Pediatric Anesthesia最新文献

{"title":"Low-Dose Naltrexone for Pediatric Chronic Pain and Inflammatory States: Perioperative Considerations.","authors":"Henry Huang, D Chiamaka Ijebuonwu, Rodney Whitney, Karla Wyatt-Thompson","doi":"10.1111/pan.15070","DOIUrl":"10.1111/pan.15070","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"329-330"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189988","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":"Electroencephalography and Anesthetic Depth in Children Under 2 Years of Age: A Prospective Observational Study.","authors":"Soo-Bin Yoon, Jung-Bin Park, Pyoyoon Kang, Young-Eun Jang, Eun-Hee Kim, Ji-Hyun Lee, Hyung-Chul Lee, Jin-Tae Kim, Hee-Soo Kim, Sang-Hwan Ji","doi":"10.1111/pan.15058","DOIUrl":"10.1111/pan.15058","url":null,"abstract":"<p><strong>Background: </strong>Processed electroencephalogram (EEG) indices are widely used to monitor anesthetic depth. However, their reliability in children under 2 years of age remains questionable. During anesthesia maintenance in this age group, processed EEG indices frequently exhibit unexpectedly elevated values that exceed the intended target range.</p><p><strong>Aim: </strong>This study aimed to identify EEG spectral parameters associated with false positive elevations in processed EEG indices and investigate their differences from true positive elevations during emergence.</p><p><strong>Methods: </strong>This prospective observational study included 50 children aged 4-24 months undergoing general anesthesia. Bispectral index (BIS), patient state index (PSi), and raw EEG were continuously recorded throughout anesthesia. False positive was defined as elevated processed EEG indices when end-tidal sevoflurane concentration was maintained at 0.7-1.3 minimum alveolar concentration, with heart rate and mean blood pressure between 80% and 120% of baseline values. We analyzed EEG power spectra and band power values during periods of false positives and compared them with those of true positives during emergence. Bonferroni-corrected p < 0.05 was considered significant.</p><p><strong>Results: </strong>False positives in processed EEG indices were observed in 35 (70%) of the children during anesthesia maintenance, occupying 28% of the maintenance phase. These false positives were associated with decreased power in delta (269-174 dB) and theta (115-97 dB) bands, but widespread increases in alpha and beta bands, resulting in elevated spectral edge frequency (19-22 Hz). Notably, EEG band power during false positives significantly differed from those observed during emergence (delta: 52 dB, theta: 38 dB) (all p < 0.001).</p><p><strong>Conclusions: </strong>Processed EEG indices may exhibit unexpectedly elevated values during anesthesia maintenance in children under 2 years of age. Quantitative assessments derived from raw EEG data may improve the evaluation of anesthetic depth in this population.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"294-301"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896502","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 Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial.","authors":"Iris J de Heer, Hannah A C Raab, Joost de Vries, Gulhan Karaöz-Bulut, Frank Weber","doi":"10.1111/pan.15065","DOIUrl":"10.1111/pan.15065","url":null,"abstract":"<p><strong>Background: </strong>In children, monitoring depth of anesthesia is challenging because of the still developing brain. Electroencephalographic density spectral array monitoring provides age- and anesthetic drug-specific electroencephalographic patterns, making it suitable for use in children. Yet, not much is known about the benefits of using density spectral array on post-operative recovery in children.</p><p><strong>Aim: </strong>In this randomized controlled trial, the primary aim was to investigate the influence of density spectral array monitoring during general anesthesia on the speed of recovery after surgery.</p><p><strong>Methods: </strong>Children aged 6 months-12 years scheduled for elective surgery under general anesthesia supplemented with caudal analgesia had either sevoflurane anesthesia titrated to maintain a characteristic density spectral array pattern or based on a predefined end-tidal sevoflurane concentration of 2.3% (standard care group). The time interval between the discontinuation of sevoflurane and the moment when discharge criteria from the operating room were met (Steward score of 3 or more) was defined as the primary outcome parameter of this trial.