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Shioji N, Sumie M, Englesakis M, Gilfoyle E, Maynes JT, Aoyama K. Multisystem inflammatory syndrome in children: an Umbrella review. J Anesth 2024; 38:309-320. [PMID: 38530453 DOI: 10.1007/s00540-024-03323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
We conducted an Umbrella review of eligible studies to evaluate what patient features have been investigated in the multisystem inflammatory syndrome in children (MIS-C) population, in order to guide future investigations. We comprehensively searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from December 1, 2019 to the May 6, 2022. The time period was limited to cover the coronavirus disease-2019 (COVID-19) pandemic period. The protocol was registered in the PROSPERO registry (CRD42022340228). Eligible studies included (1) a study population of pediatric patients ≤21 years of age diagnosed with MIS-C; (2) an original Systematic review or Mata-analysis; (3) published 2020 afterward; and (4) was published in English. A total of 41 studies met inclusion criteria and underwent qualitative analysis. 28 studies reported outcome data of MIS-C. 22 studies selected clinical features of MIS-C, and 6 studies chose demographic data as a main topic. The mortality rate for children with MIS-C was 1.9% (interquartile range (IQR) 0.48), the ICU admission rate was 72.6% (IQR 8.3), and the extracorporeal membrane oxygenation rate was 4.7% (IQR 2.0). A meta-analysis of eligible studies found that cerebral natriuretic peptide in children with MIS-C was higher than that in children with COVID-19, and that the use of intravenous immunoglobulin (IVIG) in combination with glucocorticoids to treat MIS-C compared to IVIG alone was associated with lower treatment failure. In the future, for patients with MIS-C, studies focused on safety of surgery requiring general anesthesia, risk factors, treatment, and long-term outcomes are warranted.
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Affiliation(s)
- Naohiro Shioji
- Department of Anesthesiology and Intensive Care Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Sumie
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Department of Anesthesiology, St. Mary's Hospital, Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Canada
| | - Elaine Gilfoyle
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
- Program in Molecular Medicine, SickKids Research Institute, Toronto, ON, Canada
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada.
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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Park JB, Sohn JY, Kang P, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS, Jang YE. Perioperative Respiratory-Adverse Events Following General Anesthesia Among Pediatric Patients After COVID-19. J Korean Med Sci 2023; 38:e349. [PMID: 38050910 PMCID: PMC10695756 DOI: 10.3346/jkms.2023.38.e349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The perianesthetic morbidity, mortality risk and anesthesia-associated risk after preoperative coronavirus disease 2019 (COVID-19) omicron variant in pediatric patients have not been fully demonstrated. We examined the association between preoperative COVID-19 omicron diagnosis and the incidence of overall perioperative adverse events in pediatric patients who received general anesthesia. METHODS This retrospective study included patients aged < 18 years who received general anesthesia between February 1 and June 10, 2022, in a single tertiary pediatric hospital. They were divided into two groups; patients in a COVID-19 group were matched to patients in a non-COVID-19 group during the omicron-predominant period in Korea. Data on patient characteristics, anesthesia records, post-anesthesia records, COVID-19-related history, symptoms, and mortality were collected. The primary outcomes were the overall perioperative adverse events, including perioperative respiratory adverse events (PRAEs), escalation of care, and mortality. RESULTS In total, 992 patients were included in the data analysis (n = 496, COVID-19; n = 496, non-COVID-19) after matching. The overall incidence of perioperative adverse events was significantly higher in the COVID-19 group than in the non-COVID-19 group (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.89-1.94). The difference was significant for PRAEs (OR, 2.00; 95% CI, 1.96-2.02) but not in escalation of care or mortality. The most pronounced difference between the two groups was observed in instances of high peak inspiratory pressure ≥ 25 cmH2O during the intraoperative period (OR, 11.0; 95% CI, 10.5-11.4). Compared with the non-COVID-19 group, the risk of overall perioperative adverse events was higher in the COVID-19 group diagnosed 0-2 weeks before anesthesia (OR, 6.5; 95% CI, 2.1-20.4) or symptomatic on the anesthesia day (OR, 6.4; 95% CI, 3.30-12.4). CONCLUSION Pediatric patients with the preoperative COVID-19 omicron variant had increased risk of PRAEs. Patients within 2 weeks after COVID-19 or those with symptoms had a higher risk of PRAEs.
