and Children: Is It Time? Which Monitor Should I Use?","authors":"Joseph D Tobias","doi":"10.1002/pan.70230","DOIUrl":"10.1002/pan.70230","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1179-1181"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043223","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":"Adverse Respiratory Events After Cleft Palate Repair-Closing the Quality Gap.","authors":"David M Polaner","doi":"10.1002/pan.70207","DOIUrl":"10.1002/pan.70207","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1175-1176"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Anesthesia Practice and Training in Ibero-America: A Web-Based Cross-Sectional Survey.","authors":"John Pirez, Andrés Bacigalupo Landa, Vinicius Caldeira Quintao, Federico Cristiani, Mónica Hervías, Enrique Pazos Alvarado, Eloy Sánchez-Hernández, Gabriel Soares, Pablo Motta","doi":"10.1002/pan.70221","DOIUrl":"10.1002/pan.70221","url":null,"abstract":"<p><strong>Background: </strong>Pediatric anesthesia training varies widely across Ibero-America, and many anesthesiologists care for children without formal specialized preparation.</p><p><strong>Aims: </strong>To describe training patterns, clinical exposure, and practice characteristics in pediatric anesthesia across the region.</p><p><strong>Methods: </strong>A cross-sectional online survey was distributed to anesthesiologists in 21 Ibero-American countries. Data on training, clinical experience, case volume, and use of pediatric anesthesia techniques were analyzed.</p><p><strong>Results: </strong>Among 1416 respondents, only 27.8% reported formal fellowship training in pediatric anesthesia, while 72.2% developed pediatric skills through routine practice. Most (56.6%) had < 10 years of pediatric anesthesia experience, and 41% dedicated ≤ 20% of clinical time to pediatric cases. Fellowship-trained anesthesiologists performed higher pediatric case volumes and used more advanced techniques.</p><p><strong>Conclusions: </strong>Pediatric anesthesia practice in Ibero-America shows marked heterogeneity and limited structured training. Expanding fellowship programs and increasing opportunities for sustained pediatric clinical exposure are needed to support safe anesthesia care for children.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1238-1246"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974208","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":"Toward Precision Analgesia in Pediatric Tonsillectomy: More Than Opioid Choice.","authors":"Kimmo Murto, Britta S von Ungern-Sternberg","doi":"10.1002/pan.70266","DOIUrl":"10.1002/pan.70266","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1182-1184"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471951","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":"Pharmacokinetics of Intravenous Melatonin in Preschool-Aged Pediatric Surgical Patients.","authors":"Anne Louise de Barros Garioud, Arash Afshari, Lau Romlund Halgreen, Kristian Østergaard Nielsen, Lars Peter Kloster Andersen","doi":"10.1002/pan.70248","DOIUrl":"10.1002/pan.70248","url":null,"abstract":"<p><strong>Background: </strong>Melatonin may have several beneficial clinical effects in the perioperative setting. In children, it has been studied for preoperative anxiety, postoperative pain, and emergence delirium. Melatonin's pharmacokinetic profile is well-known in adults, but data in young children are sparse. We aimed to investigate the pharmacokinetic parameters of an intravenous intraoperative bolus of melatonin in pediatric surgical patients.</p><p><strong>Methods: </strong>We enrolled 20 participants aged 1-6 years undergoing general anesthesia for elective surgery to receive an intravenous melatonin dose of 0.15 mg·kg^-1 before end of surgery. A total of six blood samples were drawn from each participant at the following time points: baseline, 0, 15, 30, 60, and 90 min post-injection. Plasma melatonin concentrations were determined with High-Performance Liquid Chromatography with Fluorescence Detection (HPLC-FLD). Pharmacokinetic parameters were estimated with non-compartmental analysis. Clinical outcomes were recorded.