Pediatric Anesthesia最新文献

{"title":"Does Combining Dexmedetomidine and Esketamine Truly Improve Pediatric Premedication Outcomes?","authors":"Mattia Madeo, Zaninni Caroleo, Eugenio Garofalo, Andrea Bruni","doi":"10.1002/pan.70192","DOIUrl":"10.1002/pan.70192","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"1004-1005"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691250","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":"A Rare Case of Successful Perioperative Management of a Child With Oropharyngeal Sharp Foreign Body Penetrating the Brain stem: A Case Report.","authors":"Satyaki Sarkar, Nitasha Mishra, Parnandi Bhaskar Rao, Priyank Tapuria","doi":"10.1002/pan.70211","DOIUrl":"10.1002/pan.70211","url":null,"abstract":"<p><strong>Background: </strong>Penetrating foriegn bodies extending into brain stem are rare in children and present unique anesthetic and surgical challenges. Airway management is particularly difficult because of restricted oral access, risk of displacement leading to catastrophic hemorrhage and neurological complications.</p><p><strong>Case: </strong>We describe the perioperative management of achild who presented in emergency with accidentally impacted foriegn body. The metallic foriegn body occupied the oral cavity significantly limiting the airway access and posing a risk of airway obstruction. A multidisciplinary team involving neurosurgeons, anesthesiologists and otolaryngologists was adopted. Tracheostomy under sevoflurane anesthesia with bag mask ventilation, provisions for major intracranial bleeds (due to proximity to basilar and vertebral vessels), postoperative infection control and a properly planned staged decannulation leds to an uneventful recovery without any major sequelae.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"995-997"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016763","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":"Analysis of Trajectories of Anxiety Behaviors During Induction of Anesthesia in Children With Multiple Encounters: A Secondary Analysis of a Multicenter Retrospective Cohort Study.","authors":"Annie Xin, Allan F Simpao, Timothy Liversedge, Abby V Winterberg, Ari Y Weintraub, James J Thomas, Clyde T Matava","doi":"10.1002/pan.70210","DOIUrl":"10.1002/pan.70210","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is a significant stressor for children and is associated with negative postoperative outcomes. Although the incidence of difficult inductions during a single anesthetic encounter is well documented, the longitudinal trajectory of anxiety behaviors in children undergoing repeated anesthesia remains poorly characterized. It is unclear whether repeated inductions lead to habituation (reduced difficult inductions) or sensitization (increased difficult inductions).</p><p><strong>Methods: </strong>We conducted a secondary analysis of a large multicenter retrospective observational study involving data from six pediatric hospitals between 2019 and 2022. The cohort consisted of children under 18 years of age. The primary outcome was the trajectory of difficult induction, defined as a Child Induction Behavioral Assessment (CIBA) score of 3. Secondary outcomes included mask acceptance and trends in anxiolytic interventions. We employed mixed effects logistic regression models to analyze anxiety trajectories, adjusting for age, parental presence, and behavioral diagnoses. Lorenz curves were used to assess the concentration of anesthetic burden within the population.</p><p><strong>Results: </strong>The study included 102 017 unique patients, of whom 24 564 (24%) underwent multiple encounters. The prevalence of difficult induction remained stable during the initial visits but decreased significantly after the fifth encounter, with the odds of difficult induction decreasing by at least 30% compared to the index visit. This \"learning effect\" was setting-dependent: children aged 1-12 years undergoing Nonoperating room anesthesia (NORA) demonstrated significant habituation, whereas difficult induction rates in the operating room (OR) remained static regardless of visit frequency. Additionally, high-frequency utilizers in NORA settings exhibited a pragmatic shift in anxiolytic strategy, transitioning from pharmacological premedication to increased incidence of parental presence at induction of anesthesia.</p><p><strong>Conclusions: </strong>In this secondary analysis, we found that repeated anesthetic exposure did not inherently lead to sensitization. Instead, children-particularly in NORA settings-exhibited habituation, characterized by decreasing anxiety behaviors over time. This divergence suggests that the less hostile physical environment and absence of surgical pain in NORA facilitate desensitization, whereas the OR environment maintains a higher baseline threat level. Clinicians should consider these distinct trajectories and prioritize environmental adaptations or parental involvement for high-frequency patients.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"964-973"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841362","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":"Airway Management in Neonates and Young Infants: Changes in Clinical Outcomes With Adoption of Routine Video Laryngoscopy in a Single Center Retrospective Cohort.","authors":"Iasha Z Khan, Julia H Nagle, Steven J Staffa, Amira Toivonen, Alisha Suthar, Jennyfer Vallejo, Stephen G Flynn, James M Peyton, Raymond S Park, Pete G Kovatsis, Mary Lyn Stein","doi":"10.1002/pan.70213","DOIUrl":"10.1002/pan.70213","url":null,"abstract":"<p><strong>Background: </strong>While randomized trials show standard blade video laryngoscopy (SVL) improves first attempt tracheal intubation success in neonates and infants, data on outcomes following adoption in routine clinical practice are limited. We hypothesized that SVL use would increase over time and would be associated with higher first attempt success, fewer difficult intubations, and less hypoxemia during induction.