Pediatric Anesthesia最新文献

{"title":"Error Traps in Developing a Pediatric Enhanced Recovery After Surgery (ERAS) Program.","authors":"Christian M Taylor, Emily L Weisberg, Nichole M Doyle, Todd A Glenski","doi":"10.1111/pan.15042","DOIUrl":"10.1111/pan.15042","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) pathways have been shown to improve patient outcomes, increase patient satisfaction, and decrease costs. First created and implemented in the adult population, these pathways are now commonplace and continue to expand in the pediatric realm. While there are many proven benefits to ERAS pathways, there continue to be challenges to their proper implementation and long-term success. This article aims to explore common challenges in pediatric ERAS development and implementation, along with strategies to avoid potential pitfalls. Key themes include departmental and institutional support, stakeholder engagement, awareness of pathways, data management and dissemination, and long-term maintenance including Plan-Do-Study-Act (PDSA) cycles. Pathway development teams should be aware of these considerations and potential pitfalls, and focusing on them can promote long-term success for a well-designed pathway.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"199-206"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693328","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":"Retrospective Cohort Study of Perioperative Complications in Symptomatic and Asymptomatic Children Testing SARS-CoV-2-Positive Within 21 Days Before Surgery.","authors":"Anitra Karthic, Zandantsetseg Orgil, Sidhant Kalsotra, Michelle Cugino, Adelei Durban, Nguyen K Tram, Julie Rice-Weimer, Brittany L Willer, Ajay D'Mello, Joseph D Tobias, Vanessa A Olbrecht","doi":"10.1111/pan.15051","DOIUrl":"10.1111/pan.15051","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 increases anesthetic risk in children, but understanding of complication differences by symptom presence and severity is limited. We hypothesized that symptomatic COVID-19+ children, especially with lower respiratory symptoms, would have higher perioperative complications than asymptomatic patients and that complications would be higher in all patients diagnosed < 6 days before anesthesia.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study reviewed records of children < 18 years old undergoing surgery with general anesthesia from March 1, 2020, to March 1, 2022, who tested COVID-19+. A total of 225 patients who tested positive ≤ 10 days before anesthesia were analyzed for the primary outcome, and an additional 298 patients who tested positive ≤ 21 days before anesthesia were analyzed for secondary outcomes. Data on demographics, comorbidities, vaccination, preoperative and perioperative care, complications, and mortality were collected. Primary outcome analysis used univariate regression; secondary outcome analysis used analysis of variance.</p><p><strong>Results: </strong>Primary Outcome: Symptomatic patients were more likely to experience postoperative respiratory complications (OR: 3.53, 1.18-10.6, p = 0.024), require postoperative medications (OR: 7.64, 2.29-25.51, p = 0.001), and require postoperative oxygen support (OR: 2.62, 1.19-5.79, p = 0.017) versus asymptomatic patients. Those with upper respiratory symptoms were less likely to require postoperative medications (OR: 0.1, 0.01-0.89, p = 0.039) and oxygen support (OR: 0.08, 0.01-0.45, p = 0.004) versus those with lower respiratory symptoms.</p><p><strong>Secondary outcome: </strong>Patients testing COVID-19+ < 6 days before anesthesia had longer PACU stays (p < 0.001) and more postoperative respiratory complications (p = 0.001), medication use (p = 0.038), and oxygen use (p = 0.002) versus other groups.</p><p><strong>Discussion: </strong>Preoperative symptoms, especially of the lower respiratory tract, increased the risk for perioperative complications in children diagnosed with COVID-19 within 10 days of surgery.</p><p><strong>Conclusion: </strong>The presence of symptoms, particularly of the lower respiratory tract, should be strongly considered in the shared decision-making process between providers and families when discussing the potential delay of procedures in the setting of COVID-19.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"239-248"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786398","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":"Understanding Racial and Ethnic Disparities in Perioperative Pain Management After Routine Pediatric Tonsillectomy.","authors":"Alisha R Pershad, Rashel Moscoso-Morales, Giuliana Di Bono, Aryana Kavuri, Alexa Shahine, Md Sohel Rana, Hengameh K Behzadpour, Diego A Preciado, Caroll N Vazquez-Colon","doi":"10.1111/pan.15048","DOIUrl":"10.1111/pan.15048","url":null,"abstract":"<p><strong>Background: </strong>Hispanic/Latino (H/L) patients are often excluded from studies addressing pain management. Limited data suggests disparities in administration of perioperative opioid analgesia. We hypothesize that H/L patients are less likely to have their pain assessed and managed appropriately with opioids following routine pediatric tonsillectomy.