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Affiliation(s)
- Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Young Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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Shioji N, Sumie M, Aoyama K. How long elective surgery should be delayed from COVID-19 infection in pediatric patients? J Anesth 2023:10.1007/s00540-023-03284-3. [PMID: 37975914 DOI: 10.1007/s00540-023-03284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Naohiro Shioji
- Department of Anesthesiology and Intensive Care Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Sumie
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Department of Anesthesiology, St. Mary's Hospital, Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada.
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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Challa C, Geng-Ramos G, Gray L, Orshan T, Thackeray L, Gupta P. Anxiety in children: A review on how to address it in the perioperative setting post-pandemic. Paediatr Anaesth 2023; 33:422-426. [PMID: 36876996 DOI: 10.1111/pan.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/22/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023]
Abstract
In this paper, we review the psychological burden of SARS-CoV-2 on children and how health care workers can play a role in mitigating its mental health impact during anesthetic procedures. We evaluate the societal changes that have affected children over 2 years of the pandemic and the subsequent soaring rates of anxiety and depression reported. Unfortunately, the perioperative setting is a stressful experience at baseline and the addition of COVID-19 has only exacerbated the situation. Anxiety and depression are often linked to maladaptive behavior post-surgery, including increased rates of emergence delirium. Providers can utilize techniques based on developmental milestones, Certified Child Life Specialists, parental presence during induction, and medications to reduce anxiety. As health care workers, we need to recognize and address these concerns as untreated mental health issues can leave long-term consequences for children.
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Affiliation(s)
- Chaitanya Challa
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Giuliana Geng-Ramos
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Laura Gray
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Taytum Orshan
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Laura Thackeray
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
| | - Pooja Gupta
- Children's National Hospital Ringgold Standard Institution - Anesthesiology, Pain & Preoperative Medicine, Washington, District of Columbia, USA
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Geng‐Ramos G, Nelson J, Lee AC, Deutsch N, Challa C, Pestieau S, Rana MS, Hubbard M, Cronin JA. Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study. Paediatr Anaesth 2023; 33:79-85. [PMID: 36314047 PMCID: PMC9877943 DOI: 10.1111/pan.14585] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/30/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with SARS-CoV-2 infection are at increased risk for postanesthesia complications. There is minimal data regarding how long that elevated complication risk persists beyond initial SARS-CoV-2 diagnosis. AIMS We investigated postanesthesia complications in children with SARS-CoV-2 infection within 90 days of diagnosis. METHODS We completed a single-center, retrospective, case-control study of pediatric patients with confirmed SARS-CoV-2 infection within 90 days undergoing anesthesia between January 3-October 7, 2020. Each SARS-CoV-2 positive patient was matched 1:2 by age and type of procedure with a non-SARS-CoV-2 cohort. The primary outcome was the rate of all postanesthesia complications within 30 days of the procedure, defined as unplanned escalations of care within 48 h, cardiac, respiratory, thrombotic, and hemorrhagic events within 30 days. Secondary outcomes were 30-day mortality and hospital length of stay. RESULTS Of the 341 patients included, 114 patients were SARS-CoV-2 positive and 227 were SARS-CoV-2 negative. Patients with a positive test 0-7 days prior to anesthesia had an increased risk difference in all postanesthesia complications within 30 days (19.9, 95% CI [4.7, 35.1], p = .001) and increased risk difference in length of hospital stay (7.8, 95% CI [1.2, 14.4], p < .001). Patients who underwent anesthesia greater than 42 days from SARS-CoV-2 diagnosis had an increased risk difference in cardiac complications within 30 days (4.3, 95% CI [0.9, 10.0], p = .029). There was no increased hospital length of stay among SARS-CoV-2 positive patients diagnosed greater than 8 days before anesthetic. There were no deaths within 30 days of anesthetic. CONCLUSIONS Postanesthesia complications are higher in children who undergo anesthesia within 7 days of SARS-CoV-2 diagnosis. Additional cardiac risk may persist beyond the immediate period of initial diagnosis. Larger samples are needed to further evaluate the risk of delayed postanesthesia complications and guide optimal timing of surgery.
