Pediatric AnesthesiaPub Date : 2025-06-01Epub Date: 2025-03-15DOI: 10.1111/pan.15094
Ann-Chatrin Linqvist Leonardsen, Berit Taraldsen Valeberg, Annette Danielsen, Cecilia Jonth, Ingrid Marie Brunborg, Endre Dingstad Jørgensen
{"title":"Parent Satisfaction With Pediatric Anesthesia-A Cross-Sectional, Multicenter Study in Norway.","authors":"Ann-Chatrin Linqvist Leonardsen, Berit Taraldsen Valeberg, Annette Danielsen, Cecilia Jonth, Ingrid Marie Brunborg, Endre Dingstad Jørgensen","doi":"10.1111/pan.15094","DOIUrl":"10.1111/pan.15094","url":null,"abstract":"<p><strong>Background: </strong>Parental satisfaction with anesthetic care is utilized as a proxy for child satisfaction. The evidence base regarding parent satisfaction with pediatric anesthesia care is limited. The aim of the current study was to assess (1) parent satisfaction with pediatric anesthesia in three hospitals, (2) potential differences across hospitals, and (3) potential associations between parent satisfaction and the child's age, surgical specialty, hospital, whether the parent previously had followed a child to surgery, and relation to the patient.</p><p><strong>Methods: </strong>The Norwegian version of the \"pediatric anesthesia parent satisfaction survey\" questionnaire (NPAPS) was used. Descriptive statistics, Kruskal-Wallis test and linear regression analysis were used to analyze the data.</p><p><strong>Results: </strong>In total, 234 parents responded. Most respondents agreed that their child had received the highest quality care during the surgical experience (96.4%-97.4%). Nearly all respondents agreed that their questions were responded to (94.6%-97.6%), information was understandable (96.4%-97.4%), the amount of information was appropriate (96.4%-97.4%), the child's integrity was respected (94.6%-97.4%), the child was treated respectfully and professionally (96.45%-97.6%), and that personnel paid attention to the parent's concerns (93.8%-94.7%). Respondents disagreed with being explained how the child might feel physically and emotionally after anesthesia (9.5%-10.5%) and also disagreed with being satisfied with the way the child fell asleep and woke up from anesthesia (5.3%-7.1%). No factors were associated with the level of parent satisfaction, and there were few differences between hospitals.</p><p><strong>Conclusion: </strong>Even if parents are overall satisfied with anesthesia care, improvement areas regarding the preparation of parents and control of postoperative symptoms were detected.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"446-453"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634214","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 : 2025-06-01Epub Date: 2025-03-17DOI: 10.1111/pan.15097
Dominik Ochocinski, Manchula Navaratnam, Amy Babb, Elizabeth De Souza, Komal Kamra, Justin R Sleasman, Tristan Day Margetson, Jyoti K Bhamidipati, Chandra Ramamoorthy, Alexander R Schmidt
{"title":"Comparison of the Point-Of-Care Coagulation Device Quantra With the TEG-5000 for Congenital Cardiac Surgery-A Pilot Study.","authors":"Dominik Ochocinski, Manchula Navaratnam, Amy Babb, Elizabeth De Souza, Komal Kamra, Justin R Sleasman, Tristan Day Margetson, Jyoti K Bhamidipati, Chandra Ramamoorthy, Alexander R Schmidt","doi":"10.1111/pan.15097","DOIUrl":"10.1111/pan.15097","url":null,"abstract":"<p><strong>Background: </strong>Congenital cardiac surgery with cardiopulmonary bypass (CPB) alters patients' hemostasis. Viscoelastic testing is a modern technology identifying coagulation abnormalities. A new device, the Quantra-QPlus System (HemoSonics LLC, Charlottesville, VA) has not yet been investigated during congenital cardiac surgery.</p><p><strong>Aim: </strong>This prospective observational pilot study investigated the correlation of Quantra and TEG-5000 in children undergoing cardiac surgery at Stanford Medicine Children's Health (SMCH).</p><p><strong>Methods: </strong>Patients (0-8 years) undergoing cardiac surgery with CPB were included after parental consent. Per standard of care at SMCH, a TEG-5000 and Clauss Fibrinogen were measured on CPB during rewarming (T1) as well as after administration of blood components and coagulation factors (T2). For the study purpose, Quantra measurements were performed simultaneously at T1 and T2. Quantra results were correlated with TEG-5000 results and Clauss Fibrinogen. In addition, the agreement for normal and abnormal results was calculated, and a post hoc simulated transfusion algorithm using TEG-5000 and Quantra thresholds was compared to patients' clinical management.