Pediatric Anesthesia最新文献

{"title":"Comparison of Discharge Readiness in Pediatric Patients: Oral Versus Intranasal Preoperative Midazolam Administration.","authors":"Mohammad Naem, Jobayer Hossain, Janna Hamideh, Judit Szolnoki","doi":"10.1002/pan.70267","DOIUrl":"10.1002/pan.70267","url":null,"abstract":"<p><strong>Background: </strong>Midazolam is commonly administered orally or intranasally to reduce preoperative anxiety in children undergoing tympanostomy. Prior studies suggest differences in recovery exist between the two routes, but their impact on post-anesthesia care unit (PACU) length of stay remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of pediatric patients aged 6 months to 10 years undergoing tympanostomy at Nemours Children's Hospital, Central Florida, between November 2023 and November 2024. Patients were grouped by midazolam route (intranasal 0.2 mg/kg IV formulation vs. oral 0.5 mg/kg syrup). The primary outcome was PACU length of stay, defined as time from PACU arrival to discharge based on standard hospital criteria. Predictors of administration route were evaluated using univariate logistic regression, and PACU length of stay was analyzed using age-adjusted ANCOVA with backward stepwise variable selection.</p><p><strong>Results: </strong>A total of 463 patients were included: 322 received oral midazolam and 141 received intranasal midazolam. In unadjusted analysis, intranasal midazolam was associated with a shorter PACU stay (mean 39.7 vs. 42.9 min, p = 0.02). However, patients receiving intranasal midazolam were significantly younger (31.5 vs. 37.8 months, p < 0.001). After adjustment for age, age emerged as the only independent predictor of PACU length of stay, and the association between administration route and PACU duration was attenuated and no longer significant (p = 0.15).</p><p><strong>Conclusions: </strong>Age, rather than route of midazolam administration, primarily explained differences in PACU discharge readiness among children undergoing tympanostomy. Previously reported differences in recovery time between oral and intranasal midazolam may reflect age-related confounding rather than a true effect of route. Future prospective, age-stratified studies are needed to clarify this relationship and refine pediatric sedation practices.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1319-1321"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448604","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":"Near-Fatal Silent Lung During Anesthesia Induction: Rapid Differential Diagnosis and Rescue Intratracheal Epinephrine.","authors":"I Made Prema Putra, I Made Bhasma Adiyana","doi":"10.1002/pan.70281","DOIUrl":"10.1002/pan.70281","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1322-1324"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702003","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":"Incidence, Predictors, and Outcomes of Early Postoperative Dysnatremia After Pediatric Neurosurgery: A Prospective Observational Study.","authors":"Amruta Nirale, Suparna Bharadwaj, Sangeetha R Palaniswamy, Dhaval Shukla, Kamath Sriganesh","doi":"10.1002/pan.70274","DOIUrl":"10.1002/pan.70274","url":null,"abstract":"<p><strong>Background: </strong>Sodium abnormalities are frequent in the neuro intensive care unit (ICU) settings. Dysnatremia can also manifest in the perioperative period in neurosurgical patients and can lead to adverse consequences. The burden of dysnatremia following elective pediatric neurosurgery is unclear. Hence, we aimed to assess the incidence, risk factors, and outcomes of dysnatremia in children undergoing elective neurosurgeries.</p><p><strong>Methods: </strong>This was a single-center, prospective observational study in consecutive elective pediatric neurosurgical patients aged < 18 years. Perioperative data were collected for the first 3 postoperative days and included age, gender, weight, American Society of Anesthesiologists Physical Status classification, location of surgical pathology, preoperative sodium, intraoperative blood loss and transfusion, intraoperative fluid balance, balanced salt solution use, perioperative vomiting, steroid use, seizures, Glasgow coma scale score, duration of ICU and hospital stay, and in-hospital mortality. Hyponatremia was defined as serum sodium < 135 mEq/L, hypernatremia as serum sodium > 145 mEq/L, and dysnatremia as the presence of either hyponatremia or hypernatremia.