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Affiliation(s)
- Giuliana Geng‐Ramos
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jonathan Nelson
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Angela C. Lee
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Nina Deutsch
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Chaitanya Challa
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Sophie Pestieau
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Md Sohel Rana
- Joseph E. Robert Jr, Center for Surgical CareChildren's National HospitalWashingtonDistrict of ColumbiaUSA
| | - Mark Hubbard
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Jessica A. Cronin
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National HospitalThe George Washington UniversityWashingtonDistrict of ColumbiaUSA
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Jarymowicz T, Baranowski A, Pietrzyk J, Pągowska-Klimek I. Anaesthesia in SARS-CoV-2 infected children - single-centre experience. A case-control study. Anaesthesiol Intensive Ther 2023; 55:223-228. [PMID: 37728451 PMCID: PMC10496091 DOI: 10.5114/ait.2023.130791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Although manifestation of SARS-CoV-2 infection in children is gene-rally mild or asymptomatic, anaesthetic implications of the infection in children are still a matter of concern. Single reports suggest that patients with SARS-CoV-2 infection are at higher risk of anaesthetic complications. MATERIAL AND METHODS We performed a retrospective, case control study analysing the risk of general anaesthesia in SARS-CoV-2 infected children admitted to a tertiary paediatric university hospital for the purpose of urgent procedures requiring anaesthesia between April 1st and September 30 th , 2021. The control group consisted of SARS-CoV-2 negative children consecutively anaesthetised for the same reasons during the first month of observation. Our hypothesis was: general anaesthesia can be safely performed in SARS-CoV-2 infected children. Study endpoints: primary - anaesthetic respiratory complications (bronchospasm, laryngospasm, intraoperative desaturation below 94%, desaturation below 94% after awakening, unplanned postoperative mechanical ventilation); secondary - hospital length of stay, thrombotic, cardiac, haemorrhagic events, ICU admission, deaths during hospitalisation. RESULTS The examined group consisted of 58 SARS-CoV-2 infected children, the matched control group of 198 patients. The rate of complications in both groups was very low, with no significant difference between the groups. The only differences observed were a higher frequency of desaturations in the awakening period and longer time of hospitalisation in SARS-CoV-2 infected patients. Multivariate logistic regression analysis showed that physical status of the patient and duration of the procedure were the main factors influencing the risk of complications. CONCLUSIONS In our experience anaesthesia of SARS-CoV-2 infected children can be safely performed.