</p><p><strong>Results: </strong>Data from 96 children were analyzed. The time until discharge readiness from the operating room was shorter in group density spectral array (6 min. [13[4-16.8]]) than in group standard care (12 min. [18[6-24.3]]), with a difference between medians of 6 min (95% CI -7 to 0), p = 0.041. The mean end-tidal sevoflurane concentration during the surgical procedure was lower in group density spectral array, 1.8% (0.34) versus 2.3% (0.1) in group standard care (95% CI 0.4-0.7), p < 0.001.</p><p><strong>Conclusion: </strong>This randomized controlled trial provides initial evidence of an added value of density spectral array monitoring in terms of the speed of recovery and allows sevoflurane to be dosed 22% lower during maintenance than with a more traditional approach using a minimal alveolar concentration of 0.9.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05525104.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"287-293"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971801","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":"Adverse Events and External Factors Affecting Nitrous Oxide Dental Sedation in an Academic Center.","authors":"Valeria Muñoz L, María Eugenia Guevara V, Pilar Morales, Emilia Lacassie, Hector J Lacassie","doi":"10.1111/pan.15064","DOIUrl":"10.1111/pan.15064","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"321-322"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931557","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":"Case Series of Anesthetic Management of Gene Therapy in Children With Aromatic L-Amino Acid Decarboxylase Deficiency.","authors":"Simon Clariot, Séverine Gras, Laurent Goetz, Christophe Boulloud, Julie Bonheur, Pia Vayssiere, Vincent D'Hardemare, Claudia Ravelli, Nathalie Dorison, Jean-Michel Devys","doi":"10.1111/pan.15060","DOIUrl":"10.1111/pan.15060","url":null,"abstract":"<p><strong>Background: </strong>Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare life-threatening inborn error of neurotransmitter biosynthesis. It is characterized by deficient biosynthesis of neurotransmitters dopamine and serotonin, leading to catecholamines deficiency and sympathetic deprivation, while the parasympathetic system remains functional. Since 2012, gene therapy has led to clinical improvements in symptoms and motor function with a severe phenotype. General anesthesia of children with AADC deficiency is challenging.</p><p><strong>Aim: </strong>Describe prolonged anesthesia management of children with aromatic L-amino acid decarboxylase deficiency undergoing stereotactically guided gene therapy.</p><p><strong>Methods: </strong>Prospective reporting of epidemiologic and anesthetics data of four children consecutively undergoing magnetic resonance-guided direct delivery of an AADC vector for gene therapy under general anesthesia.</p><p><strong>Results: </strong>General anesthesia was initiated with sevoflurane and ketamine and rocuronium was the neuromuscular blocking agent of choice throughout the procedures. Intraoperative hemodynamic monitoring included an arterial line. All children required low doses of diluted norepinephrine during the intraoperative period. No dysautomic episodes as well as no episode of severe hypotension and no severe hypoglycemia were reported throughout the procedures. Vasopressor support was discontinued for all children at the end of the procedures. Moreover, no peroperative and postoperative effects secondary to AADC vector injection were noted.</p><p><strong>Conclusion: </strong>Using an anesthetic plan based on atropine, ketamine, sevoflurane, and a titrated infusion of norepinephrine, prolonged anesthesia appeared to be safe and reproductible in this population.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"316-320"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033921","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":"BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial.","authors":"T Wesley Templeton, Gijo Alex, Jean D Eloy, Lindsay Stollings, Richard J Ing, Eric C Cheon, Kumar Belani, Ilan Breskin, Peter S Sebel, Brad M Taicher","doi":"10.1111/pan.15057","DOIUrl":"10.1111/pan.15057","url":null,"abstract":"<p><strong>Background: </strong>In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.</p><p><strong>Aims: </strong>The primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4-18 years of age.