Pediatric Anesthesia最新文献

{"title":"Comparison Over Two Eras of Perioperative Adverse Outcomes in Children With and Without Congenital Heart Disease Undergoing Noncardiac Surgery.","authors":"Carine Foz, Steven Staffa, David Faraoni, James A DiNardo, Viviane G Nasr","doi":"10.1111/pan.70040","DOIUrl":"https://doi.org/10.1111/pan.70040","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in medical care, noncardiac surgery in children with congenital heart disease (CHD) remains associated with considerable perioperative morbidity and mortality. This study evaluates trends in postoperative outcomes after noncardiac surgery in children with and without CHD across two time periods.</p><p><strong>Aims: </strong>We aimed to determine and compare the incidence of adverse outcomes following noncardiac surgery in a large cohort of children without CHD, in children with minor CHD, major CHD, and severe CHD, across two time periods (2012-2016 and 2017-2022, excluding 2020).</p><p><strong>Methods: </strong>Children undergoing noncardiac surgery from 2012 to 2022 were identified from the ACS-NSQIP Pediatric database, excluding 2020. Patients were stratified by CHD severity (none, minor, major, severe) and by era (2012-2016 vs. 2017-2022). Outcomes included 30-day mortality, cardiac arrest, reintubation, reoperation, and readmission. Multivariable logistic regression was used to compare outcomes across eras, adjusting for demographic, clinical, and procedural variables.</p><p><strong>Results: </strong>Among 1 023 638 children, there were 88.3% patients with no CHD and 11.7% with CHD (5.9% minor, 5.2% major, 0.6% severe). Improvements were seen across all CHD subgroups, particularly in reintubation and readmission rates. The most consistent improvement was in reintubation, including in severe CHD (aOR 0.69; 95% CI: 0.53, 0.89; p = 0.005).</p><p><strong>Conclusion: </strong>These findings demonstrate meaningful improvements in postoperative outcomes over time, notably reduced rates of 30-day mortality, reintubation, and readmission in the non-CHD group. Patients with minor and major CHD experienced significant declines in reintubation and readmission, while those with severe CHD showed reduced reintubation. Despite rising CHD prevalence and complexity, improvements likely reflect advances in perioperative care, risk stratification, and multidisciplinary management at specialized centers for children undergoing noncardiac surgery.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963889","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":"In This Issue October 2025.","authors":"","doi":"10.1111/pan.70042","DOIUrl":"https://doi.org/10.1111/pan.70042","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963903","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":"Real-World Impact on Postoperative Vomiting by Changing Anesthesia Regimens in Children Undergoing Strabismus Surgery: An Interrupted Time Series Analysis.","authors":"Taiki Kojima, Yusuke Yamauchi, Sayuri Yasuda, Soichiro Obara, Takashi Fujiwara, Aya Sueda","doi":"10.1111/pan.70041","DOIUrl":"https://doi.org/10.1111/pan.70041","url":null,"abstract":"<p><strong>Background: </strong>Preventive measures for postoperative vomiting (POV) in pediatric strabismus surgery are essential. Previous experimental studies have shown the independent antiemetic effects of propofol-based total intravenous anesthesia (TIVA), dexamethasone (DEX), and ondansetron (OND). However, the real-world outcomes of POV following the combined use of DEX and OND with propofol/opioid TIVA remain unknown.</p><p><strong>Aims: </strong>To evaluate the longitudinal incidence of POV across three phases of different anesthesia regimens.</p><p><strong>Methods: </strong>This retrospective observational study was conducted at a single tertiary-care children's hospital in Japan, including children aged < 18 years who underwent strabismus surgery and had no major comorbidities. The primary outcome was either POV or the use of antiemetics within 24 h or by discharge. Changes in the levels and time-trend slopes of POV were evaluated using interrupted time series analysis among three phases: (1) sevoflurane with pentazocine, (2) propofol/opioid TIVA with DEX, and (3) propofol/opioid TIVA with DEX and OND.</p><p><strong>Results: </strong>Of the 2378 children, the POV incidence in Phases 1, 2, and 3 was 109/471 (23.1%), 87/1260 (6.9%), and 28/647 (4.3%), respectively (p < 0.001). A significant level change in POV occurrence was observed from Phase 1 to Phase 2, while no significant level change was found from Phase 2 to Phase 3. The time-trend changes in POV occurrence showed no significant difference during Phases 2 and 3.</p><p><strong>Conclusions: </strong>Real-world departmental-level data showed a decrease in POV occurrence after transitioning from sevoflurane-based anesthesia with pentazocine to propofol/opioid TIVA with DEX. However, no significant decrease in POV occurrence was found by adding OND to propofol/opioid TIVA with DEX. Further studies are needed to improve the generalizability of evaluating the real-world antiemetic effect of combining antiemetic medications on propofol/opioid TIVA.