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Jurbergs N, Kennedy A, Harman JL. Promoting Completion of Cranial Radiation Therapy Without Sedation in Young Patients With Brain Tumors: A Case Series Illustrating Flexible Application of Empirically Supported Intervention. J Pediatr Hematol Oncol 2023; 45:91-94. [PMID: 36044332 DOI: 10.1097/mph.0000000000002542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/16/2022] [Indexed: 11/25/2022]
Abstract
Repeated anesthesia poses risks to patients but is often utilized to immobilize young children undergoing cranial radiation therapy for brain tumors. To enable young patients to remain still during cranial radiation therapy and thereby avoid sedation, medical and psychosocial clinicians can use behavioral and other supportive interventions. This case series illustrates the utility of behavioral training for motion control in 3 children 6 years old or younger who were treated for brain tumors. We demonstrate the efficacy of flexible, individualized intervention approaches to accommodate patients with brain tumors in the context of emotional dysregulation, significant communication barriers, and profound sensory deficits.
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Affiliation(s)
| | - Amy Kennedy
- Child Life, St. Jude Children's Research Hospital, Memphis, TN
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2
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Kotlarek KJ, Sitzman TJ, Williams JL, Perry JL. Nonsedated Magnetic Resonance Imaging for Visualization of the Velopharynx in the Pediatric Population. Cleft Palate Craniofac J 2023; 60:249-252. [PMID: 34787476 PMCID: PMC9110557 DOI: 10.1177/10556656211057361] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Non-sedated MRI is gaining traction in clinical settings for visualization of the velopharynx in children with velopharyngeal insufficiency. However, the behavioral adaptation and training aspects that are essential for successful pediatric MRI have received limited attention. SOLUTION We outline a program of behavioral modifications combined with patient education and provider training that has led to high success rates for non-sedated velopharyngeal MRI in children.
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Affiliation(s)
- Katelyn J. Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, USA
| | - Thomas J. Sitzman
- Division of Plastic Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA, Division of Plastic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA, Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
| | - Jessica L. Williams
- Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA, Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA
| | - Jamie L. Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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3
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Liao EN, Li Y, Fung A, Lawless L, Czechowicz J, Ho M, Luu K, Meyer L, Mohamad NI, Nadaraja GS, Taketa E, Virbalas J, Weinstein JE, Tsai T, Chan DK. Predictors of successful natural sleep MRI for sensorineural hearing loss in infants. Int J Pediatr Otorhinolaryngol 2023; 165:111430. [PMID: 36603347 DOI: 10.1016/j.ijporl.2022.111430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/08/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cochlear implantation (CI) in children with sensorineural hearing loss (SNHL) before 12 months of age (mo) improves language outcomes. MRI is important to assess CI candidacy. Anesthesia before 3 years old may increase risk of neurocognitive delay. Natural sleep MRI (NS-MRI) is an emerging technique to avoid anesthesia in infants, but relies on successful sleep for adequate imaging. Our multidisciplinary team hypothesized the following predictors of successful NS-MRI for CI evaluation: age, distance travelled, comorbidities, primary language, insurance type, HL characteristics, time and duration of MRI. METHODS We performed retrospective review of children 0-12mo who attempted NS-MRI. The NS-MRI was successful if imaging was sufficient for definitive clinical management per the managing otolaryngologist. RESULTS Among 26 patients (29 scans), the median age was 3.2mo (range: 1.2-6.8mo), distance travelled was 16.3 miles (range: 0.9 to 365 miles), 12 (46%) children had medical comorbidities. 8 (31%) had public insurance. 10 (38%) had bilateral HL. 52% (15/29) of scans were successful. Patients with comorbidities had significantly lower odds of successful NS-MRI (OR 0.09; 95% CI 0.01-0.54). Success was not associated with age, distance travelled, insurance type, primary language, HL characteristics, time or duration of MRI on univariable analysis. All 11 children who failed NS-MRI underwent hearing-aid fitting and/or imaging with sedation and CI as clinically indicated before 12mo. CONCLUSION NS-MRI was successful in 52% of infants, regardless of age, demographics, HL or MRI characteristics. Unsuccessful NS-MRI did not result in delayed intervention. NS-MRI is an effective consideration for a broad range of infants with SNHL.