</p><p><strong>Aims: </strong>Our primary outcome was to compare the proportion of H/L patients who receive perioperative opioids to their non-H/L counterparts. Secondarily, we studied the proportion of H/L patients who had their pain score assessed.</p><p><strong>Methods: </strong>A retrospective medical record review of patients receiving routine tonsillectomy from October 2017 to March 2022 was performed. Descriptive statistics, univariate, and multivariate analyses were conducted with levels of significance at 0.05 and calculation of adjusted odds ratios (aORs).</p><p><strong>Results: </strong>Of 6553 patients included, 582 (9%) of those self-identified as H/L. The median age of the cohort was 5.6 years (IQR 3.4-9.1) and 53.3% identified as male. H/L patients were more likely to have a higher BMI (p < 0.001), have an income level of < $100 000/year (p < 0.001), and utilize public insurance (p < 0.001) than non-H/L patients. On multivariate analysis, non-H/L patients were less likely to receive opioids (aOR 0.78 [0.66, 0.93], p = 0.006). They were also more likely to have their pain assessed (aOR 2.38 [1.75, 3.21], p < 0.001).</p><p><strong>Conclusions: </strong>Disparities in perioperative pain management following routine pediatric tonsillectomy exist. In contrast with current literature and our prior hypothesis, children of non-H/L ethnicity were less likely to receive opioids and more likely to have their pain assessed. Given H/L patients received fewer pain assessments, they are at risk for inferior pain management. Further understanding of factors driving differences in pain management may improve perioperative patient experience, quality of care, and aid in the creation of more standardized protocols.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"215-222"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770528","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":"Pain and Analgesic Use Post-Procedure and Post-Discharge After Infant Spinal Anesthesia Versus General Anesthesia: A Retrospective Cohort Analysis.","authors":"Ashlee Ellen Holman, Bishr Haydar, Calista Harbaugh, Allison Lange, Shobha Malviya","doi":"10.1111/pan.15045","DOIUrl":"10.1111/pan.15045","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"253-255"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786396","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":"The Newborn Infant Parasympathetic Evaluation Index for Assessment of Procedural Pain and Discomfort in Mechanically Ventilated Pediatric Intensive Care Patients: A Prospective, Exploratory, Observational Study.","authors":"Frank Weber, Emma Langen, Thomas Kerbusch, Eric Bokhorst","doi":"10.1111/pan.15050","DOIUrl":"10.1111/pan.15050","url":null,"abstract":"<p><strong>Background: </strong>The heart rate variability-based Newborn Infant Parasympathetic Evaluation (NIPE) Index is a continuous noninvasive tool for the assessment of pain and discomfort in infants. Little is known about its performance in the pediatric intensive care unit (PICU) setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff.</p><p><strong>Aim: </strong>Evaluation of the performance of NIPE as an indicator of procedural pain and/or discomfort in conscious mechanically ventilated PICU patients.</p><p><strong>Methods: </strong>Procedural pain/discomfort was simultaneously assessed during pain- or stressful procedures by two validated discontinuous clinical scoring systems (FLACC and COMFORT-B scale) and the NIPE.</p><p><strong>Results: </strong>NIPE values, FLACC- and COMFORT-B scores were recorded in 17 infants with a mean age of 1.2 (range 0.8-5.9) months. NIPE values associated with positive FLACC- (≥ 4; indicative of pain) and/or COMFORT-B (≥ 17, indicative of discomfort) scores were lower (p < 0.001) than when associated with negative FLACC (< 4) and/or COMFORT-B (< 17) scores with 95% CI's of a difference of -14 to -11 (FLACC), -13 to -11 (COMFORT-B) and -14 to -11 (FLACC and COMFORT-B), with significant interindividual variability in NIPE values. Logistic regression analyses revealed odds ratios between 0.84 and 0.85; the adjacent receiver operating curve analyses showed areas under the curve between 0.83 and 0.88. NIPE data recording failure occurred during 49.3% of the periods with a FLACC ≥ 4% and 40.7% with a COMFORT-B ≥ 17.</p><p><strong>Conclusions: </strong>The NIPE detects procedural pain and discomfort in conscious mechanically ventilated infants with an accuracy comparable to established clinical scoring systems. However, because of significant interindividual variability of NIPE values and frequent data recording failure associated with patient movement, we believe it is premature to recommend its use in conscious infants.