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963922","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":"Editor's Picks for the Pediatric Anesthesia Article of the Day: January 2025.","authors":"Melissa Brooks Peterson, Justin L Lockman, Myron Yaster","doi":"10.1111/pan.70024","DOIUrl":"https://doi.org/10.1111/pan.70024","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874480","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":"Editor's Picks for the Pediatric Anesthesia Article of the Day: December 2024.","authors":"Melissa Brooks Peterson, Justin L Lockman, Myron Yaster","doi":"10.1111/pan.70025","DOIUrl":"https://doi.org/10.1111/pan.70025","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874479","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":"On-Table Extubation After Pediatric Cardiac Surgery: A Systematic Review.","authors":"Vanessa Tapioca, Lucas Caetano, Tathiane Gibicoski, Walid Alrayashi, Sara Amaral","doi":"10.1111/pan.70026","DOIUrl":"https://doi.org/10.1111/pan.70026","url":null,"abstract":"<p><strong>Context: </strong>On-table extubation after pediatric cardiac surgery has been increasingly considered a safe and effective strategy to reduce postoperative ventilation time. However, concerns regarding reintubation risk, patient selection, and variability in outcomes remain.</p><p><strong>Objective: </strong>To systematically review the available literature on the effectiveness and safety of on-table extubation compared to off-table extubation in pediatric cardiac surgery. Primary outcomes were reintubation rate, mortality, intensive care unit (ICU) and hospital length of stay (LOS). Secondary outcomes were arterial pH, lactate, and PaCO₂ after surgery.</p><p><strong>Data sources: </strong>MEDLINE, Cochrane Library, Web of Science, and Embase were searched from inception to January 8th, 2025, without language or date restrictions. Additional studies were identified through the backward snowballing technique.</p><p><strong>Study selection: </strong>We included randomized controlled trials (RCTs) and observational studies comparing on-table and off-table extubation in pediatric patients (< 18 years) undergoing cardiovascular surgery. Studies with overlapping populations or conference abstracts were excluded.</p><p><strong>Data extraction: </strong>Two independent reviewers screened studies completed a quality assessment, and extracted data.</p><p><strong>Results: </strong>Twenty-nine studies (2 RCTs, 27 observational), including 9070 patients, met the eligibility criteria. On-table extubation was associated with lower reintubation rates in most studies, though findings were not consistent across all. Mortality rates were generally comparable between groups. ICU and hospital LOS were consistently shorter in the on-table group. Postoperative blood gas analyses showed a better arterial pH, lactate, and PaCO₂ profile in the on-table group. The risk of bias was elevated between observational studies.</p><p><strong>Limitations: </strong>Selection bias was present, as the majority of studies were observational, and the decision for on-table extubation was largely based on clinician assessment of suitability and stability at the end of surgery. High heterogeneity across studies limited meta-analysis feasibility.</p><p><strong>Conclusion: </strong>Although this systematic review suggests that on-table extubation may be associated with potentially better outcomes following pediatric cardiac surgery, no safe conclusions can be drawn about its benefit due to the high heterogeneity and potential high risk of bias of most included studies. Well-designed RCTs are needed to confirm the benefits and safety of on-table extubation and to guide appropriate patient selection.</p><p><strong>Trial registration: </strong>International Prospective Register of Systematic Reviews (PROSPERO): CRD42025644238.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837284","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 Single-Center Descriptive Analysis of Interventions for Hypotension in Children: A Retrospective Cohort Study.","authors":"Christopher S McLaughlin, Vikas N O'Reilly-Shah, L Daniela Smith, Amit Saha, Benjamin Y Andrew, Sarah E Brown, Lisa K Lee, Lucinda L Everett, Julia Gálvez Delgado, Brad M Taicher, Allan F Simpao, T Wesley Templeton","doi":"10.1111/pan.70032","DOIUrl":"https://doi.org/10.1111/pan.70032","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hemodynamic management goals in pediatric patients vary significantly with age. Physiologic variability and the absence of a widely accepted definition of intraoperative hypotension contribute to inconsistent treatment thresholds and practice variation.</p><p><strong>Aims: </strong>The primary aim was to observe which blood pressure thresholds in various age groups led to clinical intervention in noncardiac surgery. The secondary aim was to determine the most commonly employed treatment interventions.</p><p><strong>Methods: </strong>A single-center, retrospective, observational cohort study analyzed anesthesia records for 37 958 pediatric patients aged < 18 years of age who underwent noncardiac surgery and general anesthesia at our institution from January 1, 2015, through December 31, 2023. Age groups included: infants (0-12 months), preschool (1-6 years), children (7-12 years), and teenagers (13-17 years). The primary outcome was the adjusted rate of intervention, defined as any bolus of ephedrine, phenylephrine, epinephrine, norepinephrine, vasopressin, or 5% albumin. An algorithmic approach was used to examine the time epoch both before (6 min) and after (3 min) any study-defined interventions to identify the lowest mean arterial pressure that was associated with an intervention.