Pediatric Anesthesia最新文献

{"title":"Metabolic Alkalosis in the Pediatric Cardiac Intensive Care Unit-A Prospective Observational Study.","authors":"Diana Thomas, Suneel P Raman, Baiju S Dharan","doi":"10.1111/pan.15104","DOIUrl":"10.1111/pan.15104","url":null,"abstract":"<p><strong>Background: </strong>Metabolic alkalosis in pediatric patients following cardiac surgery warrants a comprehensive study. Newer methods of arterial blood gas (ABG) assessment can offer more insights into the mechanisms behind such derangement.</p><p><strong>Objective(s): </strong>To study the incidence of metabolic alkalosis in postsurgical infants admitted to the pediatric cardiac intensive care unit and analyze factors associated with its development and its effect on prognosis.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Tertiary care teaching hospital in India during 2020-2021.</p><p><strong>Patients: </strong>One hundred four infants < 1 year of age undergoing elective cardiac surgery and who required more than 6 h of postoperative mechanical ventilation were included. Infants on preoperative mechanical ventilation or with metabolic alkalosis were excluded.</p><p><strong>Main outcome measures: </strong>Incidence of metabolic alkalosis and causative preoperative, intraoperative, and postoperative factors were studied along with their morbidity profile.</p><p><strong>Results: </strong>Metabolic alkalosis was detected in 23 (22.1%) subjects. In group MA (who developed metabolic alkalosis), 73.9% of infants belonged to risk adjustment for congenital heart surgery-1 (RACHS-1) category 3 and above (p = 0.009). They also had longer cardiopulmonary bypass time (200.04 ± 83.35 min vs. 144.59 ± 64.77; 95% confidence interval of the difference in means [23, 87.9]), longer cross-clamp time (119.78 ± 63.12 min vs. 84.95 ± 48.8; 95% CI [10.4, 59.3]), greater application of modified ultrafiltration (MUF) (91.3% vs. 60.5%, p = 0.005), and larger volume of MUF removed (60 (44.4, 70) ml kg^-1 vs. 44.44 (32.9, 54.3), p = 0.003). Partitioning of base excess showed similar standard base excess due to free water (SBE_FW) (MA -0.18 ± 0.94 vs. No MA 0.25 ± 1.1; confidence interval of the difference in means [-0.95, 0.09]) and due to chloride (SBE_Cl) (MA -5.7 ± 4.8 vs. No MA -5.18 ± 5.05; 95% CI [-2.9, 1.8]) in both groups. A longer period of ventilation, intensive care unit stay, and hospital stay were found in group MA.</p><p><strong>Conclusion: </strong>This prospective study on postcardiotomy infants revealed a much lower incidence of metabolic alkalosis than historical data. Physicochemical analysis of the blood samples for mechanisms underlying metabolic alkalosis found that its development is not entirely dependent on overt volume depletion or significant chloride loss. The administration of chloride-containing solutions appears to mitigate both the occurrence and severity of metabolic alkalosis.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"776-783"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764588","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":"Virtual or In-Person Conferences? The Success of the Visiting Scholars in Pediatric Anesthesia Program (ViSiPAP) as a Hybrid Model for Perioperative Education.","authors":"Marla B Ferschl, Monica Hoagland, Viviane G Nasr, Steven J Staffa, Andrew Infosino","doi":"10.1111/pan.15128","DOIUrl":"10.1111/pan.15128","url":null,"abstract":"<p><strong>Background: </strong>The Visiting Scholars in Pediatric Anesthesia Program (ViSiPAP) was founded in 2017 to promote professional and academic development and provide opportunities for extramural networking and collaboration in pediatric anesthesia. The COVID-19 pandemic necessitated the rapid pivot to a virtual format in 2020. With the lifting of COVID-19 travel restrictions, in-person exchanges were reinstituted.</p><p><strong>Aims: </strong>Our goal was to examine the advantages and disadvantages of both the virtual and in-person formats for ViSiPAP.</p><p><strong>Methods: </strong>We surveyed ViSiPAP participants from 2021 to 2023 to compare in-person and virtual formats. Questions included Likert-scale ratings and free-text qualitative questions.</p><p><strong>Results: </strong>The survey response rate was 81.1% (n = 146). 46.3% of respondents preferred virtual exchanges, while 53.7% preferred an in-person format. Among those participating in person, 87% preferred the in-person format, while among those participating virtually, only 54% preferred the virtual format; 63% of men preferred in-person exchanges, and only 47% of women preferred in-person exchanges. Faculty rank or Under-Represented in Medicine (URiM) status did not significantly affect format preference. Most participants strongly agreed that they would recommend participating in ViSiPAP to their colleagues and that ViSiPAP should be continued in both the in-person and virtual formats.</p><p><strong>Conclusions: </strong>ViSiPAP is a valuable professional development program. Both in-person and virtual sessions are well received by participants. A mixed model incorporating both formats allows pediatric anesthesia divisions and speakers to optimize ViSiPAP for their individual institutions. These results could be extrapolated to other departmental conferences that have shifted to the virtual format.