Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-04-03DOI: 10.1111/pan.15106
Jerrold Lerman, Ana Maria Restrepo Correa
{"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":"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":"535-541"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","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}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-05-01DOI: 10.1111/pan.15123
Matthew Desmond, Britta S von Ungern-Sternberg
{"title":"Pediatric Endotracheal Tube Cuff Management at Altitude: Implications for Aeromedical Retrieval and Other Austere Environments.","authors":"Matthew Desmond, Britta S von Ungern-Sternberg","doi":"10.1111/pan.15123","DOIUrl":"10.1111/pan.15123","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children are sometimes transported via fixed or rotary wing aircraft for medical care. If they are intubated with a cuffed endotracheal tube (ETT), changes in environmental pressure during transport can alter cuff pressure. Cuff management in this setting varies widely by region and by organization. In this historical review, we sought to delineate the evolution of ETT cuff management in children undergoing aeromedical retrieval in order to progress the field toward an optimum strategy in the future.</p><p><strong>Descriptions and conclusions: </strong>Problems with extremely high ETT cuff pressures in adults due to altitude gain were identified by the 1970s. During subsequent decades, this topic was the subject of fervent research and device development, with a relative waning in interest more recently. Children, being transported less frequently and almost always with non-cuffed ETTs, were not included in these research efforts. During a similar epoch, the field of hyperbaric medicine also recognized the issue of ETT cuff pressure changes and almost uniformly changed to cuff insufflation with an incompressible liquid. This was based on cuff pressure measurements and deductive reasoning, rather than on evidence from patient outcome trials. Aeromedical retrieval has not consistently adopted this technique. Further investigation and discussion on an optimum strategy of cuff management in aeromedical transport of children is needed to reach an agreement on best practice.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"504-510"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036995","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}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-04-29DOI: 10.1111/pan.15125
Kevin Finbarr McCarthy
{"title":"Maintaining Privacy During the Intrahospital Transport of Anesthetized Children.","authors":"Kevin Finbarr McCarthy","doi":"10.1111/pan.15125","DOIUrl":"10.1111/pan.15125","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"577-578"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976207","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}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-04-29DOI: 10.1111/pan.15119
Tim Dare
{"title":"Authorship and Its Virtues.","authors":"Tim Dare","doi":"10.1111/pan.15119","DOIUrl":"10.1111/pan.15119","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"494-496"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037024","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}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-03-20DOI: 10.1111/pan.15099
Alexandra C Cates, Bradley J Curtis, Christy J Crockett
{"title":"Documentation of Core Temperature in Pediatric Patients Undergoing General Anesthesia: A Quality Improvement Initiative to Increase Compliance.","authors":"Alexandra C Cates, Bradley J Curtis, Christy J Crockett","doi":"10.1111/pan.15099","DOIUrl":"10.1111/pan.15099","url":null,"abstract":"<p><strong>Background: </strong>Children's body composition makes them highly susceptible to heat loss, which is further amplified by anesthetic-induced inhibition of thermoregulatory control. Perioperative hypothermia can lead to adverse outcomes, thus highlighting the importance of core temperature monitoring for pediatric patients undergoing general anesthesia. We launched and completed a quality improvement (QI) initiative at our institution starting in February 2023, with the SMART aim to increase the percentage of pediatric patients in our dental OR who receive a documented core temperature in the anesthetic record from 10% to 60% by October 2023.</p><p><strong>Methods: </strong>We referenced the Standards for Quality Improvement Reporting Excellence guidelines and used the Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We tested 5 interventions between February and October 2023. These included an educational email to all anesthesia professionals, a posted sign in the OR, a Morbidity and Mortality Conference regarding core temperature monitoring, and the development of an integrated pop-up reminder to measure core temperature in our electronic healthcare record.</p><p><strong>Results: </strong>With this QI initiative, the percentage of pediatric patients undergoing general anesthesia for more than an hour in our dental OR with documented core temperature monitoring increased from 10% to 60% by October 2023, and to 90% by January 2024.</p><p><strong>Conclusions: </strong>We successfully increased compliance with standard ASA monitoring guidelines. By January 2024, 90% of pediatric patients undergoing general anesthesia for more than an hour in our dental OR had documented core temperature monitoring in the anesthetic record.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"520-526"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663873","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}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-04-08DOI: 10.1111/pan.15112
