Pediatric Anesthesia最新文献

{"title":"Comparison of Discharge Readiness in Pediatric Patients: Oral Versus Intranasal Preoperative Midazolam Administration.","authors":"Mohammad Naem, Jobayer Hossain, Janna Hamideh, Judit Szolnoki","doi":"10.1002/pan.70267","DOIUrl":"https://doi.org/10.1002/pan.70267","url":null,"abstract":"<p><strong>Background: </strong>Midazolam is commonly administered orally or intranasally to reduce preoperative anxiety in children undergoing tympanostomy. Prior studies suggest differences in recovery exist between the two routes, but their impact on post-anesthesia care unit (PACU) length of stay remains unclear.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of pediatric patients aged 6 months to 10 years undergoing tympanostomy at Nemours Children's Hospital, Central Florida, between November 2023 and November 2024. Patients were grouped by midazolam route (intranasal 0.2 mg/kg IV formulation vs. oral 0.5 mg/kg syrup). The primary outcome was PACU length of stay, defined as time from PACU arrival to discharge based on standard hospital criteria. Predictors of administration route were evaluated using univariate logistic regression, and PACU length of stay was analyzed using age-adjusted ANCOVA with backward stepwise variable selection.</p><p><strong>Results: </strong>A total of 463 patients were included: 322 received oral midazolam and 141 received intranasal midazolam. In unadjusted analysis, intranasal midazolam was associated with a shorter PACU stay (mean 39.7 vs. 42.9 min, p = 0.02). However, patients receiving intranasal midazolam were significantly younger (31.5 vs. 37.8 months, p < 0.001). After adjustment for age, age emerged as the only independent predictor of PACU length of stay, and the association between administration route and PACU duration was attenuated and no longer significant (p = 0.15).</p><p><strong>Conclusions: </strong>Age, rather than route of midazolam administration, primarily explained differences in PACU discharge readiness among children undergoing tympanostomy. Previously reported differences in recovery time between oral and intranasal midazolam may reflect age-related confounding rather than a true effect of route. Future prospective, age-stratified studies are needed to clarify this relationship and refine pediatric sedation practices.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448604","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":"Routine Replacement of Fasting Deficits in Pediatric Ambulatory Anesthesia: A Propensity-Matched Retrospective Cohort Study.","authors":"Xiang Sharon Luo, Mathew Mason, Shannon Chan, Peter C Minneci, Kimberly Russo, Karie Steinmetz, Vanessa A Olbrecht","doi":"10.1002/pan.70261","DOIUrl":"10.1002/pan.70261","url":null,"abstract":"<p><strong>Background: </strong>Routine replacement of calculated fasting deficits is common during pediatric anesthesia, but it remains uncertain whether formula-based deficit replacement is necessary to maintain intraoperative stability or postoperative recovery.</p><p><strong>Aims: </strong>We aimed to evaluate whether reducing routine fasting-deficit replacement adversely affected intraoperative hemodynamic stability or early postoperative recovery in pediatric ambulatory procedures.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 9640 pediatric ambulatory procedures at a tertiary children's hospital (May 2024-March 2025), of whom 8508 were included after propensity score matching (4254 per group). A national intravenous fluid shortage prompted an institution-wide reduction in routine fasting-deficit replacement, creating a natural experiment independent of clinician preference. The primary outcome was intraoperative vasopressor administration; secondary outcomes included post-anesthesia care unit (PACU) rescue antiemetic use, PACU length of stay, and emergency department encounters within 24 h.</p><p><strong>Results: </strong>Mean intraoperative crystalloid administration decreased by 38.1% following the practice change. Reduced fluid administration was not associated with increased vasopressor use (adjusted OR 1.13, 95% CI 0.92-1.38). Secondary outcomes-PACU rescue antiemetic use (adjusted OR 0.44, 95% CI 0.13-1.43), PACU length of stay (mean difference -0.7 min), and emergency department encounters within 24 h (adjusted OR 0.53, 95% CI 0.21-1.32)-did not differ between groups, though event rates were low and the study was not powered to detect differences in these outcomes. The confidence interval for the primary outcome does not exclude a clinically meaningful increase in vasopressor use; statistical non-significance should not be interpreted as equivalence.</p><p><strong>Conclusions: </strong>In children undergoing ambulatory procedures, a substantial reduction in routine fasting-deficit replacement was not associated with increased vasopressor use, and no important differences were observed in early postoperative recovery. These findings did not identify a clear benefit of routine empiric fasting-deficit replacement in otherwise healthy children undergoing short ambulatory procedures.