Pediatric Anesthesia最新文献

{"title":"Esketamine and Tracheal Extubation Time: Are the Meta-Analytic Estimates Reliable?","authors":"Jo-Hsin Wu, Pei-Fu Chen, Chia-Hao Ho","doi":"10.1002/pan.70315","DOIUrl":"https://doi.org/10.1002/pan.70315","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990932","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":"Implementation and Iterative Refinement of a Society-Led Pediatric Anesthesia Emergency Simulation Course in Japan.","authors":"Sachi Ishida, Taiki Kojima, Tetsuro Kagawa","doi":"10.1002/pan.70313","DOIUrl":"https://doi.org/10.1002/pan.70313","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963706","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":"Effect of Intraoperative Hemispheric Synchronized Sounds on Depth of Anesthesia and Postoperative Pain in Children Undergoing Infraumbilical Surgery: A Double-Blinded Randomized Controlled Trial.","authors":"Nishitha Vashist, Kavita Rani Sharma, Anju Romina Bhalotra, J S Dali","doi":"10.1002/pan.70307","DOIUrl":"https://doi.org/10.1002/pan.70307","url":null,"abstract":"<p><strong>Background: </strong>Binaural beats have been shown to have sedative effects in adults. Our study aimed to evaluate the effect of hemispheric synchronized sounds on depth of anesthesia primarily and postoperative pain relief in children.</p><p><strong>Objective: </strong>This study aimed to evaluate the effect of Intraoperative hemispheric synchronized sounds on depth of anesthesia in children undergoing infraumbilical surgeries receiving caudal epidural block along with general anesthesia. We also determined postoperative pain and analgesic requirement.</p><p><strong>Materials and methods: </strong>A double blinded randomized controlled trial was conducted at a tertiary care hospital in India on 60 children between the ages of 6 months to 7 years planned for elective infraumbilical surgery under general anesthesia with caudal epidural block. The study subjects were allocated into two equal groups, Group-S (headphones applied, blank file played) and Group-H (headphones applied, hemispheric synchronized sounds played). Bispectral index (BIS) values were recorded every 5 min till the end of the procedure; duration of sound file played and FLACC score at 60 min and 24 h after surgery were also recorded.</p><p><strong>Results: </strong>The study conducted in the pediatric population had a mean age of 4.02 ± 2.08 in group H and 4.77 ± 2.16 in group S. Both groups had comparable gender distribution (66.6% males in group H and 76.6% males in group S). The mean ± SD Intraoperative BIS values were 47.18 ± 9.77 in Group H and 54.32 ± 6.15 in group S (p = 0.001). The median (IQR) postoperative FLACC score at 60 min in group S was 0 (0-1) and group H was 0 (0-1) (p = 0.539). The postoperative FLACC score at 24 h was 0 in both groups.</p><p><strong>Conclusion: </strong>In our study, we observed that these sounds deepened the plane of anesthesia and had no evidence of a statistically significant difference in postoperative pain scores. We conclude that they may be used as part of a multimodal therapy to reduce the requirement of pharmacological anesthetic agents thereby alleviating their short-term and long-term effects.</p><p><strong>Trial registration: </strong>Clinical Trials Registry of India: CTRI/2021/10/037216.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956390","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":"Continuous Respiratory Oscillometry in Pediatric Laparoscopic Surgery-The COMET Study.","authors":"Neil Hauser, Emanuela Zannin, Julie Nguyen, Anwen Taplin, Sara Vigevani, David Sommerfield, Raffaele Dellaca, R Nazim Khan, Aine Sommerfield, Britta S von Ungern-Sternberg","doi":"10.1002/pan.70300","DOIUrl":"https://doi.org/10.1002/pan.70300","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic appendectomy is the accepted surgical approach for appendicitis in centers worldwide. Laparoscopic surgery requires the creation of a pneumoperitoneum to facilitate surgical access. Laparoscopic surgery affects the respiratory mechanics of patients under general anesthesia. In pediatric patients, there is very little published data that has investigated this effect.</p><p><strong>Aims: </strong>This feasibility study aims to determine whether it is possible to continually track the respiratory mechanics of patients undergoing laparoscopic appendectomy utilizing respiratory oscillometry.