</p><p><strong>Aims: </strong>Our primary aims were to report first attempt success and incidence of difficult intubation. Secondary aims included evaluation of temporal trends in SVL use and association of modifiable factors with hypoxemia at induction.</p><p><strong>Methods: </strong>Following IRB approval, we retrospectively reviewed anesthetics with tracheal intubation for noncardiac procedures in neonates and infants < 2 months of age at our institution from August 2012 to May 2024. Group comparisons were made using Fisher's exact test or the Chi-square test. Trends over time were analyzed using the Cochran-Armitage test of trend. Multivariable logistic regression identified factors independently associated with airway outcomes.</p><p><strong>Results: </strong>First attempt tracheal intubation success was 80.4% (2994/3724); incidence of difficult intubation was 5.0% (186/3724). Hypoxemia at induction occurred in 5.5% (205/3724), and airway-related cardiac arrest occurred in 0.2% (6/3724). First attempt success increased over time, paralleling increased SVL use. SVL use was associated with increased odds of first attempt success (85.9%,1381/1607 SVL vs. 76.2%,1613/2117 direct laryngoscopy (DL), aOR 1.77 95% CI 1.48, 2.12, p < 0.001) and decreased odds of difficult intubation (3.1%, 49/1607 SVL vs. 6.5%, 137/2117 DL, aOR 0.47, 95% CI 0.33, 0.66, p < 0.001). Each additional intubation attempt was strongly associated with hypoxemia at induction.</p><p><strong>Conclusions: </strong>We found clinically important improvements in first attempt tracheal intubation over time. These changes occurred in the context of increased SVL use in conjunction with other practice changes in airway management. We advocate routine SVL use in neonates and young infants with the goal of minimizing the number of intubation attempts, a key target for reducing hypoxemia at induction.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"943-956"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819294","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":"Reduction of Anesthesiologists' Sevoflurane Exposure During Pediatric Mask Induction With an Additional Scavenger: A Randomized Study.","authors":"Feras Somri, Jalaa Hossein, Mostafa Somri, Ohad Hochman, Luis Gaitini, Edna Efrati, Manuel Á Gómez-Ríos","doi":"10.1002/pan.70205","DOIUrl":"10.1002/pan.70205","url":null,"abstract":"<p><strong>Background: </strong>Pediatric inhalational induction with a face mask is a well-recognized source of occupational exposure to waste anesthetic gases. Conventional anesthesia machine scavenging systems are ineffective in capturing extra-circuit leaks occurring at the patient-mask interface. Urinary hexafluoroisopropanol (HFIP), a metabolite of sevoflurane, is a sensitive biomarker of systemic exposure.</p><p><strong>Methods: </strong>In this prospective randomized parallel-group study, 20 anesthesiologists performing pediatric mask inductions with sevoflurane in an induction anesthesia room were allocated to work either with or without an additional external active gas scavenger positioned near the patient's face. Urine samples were collected before exposure and the following morning. HFIP concentrations were quantified by chromatography and normalized to creatinine. Between-group comparisons were performed using Welch's t-test, with a Mann-Whitney U test used as a sensitivity analysis.</p><p><strong>Results: </strong>Urinary HFIP concentrations were significantly higher in anesthesiologists working without the additional scavenger compared with those using the scavenging system (mean ± SD: 0.63 ± 0.30 vs. 0.02 ± 0.04 μg/mL; p = 0.002; Cohen's d = 3.19). HFIP was undetectable or near the analytical detection limit in most samples obtained with scavenging. The observed difference corresponded to a very large effect size, indicating a marked reduction in systemic sevoflurane exposure when the additional scavenger was used.</p><p><strong>Conclusions: </strong>Use of an additional external scavenging system during pediatric mask induction was associated with a substantial reduction in anesthesiologists' biological exposure to sevoflurane, as assessed by urinary HFIP. These findings provide biological evidence supporting exposure reduction strategies during pediatric inhalational anesthesia, although the clinical significance of the observed differences remains to be established.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT06487169.