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430886","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 Study of Socioeconomic Status and Emergence Delirium.","authors":"Tiffanie Lautenbach, Vinod Patil","doi":"10.1002/pan.70264","DOIUrl":"https://doi.org/10.1002/pan.70264","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412548","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":"Perspectives in Pediatric Ambulatory Anesthesia: Part 3-One Center's Evolving Regional Anesthesia Experience and Outcomes.","authors":"David E Liston, Elizabeth E Hansen, Jennifer L Chiem, Sean H Flack, Daniel K W Low, Lynn D Martin","doi":"10.1002/pan.70255","DOIUrl":"https://doi.org/10.1002/pan.70255","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric ambulatory surgery is the dominant model of surgical care in the U.S. and has impacted the practice of regional anesthesia (RA). Pediatric RA's use has expanded as a supplement to general anesthesia with the introduction of ultrasound. We wish to document RA practice changes over the last 14 years in our ambulatory surgery center (ASC).</p><p><strong>Methods: </strong>A retrospective review of RA practice from 7/2010 to 12/2024 at a free-standing pediatric ASC was performed. A commercial software system extracted de-identified, aggregated health data from the system's EMR. Using statistical process control methods, data were processed to distinguish between common and special cause variation.</p><p><strong>Results: </strong>Incidence of peripheral nerve blocks (PNB) was 13% and increased to 35.4% (associated with ultrasound use and pudendal block standard for penile surgery). The inverse was seen with central neuraxial block (CNB), dropping from 10% of cases to 2%. At baseline 25% of cases received a single injection block, increasing three-fold (associated with ultrasound/pudendal introductions, COVID-related reduction in non-regional cases, and non-regional case volume recovery). The incidence of continuous catheter cases was 3.7% and decreased twice (associated with COVID and sports medicine catheter program closure). Anesthesia preparation time with RA decreased from 16.8 to 12.5 min (associated with ultrasound introduction, end of COVID restrictions, and sports medicine catheter program closure). The first attempt RA success rate was high (PNB-90%, CNB-83%; single injection-89%, continuous catheter-96%). PACU maximum pain and opioid use rates decreased for RA and non-RA patients. Wrong-site blocks, their root cause analyses, and improvements to the RA timeout are discussed.</p><p><strong>Discussion: </strong>This review's key findings include an evolution in RA practice, which in conjunction with opioid-sparing efforts, have driven improvements in clinical outcomes. Our ambulatory pediatric RA practice may not reflect practice seen in others; thus, we do not make inferences outside our facility.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412569","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":"Implementing the Safer Anaesthesia From Education Paediatrics Course in Japan: Contextual Adaptation and Early National Dissemination.","authors":"Yuki Fujimoto, Norifumi Kuratani","doi":"10.1002/pan.70262","DOIUrl":"https://doi.org/10.1002/pan.70262","url":null,"abstract":"<p><strong>Background: </strong>In Japan, declining birth rates and concentration of pediatric cases in fewer high-volume children's hospitals have reduced anesthesiologists' opportunities, particularly during training, to gain experience in pediatric anesthesia. There is no standardized national curriculum, and training relies largely on workplace-based learning. The Safer Anaesthesia From Education (SAFE) Paediatrics Course is a structured program originally developed for low- and middle-income countries; whether it can be contextually adapted and disseminated in a high-income country facing different training challenges has not been established.</p><p><strong>Aims: </strong>To describe the translation, contextual adaptation, early implementation, and initial national dissemination of the SAFE Paediatrics Course in Japan, including preliminary educational outcomes from a single-center resident training program.</p><p><strong>Methods: </strong>We conducted a two-phase descriptive educational project. Phase 1 comprised course translation, contextual adaptation, pilot testing of a multiple-choice question (MCQ) examination, and pilot delivery. Phase 2 comprised single-center implementation and evaluation at Saitama Children's Medical Center among anesthesia residents (October 2021-March 2023). Participants completed pre- and post-course MCQ tests and confidence ratings; a post-course survey assessed satisfaction. National dissemination was described using aggregated course-level data.