</p><p><strong>Results: </strong>Six hundred sixty-eight children who underwent neurosurgery had perioperative sodium values assessed during the 22-month study period. The incidence of postoperative dysnatremia was 18.6% (124/668). In multivariate regression analysis, sellar/suprasellar region pathologies, preoperative dysnatremia, and higher blood loss were predictors of postoperative dysnatremia. Children with postoperative dysnatremia had a higher occurrence of seizures, neurological deterioration, and death, and longer ICU and hospital stays.</p><p><strong>Conclusions: </strong>About one-in-five children undergoing neurosurgery develop postoperative dysnatremia, and it is predicted by preoperative dysnatremia, sellar/suprasellar pathology, and higher blood loss. Dysnatremia is associated with poor clinical outcomes.</p><p><strong>Study registration: </strong>Clinical Trials Registry-India: CTRI/2022/01/039795.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1283-1289"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606057","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":"Intra- and Peri-Operative Cardiac Arrest in Pediatric Patients: Epidemiology, Risk Factors, Mechanisms, and Management Strategies.","authors":"Eleni Asimacopoulos, Gloria M Al Karaki, Kirsten C Odegard","doi":"10.1002/pan.70265","DOIUrl":"10.1002/pan.70265","url":null,"abstract":"<p><p>Intraoperative (IOCA) and perioperative cardiac arrest (POCA) in pediatric patients represents a rare but catastrophic event with significant implications for morbidity and mortality. Despite advances in anesthetic techniques, monitoring technology, and resuscitation protocols, the incidence of IOCA and POCA in children has remained relatively stable over the past two decades. In the pediatric noncardiac surgery population, the incidence ranges from approximately 3 to 22 per 10 000 cases. Key risk factors include young age, particularly neonates and infants, high American Society of Anesthesiologists (ASA) physical status classification, emergency surgery, the presence of congenital heart disease (CHD), and pulmonary hypertension. Respiratory events remain the leading cause of anesthesia-related cardiac arrest, with cardiovascular causes carrying a higher mortality. Prevention strategies emphasize preoperative risk stratification, team communication, and preparedness. Management requires rapid recognition, high-quality cardiopulmonary resuscitation, and consideration of extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cases. This review synthesizes current evidence regarding the epidemiology, risk factors, mechanisms, and provides clinicians with management strategies for pediatric IOCA and POCA.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1207-1216"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550107","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":"Evaluating the Impact of Clonidine and Midazolam Premedication on Emergence Delirium in Pediatric Patients.","authors":"Anne Louise de Barros Garioud, Anwen Taplin, Yufei Shang, R Nazim Khan, David Sommerfield, Neil Hauser, Aine Sommerfield, Britta S von Ungern-Sternberg","doi":"10.1002/pan.70275","DOIUrl":"10.1002/pan.70275","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is common in children and is associated with emergence delirium-a distressing postoperative complication characterized by agitation and disorientation. Midazolam has long been the drug of choice for preoperative anxiolysis. More recently, α₂ adrenoceptor agonists, such as clonidine, have gained popularity for their sedative and analgesic properties. The effect of these agents on the incidence of emergence delirium remains uncertain. This study evaluated whether premedication with clonidine or midazolam is associated with emergence delirium in children undergoing general anesthesia.</p><p><strong>Methods: </strong>We performed a post hoc analysis of prospectively collected data pooled from 10 clinical studies, comprising data from 4796 general anesthetics in children (0-16 years). The studies were carried out at a tertiary pediatric hospital in Perth, Australia. We assessed the impact of premedication with clonidine or midazolam on the incidence of emergence delirium using validated scales.</p><p><strong>Results: </strong>In this cohort, with a mean age of 6.8 (range: 0.03-16.97), 331 children received clonidine and 731 received midazolam. Overall, the incidence of emergence delirium was 6%. Primary propensity score-matched analyses found no significant association between clonidine (OR 1.19, 95% CI 0.65-2.16) or midazolam (OR 1.23, 95% CI 0.79-1.92) and emergence delirium. In our secondary adjusted logistic regression models, midazolam was associated with increased odds of emergence delirium, whereas clonidine showed no statistically significant association overall.