</p><p><strong>Results: </strong>Following exclusions, 37 958 anesthetic records were analyzed in this cohort. The median arterial pressure value and interquartile range associated with an intervention were: 36 mmHg [29, 43] in infants, 44 mmHg [38.5, 52] in preschool, 51 mmHg [44, 58] in children, and 57 mmHg [51, 63] in teenagers. The most common intervention was 5% albumin, followed by phenylephrine.</p><p><strong>Conclusion: </strong>Intervention rates in pediatric patients were lower than those reported in adults, with intervention thresholds decreasing with younger age. Use of intravascular volume expansion appears to be more commonly used to treat hypotension in infants compared to older children. These findings highlight the need for multicenter studies to establish standardized intervention thresholds and assess their impact on clinical outcomes.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817286","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":"Pharmacodynamic Safety Endpoints for Propofol Anesthesia in Children by Age and Sex: A Multicohort Observational Study.","authors":"Lindy Moxham, Aanisah Golam, Nicholas C West, Matthias Görges, Simon D Whyte","doi":"10.1111/pan.70031","DOIUrl":"https://doi.org/10.1111/pan.70031","url":null,"abstract":"<p><strong>Background: </strong>Propofol is a commonly used intravenous sedative and general anesthetic, with rapid onset and short duration of action. It has a narrow therapeutic index and significant interindividual variability in dosing requirements, which may elevate risks of its use, particularly in children.</p><p><strong>Aims: </strong>We aimed to quantify the doses required to induce loss of consciousness and apnea in children by age and sex to contribute to tailored propofol dosing recommendations for improved safety and efficacy in pediatric anesthesia.</p><p><strong>Methods: </strong>In this stratified- and purposive-sampling study, we enrolled children in six groups based on sex and age (3- to 5-year-olds, 6- to 10-year-olds, 11- to 18-year-olds), targeting 60 participants per group. For induction of anesthesia, we administered propofol at a constant rate until apnea was reached (absence of end-tidal CO₂ for 20 s) up to a maximum dose of 10 mg/kg. We measured the propofol dose required to reach pharmacodynamic endpoints, including loss of eyelash reflex (LOER) and apnea, and estimated the effect of sex and age on these doses.</p><p><strong>Results: </strong>Data were available for 318 participants, with 162 females and a median (interquartile range) age of 8.1 (5.3-12.9) years. The mean (SD) propofol dose to LOER was 2.65 (0.69) mg/kg with no effect of sex (-0.10 mg/kg for male, 95% confidence interval (CI) -0.26 to 0.05, p = 0.183) or age (0.0 mg/kg per year, 95% CI -0.02 to 0.02, p = 0.876). The mean (SD) propofol dose to apnea was 6.82 (1.64) mg/kg, with significant effects of both sex (+0.67 mg/kg for male, 95% CI 0.30 to 1.03, p < 0.001) and age (-0.14 mg/kg per year, 95% CI -0.19 to -0.1, p < 0.001). Apnea was not reached in 62 participants.</p><p><strong>Conclusions: </strong>Older and female children exhibited narrower therapeutic indices for the margin between LOER and apnea. This requires heightened vigilance, especially when maintaining spontaneous respiration. A planned genome-wide association study may identify pharmacogenetic-pharmacodynamic relationships and correlations with genetic ancestry.</p><p><strong>Trial registration: </strong>The trial was registered on clinicaltrials.gov before enrolment (NCT04164264; date of registration 2019-11-15).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817287","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":"Measurement of Airway Length in Neonates Using Fiberoptic Bronchoscopy.","authors":"Vanya Chugh, Rohit Kashyap, Charu Bamba","doi":"10.1111/pan.70028","DOIUrl":"https://doi.org/10.1111/pan.70028","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal positioning of the endotracheal tube is a crucial step in the airway management of neonates. Short airway length creates a narrow margin of safety and thus a higher chance of ETT malpositioning. Published literature reports airway length of 5-7.5 cm, which is primarily based on autopsy and radiologic studies. We decided to measure the airway length in neonates undergoing surgeries using flexible fiberoptic bronchoscopy (FFOB).</p><p><strong>Methodology: </strong>Sixty full-term neonates, scheduled for surgery under general anesthesia with endotracheal intubation, were included in the study. Neonates with airway anomalies and anticipated difficult airways were excluded. Airway length was measured using FFOB.</p><p><strong>Results: </strong>Sixty neonates were included in the study. The mean airway length ± SD was 3.85 ± 0.71 cm. The mean ± SD length in males was 3.87 ± 0.63 cm, and in females was 3.82 ± 0.86 cm. The Spearman rank correlation coefficient of airway length (cm) with age was 0.139, and for weight was 0.130.</p><p><strong>Conclusion: </strong>Airway length is much smaller in neonates as compared to that reported in the literature. Airway dimensions need reassessment in this population in order to improve safety and effectiveness of neonatal intubation practices.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784954","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":"Anesthetic Considerations in Unvaccinated Pediatric Patients.","authors":"Michael McNally, John McNally","doi":"10.1111/pan.15126","DOIUrl":"10.1111/pan.15126","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"664-665"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079227","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}