</p><p><strong>Results: </strong>Thirty residents participated in the single-center evaluation. MCQ scores increased from 37.87 to 41.67 out of 50 (mean increase 3.80; 95% CI: 2.64-4.96; p < 0.001), and self-rated confidence increased. Satisfaction was high (17/20 respondents rated the course 4 or 5). Between October 2021 and January 2026, 28 courses were delivered across four geographical areas and national meeting-affiliated sessions, accounting for 359 participant attendances; many used condensed one-day or half-day formats.</p><p><strong>Conclusions: </strong>The SAFE Paediatrics Course was translated, contextually adapted, and implemented in Japan, with early dissemination across multiple geographical areas and flexible delivery formats. Preliminary single-center outcomes support its suitability as a structured pediatric anesthesia educational program in this setting. Further multicenter and longitudinal evaluation is warranted.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405397","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":"Perianesthetic Complications in Genetic Mitochondrial Disease: A Review of Case Reports.","authors":"Brittany M Johnson, Simon C Johnson","doi":"10.1002/pan.70257","DOIUrl":"https://doi.org/10.1002/pan.70257","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Genetic mitochondrial diseases (GMDs) are a large group of genetically and clinically heterogeneous disorders caused by defects in genes encoding mitochondrial components. GMDs are grouped into named syndromes based on clinical presentation, for example, Leigh syndrome (LS). Surgical interventions are often required in GMDs, necessitating the use of general anesthesia (GA). Some GMD animal models show both a marked reduction in anesthetic concentrations necessary for sedation and toxic sequelae resulting from anesthetic exposures. Hypersensitivity to sedation by anesthetic agents, most notably volatile anesthetic agents (VAs), occurs in a subset of GMD patients, and some evidence suggests toxicities are also present. Reported complications of anesthesia in GMD are varied, including minor metabolic changes, acceleration of underlying disease, and death. The potential toxicity of anesthetics in the setting of GMDs has recently been underscored by deaths among pediatric and young adult patients of Venezuelan descent putatively linked to a specific mitochondrial DNA haplotype. Interpretation of clinical findings is limited by the lack of a thorough review of case reports for anesthetic exposures in GMD patients. Here, we provide a comprehensive review of published case reports for GMD patients undergoing anesthetic exposures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using search terms \"anesthesia mitochondrial disease,\" \"anesthesia mitochondrial disease case report,\" and \"anesthesia Leigh syndrome\" we identified case reports published up to May 2025. Non-English articles were translated and included where possible. Only reports of GMD patients undergoing GA with total intravenous anesthesia (TIVA) or VAs containing outcome information were included, totaling 148 cases from 123 reports. We examined relationships between complications and GA type, clinical diagnosis, perianesthetic drugs, procedure length and type, and general demographics. We performed a narrative review of clinical and pre-clinical literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall complication rate was significantly higher in VA versus TIVA cases (42% vs. 18%, Fisher's exact p-value **p = 0.0022), as was rate of severe complications (*p = 0.01). Encephalomyelopathies, including LS, were overrepresented among cases resulting in death. Complication rate has remained relatively stable over time. Sex and age were not associated with significant differences in complication rate. Complication rate varied significantly by procedure type, and severe complications were associated with procedure length. While not statistically significant, older VAs had higher complication rates than newer VAs. Similarly, older neuromuscular blockade agents may be less safe than newer drugs. N&lt;sub&gt;2&lt;/sub&gt;O and ketamine were notably safe among drugs used in TIVA procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Available case-report data support the notion that GMD patients are at increas","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397393","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":"Response to: Reliability of the Pediatric Specific ASA Physical Status Classification.","authors":"Lynne Ferrari, Steven J Staffa, Peter Hong, Jay G Berry","doi":"10.1002/pan.70258","DOIUrl":"https://doi.org/10.1002/pan.70258","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376434","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":"Inflammatory Indices and Pediatric Emergence Delirium: Predictive Signal or Statistical Artifact?","authors":"Robert Luo, Anupa Parajuli, Aimee Pak, Amir L Butt","doi":"10.1002/pan.70259","DOIUrl":"https://doi.org/10.1002/pan.70259","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382619","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":"Perspectives in Pediatric Ambulatory Anesthesia: Part 1-One Center's 15 Year Evolution