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"768-775"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258672","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":"Pentazocine Pharmacodynamics in Children: Simulations to Assess Safety and Effectiveness.","authors":"Takayuki Omori, Takahiko Aoyama, Yasuhiro Tsuji","doi":"10.1111/pan.15135","DOIUrl":"10.1111/pan.15135","url":null,"abstract":"<p><strong>Background: </strong>Pentazocine is used for postoperative pain but is known to cause respiratory depression. Although hepatic metabolic activity in children gradually reaches adult levels, the effect of multiple doses in children with decreased clearance has not been elucidated.</p><p><strong>Aims: </strong>The objective of this study is to evaluate respiratory depression caused by pentazocine using a pharmacokinetic-pharmacodynamic model and to optimize the dosing frequency to maintain target concentrations for analgesia.</p><p><strong>Methods: </strong>The pharmacokinetic model used the parameters of the three-compartment model reported by Hamunen et al. Pharmacodynamic parameters were estimated through sequential analysis, with the pharmacokinetic parameters fixed. Mean respiratory rate and oxygen saturation data were collected from Hamunen et al. after the administration of 0.5 mg/kg pentazocine. The pharmacodynamic model was a turnover model in which the plasma pentazocine concentration affected the respiratory rate and oxygen saturation. We used the pharmacokinetic-pharmacodynamic model to simulate changes in respiratory rate and oxygen saturation after 0.5 mg/kg pentazocine at 2-, 4-, and 6-h dosing intervals. We also simulated cases with 20% and 40% decreased clearance. Pain relief was assessed using our previous model.</p><p><strong>Results: </strong>After a single dose, respiratory rate dropped with a delayed response to the plasma concentration, reaching a minimum within 15 to 30 min and falling below the normal range. It returned to baseline after about 75 min. With multiple dosing, respiratory rate and oxygen saturation considerably decreased every 2 h, regardless of clearance changes. At a 4-h interval, respiratory depression occurred due to decreased clearance, whereas at a 6-h interval, it was minimal. Pain was well controlled at 2-, 4-, and 6-h dosing intervals.</p><p><strong>Conclusions: </strong>This pharmacokinetic-pharmacodynamic modeling study supports a 6-h dosing interval for pentazocine at 0.5 mg/kg in children. This interval strikes a balance between achieving effective analgesia and minimizing the risk of respiratory depression.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"732-739"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249058","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":"10.1111/pan.15122","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"790-791"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","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}

{"title":"Perspectives in Perioperative Quality Improvement: Case Studies in Positive Deviance Using Real-World Data.","authors":"Aaron B Low, Jill R Maresh, Terri Jarvi, Jennifer Esser, Terrance Rawson, Nicolas Fernandez, Jennifer L Chiem, Rachel M Feldman, John V Hale, Paul A Merguerian, Timothy A Lander, Lynn D Martin","doi":"10.1111/pan.15143","DOIUrl":"10.1111/pan.15143","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare quality/safety efforts frequently carry negative themes. This 'find and fix' method typically highlights little about the presence but rather the absence of quality and safety. Positive deviance (PD) is an approach that instead focuses on spreading success rather than eliminating errors. We describe four PD case studies from two pediatric health systems where procedural quality outcomes were improved.</p><p><strong>Methods: </strong>Utilizing common continuous quality improvement methods, multidisciplinary teams assessed and improved clinical processes. AdaptX (Seattle, WA), a software solution that allows clinicians to extract continuously updated, aggregated health data from EMRs, was used to analyze data using statistical process control methods. Funnel charts identified PD providers for key processes. The team leader interviewed, observed, and documented their practice. Team members tested these new processes in clinical practice utilizing Plan-Do-Study-Act (PDSA) cycles. The team monitored real-time data to guide each PDSA cycle decision. Once finalized, the team disseminated this new best practice standard across the staff.</p><p><strong>Results: </strong>Reduction in surgical prep time yielded a sustained 35% increase in monthly procedure volumes. Gastroenterology anesthesia improvements coupled with a second procedural room led to a sustained 74% increase in monthly case counts. Improvements in Post-Anesthesia Care Unit duration and on-time performance reduced case durations, staff overtime, and increased operational capacity. Balance measures were unchanged.</p><p><strong>Discussion: </strong>These PD methods successfully improved the timeliness of procedural processes and capacity without adverse impacts on other quality measures. Real-time, democratized access to data made finding PD providers easy and eased the spread of this practice, facilitating sustained improvement in outcomes. This approach aligns with clinicians' desire to provide the best care, thus enhancing staff engagement.</p><p><strong>Conclusions: </strong>The PD approach improved procedural efficiency in two unique and unaffiliated pediatric healthcare systems. Future efforts will focus on PD beyond the procedural domain and in additional healthcare institutions.