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Affiliation(s)
- Elizabeth N Liao
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Andrea Fung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Lindsay Lawless
- Department of Radiology Central Nursing and Support, University of California, San Francisco, San Francisco, CA, USA
| | - Josephine Czechowicz
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Ho
- Department of Audiology, University of California, San Francisco, San Francisco, CA, USA
| | - Kimberly Luu
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren Meyer
- Department of Child Life Services, University of California, San Francisco, San Francisco, CA, USA
| | - Noura I Mohamad
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Garani S Nadaraja
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Emily Taketa
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jordan Virbalas
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jacqueline E Weinstein
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Tiffany Tsai
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Dylan K Chan
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
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Schneider DT, Balg J, Bernbeck B, Ellerkmann R, Klein M, Leutner A, Lindel P, Manns G, Mause U, Preziosi M, Schilling A, Schnittfeld S, Seyfert A, Winkelmann A, Rohde S. Magnetresonanztomographie-Untersuchung von Kindern in einem audiovisuell gestalteten Kinder-Magnetresonanztomographen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01541-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Anwar I, McCabe B, Simcock C, Harvey-Lloyd J, Malamateniou C. Paediatric magnetic resonance imaging adaptations without the use of sedation or anaesthesia: A narrative review. J Med Imaging Radiat Sci 2022; 53:505-514. [DOI: 10.1016/j.jmir.2022.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
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Sobey J, Tsai MH, Evans RE. An update on pediatric sedation techniques in nonoperating room locations. Curr Opin Anaesthesiol 2021; 34:449-454. [PMID: 34039846 DOI: 10.1097/aco.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review advancements in care for pediatric patients in nonoperating room settings. RECENT FINDINGS Advances in patient monitoring technology, utilization of Child Life specialists, and alternative staffing models are helping anesthesia providers meet the rising demand for coverage of pediatric nonoperating room anesthesia (NORA) cases. The Wake Up Safe and Pediatric Sedation Research Consortium registries are exploring outcome measures regarding the safety of pediatric anesthesia in off-site locations and have reported an increased risk for severe respiratory and cardiac adverse events when compared to OR anesthesia sites. Additionally, malpractice claims for NORA have a higher proportion of claims for death than claims in operating rooms. SUMMARY Pediatric NORA requires thorough preparation, flexibility, and vigilance to provide safe anesthesia care to children in remote locations. Emerging techniques to reduce anesthetic exposure, improve monitoring, and alternative staffing models are expanding the boundaries of pediatric NORA to provide a safer, more satisfying experience for diagnostic and interventional procedures.
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Affiliation(s)
- Jenna Sobey
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mitchell H Tsai
- Department of Anesthesiology, Orthopaedics and Rehabilitation (by courtesy), and Surgery (by courtesy), Larner College of Medicine, University of Vermont
| | - Rebecca E Evans
- Division of Pediatric Anesthesiology, Larner College of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
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Pediatric MRI Without Anesthesia: The Effect of Application-Supported Communication to Prepare the Child. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.jradnu.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jacola LM, Anghelescu DL, Hall L, Russell K, Zhang H, Wang F, Peters JB, Rossi M, Schreiber JE, Gajjar A. Anesthesia Exposure during Therapy Predicts Neurocognitive Outcomes in Survivors of Childhood Medulloblastoma. J Pediatr 2020; 223:141-147.e4. [PMID: 32532646 PMCID: PMC7387137 DOI: 10.1016/j.jpeds.2020.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/11/2020] [Accepted: 04/15/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the contribution of anesthesia exposure during treatment for childhood medulloblastoma to neurocognitive outcomes 3 years after tumor diagnosis. STUDY DESIGN In this retrospective study, anesthesia data were abstracted from medical records for 111 patients treated with risk-adapted protocol therapy at St Jude Children's Research Hospital. Neurocognitive testing data were obtained for 90.9% of patients. RESULTS For the 101 patients (62.4% male) who completed testing, mean age at diagnosis was 10.1 years, and 74.3% were staged to have average-risk disease. Anesthesia exposure during treatment ranged from 1 to 52 events (mean = 19.9); mean cumulative duration per patient was 21.1 hours (range 0.7-59.7). Compared with normative expectations (16%), the group had a significantly greater frequency of at-risk scores (<1 SD) on measures of intelligence (28.7%), attention (35.2%), working memory (26.6%), processing speed (46.7%), and reading (25.8%). Including anesthesia exposure duration to linear regression models accounting for age at diagnosis, treatment intensity, and baseline IQ significantly increased the predicted variance for intelligence (r2 = 0.59), attention (r2 = 0.29), working memory (r2 = 0.31), processing speed (r2 = 0.44), and reading (r2 = 0.25; all P values <.001). CONCLUSIONS In survivors of childhood medulloblastoma, a neurodevelopmentally vulnerable population, greater exposure to anesthesia significantly and independently predicts deficits in neurocognitive and academic functioning. When feasible, anesthesia exposure during treatment should be reduced.