</p><p><strong>Methods: </strong>Single center, prospective, observational feasibility study conducted at a Tertiary Pediatric center in Western Australia, between May 2020 and April 2023. Patients with known difficult airways, thoracic malformations, and severe cardiopulmonary disease were excluded. Respiratory oscillometry was utilized to measure Reactance (Xrs) and Resistance (Rrs) in all patients to determine the effects of pneumoperitoneum on the respiratory mechanics at specific time points through the surgical procedure.</p><p><strong>Results: </strong>One hundred & Fifty-Four (154) pediatric patients, male & female, between the ages of 2-16 years, undergoing laparoscopic appendectomy were approached. One hundred were recruited to the study with 99 included in the final analysis. Feasibility was demonstrated in terms of both patient acceptance (65% recruitment rate) and the collection of acceptable, usable and reproducible data from 80% of recruited patients.</p><p><strong>Conclusion: </strong>The utilization of respiratory oscillometry has previously been described in pediatric literature, but this has been limited to studies of isolated points in time. This study has demonstrated that it is both feasible and acceptable to continuously measure respiratory mechanics in pediatric patients and that future larger randomized control trials are warranted based on these findings.</p><p><strong>Trial registration: </strong>ANZCTR 12620000380998.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956297","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":"Effect of Thermal Softening of Endotracheal Tubes on Perioperative Respiratory Adverse Events in Children Undergoing Adenotonsillectomy: A Randomized Controlled Trial.","authors":"Mustafa Dikici, Ahmet Kaciroglu, Eralp Cevikkalp, Turgay Aras, Merih Y Eglen, Yusuf Alan, Gokhan Tuzemen, Irem Aydogmus, Mursel Ekinci","doi":"10.1002/pan.70312","DOIUrl":"https://doi.org/10.1002/pan.70312","url":null,"abstract":"<p><strong>Background: </strong>Perioperative respiratory adverse events (PRAEs) are a major source of morbidity in children undergoing adenotonsillectomy (AT). Thermal softening of polyvinyl chloride endotracheal tubes (ETTs) has been proposed to reduce airway irritation, yet its effect on PRAE incidence in the pediatric setting remains unclear. We sought to determine whether the use of thermally softened ETTs reduces PRAE incidence in children undergoing elective AT.</p><p><strong>Methods: </strong>This prospective, randomized controlled trial enrolled 254 children aged 3-9 years scheduled for elective AT. Participants were randomly assigned to intubation with either a room-temperature ETT (Group T1) or a thermally softened ETT pre-warmed to 37°C (Group T2). The primary outcome was the occurrence of any PRAE-including coughing, oxygen desaturation, laryngospasm, or bronchospasm-from extubation through the second postoperative hour. Secondary outcomes included the incidence of individual PRAE components and perioperative hemodynamic and ventilatory parameters. Independent predictors of PRAEs were evaluated using multivariable logistic regression.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. The overall PRAE incidence was significantly lower in Group T2 than in Group T1 (14.1% vs. 24.6%; p = 0.039). Both laryngospasm (2.3% vs. 8.7%; p = 0.029) and postoperative coughing (11.7% vs. 21.4%; p = 0.043) occurred significantly less often in Group T2. No significant differences were detected in oxygen desaturation, bronchospasm, intraoperative hemodynamic parameters, or ventilatory variables. Multivariable analysis identified room-temperature ETT use (adjusted OR: 2.29; 95% CI: 1.16-4.54) and higher Obstructive Sleep Apnea-18 score (adjusted OR: 1.04; 95% CI: 1.01-1.07) as independent PRAE predictors.</p><p><strong>Conclusions: </strong>Warming ETTs to body temperature before intubation was associated with a meaningful reduction in PRAEs-particularly laryngospasm and postoperative coughing-in children undergoing AT. This straightforward, low-cost approach that requires no additional equipment or pharmacological agents may serve as a practical strategy to improve pediatric airway safety. Multicenter studies are needed to confirm these findings and clarify the underlying mechanisms.