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"707-715"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317576","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":"Perspectives on Starting a Pediatric Spinal Anesthesia Program.","authors":"Alina Lazar, Alexander B Froyshteter, Ashlee E Holman, Emmett E Whitaker","doi":"10.1111/pan.15141","DOIUrl":"10.1111/pan.15141","url":null,"abstract":"<p><p>The use of spinal anesthesia as an alternative to general anesthesia for infants has seen a significant resurgence in recent years, but achieving its successful implementation at an institutional level is not without challenges. This manuscript provides a structured approach to establishing a pediatric spinal anesthesia program, with emphasis on identifying implementation champions, careful preparation, stakeholder engagement, and quality control to ensure a successful and sustainable initiative. The key to success lies in creating an early blueprint for the process, with a focus on ensuring procedural success early on via thorough preparation and careful selection of patients within an initial pilot program. Successful expansion of the program depends on the implementation of robust staffing models and proactive efforts to educate staff and maintain adherence to established protocols.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"716-724"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258671","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":"Clear Liquid Fasting Guidelines for Pediatric Patients: A Survey of the Society for Pediatric Anesthesia.","authors":"Todd A Glenski, Michelle Wu, Christian Taylor, Emily Weisberg, Nichole Doyle","doi":"10.1111/pan.15140","DOIUrl":"10.1111/pan.15140","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, several international anesthesia societies have updated their guidelines by shortening the NPO clear liquid time from 2 to 1 h in children. When the American Society of Anesthesiologists (ASA) released their interim update to the preoperative fasting guidelines, they maintained the 2-h clear liquid fasting recommendation, while advising the use of clinical judgment for cases involving PO intake within 2 h. Given international support for decreased NPO times, we aimed to evaluate the current practice and opinions of the Society for Pediatric Anesthesia (SPA) members regarding clear liquid NPO times.</p><p><strong>Methods: </strong>A 17-question survey was developed by members of Children's Mercy Kansas City Department of Anesthesiology and submitted to the SPA Research Committee for review. After approval, a survey link and QR code were distributed to all SPA members.</p><p><strong>Results: </strong>A total of 430 surveys (9.85%) were completed. Seventy-three percent indicated that their department follows a 2-h NPO policy for clear liquids, while 24% reported a 1-h policy. Overall, 71% of respondents felt that 1-h is the ideal NPO time for clear liquids. Of the respondents whose department follows a 2-h policy, 86% believe their NPO policy would be shortened if ASA guidelines were updated to 1-h. Forty-nine percent of respondents reported that NPO instructions to patients are congruent with departmental policies, while 33% reported that NPO instructions differ from departmental NPO policies.</p><p><strong>Discussion: </strong>The results demonstrate that although only a small number of respondents practice a 1-h policy, most respondents believe that a 1-h policy is ideal. This discrepancy is potentially due to adherence to ASA practice guidelines/recommendations, as 86% of respondents who have an NPO policy of 2 or more hours indicated that their departments would switch to 1-h if the ASA were to revise their guideline.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"761-767"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234718","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":"Comparison of Spontaneous Breathing Versus Paralyzed Technique During Flexible Bronchoscopic Intubation in Anesthetized Children and Adolescents With Temporomandibular Joint Ankylosis: Randomized Parallel Group Trial.","authors":"Roopa, Devalina Goswami, Souvik Maitra, Ajoy Roychoudhury, Ongkilla Bhutia, Ramkumar Mukundarajan, Dalim Kumar Baidya","doi":"10.1111/pan.15130","DOIUrl":"10.1111/pan.15130","url":null,"abstract":"<p><strong>Background: </strong>Literature is sparse on airway management in temporomandibular joint ankylosis patients, and it is not known whether spontaneous or paralyzed technique of intubation will be better for flexible bronchoscopic intubation.</p><p><strong>Aim: </strong>To compare the incidence of difficult flexible bronchoscopic intubation between the spontaneously breathing and paralyzed groups in anesthetized children and adolescents.</p><p><strong>Methods: </strong>In this Randomized parallel group study, after ethics committee approval and trial registration, we enrolled 70 children and adolescents up to 18 years with temporomandibular joint ankylosis and mouth opening < 1.5 cm scheduled for elective surgery after informed written consent from the parents. Patients were randomized into anesthetized spontaneous breathing (group S) and paralyzed (group P) groups. The primary objective was the incidence of difficult flexible bronchoscopic intubation. Secondary outcomes were time to glottis, carina, time required for intubation, desaturation, coughing/movement, and hemodynamics during intubation and postoperative sore throat. Data were analyzed in SPSS version 29.