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Affiliation(s)
- Lisa M Jacola
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN.
| | | | | | | | - Hui Zhang
- St. Jude Children’s Research Hospital
| | - Fang Wang
- St. Jude Children’s Research Hospital
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Developing communication support for interaction with children during acute radiographic procedures. Radiography (Lond) 2020; 26:96-101. [DOI: 10.1016/j.radi.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/22/2022]
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Hanafy AK, Mujtaba B, Roman-Colon AM, Elsayes KM, Harrison D, Ramani NS, Waguespack SG, Morani AC. Imaging features of adrenal gland masses in the pediatric population. Abdom Radiol (NY) 2020; 45:964-981. [PMID: 31538225 DOI: 10.1007/s00261-019-02213-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The spectrum of adrenal masses in the pediatric population markedly differs from that in the adult population. Imaging plays a crucial role in detecting adrenal masses, differentiating malignant from benign lesions, recognizing extra-adrenal lesions in the suprarenal fossa, and directing further management. Ultrasound is the primary imaging modality of choice for the evaluation of adrenal masses in the neonatal period, whereas MRI or CT is used as a problem-solving tool. In older children, computed tomography or magnetic resonance imaging is often required after initial sonographic evaluation for further characterization of a lesion. Herein, we discuss the salient imaging features along with pathophysiology and clinical features of pediatric adrenal masses.
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Affiliation(s)
- Abdelrahman K Hanafy
- The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Bilal Mujtaba
- The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Alicia M Roman-Colon
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Khaled M Elsayes
- The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Douglas Harrison
- Department of Pediatrics - Patient Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 0087, Houston, TX, 77030-4009, USA
| | - Nisha S Ramani
- Department of Anatomic Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia, & Hormonal Disorders, University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA
| | - Ajaykumar C Morani
- The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX, 77030, USA.
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Ashmore J, Di Pietro J, Williams K, Stokes E, Symons A, Smith M, Clegg L, McGrath C. A Free Virtual Reality Experience to Prepare Pediatric Patients for Magnetic Resonance Imaging: Cross-Sectional Questionnaire Study. JMIR Pediatr Parent 2019; 2:e11684. [PMID: 31518319 PMCID: PMC6716438 DOI: 10.2196/11684] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A magnetic resonance image (MRI) is a diagnostic test that requires patients to lie still for prolonged periods within a claustrophobic and noisy environment. This can be difficult for children to tolerate, and often general anesthetic (GA) is required at considerable cost and detriment to patient safety. Virtual reality (VR) is a newly emerging technology that can be implemented at low cost within a health care setting. It has been shown to reduce fear associated with a number of high-anxiety situations and medical procedures. OBJECTIVE The goal of the research was to develop a VR resource to prepare pediatric patients for MRI, helping to reduce anxieties in children undergoing the procedure. METHODS A freely accessible VR preparation resource was developed to prepare pediatric patients for their upcoming MRI. The resource consists of an app and supporting preparation book and used a series of panoramic 360 degree videos of the entire MRI journey, including footage from within the bore of the scanner. The app, deployed via the Android Play Store and iOS App Store, can be viewed on most mobile phones, allowing a child to experience an MRI in VR using an inexpensive Google Cardboard headset. The app contains 360 degree videos within an animated, interactive VR interface designed for 4 to 12-year-olds. The resource was evaluated as part of a clinical audit on 23 patients (aged 4 to 12 years), and feedback was obtained from 10 staff members. In 5 patients, the resource was evaluated as a tool to prepare patients for an awake MRI who otherwise were booked to have an MRI under GA. RESULTS The VR preparation resource has been successfully implemented at 3 UK institutions. Of the 23 patients surveyed, on a scale of 1 to 10, the VR resource was rated with a median score of 8.5 for enjoyment, 8 for helpfulness, and 10 for ease of use. All patients agreed that it made them feel more positive about their MRI, and all suggested they would recommend the resource to other children. When considering their experiences using the resource with pediatric patients, on a scale of 1 to 10, the staff members rated the VR resource a median score of 8.5 for enjoyment, 9 for helpfulness, and 9 for ease of use. All staff believed it could help prepare children for an awake MRI, thus avoiding GA. A successful awake MRI was achieved in 4 of the 5 children for whom routine care would have resulted in an MRI under GA. CONCLUSIONS Our VR resource has the potential to relieve anxieties and better prepare patients for an awake MRI. The resource has potential to avoid GA through educating the child about the MRI process.
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Affiliation(s)
- Jonathan Ashmore
- Department of Medical Physics and Bioengineering, NHS Highland, Inverness, United Kingdom.,Department of Neuroradiology, King's College Hospital, London, United Kingdom.,Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
| | - Jerome Di Pietro
- Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | | | - Euan Stokes
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
| | - Anna Symons
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
| | - Martina Smith
- Department of Neuroradiology, King's College Hospital, London, United Kingdom
| | - Louise Clegg
- South London and the Maudsley NHS Trust, London, United Kingdom
| | - Cormac McGrath
- Radiological Sciences & Imaging, Regional Medical Physics Service, Belfast Health and Social Care Trust, Belfast, United Kingdom
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