</p><p><strong>Conclusions: </strong>The overall incidence of emergence delirium was low. While clonidine showed no statistically significant association with emergence delirium, our secondary multivariate analysis suggests midazolam might be associated with an increased risk of emergence delirium.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1290-1307"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649184","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":"Acute Kidney Injury Following Pediatric Liver Transplantation: A Single-Center Retrospective Cohort Study.","authors":"Ying Li, Tingyan Wang, Peihan Li, Kepu Zhang, Tengti Wang, Liying Sun, Lin Wei, Wei Qu, Zhigui Zeng, Liang Zhang, Zhijun Zhu, Haiyang Lu","doi":"10.1002/pan.70317","DOIUrl":"https://doi.org/10.1002/pan.70317","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute kidney injury (AKI) is a common and serious complication following pediatric liver transplantation, but the optimal diagnostic approach and modifiable risk factors in this population remain incompletely understood.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To determine the incidence and independent risk factors of AKI following pediatric liver transplantation, and to evaluate the diagnostic performance of different Kidney Disease: Improving Global Outcomes criteria components.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical data from 336 pediatric liver transplant recipients at Beijing Friendship Hospital between 2016 and 2021 were retrospectively analyzed. AKI was diagnosed and staged according to the Kidney Disease: Improving Global Outcomes criteria. Logistic regression identified independent risk factors for AKI, and clinical outcomes were compared across different AKI stages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;AKI incidence within 7 days post-transplant was 56.0% (188/336). Creatinine criteria identified 85 cases (25.3%) of AKI, whereas urine output criteria identified 154 cases (45.8%); agreement was poor (weighted κ = 0.160). Time-to-event analysis showed creatinine criteria captured immediate postoperative renal stress, whereas urine output criteria identified evolving renal dysfunction. Multivariate logistic regression revealed that Pediatric End-Stage Liver Disease (PELD) score (OR = 1.02, 95% CI: 1.01-1.04, p = 0.009) and total intraoperative fluid volume (OR = 1.01, 95% CI: 1.01-1.01, p = 0.033) were independent predictors of AKI. Stage 1 and 2 AKI prolonged intensive care unit stay by 31.2% (p = 0.0054) and 47.0% (p = 0.0007), respectively. Overall 28-day mortality was 0.60%, and 3-year mortality was 4.17%, with no significant differences across AKI stages (p = 0.285).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The incidence of AKI following pediatric liver transplantation is high, with urine output criteria demonstrating substantial value in capturing evolving renal dysfunction, complementing the immediate risk stratification provided by serum creatinine. PELD score and total intraoperative fluid volume were independently associated with AKI, though external validation is warranted. AKI was associated with prolonged intensive care unit stay but not long-term mortality. These findings provide a foundation for future intervention studies to test whether targeting these factors can reduce AKI incidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Acute kidney injury is a common complication after pediatric liver transplantation, yet optimal diagnostic approaches and perioperative factors remain incompletely characterized. This study reveals the complementary nature of Kidney Disease: Improving Global Outcomes criteria: urine output criteria identified more AKI cases, while creatinine criteria enabled earlier detection. PELD score and total intraoperative fluid volume showed independent associations with AKI. These findings un","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070025","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":"Association of Multimorbidity in Children Undergoing Ambulatory Surgical Procedures With Same-Day Admissions.","authors":"Chhaya Patel, Christian Mpody, Emmanuel Alalade, Oluwaseun Akinkuolie, Sibelle Aurelie Yemele Kitio, Olubukola O Nafiu","doi":"10.1002/pan.70319","DOIUrl":"https://doi.org/10.1002/pan.70319","url":null,"abstract":"<p><strong>Background: </strong>Chronic health conditions affect approximately 27% of children in the United States and about 1 in 15 has multimorbidity (MM), defined as the coexistence of two or more chronic conditions. Despite its prevalence, the effect of MM on outcomes after ambulatory surgery remains poorly understood. Hospital admission following a scheduled outpatient procedure is an important measure of perioperative quality and safety. We therefore aimed to estimate the prevalence of MM among children scheduled for elective ambulatory surgery and to evaluate its association with same-day hospital admission.