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06838260.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945492","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":"Remimazolam in Children: Can We Do Better Than We Did With Propofol?","authors":"Tom Giedsing Hansen, Thomas Engelhardt","doi":"10.1002/pan.70306","DOIUrl":"https://doi.org/10.1002/pan.70306","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920624","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":"Continuous Wrist-Derived Heart Rate Correlates With mYPAS Scores and Detects Between-Assessment Heart-Rate Elevations in Children: A Feasibility Study.","authors":"Shawn D Safford, Sikiru Adewale, Denis Gracanin","doi":"10.1002/pan.70309","DOIUrl":"https://doi.org/10.1002/pan.70309","url":null,"abstract":"<p><strong>Background: </strong>Perioperative anxiety affects most children undergoing surgery and predicts emergence delirium, postoperative pain, and behavioral change. The validated modified Yale Preoperative Anxiety Scale (mYPAS) is scored at only a few discrete timepoints, leaving physiologic status between assessments unmeasured.</p><p><strong>Aims: </strong>We tested whether continuous wearable heart rate correlates with the mYPAS where scored, and whether heart-rate elevations of undetermined cause occur during intervals without concurrent mYPAS observation.</p><p><strong>Methods: </strong>Children aged 4-17 undergoing elective surgery wore a wrist biosensor (Empatica EmbracePlus) from holding through induction; the mYPAS was scored at consent, parental separation, and induction. We assessed heart rate-mYPAS concordance and the proportion of heart-rate elevations falling outside ±5 min of any mYPAS timepoint, stratified by premedication.</p><p><strong>Results: </strong>Of 32 consented children, 15 were analyzable (median age 10 years, nine male, eight premedicated). Induction-window heart rate correlated with induction anxiety (Spearman ρ = 0.55, 95% CI 0.01-0.84, p = 0.034) and rose into induction in 13 of 15 children (median + 10 beats/min, p = 0.022). Of 90 heart-rate elevations among 14 children with reliable timing, 71% fell outside the assessment windows (95% CI 58%-80%); 12 of 14 (86%) had ≥ 1 event outside all assessment windows. This pattern persisted regardless of premedication. Heart rate tracked children's state self-report (ρ = 0.62, ages ≥ 9) but not trait anxiety; informants agreed modestly.</p><p><strong>Conclusions: </strong>In this small feasibility cohort, wrist-derived induction-window heart rate was associated with concurrent mYPAS scores. The majority of heart-rate elevations of undetermined cause occurred outside scheduled mYPAS assessment windows. These exploratory findings require confirmation in a larger study incorporating raw physiologic signals, motion measurement, and continuous or event-linked behavioral assessment, which would establish whether continuous physiologic monitoring can complement intermittent behavioral assessment by identifying physiologic events occurring between scheduled anxiety assessments.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920559","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":"Artificial Intelligence-Assisted Videolaryngoscopy: Preserving Independent Airway Competence.","authors":"Emily M Ostermaier, Weerapong Lilitwat","doi":"10.1002/pan.70310","DOIUrl":"https://doi.org/10.1002/pan.70310","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906655","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":"EEG-Derived Wavelet Index for Assessment of Procedural Sedation in Children Undergoing Magnetic Resonance Examination: A Diagnostic Study.","authors":"Siyi Zhou, Yingzhi Dan, Jing Jiang, Shengqun Ni, Yue Huang, Jijian Zheng, Kan Zhang","doi":"10.1002/pan.70305","DOIUrl":"https://doi.org/10.1002/pan.70305","url":null,"abstract":"<p><strong>Background: </strong>Procedural sedation is often essential for children undergoing imaging examinations. Whether the wavelet index (WLI) could outperform Ramsay Sedation Score (RS) in assessing sedation depth and identifying children at risk of MRI sedation failure was unknown.