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Affiliation(s)
- Tomasz Jarymowicz
- Department of Pediatric Anesthesiology and Intensive Care, Pediatric Teaching Hospital, University Clinical Center Warsaw Medical University, Warsaw, Poland
| | - Artur Baranowski
- Department of Pediatric Anesthesiology and Intensive Care, Pediatric Teaching Hospital, University Clinical Center Warsaw Medical University, Warsaw, Poland
- Medical University of Warsaw, Warsaw, Poland
| | - Justyna Pietrzyk
- Department of Pediatric Anesthesiology and Intensive Care, Pediatric Teaching Hospital, University Clinical Center Warsaw Medical University, Warsaw, Poland
| | - Izabela Pągowska-Klimek
- Department of Pediatric Anesthesiology and Intensive Care, Pediatric Teaching Hospital, University Clinical Center Warsaw Medical University, Warsaw, Poland
- Medical University of Warsaw, Warsaw, Poland
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Ruby JM, Illescas A, Zhong H, DelPizzo KR, Poeran J, Liu J, Cozowicz C, Memtsoudis SG. Pediatric anesthesia practices during the COVID‐19 pandemic: A retrospective cohort study. Health Sci Rep 2022; 6:e979. [PMCID: PMC9742494 DOI: 10.1002/hsr2.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Aims The onset of the coronavirus 2019 (COVID‐19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use. Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. Methods Using the Premier Health Database, we retrospectively analyzed pediatric patients undergoing a surgical intervention for fractures or ligament repair before and during COVID‐19. We sought to determine if there were differences in anesthesia use among this cohort during the two time periods. Fracture groups included shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankles, and foot and toes. Ligament procedures included surgical intervention for the anterior cruciate ligament and ulnar collateral ligament repair. Results We identified a total of 5935 patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. After exclusion for unknown anesthesia use, 2,807 patients were included in our cohort with 81.5% (n = 2288) of patients undergoing a procedure under general anesthesia, 6.4% (n = 181) under regional anesthesia, and 12.0% (n = 338) under combined general‐regional anesthesia. There did not appear to be a significant difference in the type of anesthesia used before and during COVID‐19 (p = 0.052). Conclusions Our study did not identify a difference in anesthesia use before and during COVID‐19 among pediatric patients undergoing a surgical procedure. Further studies should estimate the change in anesthesia used during the time period when elective procedures were resumed.
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Affiliation(s)
- Jordan M. Ruby
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Alex Illescas
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA
| | - Kathryn R. DelPizzo
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jashvant Poeran
- Department of Population Health Science & Policy/Orthopedics, Icahn School of Medicine at Mount SinaiInstitute for Healthcare Delivery ScienceNew YorkNew YorkUSA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Crispiana Cozowicz
- Department of Anesthesiology, Perioperative Medicine and Intensive Care MedicineParacelsus Medical UniversitySalzburgAustria
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Critical Care & Pain ManagementHospital for Special SurgeryNew YorkNew YorkUSA,Department of AnesthesiologyWeill Cornell MedicineNew YorkNew YorkUSA,Department of Health Policy and ResearchWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Asai T. Pandemic and infodemic: the role of academic journals and preprints. J Anesth 2022; 37:173-176. [PMID: 36459231 PMCID: PMC9716145 DOI: 10.1007/s00540-022-03149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Giwangkancana G, Oktaliansah E, Ramlan AAW, Utariani A, Kurniyanta P, Arifin H, Widyastuti Y, Pratiwi A, Syukur R. Perioperative Management for Emergency Surgery in Pediatric Patients with COVID-19: Retrospective Observational Study. Open Access Emerg Med 2022; 14:515-524. [PMID: 36164588 PMCID: PMC9509001 DOI: 10.2147/oaem.s377201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background The first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning. Aim To describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country. Methods The study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines. Results About 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ±13.3 days, and in-hospital mortality was 8.3%. Discussions Lockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment during these early pandemic times are often not efficient. Conclusion The incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.