</p><p><strong>Results: </strong>From October 2022 to May 2023, 289 congenital cardiac surgeries were performed, 97 met inclusion criteria, 63 patients were consented, and 40 patients (12 females [30%] 28 males [70%]) included in the analysis. Median age and weight were 0.5 years and 6.33 kg, respectively. Correlation of Quantra/Clauss Fibrinogen was \"moderate\" and correlation of Quantra/TEG-5000 parameters ranged from \"weak\" to \"very strong\" Levels of agreement ranged from 15% to 97%. The post hoc simulated transfusion algorithm for TEG-5000 showed an agreement of 56% for FFP, 56% for Fibrinogen, and 95% for platelets and for Quantra, it was 40% for FFP, 87.5% for Fibrinogen, and 98% for platelets.</p><p><strong>Conclusions: </strong>Despite weaknesses in correlation and agreement both VET devices suggested appropriate coagulation management based on the simulated transfusion algorithms. Quantra and TEG-5000 are not interchangeable and none of them can be considered as \"the gold standard\".</p><p><strong>Trial registration: </strong>NTC 05295693.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"469-480"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649836","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}
Alexander B Froyshteter, Alina Lazar, Ashlee E Holman, Geoff Frawley, Emmett E Whitaker
{"title":"Error Traps in Infant Spinal Anesthesia.","authors":"Alexander B Froyshteter, Alina Lazar, Ashlee E Holman, Geoff Frawley, Emmett E Whitaker","doi":"10.1111/pan.15132","DOIUrl":"https://doi.org/10.1111/pan.15132","url":null,"abstract":"<p><p>Infant spinal anesthesia is a viable alternative to general anesthesia for short procedures below the upper abdomen. It provides a hemodynamically stable anesthetic technique that avoids airway manipulation and associated respiratory complications. Spinal anesthesia allows surgery to be performed without inhaled anesthetic agents or, in certain cases, opioids. This manuscript highlights five preventable perioperative error traps that may occur while performing infant spinal anesthesia with the goal of providing expert clinical guidance for the provision of safe, effective, and efficient spinal anesthesia in pediatric patients.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura Palacio-Guzmán, Sergio Alzate-Ricaurte, Natalia Plata-Ayala, Andres Pombo-Jiménez, Gustavo Adolfo Cruz-Suarez
{"title":"Thrombotic Complications of Low-Dose Versus High-Dose Four-Factor Prothrombin Complex Concentrate for Massive Bleeding in Pediatric Cardiovascular Surgery.","authors":"Laura Palacio-Guzmán, Sergio Alzate-Ricaurte, Natalia Plata-Ayala, Andres Pombo-Jiménez, Gustavo Adolfo Cruz-Suarez","doi":"10.1111/pan.15118","DOIUrl":"https://doi.org/10.1111/pan.15118","url":null,"abstract":"<p><strong>Introduction: </strong>Major bleeding is a life-threatening complication in pediatric cardiovascular surgery, particularly in neonates and infants with immature coagulation systems and congenital heart defects (CHD). Cardiopulmonary bypass (CPB) exacerbates these risks by depleting coagulation factors and platelets. Four-factor prothrombin complex concentrates (4F-PCC) provide targeted hemostatic correction but carry potential thrombotic risks.</p><p><strong>Methods: </strong>Among 1296 pediatric patients who underwent cardiovascular surgery between January 2018 and April 2024, a retrospective cohort study analyzed 104 patients who received 4F-PCC. Patients were grouped into low-dose (< 35 U/kg) and high-dose (≥ 35 U/kg). Thrombotic complications were evaluated within 15 days after use.</p><p><strong>Results: </strong>The median age was 1 month (IQR: 0-7.5), and 69.23% of patients were male. Common diagnoses included hypoplastic left heart syndrome (14.42%), ventricular septal defect (13.46%), and coarctation of the aorta (12.5%). Frequent procedures included Norwood procedure (14.42%) and ventricular septal defect closure (13.46%). Thrombotic complications occurred in 6.73% overall, with no significant differences between high-dose (5.26%) and low-dose (8.51%) groups (p = 0.698). High-dose 4F-PCC was associated with shorter CPB times (p = 0.007) (Cohen's d 0.537) but higher reintervention rates (57.89% vs. 34.04%; p = 0.015) (Cramér's V 0.118).</p><p><strong>Conclusion: </strong>High-dose 4F-PCC was not associated with increased thrombotic complications. Thrombotic complications in this study were inferior to all-cause thrombotic complications in pediatric cardiovascular surgery of 11%. These findings support 4F-PCC as a viable option for managing severe bleeding in pediatric cardiovascular surgery. Further studies should explore dose optimization and preventive applications.