in Eligibility, Utilization, Efficiency, and Outcomes.","authors":"Aaron B Low, Jennifer L Chiem, Corrie Casey, Samuel M Vanderhoek, Lynn D Martin","doi":"10.1002/pan.70254","DOIUrl":"10.1002/pan.70254","url":null,"abstract":"<p><strong>Introduction: </strong>Ambulatory surgery has become the dominant model of surgical care in the United States as surgical procedures increasingly shifted from inpatient to outpatient sites of practice. Similar growth in volumes has been observed in pediatric practice. Investigators have highlighted the challenges and opportunities in this current climate, including increasing medical and procedural complexity, difficulties matching pediatric-specific resources to meet the child's perioperative needs and unique risk profile, and limited availability of pediatric ambulatory surgical and anesthesia guidelines of care. Further, they call out the complete lack of pediatric outcomes data to help inform the creation and modification of national care guidelines.</p><p><strong>Methods: </strong>To address these challenges, we chose to complete a comprehensive, single center retrospective review of our process, outcome, and balancing metrics contained in our EMR from our free-standing pediatric ambulatory surgery center (ASC) since its opening in July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EMR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.</p><p><strong>Results: </strong>Patient and procedural acuity increased as the system matured via lower age cutoffs and higher ASA physical status scores. This higher acuity was managed with a dynamic and evolving screening process, resulting in no change in unplanned emergency visit or hospital admissions. The COVID-19 pandemic had profound impacts on ASC operations and case mix, including a temporary closure.</p><p><strong>Discussion: </strong>This retrospective, observational assessment created a detailed picture of our ASC practice changes over time. A pediatric-specific ASC with appropriate patient selection processes, practice guidelines, and clinical expertise successfully mitigated the risk of complications. These results are not generalizable to non-academic, community ambulatory facilities due to the unique characteristics of our pediatric-specific academic center.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382624","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":"Perspectives in Pediatric Ambulatory Anesthesia: Part 2-One Center's 15 Year Experience Improving Quality and Safety Outcomes.","authors":"Jennifer L Chiem, Elizabeth E Hansen, Kayla Reece, Samuel M Vanderhoek, Sanjay R Parikh, Paul A Merguerian, Lynn D Martin","doi":"10.1002/pan.70252","DOIUrl":"https://doi.org/10.1002/pan.70252","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric ambulatory surgery has become the dominant model of surgical care in the United States, driven primarily by economic forces. There is variability in regional practice patterns, quality improvement cycles, and outcomes. Opportunity exists to overcome knowledge gaps and provide sustainable pathways of quality improvement. Our unique capability of describing the evolution of our pediatric ambulatory quality improvement practice allows us to contribute a single center's perspective.</p><p><strong>Methods: </strong>We chose to complete a comprehensive retrospective review of our quality improvement process, outcome, and balancing metrics contained in our electronic health record (EHR) from our free-standing pediatric ambulatory surgery center (ASC) from July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EHR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation.</p><p><strong>Results: </strong>Improvement themes (opioid-free anesthesia and stewardship, enhanced recovery, environmental efforts, positive deviance, and learning healthcare system) are described. Improvements in all six domains of quality (effectiveness, efficiency/timeliness, patient experience, equity, and safety) are illustrated with reliable sustainability. Our system achieved approximately a 13-fold increase in quality improvement (QI) project completion rate with self-serve, real-world data access; enabling the team to take on improvement tasks previously deemed too big, lengthy, or risky to complete.</p><p><strong>Discussion: </strong>We provide preliminary evidence that these methods may be generalizable. Requirements include engaged leadership, a standard framework for improvement with experienced leadership or accessible support, and easy access to real-world electronic medical record data (i.e., learning healthcare system [LHS]). Lastly, leaders must create a culture supportive of teamwork, change, and continuous improvement. Systems facilitate adoption and hinder resistance to standards, always with implementation and sustainability in mind. Meaningful, large-scale improvements in healthcare outcomes require collaboration across LHSs.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382659","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}