Pediatric Anesthesia最新文献

{"title":"Editor's Picks for the Pediatric Anesthesia Article of the Day: October 2024.","authors":"Melissa Brooks Peterson, Myron Yaster, Justin L Lockman","doi":"10.1111/pan.15062","DOIUrl":"10.1111/pan.15062","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"323-324"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067078","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":"Pharmacokinetic and Physiological Concepts Relevant for Determining Sevoflurane Dose.","authors":"James D Morse, Brian J Anderson","doi":"10.1111/pan.15077","DOIUrl":"10.1111/pan.15077","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"267-269"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189997","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":"Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.","authors":"Kristen K Thomsen, Michael Fritz, Christian Zöllner, Till Kessler, Bernd Saugel, Leonie Schulte-Uentrop","doi":"10.1111/pan.15059","DOIUrl":"10.1111/pan.15059","url":null,"abstract":"<p><strong>Background: </strong>Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.</p><p><strong>Aims: </strong>We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.</p><p><strong>Methods: </strong>This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.</p><p><strong>Results: </strong>150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).</p><p><strong>Conclusion: </strong>TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.</p><p><strong>Trial registration: </strong>German Clinical Trial Register: DRKS00028271.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"310-315"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927588","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":"Mucositis Pain and Its Temporal Relationship to White Cell Count.","authors":"Claire Douglas, James D Morse, Brian J Anderson","doi":"10.1111/pan.15063","DOIUrl":"10.1111/pan.15063","url":null,"abstract":"<p><strong>Background: </strong>Children who have received chemotherapy and/or radiotherapy treatment resulting in neutropenia can suffer painful mucositis. We explored the relationship between pain score and white cell count in children with mucositis due to immunosuppression and assessed the influence of opioid and ketamine analgesia.</p><p><strong>Methods: </strong>Children with mucositis nursed in the pediatric oncology and hematology ward were invited to partake in this observational study following referral to the pediatric pain service for intravenous analgesia. Pain scores, white cell count, neutrophil count, and analgesia requirements were recorded daily until intravenous analgesia was either stopped or transitioned to oral analgesia. Data were analyzed using nonlinear mixed effects models that sought a relationship between white cell count and pain score using a sigmoid maximal effect (E_MAX) model. The impact of analgesic use on pain score was determined. The temporal relationship between white cell count and pain score was characterized by using a delayed effect model with an equilibration half-time.</p><p><strong>Results: </strong>Fifty children were enrolled in the study from January 2022 to December 2023. The equilibration half-time relating the rise in white cell count and pain response was 0.29 days. The initial pain score (estimated in those children already started on treatment with paracetamol and tramadol) was 6.3 (maximum pain 10). The maximum pain reduction was 59% of that initial pain score. Morphine and ketamine further reduced pain; the maximum response for opioids was 38% reduction and that for ketamine was 11%.</p><p><strong>Conclusion: </strong>Pain relief from mucositis is related to an increase in white cell count after a period of severe neutropenia, where white cell count is a surrogate for neutrophil count. There is a delay in analgesic response of approximately 1 day. This analgesic response to increasing white cell count had greater dominance than analgesia achieved using either opioids or ketamine.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"302-309"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932133","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":"Anesthesia Delivery in Humanitarian Context: Lessons From the Front Line.","authors":"Rodrigo Lopez-Barreda","doi":"10.1111/pan.15108","DOIUrl":"https://doi.org/10.1111/pan.15108","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743506","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":"Anesthesia Provider and Facility Practice Patterns in Ambulatory Surgical Centers Caring for Children: A Survey of the Society for Ambulatory Anesthesia.","authors":"Samuel M Vanderhoek, Sameh Nour, Shiu-Yi Emily Chen","doi":"10.1111/pan.15102","DOIUrl":"https://doi.org/10.1111/pan.15102","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701127","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 May 2025.","authors":"","doi":"10.1111/pan.15101","DOIUrl":"https://doi.org/10.1111/pan.15101","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663896","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":"Hemodynamic Effects of Altering Tidal Volume During Positive Pressure Ventilation in the Fontan Circulation: A Randomized Crossover Trial.","authors":"Manchula Navaratnam, Alexander R Schmidt, Michelle Kaplinski, Elizabeth De Souza, Meaghan J Beattie, Echo V Rowe, Rajesh Punn, Chandra Ramamoorthy","doi":"10.1111/pan.15096","DOIUrl":"https://doi.org/10.1111/pan.15096","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Primary determinants of pulmonary blood flow in the Fontan circulation are low transpulmonary gradient and pulmonary vascular resistance (PVR). Changes in intrathoracic pressure during intermittent positive pressure ventilation can influence the transpulmonary gradient, PVR, pulmonary blood flow, and cardiac output. The aim of this study was to evaluate the effect of low (5 mL/kg) versus high (10 mL/kg) tidal volume (V&lt;sub&gt;T&lt;/sub&gt;) ventilation on Fontan circulation hemodynamics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Postoperative patients with a Fontan circulation were enrolled in this single-center, randomized crossover trial. Patients, randomized to group 1 or 2, underwent a ventilation study sequence (baseline ventilation [7 mL/kg], then high V&lt;sub&gt;T&lt;/sub&gt; [10 mL/kg] or low