</p><p><strong>Methods: </strong>This prospective, single-blind study was performed at a tertiary care hospital. WLI and RS were measured in 74 pediatric patients who underwent MRI scanning after procedural sedation with chloral hydrate and dexmedetomidine. Once the patient reached RS scores 5 or 6, the MRI examination was initiated. Successful MRI sedation was defined as completion of the planned MRI examination at the first attempt with no clinically significant motion artifact and no need for additional rescue sedation or conversion to general anesthesia.</p><p><strong>Results: </strong>Sixty-five children successfully completed the MRI examination, and nine failed due to insufficient sedation. The AUC for WLI was 0.902 (95% CI, 0.814-0.990) versus 0.734 (95% CI, 0.603-0.876) for RS, with a significant paired difference between the two ROC curves (ΔAUC, 0.162; 95% CI, 0.004-0.329; p = 0.038). The WLI-based model showed better overall predictive performance than the RS-based model, with a lower Brier score (0.0704 vs. 0.0908). On decision curve analysis, the WLI-based model provided greater net benefit throughout the clinically relevant threshold range (0.05-0.40).</p><p><strong>Conclusions: </strong>WLI may provide an adjunctive, non-stimulating measure for risk stratification in pediatric MRI sedation, although the clinical utility of WLI-guided management should be confirmed in prospective studies.</p><p><strong>Trial registration: </strong>Clinical Trial Registry of China: ChiCTR2500103661.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900978","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":"Evaluation of Play Distraction and Streamed Video Clips in Alleviating Anxiety Before Oral Premedication Among Pediatric Patients: A Randomized Controlled Trial.","authors":"Gunjan Sabharwal, Lalit Gupta, Kapil Chaudhary","doi":"10.1002/pan.70308","DOIUrl":"https://doi.org/10.1002/pan.70308","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety in children is common and may impair cooperation and perioperative outcomes. Although oral midazolam is widely used, acceptance may be poor and residual anxiety often persists, resulting in increased distress for both child and parent. Behavioral distraction techniques may improve anxiolysis and facilitate premedication administration.</p><p><strong>Aim: </strong>To compare active distraction using play dough with passive distraction using video clips for reducing preoperative anxiety and improving acceptance of oral midazolam in children undergoing elective surgery under general anesthesia.</p><p><strong>Methods: </strong>Two hundred and ten children aged 3-7 years with American Society of Anesthesiologists physical status I-III were randomized in a 1:1:1 ratio to receive play dough, streamed video clips, or standard care. Anxiety was assessed using the Modified Yale Preoperative Anxiety Scale at baseline, after a 3-min acclimatization period, immediately after the intervention, and 20 min after oral midazolam administration.</p><p><strong>Results: </strong>Baseline anxiety scores were comparable among groups. Immediately after the intervention and 20 min after oral midazolam administration, anxiety scores were significantly lower in both intervention groups than in the standard care group (p < 0.001). Twenty minutes after oral midazolam administration, anxiety reduction was greater in the play dough group than in the streamed video clips group (adjusted mean difference -15.4, 95% confidence interval -18.2 to -12.6; p < 0.001). Acceptance of oral midazolam was highest in the play dough group (98.6%), followed by the streamed video clips group (78.6%) and the standard care group (11.4%) (p < 0.001). Both intervention groups also demonstrated lower parental anxiety and higher parental satisfaction than standard care.</p><p><strong>Conclusions: </strong>Active distraction using play dough provides superior anxiolysis and improves premedication acceptance compared with passive video distraction and standard care in young children undergoing general anesthesia. Incorporating simple play-based distraction into routine preoperative practice may improve the perioperative experience for both children and parents.</p><p><strong>Trial registration: </strong>Clinical Trials Registry-India (CTRI/2024/05/067549; URL: www.ctri.nic.in).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900984","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}