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the multicenter Pediatric Health Information System (PHIS) database (2010-2022). We included children aged 2-18 years undergoing elective, non-otolaryngologic ambulatory surgery. MM was defined using complex chronic conditions and categorized as no chronic condition, mild-moderate MM (1-2 conditions), or severe MM (≥ 3 conditions). The primary outcome was same-day hospital admission, defined as hospital length of stay ≥ 1 day among children who were scheduled for ambulatory surgery. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sex, age, insurance status, and procedural group.</p><p><strong>Results: </strong>Among 1 609 584 children who underwent outpatient surgery, 7.6% (n = 126 403) had MM, including 6.9% (n = 111 090) with Mild-moderate MM and 0.7% (n = 15 313) with severe MM. Same-day admission occurred in 4.1% (60 576/1483181) of children without MM, 10.0% (11 131/111090) with mild-moderate MM, and 11.1% (1699/15313) with severe MM. Compared with children without MM, adjusted odds of same-day admission were higher for mild-moderate MM (OR: 1.94; 95% CI: 1.90-1.99) and severe MM (OR: 2.30; 95% CI: 2.18-2.43).</p><p><strong>Conclusions: </strong>MM is prevalent among pediatric ambulatory surgical patients. Children with MM have higher rates of same-day hospital admission following elective ambulatory surgery compared to their peers, a factor that should be considered in scheduling these patients.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063367","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":"Advancing Precision Medicine: Ultrasound and the Pediatric Airway.","authors":"Annery G Garcia-Marcinkiewicz, Britta S von Ungern-Sternberg, Elaina E Lin","doi":"10.1002/pan.70314","DOIUrl":"https://doi.org/10.1002/pan.70314","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039473","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":"Captured at Induction: Navigating Parental Photography in Perioperative Care.","authors":"Britta S von Ungern-Sternberg, Aine Sommerfield","doi":"10.1002/pan.70318","DOIUrl":"https://doi.org/10.1002/pan.70318","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025845","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":"Anesthesia in the Ophthalmology Clinic for Infants Younger Than 1 Year Undergoing Retinoblastoma Treatment. Review of 888 Cases.","authors":"Vittoria Arslan-Carlon, Peter J Fusco, David H Abramson, John G Hagen","doi":"10.1002/pan.70316","DOIUrl":"https://doi.org/10.1002/pan.70316","url":null,"abstract":"<p><strong>Background: </strong>Safety data for infants under 12 months undergoing anesthesia in clinic settings is limited. Retinoblastoma, the most common pediatric intraocular cancer, often requires general anesthesia for outpatient ophthalmology procedures in a clinic setting.</p><p><strong>Methods: </strong>This is a retrospective study of 888 anesthesia encounters in 237 infants (< 12 months) undergoing clinic visits at MSKCC (2014-2024) for the diagnosis and localized intraocular treatment of retinoblastoma. The primary outcome was the incidence of anesthesia-related complications requiring readmission within 24 h. Secondary outcomes included anesthesia duration, recovery time, airway management approach, and use of opioid or non-opioid analgesia.</p><p><strong>Results: </strong>No anesthesia-related readmissions occurred. Median anesthesia duration was 43 min (0-6 months) and 36 min (7-< 12 months); median recovery times were 36 and 25 min, respectively. Laryngeal mask airways were used in 824 (93%) cases.</p><p><strong>Conclusions: </strong>General anesthesia in outpatient clinic settings can be safe for infants with retinoblastoma undergoing non-narcotic-requiring localized intraocular treatment procedures.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012749","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}