V&lt;sub&gt;T&lt;/sub&gt; [5 mL/kg], then washout ventilation [7 mL/kg], followed by low [5 mL/kg] or high V&lt;sub&gt;T&lt;/sub&gt; [10 mL/kg]) in the operating room at the end of the cardiac surgical procedure. Respiratory, hemodynamic, and transesophageal (TEE) measurements were recorded after 5 min in each ventilation condition. The primary aim of this study was to evaluate the effect of low V&lt;sub&gt;T&lt;/sub&gt; ventilation (5 mL/kg) versus high V&lt;sub&gt;T&lt;/sub&gt; ventilation (10 mL/kg) on transpulmonary gradient (Fontan pressure minus left atrial pressure). The secondary aim was to compare TEE measurements of pulmonary blood flow, stroke volume, and Fontan flow between low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation. We also compared standard hemodynamic and ventilation parameters for all ventilation conditions. Analysis was of paired data, calculating the between-treatment difference within participants across ventilation conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eleven patients were included in the final data analysis with a median [IQR] age of 5 [4, 11] years and weight of 16.3 [13.8, 31.6] kg. The mean (±SD) peak inspiratory pressure during low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation was 15.3 (±2.9) cmH&lt;sub&gt;2&lt;/sub&gt;O and 22.2 (±3.7) cmH&lt;sub&gt;2&lt;/sub&gt;O, respectively (difference -6.9, 95% CI -7.8, -5.9, p &lt; 0.001). The mean airway pressure during low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation was 7.3 ± 0.8 and 8.7 ± 0.9 (difference -1.5, 95% CI -2.1, -0.8, p = 0.001) with a mean inspiratory time of 0.62 (±0.22) s and 1.21 (±0.55) s (difference -0.59, 95% CI -0.84, -0.34, p &lt; 0.001), respectively. During low V&lt;sub&gt;T&lt;/sub&gt; ventilation, the mean Fontan pressure was 13.3 (±1.8) mmHg compared to 12.3 (±2.5) mmHg for high V&lt;sub&gt;T&lt;/sub&gt; ventilation (difference 0.8, 95% CI -0.5, 2.1, p = 0.18). The mean transpulmonary gradient was 7.0 ± 1.3 mmHg compared to 6.8 ± 1.2 mmHg during low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation, respectively (difference 0.2, 95% CI -0.2, 0.6, p = 0.21). We found no significant differences between low and high V&lt;sub&gt;T&lt;/sub&gt; ventilation in TEE measures of pulmonary blood flow, stroke volume, and Fontan flow.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This randomized, crossover pilot trial of Fo","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657951","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":"Predictors of Perioperative Respiratory Adverse Events in Children Undergoing Surgery for Oropharyngeal Cleft Deformity: A Prospective Observational Study (PRAE-OPCD Study).","authors":"Usha Shenoy, Bijoy Chirayath, P V Narayanan, Avni Francis, Mariam Koshy Thomas, Rakesh Rajagopal","doi":"10.1111/pan.15100","DOIUrl":"https://doi.org/10.1111/pan.15100","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children with oropharyngeal cleft deformity (OPCD) undergoing reconstructive surgery are at greater risk for perioperative respiratory adverse events (PRAEs). Predictors for PRAE specific to this population have not been investigated, despite it being the most common congenital malformation seen worldwide.</p><p><strong>Materials and methods: </strong>This single-center, prospective, observational study recruited 270 children under 2 years of age, undergoing elective cleft surgery from May 1, 2023, to June 30, 2024. The primary aim was to identify predictors of pre-determined PRAE (laryngospasm, bronchospasm, stridor, airway obstruction and desaturation). We also aimed to identify the more common PRAE in this patient population.</p><p><strong>Results: </strong>Of the 345 children who underwent cleft correction surgery, 270 were included in the study. There was a statistically increased incidence of PRAE in children with a positive history of upper airway obstruction and a history of feeding disorder in early infancy, Cormack Lehane (CL) grade ≥ 3, and COLDS score ≥ 15. A significant association was found between the COLDS score (odds ratio [OR]: 0.005, 95% confidence interval [CI]: 0.001-0.049), CL grade ≥ 3 (OR: 0.008, 95% CI: 0.001-0.078) and PRAE.COLDS score ≥ 15 (p = 0.046; adjusted OR [AOR]: 18.07, 95% CI: 1.06-308.45) and CL grade ≥ 3 (p = 0.007; AOR: 41.79, 95% CI: 2.74-636.40) were associated with PRAEs in the multivariate regression. The overall incidence of PRAE was 1.85%, laryngospasm being the most common.</p><p><strong>Conclusion: </strong>Children with OPCD with higher COLDS scores and/or those with a CL grade view ≥ 3 are more likely to develop PRAE following corrective surgery. The limited data indicate the increased possibility of PRAE in children with a positive history of airway obstruction and/or feeding disorder in early infancy. The relatively low incidence of PRAE restricts the generalizability.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649839","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":"Error Traps in Developing a Pediatric Enhanced Recovery After Surgery (ERAS) Program.","authors":"Christian M Taylor, Emily L Weisberg, Nichole M Doyle, Todd A Glenski","doi":"10.1111/pan.15042","DOIUrl":"10.1111/pan.15042","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) pathways have been shown to improve patient outcomes, increase patient satisfaction, and decrease costs. First created and implemented in the adult population, these pathways are now commonplace and continue to expand in the pediatric realm. While there are many proven benefits to ERAS pathways, there continue to be challenges to their proper implementation and long-term success. This article aims to explore common challenges in pediatric ERAS development and implementation, along with strategies to avoid potential pitfalls. Key themes include departmental and institutional support, stakeholder engagement, awareness of pathways, data management and dissemination, and long-term maintenance including Plan-Do-Study-Act (PDSA) cycles. Pathway development teams should be aware of these considerations and potential pitfalls, and focusing on them can promote long-term success for a well-designed pathway.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"199-206"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693328","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}