</p><p><strong>Results: </strong>Baseline and demographic data were comparable. The paralyzed group had a significantly lower incidence of difficult flexible bronchoscopic intubation [group P versus group S: 1 (2.86%) vs. 18 (51.42%), p < 0.001; RR (95% CI): 0.06 (0.01-0.39)], lower time to visualize the glottis [Median difference 30 (24, 36) sec, p < 0.001], lower time to the carina [Median difference 62 (29, 94) sec; p = 0.001], lower time to intubation [Median difference 97 (59, 135) sec, p = 0.003], lower incidence of vocal cord closure [-20% (-33.3% to -6.7%); p = 0.005], lower incidence of blood in the bronchoscopy field [-28.6% (-44.9% to -12.2%); p = 0.002], and lower incidence of desaturation [-14.3% (-27.9% to -0.63%); p = 0.04] compared to the spontaneous group. Coughing, hemodynamic response to intubation, and postoperative sore throat were comparable between the groups.</p><p><strong>Conclusion: </strong>Paralyzed technique is associated with lower incidence of difficult flexible bronchoscopic intubation compared to spontaneously breathing technique in children and adolescents with temporomandibular joint ankylosis.</p><p><strong>Trial registration: </strong>CTRI/2022/03/041362.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"740-746"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258669","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":"Educational Review and Cases of Delayed Gastric Emptying in Children With Short Bowel Syndrome.","authors":"Kelly Kathleen Everhart, Bukola Ojo, Danielle Wendel, Patrick J Javid, Vincent C Hsieh","doi":"10.1111/pan.15117","DOIUrl":"10.1111/pan.15117","url":null,"abstract":"<p><strong>Background: </strong>Patients with short bowel syndrome (SBS) and intestinal failure (IF) often require repeated sedation and anesthesia throughout their lives. These patients may present for elective procedures well-appearing, with appropriate preoperative fasting and no clear signs of gastrointestinal (GI) obstruction. Despite appearing to be at normal risk for anesthesia-related aspiration, unique physiologic adaptations in this patient population are likely to increase the risk of gastrointestinal dysmotility and aspiration. Current guidelines do not specifically identify IF and SBS as conditions associated with high aspiration risk.</p><p><strong>Objectives: </strong>To highlight the elevated risk of pulmonary aspiration in patients with SBS and IF and propose mitigation strategies for anesthesia providers.</p><p><strong>Methods: </strong>We present two illustrative cases of patients with SBS who nearly experienced pulmonary aspiration under anesthesia. Both cases involved patients who exceeded standard fasting guidelines, lacked signs and symtoms of GI obstruction, and demonstrated normal to high stool output.</p><p><strong>Results: </strong>These cases reveal that intestinal adaptation, chronic physiologic changes, and prior medical and surgical interventions can significantly impair gastric emptying and intestinal motility, thereby increasing aspiration risk.</p><p><strong>Conclusions: </strong>Standard preoperative assessments may not adequately identify aspiration risk in patients with SBS and IF. Anesthesia providers should consider tailored strategies to mitigate aspiration risk in this unique patient population that include minimizing sedation or, when greater depth of anesthesia is required, avoiding natural airways and supglottic airway devices in favor of rapid sequence induction and endotracheal intubation.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"725-731"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015917","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":"Propofol: A Medication That Changed Pediatric Anesthesia Practice.","authors":"Brian J Anderson, L Ignacio Cortinez","doi":"10.1111/pan.70001","DOIUrl":"10.1111/pan.70001","url":null,"abstract":"<p><p>The introduction of propofol changed our understanding of pediatric anesthesia pharmacology, research approaches for intravenous drug study, and led to infusion pump development for the maintenance phase of anesthesia. The story of propofol development provides a blueprint for other intravenous drug development. The introduction of the target concentration strategy based on pharmacokinetic-pharmacodynamic and covariate understanding is central to total intravenous anesthesia techniques and is best exemplified by propofol. While use of the EEG to gauge depth of anesthesia preceded the propofol era, processed EEG signals enabled description of the relationship between propofol plasma concentration and effect, advancing propofol use and safety. Clinical need drove the characterization of propofol pharmacokinetics and concentration effect relationships in children. Subsequently, study in populations such as neonates, the critically ill, and children with obesity explored covariate influences. Target-controlled infusions also required an appreciation of effect site concentrations and time delays, and drug interactions such as those between propofol and opioids. Supraglottic airway use in children paralleled propofol use because greater depression of pharyngeal and laryngeal reactivity was noted with propofol than seen than with thiopental. Environmental concerns with the carbon footprint of inhalational agents may yet see infusions assume dominance for maintenance anesthesia.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"695-706"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12340365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340340","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}