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160844","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":"In This Issue July 2025.","authors":"","doi":"10.1111/pan.15134","DOIUrl":"https://doi.org/10.1111/pan.15134","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160839","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":"Flipping the Conditional: Why We Are Probably Wrong About Probabilities.","authors":"David Sidebotham, Tim Dare","doi":"10.1111/pan.15133","DOIUrl":"https://doi.org/10.1111/pan.15133","url":null,"abstract":"<p><p>Flipping the conditional is an error of reasoning that occurs when we inadvertently transpose the terms in a conditional probability. A conditional probability arises when the probability of an event occurring (e.g., a positive test result) depends on another event being true (e.g., the presence of a disease). The ordering of terms in a conditional probability is crucially important, and the consequences of transposing the terms can be severe. The error of reasoning is most easily entertained when events are very rare. Flipping the conditional explains why we sometimes misinterpret clinical and diagnostic tests and also underpins a phenomenon known as the \"prosecutor's fallacy\". Flipping the conditional occurs when we confuse the sensitivity of a diagnostic test with the positive predictive value. The prosecutor's fallacy involves confusing the probability a person is guilty given the evidence with the probability of the evidence given they are guilty. Perhaps the best-known example of the prosecutor's fallacy is that of UK solicitor Sally Clark, who in 1990 was convicted of murdering her two infant sons. Recently, the prosecutor's fallacy has again been in the news, with respect to the statistical evidence presented at the trial of UK nurse, Lucy Letby. In this article, we define the concept of conditional probability and discuss some examples of flipping the conditional that are relevant to pediatric anesthesia and to medical evidence presented at trial.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144160836","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}
Jing Jiang, Yinzhi Dan, Yue Huang, Jijian Zheng, Kan Zhang
{"title":"Prediction of EEG-Derived Wavelet Index for End-Tidal Sevoflurane in Pediatric Anesthesia: A Prospective, Single-Blind Study.","authors":"Jing Jiang, Yinzhi Dan, Yue Huang, Jijian Zheng, Kan Zhang","doi":"10.1111/pan.15127","DOIUrl":"https://doi.org/10.1111/pan.15127","url":null,"abstract":"<p><strong>Background: </strong>Processed electroencephalogram is able to assess the depth of anesthesia. EEG-derived wavelet index (WLi) is a novel indicator derived from EEG on the basis of wavelet analysis.</p><p><strong>Aims: </strong>We primarily tested whether WLi can reflect changes in end-tidal sevoflurane (sevo<sub>ET</sub>) in pediatric patients, especially during the transition from awake status to 0.6 MAC. We then explored the concentration-effect relationship between sevo<sub>ET</sub> and WLi and tested the effect of age on WLi.</p><p><strong>Methods: </strong>This prospective, single-blind study was performed at a tertiary care hospital affiliated with Shanghai Jiao Tong University School of Medicine, China. WLi and BIS were measured in 40 pediatric patients aged 6 months to 6 years who underwent elective surgeries after sevo<sub>ET</sub> was maintained at 2.0, 1.3, and 0.6 age-adjusted MAC in stepwise decrements.</p><p><strong>Results: </strong>WLi and BIS had comparable performance in predicting the transition of anesthesia status from awake to sevo<sub>ET</sub> at 0.6 MAC and from 1.3 to 2.0 MAC. In contrast to BIS, WLi exhibited a plateau effect and failed to predict the transition from 0.6 to 1.3 MAC. The indicator-specific performance of prediction was supported by their concentration-effect relationships, with EC<sub>50</sub> of 0.38 MAC for WLi and 0.95 MAC for BIS. Further, we found that the WLi values between individuals were independent of age.</p><p><strong>Conclusions: </strong>WLi can reflect the transition of anesthesia status from light to moderate sedation, and the plateau effect might indicate adequate depth of anesthesia during deeper sedation and general anesthesia.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079174","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 Role of Tracheal Tube Cuff in Dilating Subglottic Stenosis.","authors":"Nana Zhu, Jun Xu, Yingping Jia","doi":"10.1111/pan.15122","DOIUrl":"https://doi.org/10.1111/pan.15122","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973052","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}