Pediatric Anesthesia最新文献

{"title":"A Window to the Stomach-Gastric Ultrasound's Growing Role in Pediatric Anesthesia.","authors":"Ankita Dey, Nagalakshmi Swaminathan, Anju Grewal","doi":"10.1002/pan.70212","DOIUrl":"10.1002/pan.70212","url":null,"abstract":"<p><p>Gastric ultrasound (GUS) is an evolving Point-of-Care Ultrasound (POCUS) tool whose applicability is being increasingly studied in pediatric anesthesia. The technique evaluates the gastric antrum, in the right lateral decubitus or supine positions to determine the quality and quantity of stomach contents. The Perlas 3-point grading is a semi-quantitative assessment method, which can be applied to pediatric patients as well. GUS may be potentially useful in situations when a child's fasting status is uncertain or gastric emptying is delayed as an adjunct to clinical decision-making. Although quantitative gastric volume estimation models require further validation and large-scale trials are challenging due to the low incidence of aspiration, GUS holds significant promise. Its routine clinical integration demands further robust studies focused on patient-oriented outcomes.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"883-884"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841358","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Pain Management and Palliative Care in Nigeria: A Scoping Review.","authors":"Nwokpor Nnaemeka Collins, Ifoto Oghenekaro","doi":"10.1002/pan.70225","DOIUrl":"10.1002/pan.70225","url":null,"abstract":"<p><strong>Background: </strong>Pain is a common experience for pediatric patients, yet it remains inadequately managed, particularly in low-resource settings. Pediatric palliative care (PPC) services are underdeveloped in many low- and middle-income countries, including Nigeria. This scoping review examines pediatric pain management (across acute, procedural, and chronic pain types in various care settings) and palliative care in Nigeria, evaluating barriers, facilitators, and implementation gaps.</p><p><strong>Methods: </strong>A comprehensive search was conducted for literature on pediatric pain management and palliative care in Nigeria across PubMed, Scopus, African Journals Online, and Google Scholar up to December 2024. Eligible studies were screened using Rayyan QCRI (a web-based systematic review platform) and analyzed with NVivo 12 (qualitative analysis software) for qualitative synthesis. Data on healthcare provider knowledge, pain management practices, palliative care services, and patient outcomes were extracted. The review followed PRISMA-ScR guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews), with findings synthesized narratively due to study design heterogeneity.</p><p><strong>Results: </strong>Eleven studies met the inclusion criteria (surveys of healthcare providers, audits of practices, and one RCT). Healthcare providers exhibited poor knowledge and suboptimal practices in pediatric pain management; only 30% could name three non-pharmacological pain management methods, and 52% had never prescribed morphine. Acute pain management practices in major centres relied heavily on basic analgesics but lacked advanced modalities. Two-thirds of pediatric anesthetists reported no institutional guidelines for pediatric pain, only ~5% of surgeons used any formal pain assessment tool, and no neonates received morphine post-operatively in one survey. Pediatric palliative care services were limited, with only 10 dedicated centres serving a small fraction of children in need, and most children with life-limiting illnesses were managed in general wards without specialist palliative input. Children with life-limiting illnesses suffered significant symptom burdens, including pain-over 50% of pediatric cancer patients in one study reported pain as frequent and distressing. Caregivers of these children also experienced high psychological stress, correlating with the child's symptom burden.</p><p><strong>Conclusions: </strong>Pediatric pain management and palliative care in Nigeria are in early stages. Gaps in provider training, guideline implementation, and service availability hinder progress. Strengthening education (including integration of pediatric pain/palliative care into curricula), improving opioid access (e.g., implementing national pain guidelines), and expanding dedicated palliative care services are critical to meeting the needs of children in Nigeria.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"908-922"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148033412","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":"https://doi.org/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":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Association of Preoperative Inflammatory Markers With Preoperative Anxiety and Emergence Agitation in Children\".","authors":"Hafiz Zain Iftikhar, Sana Iftikhar","doi":"10.1002/pan.70271","DOIUrl":"https://doi.org/10.1002/pan.70271","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592804","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":"Difficult Airway Management Outside of the Operating Room: Rare, but Preparation Is Key.","authors":"Matthew J Rowland, Narasimhan Jagannathan","doi":"10.1002/pan.70263","DOIUrl":"https://doi.org/10.1002/pan.70263","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579567","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 Pilot and Feasibility Study of a Four-Stage Neurological Staging Framework in Pediatric Tracheal Extubation During Anesthesia Emergence.","authors":"Megumi Okuyama, Katsuhiko Ishibashi, Shiori Nakao, Tomoharu Ukiya, Kohei Takahashi, Taiki Kojima","doi":"10.1002/pan.70270","DOIUrl":"10.1002/pan.70270","url":null,"abstract":"<p><strong>Background: </strong>Postoperative tracheal extubation is a particularly high-risk period in pediatric anesthesia. Because emergence from anesthesia is a complex and complicated process, determining the optimal timing for safe tracheal extubation remains challenging.