</p><p><strong>Methods: </strong>Participants in three age groups (4-8, 9-12, and 13-18 years) were randomized to either the BIS guided group or the control group. Use of sevoflurane as the primary maintenance anesthetic was the only requirement in both arms. In the BIS guided group, sevoflurane was titrated to achieve a target BIS value of 45-60 during the maintenance period. In the control arm, clinicians were blinded to the BIS value. Primary outcome was mean end-tidal sevoflurane concentration during maintenance phase of anesthesia. Secondary assessments included time to discharge and the readiness and quality of recovery as assessed by the Pediatric Anesthesia Emergence Delirium scale, the modified Aldrete Score, and the Wong-Baker FACES scale. An intention-to-treat analysis was used to analyze and compare groups.</p><p><strong>Results: </strong>A total of 180 participants were randomized. Following randomization, 10 participants did not undergo any study procedures, leaving 84 participants in the BIS guided group and 86 participants in the control group. Across all age groups, the average end-tidal sevoflurane concentration was less in the BIS guided group compared to control (4-8 years: 2.2% ± 0.3% vs. 2.4% ± 0.4%, -0.3% [-0.4%, -0.1%]; 9-12 years: 1.7% ± 0.5% vs. 2.1% ± 0.6%, -0.4% [-0.7%, -0.1%]; 13-18 years: 1.6% ± 0.4% vs. 1.9% ± 0.5%, -0.3% [-0.5%, -0.1%]). No differences in recovery outcomes between treatment groups were observed.</p><p><strong>Conclusions: </strong>In pediatric participants, the BIS guided group reported a lower average end-tidal sevoflurane concentration compared to control, though no significant differences in recovery profile were noted.</p><p><strong>Clinical implications: </strong>The Bispectral Index (BIS) is a processed EEG tool that can be used to titrate general anesthesia to achieve desired anesthetic depth. Brain monitoring with BIS resulted in lower average end-tidal sevoflurane concentrations in children aged 4-18 years undergoing general anesthesia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04810481.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"277-286"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927583","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":"NARS1-Related Disorder-An Orphan Disease.","authors":"Neha Hasija, Jessica Lees","doi":"10.1111/pan.15071","DOIUrl":"10.1111/pan.15071","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"325-326"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189993","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":"Authorship: The Editors' Perspective.","authors":"Andrew Davidson","doi":"10.1111/pan.15072","DOIUrl":"10.1111/pan.15072","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"264-266"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190023","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":"Ball Valve Gas Trapping in Pediatric One-Lung Ventilation: Not All Ventilation Is Loss of Isolation.","authors":"Anthony M-H Ho, Julie Zalan, Amanda Jasudavisius, Fraser Johnson, Glenio B Mizubuti","doi":"10.1111/pan.15067","DOIUrl":"10.1111/pan.15067","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"327-328"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971798","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 Awake Craniotomy: An Educational Review.","authors":"Maria Nabil Henry, Maryam N Shahin, Ian Stevens, Jessica Calvert, Dana Dharmakaya Colgan, Michael Vega, Kelly Collins","doi":"10.1111/pan.15075","DOIUrl":"10.1111/pan.15075","url":null,"abstract":"<p><strong>Background: </strong>Awake craniotomies with functional cortical mapping are performed to minimize post-operative deficits from the resection of lesions adjacent to eloquent cortex. The procedure is well-established in the adult patient population and is increasingly applied to well-selected pediatric patients. A review of recent literature demonstrated that the most commonly reported anesthetic techniques were \"asleep-awake-asleep\" protocols that relied on propofol, remifentanil, or fentanyl.</p><p><strong>Main article: </strong>This educational review discusses the unique challenges that face the anesthesiology and neurosurgical teams when working with the pediatric population. To further illustrate pediatric-specific considerations, a case of a 9-year-old boy who underwent a resection of a large left peri-rolandic ependymoma is presented, including his multidisciplinary pre-operative, intra-operative, and post-operative care.</p><p><strong>Conclusion: </strong>Awake craniotomies can safely be performed in the pediatric population with appropriate patient selection, planning, and a multi-disciplinary approach.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"270-276"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075283","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}