Bishr Haydar
{"title":"Error Traps in the Intrahospital Transport of Critically Ill and Anesthetized Children.","authors":"Bishr Haydar","doi":"10.1111/pan.15112","DOIUrl":"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":"497-503"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149488/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-04-19DOI: 10.1111/pan.15116
Allan F Simpao, Jessica A Berger, Clyde T Matava
{"title":"The Right Team for the Job: Dynamic, Data-Driven Acuity Scoring in Pediatric Perioperative Care.","authors":"Allan F Simpao, Jessica A Berger, Clyde T Matava","doi":"10.1111/pan.15116","DOIUrl":"10.1111/pan.15116","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"492-493"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022970","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}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-05-03DOI: 10.1111/pan.15121
Jordan I Gaelen, Johna Joseph, Alexander B Froyshteter, Noopur Gangopadhyay, Jennifer L McGrath, Eric C Cheon
{"title":"Risk Analysis of Unplanned Extubation and Inadvertent Endobronchial Intubation During Pediatric Cleft Palate and Lip Repair.","authors":"Jordan I Gaelen, Johna Joseph, Alexander B Froyshteter, Noopur Gangopadhyay, Jennifer L McGrath, Eric C Cheon","doi":"10.1111/pan.15121","DOIUrl":"10.1111/pan.15121","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"573-576"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026293","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}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-04-03DOI: 10.1111/pan.15105
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
{"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":"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":"542-551"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149489/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pediatric AnesthesiaPub Date : 2025-07-01Epub Date: 2025-05-06DOI: 10.1111/pan.15124
Jessica Luo, Nicholas West, Samantha Pang, Aanisah Golam, Erin Adams, Matthias Görges, Roxane R Carr, Firoz Miyanji, Gillian R Lauder
{"title":"Perioperative Intravenous Lidocaine Infusion Therapy as an Adjunct to Multimodal Analgesia for Adolescent Idiopathic Scoliosis Surgical Correction: A Double-Blind Randomized Controlled Trial.","authors":"Jessica Luo, Nicholas West, Samantha Pang, Aanisah Golam, Erin Adams, Matthias Görges, Roxane R Carr, Firoz Miyanji, Gillian R Lauder","doi":"10.1111/pan.15124","DOIUrl":"10.1111/pan.15124","url":null,"abstract":"<p><strong>Background: </strong>Posterior spinal instrumentation and fusion is a common surgical correction for adolescent idiopathic scoliosis. Preventative multimodal analgesia, including opioids, is required to minimize postoperative pain, but opioids are associated with dose-dependent side effects that may disrupt recovery.</p><p><strong>Aims: </strong>We hypothesized that the addition of 48-h perioperative intravenous lidocaine therapy to a multimodal analgesia regimen would reduce morphine utilization.</p><p><strong>Method: </strong>We conducted a double-blinded randomized controlled trial in 10-19 years old, ASA I-III, undergoing single-stage scoliosis correction. Participants were randomly allocated to the Intervention group (intravenous lidocaine 1 mg kg<sup>-1</sup> bolus at anesthesia start, followed by 2 mg kg<sup>-1</sup> h<sup>-1</sup> infusion for 8 h, followed by 1 mg kg<sup>-1</sup> h<sup>-1</sup> for 40 h) or Control (normal saline). Participants received standardized perioperative multimodal analgesia, including a postoperative morphine infusion with titration rules protocolized to self-reported pain scores. The primary outcome was 48-h morphine utilization; secondary outcomes were median and worst pain scores, and times to first stand, first walk > 15 steps, urinary catheter removal, termination of morphine infusion, and hospital discharge.</p><p><strong>Results: </strong>Data were available from 38 participants: 32 (84%) female; median (IQR) age 16.3 (14.9-17.2) years, with curve magnitude (Cobb angle) 62 (56-70) degrees. The 48-h morphine utilization did not differ between groups: Intervention median (IQR) 0.86 (0.73-1.05) mg kg<sup>-1</sup> versus Control 1.00 (0.77-1.18) mg kg<sup>-1</sup>; median difference -0.11 (95% CI -0.30 to 0.13) mg kg<sup>-1</sup>; p = 0.264. There were similarly no differences in morphine utilization at 12, 24, or 36 h or any secondary outcome, except the first postoperative pain score: Intervention 3/10 (1.75-5) versus Control 5/10 (3-7); median difference -2 (95% CI 0 to -3); p = 0.035. Three cases with mild symptoms of suspected local anesthetic systemic toxicity were observed in the Intervention group.</p><p><strong>Conclusions: </strong>We found no evidence to support the adjunctive use of 48-h perioperative intravenous lidocaine therapy in adolescents undergoing scoliosis correction in which effective multimodal analgesia was adopted.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04069169.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"552-561"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041553","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}