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"957-963"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841393","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":"Arachnoid Cyst During Caudal Block: USG To the Rescue.","authors":"Amrit Kaur, Sunaakshi Puri, Poonam Motiani, Mukul Kumar Jain","doi":"10.1002/pan.70208","DOIUrl":"10.1002/pan.70208","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"998-999"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819357","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 Characteristics and Postoperative Outcomes in Patients Presenting for Cleft Lip and Palate Repair: A 1-Year Prospective Study.","authors":"Ashani Ratnayake, Parakrama Wijekoon, Saman Nanayakkara, U A Isurindi","doi":"10.1002/pan.70199","DOIUrl":"10.1002/pan.70199","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"989-991"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777913","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 Effect of Syringe Pump Vertical Position and Residual Air on the Stability of Vasoactive Drug Infusion: A Simulation Study.","authors":"Xiaowei Chang, Jianhua Sun, Zunzhu Li, Jie Jing, Tingting Yuan, Haohang Guan, Shuai Zhang, Xinyi Xu, Tianchao Chen, Jinbang Liu","doi":"10.1002/pan.70198","DOIUrl":"10.1002/pan.70198","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamic instability during vasoactive drug infusion remains a clinical challenge. While macroscopic factors are well-studied, the physical interaction between syringe residual air and vertical pump positioning is often overlooked. This study investigates how these factors synergistically disrupt flow stability using a simplified simulation model.</p><p><strong>Methods: </strong>A simulation model was constructed using a 60 mL syringe, infusion tubing, and two 3-way stopcocks. The system was tested under four conditions: with or without 1 mL of air in the syringe, and with the infusion terminal positioned 25 cm or 50 cm below the syringe level. Droplet formation at the terminal stopcock was quantified over 10 s intervals using a standardized visual scale. Each condition was repeated 30 times (n = 120 trials). Data were analyzed using non-parametric tests.</p><p><strong>Results: </strong>The presence of 1 mL of air significantly increased flow instability, yielding higher droplet counts compared to the no-air group at both 25 cm (median: 0.75 vs. 0.25 drops, p < 0.001) and 50 cm (median: 2.25 vs. 0.75 drops, p < 0.001). Increasing the height from 25 cm to 50 cm also significantly raised droplet output: from 0.25 to 0.75 drops without air (p < 0.001), and from 0.75 to 2.50 drops with 1 mL of air (p < 0.001). The greatest instability occurred under the combined condition of 50 cm height with 1 mL of air.</p><p><strong>Conclusion: </strong>Residual syringe air and infusion pump vertical position are critical, interacting factors that disrupt flow continuity during vasoactive drug delivery. Air bubbles induce transient flow variations, while height differences amplify these effects through hydrostatic pressure. Clinical protocols should emphasize meticulous air elimination and consistent pump positioning at the level of the patient's right atrium to minimize avoidable infusion-related hemodynamic instability.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"923-927"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777876","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":"Pediatric Preanesthesia Assessment Electronic Triage Tool: Implementation, Quality Improvement, and Retrospective Observational Evaluation of a Patient-Administered Questionnaire.","authors":"Natasha Mills, Everan Michalchyshyn, Megan Parry, Barbara Couper, Alida Orr, Maria Mohareb, Skye Rutherford, Kathleen Cosby, Andrew Jarvis, Jeanette So, Michelle Lachica, Angela Domingues, James Robertson, Clyde Matava","doi":"10.1002/pan.70200","DOIUrl":"10.1002/pan.70200","url":null,"abstract":"<p><strong>Background: </strong>Preanesthesia assessment is essential but resource-intensive. Electronic health records (EHRs) are widespread, yet pediatric perioperative screening remains variable.</p><p><strong>Objective: </strong>To develop and implement a preanesthesia triage tool based on patient-administered electronic triage questionnaire (PAC-Q) integrated with the Epic EHR to streamline pediatric preanesthesia assessment.</p><p><strong>Methods: </strong>Using a quality-improvement framework, we created a preanesthesia triage tool that includes an adapted version of Epic's foundation questionnaire to form a 28-item PAC-Q distributed via MyChart. Responses were weighted (0, 1, or 100) to generate a triage score that, together with surgical risk, routed patients to an RN, NP, or MD for preanesthesia assessment. Implementation was staggered across surgical services. Adoption and outcomes were monitored via Epic dashboards and Power BI.</p><p><strong>Results: </strong>By August 31, 2025, 3993 patients completed the PAC-Q. Of these, 53.7% (2144/3993) were triaged to an RN, 12.3% (492/3993) to an NP, and 6.8% (272/3993) to an MD; 27.1% (1083/3993) were cleared by chart review without further consultation. Comparing April-June 2023 with April-June 2025, completed preanesthesia assessments increased from 71.3% (1182/1659) to 83.8% (1510/1802) (χ² = 78.70, p < 0.0001). In otolaryngology, completion rose from 22.9% (65/284) to 82.7% (230/278) (χ² = 199.37, p < 0.0001). Providers and families reported high satisfaction and reductions in administrative burden.</p><p><strong>Conclusions: </strong>The PAC-Q is a scalable, patient-centered digital tool that standardizes pediatric preanesthesia triage, reduces unnecessary visits, and improves screening uptake. It can be adapted to diverse perioperative settings to enhance efficiency and patient experience.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"928-936"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777952","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":"Factors Influencing Research Output Among Pediatric Anesthesiologists: A 2-Year Analysis.","authors":"Rohan Bhardwaj, Lav Patel, Rachelle Liu, Sachin Govind, Kiara Moore, Chunyi Wu, Jillian DiBiase, Vidya Chidambaran, Eric C Cheon","doi":"10.1002/pan.70222","DOIUrl":"10.1002/pan.70222","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"992-994"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974251","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}