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Affiliation(s)
- Gezy Giwangkancana
- Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin National Referral and Teaching Hospital, Bandung, Indonesia
| | - Ezra Oktaliansah
- Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin National Referral and Teaching Hospital, Bandung, Indonesia
| | - Andi Ade W Ramlan
- Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National Referral and Teaching Hospital, Jakarta, Indonesia
| | - Arie Utariani
- Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Airlangga/Dr. Soetomo Provincial Referral and Teaching Hospital, Surabaya, Indonesia
| | - Putu Kurniyanta
- Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Udayana/ Prof Dr. I.G.N.G Ngoerah National Referral and Teaching Hospital, Bali, Indonesia
| | - Hasanul Arifin
- Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Sumatera Utara/Dr. Adam Malik National Referral and Teaching Hospital, Medan, Indonesia
| | - Yunita Widyastuti
- Department of Anesthesia and Intensive Therapy, Faculty of Medicine, Public Health and Nursing Universitas Gajah Mada/Dr. Sardjito National Referral and Teaching Hospital, Yogyakarta, Indonesia
| | - Astrid Pratiwi
- Department of Anesthesia and Intensive Care, Harapan Kita Mother and Child Hospital, Jakarta, Indonesia
| | - Rusmin Syukur
- Department of Anesthesia and Intensive Care Faculty of Medicine Universitas Hassanudin/ Dr. Wahidin Sudirohusodo National Referal and Teaching Hospital, Makassar, Indonesia
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Sundland R, Essig R, Bachier-Rodriguez M. Lessons Learned from the Surgical Management of Childhood Cancers During the COVID-19 Pandemic. Pediatr Ann 2022; 51:e270-e276. [PMID: 35858216 DOI: 10.3928/19382359-20220504-06] [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] [Indexed: 11/20/2022]
Abstract
Globally, there have been more than 285 million confirmed cases of coronavirus disease 2019 (COVID-19), with nearly 5.5 million deaths. Centers for Disease Control and Prevention data report that in the United States alone, there have been more than 59 million cases of COVID-19 with more than 800,000 lives lost as of January 2022. Similar to other health care specialties, pediatric surgery departments have modified their treatment approach to delivering timely care while respecting resource allocation during the pandemic. In this review, we focus on the surgical management of pediatric patients, with specific attention to childhood cancer. The primary subject of this review is the development of triaging methods for patients with childhood cancer for surgical procedures and precautionary measures for operating on patients with COVID-19. [Pediatr Ann. 2022;51():e270-e276.].
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Boleken ME, Günendi T, Kocaman OH, Doğan F, Karahan MA. How the Covid-19 pandemic affects our perspective on the medical treatment of acute appendicitis in children. J Pediatr Surg 2022; 57:780-781. [PMID: 34774288 PMCID: PMC8518132 DOI: 10.1016/j.jpedsurg.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mehmet Emin Boleken
- Department of Pediatric Surgery, Harran University Medical Faculty, Harran Üniversitesi Hastanesi, Şanlıurfa 63300, Turkey.
| | - Tansel Günendi
- Department of Pediatric Surgery, Harran University Medical Faculty, Harran Üniversitesi Hastanesi, Şanlıurfa 63300, Turkey
| | - Osman Hakan Kocaman
- Department of Pediatric Surgery, Harran University Medical Faculty, Harran Üniversitesi Hastanesi, Şanlıurfa 63300, Turkey
| | - Ferit Doğan
- Department of Radiology, Harran University Medical Faculty, Şanlıurfa, Turkey
| | - Mahmut Alp Karahan
- Department of Anesthesiology and Reanimation, Harran University Medical Faculty, Şanlıurfa, Turkey
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Peterson MB, Gurnaney HG, Disma N, Matava C, Jagannathan N, Stein ML, Liu H, Kovatsis PG, von Ungern‐Sternberg BS, Fiadjoe JE. Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study. Anaesthesia 2022; 77:649-658. [PMID: 35319088 PMCID: PMC9111470 DOI: 10.1111/anae.15716] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/26/2022] [Accepted: 03/02/2022] [Indexed: 01/10/2023]
Abstract
Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.