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"232-238"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792112","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":"Analysis of Transgender and Gender-Diverse Topics Within Diversity, Equity, and Inclusion Curricular Content in Pediatric Anesthesiology Fellowship Programs in the United States and Canada-A Prospective Survey.","authors":"Merry E Krueger, Remigio A Roque, Travis L Reece-Nguyen, Hilary MacCormick","doi":"10.1111/pan.15053","DOIUrl":"10.1111/pan.15053","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Transgender and gender-diverse individuals experience higher burdens of health disparities compared to their cisgender counterparts. Contributing factors include decreased access and denial of care, experiences and fear of medical violence, and increasing legislative barriers. These patients often report having to educate healthcare professionals due to lack of expertise of transgender and gender-diverse issues within the medical community, with training deficits observed at all levels of medical training.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;We surveyed pediatric anesthesiology fellowship directors in the United States and Canada with an aim to describe the current state of transgender and gender-diverse topics within diversity, equity, and inclusion curricular content across pediatric anesthesiology fellowship training programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 25-question descriptive, cross-sectional, electronic survey was created and distributed to all pediatric anesthesiology fellowship program directors in the United States and Canada investigating the inclusion of transgender and gender-diverse topics within diversity, equity, and inclusion curriculum (if present) for pediatric anesthesiology fellows.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 33 responses were collected from 69 total invited programs. Diversity, equity, and inclusion curricula were present in 93.5% (29/31) of fellowship programs but only 29% (9/31) of programs included content specific to transgender and gender-diverse populations. Just 17% (5/29) of program directors thought their curriculum adequately prepared their graduates to care for transgender and gender-diverse patients. However, 69% (20/29) expressed a desire to see more educational content included in the future. Lack of knowledgeable faculty educators and time were the most chosen perceived barriers to inclusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;To our knowledge, this study is the first to evaluate pediatric anesthesiology fellowship curricula for inclusion of transgender and gender-diverse topics within diversity, equity, and inclusion curriculum. As the population of known transgender and gender-diverse youth increases, all pediatric anesthesiologists must be equipped to treat this population with appropriate clinical and cultural sensitivity. Future endeavors must include robust sexual orientation and gender identity data collection, access to educational materials from content experts, recruitment and empowerment of LGBTQ+ anesthesiologists, and increased dedicated time toward diversity, equity, and inclusion education, specifically in regard to the transgender and gender-diverse population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Lack of physician education on the care of transgender and gender-diverse patients is one of several factors contributing to the health disparities seen in this population; training deficits in the care of transgender and gender-diverse patients ","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"207-214"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792174","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":"Use of Upper Extremity Electromyography Twitch Monitoring in a Patient With Goldenhar Syndrome and Absent Thumbs.","authors":"Mojca H Remskar, Jessica White","doi":"10.1111/pan.15054","DOIUrl":"10.1111/pan.15054","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"251-252"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813898","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 Pediatric Anesthesiology Workforce in the United States: How to Curb the Crisis?","authors":"Irim Salik, Tara Doherty, Apolonia E Abramowicz","doi":"10.1111/pan.15056","DOIUrl":"10.1111/pan.15056","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"196-198"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838630","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 Methadone for Posterior Spinal Fusion in Adolescents-Response to Letter to the Editor.","authors":"Keri R Hainsworth, Roger A Fons, Megan Jablonski, Michelle L Czarnecki, Steven J Weisman","doi":"10.1111/pan.15055","DOIUrl":"10.1111/pan.15055","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"258-259"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818805","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":"Cautious Consideration of Intraoperative Methadone Use in Pediatric Surgery: A Commentary.","authors":"Yu-Yuan Hung, Lien-Chung Wei","doi":"10.1111/pan.15043","DOIUrl":"10.1111/pan.15043","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"256-257"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676407","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}