</p><p><strong>Aims: </strong>To evaluate the feasibility and descriptive characteristics of a four-stage neuroanatomical framework for pediatric anesthesia emergence while providing exploratory incidence estimates of respiratory adverse events across these stages.</p><p><strong>Methods: </strong>Children younger than 7 years undergoing general anesthesia were enrolled. Emergence stratified into four stages, defined by cranial nerve indicators: Stage 1 (Medulla: regular breathing, movement, excluding cough or swallowing); Stage 2 (Pons: tearing or grimacing); Stage 3 (Midbrain: conjugate gaze or eye-opening); and Stage 4 (Cerebrum: purposeful movement). Primary outcomes included feasibility metrics-such as protocol completion, recruitment flow, and data completeness-and successful assignment of emergence stages. Exploratory descriptive statistics summarized the incidence of respiratory adverse events. Risk ratios were calculated to compare the occurrence of respiratory adverse events in intermediate (Stages 2 and 3) and cortical (Stage 4) stages.</p><p><strong>Results: </strong>Of the 174 patients screened, 89 completed the protocol. Overall, 153 patients provided consent (91.6% consent rate). The overall data capture rate was 58.2% (89/153), while the worksheet processing rate-adjusted for protocol-ineligible cases, such as those with supraglottic airway use-was 73.2% (112/153). Among the 89 patients analyzed, there were no missing data for key variables, and stage assignment was achieved in all cases. Respiratory adverse events were observed in 16.9% of children; descriptive analysis showed an event rate of 25.0% during Stage 2, 25.0% during Stage 3, and 11.6% during Stage 4.</p><p><strong>Conclusions: </strong>While stage assignment was possible among captured cases, the predefined data capture targets were not met. This pilot study successfully identified key workflow and feasibility barriers, which establish a foundation for refining protocols in the upcoming multicenter ExPEDIA registry.</p><p><strong>Trial registration: </strong>Clinical Trial Registration: jRCT 1030250099.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550183","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Precision Analgesia in Pediatric Tonsillectomy: More Than Opioid Choice.","authors":"Kimmo Murto, Britta S von Ungern-Sternberg","doi":"10.1002/pan.70266","DOIUrl":"10.1002/pan.70266","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471951","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":"Automated Versus Manual Endotracheal Tube Cuff Pressure Control in Mechanically Ventilated Children: A Randomized Crossover Trial.","authors":"Ekin Soydan, Esat Erdem Gokpınar, Ozlem Karakaya, Zeynep Gökoglu Sevinc, Gokhan Ceylan, Mehmet Gurkan Erbas, Selma Albayrak, Özlem Demirel, Ece Dorsan Yay, Kaan Aslan, Nihal Karaöz Özdamar, Nuriye Turgut, Utku Karaarslan, Hasan Agin","doi":"10.1002/pan.70268","DOIUrl":"10.1002/pan.70268","url":null,"abstract":"<p><strong>Background: </strong>Optimal endotracheal tube cuff pressure is key for airway sealing and minimizing microaspiration and tracheal injury in ventilated children. However, intermittent manual monitoring can allow significant pressure changes and be affected by measurement artifacts, potentially reducing airway protection.</p><p><strong>Aims: </strong>This study evaluated whether automated cuff pressure control better maintains target pressure than manual monitoring in ventilated children, and assessed its effects on off-target pressure and workload.</p><p><strong>Methods: </strong>In this prospective, randomized crossover study, mechanically ventilated pediatric patients (1 month-18 years) expected to require ventilation for ≥ 48 h underwent two randomized 24-h monitoring phases (manual and automated). During the manual phase, cuff pressure was continuously displayed via a closed system without repeated disconnection of the manometer and was intermittently adjusted by bedside nurses according to a predefined protocol. During the automated phase, cuff pressure was continuously regulated using an automated control system to maintain a target range of 15-25 cmH₂O. The primary outcomes were the frequency and cumulative duration of off-target cuff pressure exposure; secondary outcomes included nursing workload.</p><p><strong>Results: </strong>Thirty-two patients completed both phases (768 measurements). Low cuff pressure episodes (< 15 cmH₂O) were more frequent during manual monitoring than automated monitoring (12.7% vs. 1.3%, p < 0.001), while high-pressure episodes (> 25 cmH₂O) occurred only during manual monitoring (2.6% vs. 0%, p < 0.001). Total time outside the target range was markedly reduced with automated monitoring (118 vs. 10 h, p < 0.001). Nursing workload was significantly lower in the automated phase (3.65 h vs. 0.08 h, p < 0.001).</p><p><strong>Conclusions: </strong>Automated cuff pressure control more reliably maintains target pressure and minimizes clinically important deviations compared to manual management. These results support adopting continuous automated regulation as a preferred strategy to enhance airway safety and reduce workload in mechanically ventilated children.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT06965400).</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472001","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}