</p><p><strong>Results: </strong>We included 98 samples in the pharmacokinetic analysis. We found a maximum plasma concentration (C_max) of 416 298 [IQR 322 230-508 006] pg·mL^-1 and an elimination half-life (t_1/2) of 35.2 (SD 8.4) minutes. Clearance (CL) was 0.0183 (SD 0.0039) L·min^-1·kg^-1 and volume of distribution (V_d) 0.92 (SD 0.27) L·kg^-1. There were no cases of emergence delirium, mean maximum pain (FLACC) score was 1.3 (SD 2.0), and time to awakening and discharge readiness averaged one and two hours, respectively. Adverse events could be attributed to routine postoperative symptoms.</p><p><strong>Conclusion: </strong>Administering intravenous melatonin in a dose of 0.15 mg·kg^-1 in 1-6-year-olds yielded pharmacokinetic characteristics comparable to those reported in adults. The observed postoperative events were consistent with expected perioperative findings. These data support dose selection for trials investigating the perioperative use of melatonin in children.</p><p><strong>Trial registration: </strong>CTIS: EU CT 2024-517592-20.</p><p><strong>Clinicaltrials: </strong>gov: NCT05541276 (registered 12/09-2022).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1308-1315"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295949","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":"Perioperative Adverse Events in Primary Palatoplasty: \"Risk Factors and Impact on Care Escalation in a Multicenter Cohort\".","authors":"Febina Padiyath, Elizabeth M O'Brien, Jennifer Nam, Paula Hu, Nishil Mehta, Marc Parris, Anthony Alexander, Ashley Hodges, Goretti Chiang, Vinícius Caldeira Quintão, Ricardo Vieira Carlos, Gabriel Soares de Sousa, Asif Padiyath, Susan C Nicolson, John Fiadjoe, Oksana A Jackson, Lisa K Lee, Annery G Garcia-Marcinkiewicz","doi":"10.1002/pan.70224","DOIUrl":"10.1002/pan.70224","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing palatoplasty experience perioperative adverse events. Identifying risk factors for perioperative adverse events and escalation of care may improve outcomes.</p><p><strong>Methods: </strong>Pediatric patients undergoing primary palatoplasty were included in this retrospective observational study performed at two academic children's hospitals from 2014 to 2020.</p><p><strong>Results: </strong>Four hundred fifty-nine patients with a median age of 12 months (IQR: 10-17) and median weight of 9.3 kg (IQR: 8.3-10.9) were included. A perioperative adverse event occurred in 15% (69/459) patients. Multiple (> 1) perioperative adverse events occurred in 18 patients. Hypoxemia (42 events, 9.2%) was the most common perioperative adverse event, followed by upper airway obstruction (29 events, 6.3%), vomiting (11 events, 2.4%), hypoventilation (10 events, 2.2%), and bleeding (7 events, 1.5%). Two events required a rapid response team, and there was 1 cardiac arrest. Forty percent of perioperative adverse events occurred in the post-anesthesia recovery area, and 24% occurred within 12 h of arriving to the floor. Prolonged emergence time (OR 1.04 [95% CI 1.02-1.06], p < 0.001) and nasal stent placement (OR 6.02 [95% CI 2.7-13.6], p < 0.001) were significantly associated with perioperative adverse events and increased odds of unanticipated admission to the pediatric intensive care unit (OR 1.02 [95% CI, 1.01-1.04], p < 0.001) and (OR 3.39 [95% CI, 1.19-8.83], p = 0.016), respectively. The occurrence of any perioperative adverse event (OR 8.47 [95% CI, 4.06-18], p < 0.001) and increasing number of perioperative adverse events (OR 1.75 [95% CI, 1.41-2.24], p < 0.001) were also associated with increased odds of unanticipated PICU admission.</p><p><strong>Conclusions: </strong>Patients undergoing palatoplasty are at risk of perioperative adverse events, particularly in post-operative recovery areas, which may result in unanticipated escalation of care. Recognizing the risk factors associated with the development of perioperative adverse events may improve planning of post-operative care and outcomes.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1247-1253"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988608","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}