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Affiliation(s)
- M. B. Peterson
- Department of AnesthesiologyChildren's Hospital Colorado/University of Colorado School of MedicineAuroraCOUSA
| | - H. G. Gurnaney
- Department of Anesthesiology and Critical Care MedicineThe Children's Hospital of Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPAUSA
| | - N. Disma
- Unit for Research and Innovation, Department of Pediatric AnesthesiaIstituto Giannina GasliniGenovaItaly
| | - C. Matava
- Department of Anesthesia and Pain MedicineHospital for Sick ChildrenTorontoONCanada
| | - N. Jagannathan
- Ann and Robert Lurie Children's Hospital of Chicago/Northwestern UniversityChicagoILUSA
| | - M. L. Stein
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
| | - H. Liu
- Data Science and Biostatistics Unit, Department of Biomedical and HealthThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - P. G. Kovatsis
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
| | - B. S. von Ungern‐Sternberg
- Department of Anesthesia and Pain MedicinePerth Children's Hospital, Telethon Kids Institute, The University of Western AustraliaPerthAustralia
| | - J. E. Fiadjoe
- Department of Anesthesiology and Critical Care MedicineThe Children's Hospital of Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPAUSA
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
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13
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Noris A, Peraio S, Di Rita A, Ricci Z, Spezzani C, Lenge M, Giordano F. Pediatric neurosurgery AC-after COVID-19: What has really changed? A review of the literature. Front Pediatr 2022; 10:928276. [PMID: 36160801 PMCID: PMC9490313 DOI: 10.3389/fped.2022.928276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 outbreak has dramatically changed the organization of Pediatric Neurosurgery all over the world. The departments involved developed similar plans to maintain emergency surgeries without reducing clinical activities. The Association of Pediatric Neurosurgeons wrote different memoranda to detail the surgical procedures not to be postponed with special attention given to high-risk pathology for COVID-19 contamination, like trans-naso-sphenoidal surgery. On this basis, we have conducted a complete literature review focusing on many topics: hospital organization, patients and parents screening, surgical indication criteria, outpatient clinic and teleconsultation, telematic conference and meeting, fellowship and training, and virtual multidisciplinary meeting.
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Affiliation(s)
- Alice Noris
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Simone Peraio
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Andrea Di Rita
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Zaccaria Ricci
- Department of Anesthesiology and Intensive Care, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Chiara Spezzani
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Matteo Lenge
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Flavio Giordano
- Neurosurgery and Functional Neurosurgery Unit, Department of Neurosurgery, Meyer Children's Hospital, University of Florence, Florence, Italy
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14
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Tailored Pharmacokinetic model to predict drug trapping in long-term anesthesia. J Adv Res 2021; 32:27-36. [PMID: 34484823 PMCID: PMC8139433 DOI: 10.1016/j.jare.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 01/25/2023] Open
Abstract
Introduction In long-term induced general anesthesia cases such as those uniquely defined by the ongoing Covid-19 pandemic context, the clearance of hypnotic and analgesic drugs from the body follows anomalous diffusion with afferent drug trapping and escape rates in heterogeneous tissues. Evidence exists that drug molecules have a preference to accumulate in slow acting compartments such as muscle and fat mass volumes. Currently used patient dependent pharmacokinetic models do not take into account anomalous diffusion resulted from heterogeneous drug distribution in the body with time varying clearance rates. Objectives This paper proposes a mathematical framework for drug trapping estimation in PK models for estimating optimal drug infusion rates to maintain long-term anesthesia in Covid-19 patients. We also propose a protocol for measuring and calibrating PK models, along with a methodology to minimize blood sample collection. Methods We propose a framework enabling calibration of the models during the follow up of Covid-19 patients undergoing anesthesia during their treatment and recovery period in ICU. The proposed model can be easily updated with incoming information from clinical protocols on blood plasma drug concentration profiles. Already available pharmacokinetic and pharmacodynamic models can be then calibrated based on blood plasma concentration measurements. Results The proposed calibration methodology allow to minimize risk for potential over-dosing as clearance rates are updated based on direct measurements from the patient. Conclusions The proposed methodology will reduce the adverse effects related to over-dosing, which allow further increase of the success rate during the recovery period.
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15
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Banerjee S, Gupta N, Sarkar D, Choudhury KJ. Anesthetic Management in an Infant with Dandy–Walker Syndrome Presenting with Acyanotic Heart Disease and Hydrocephalous Post-COVID-19 Recovery: A Rare Experience. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1731601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractWe report a case of hydrocephalus with Dandy–Walker malformation in a 2-month-old girl child recently recovered from COVID-19. The child was detected to have acyanotic heart disease with left-to-right shunt and severe pulmonary arterial hypertension during the preoperative evaluation process for ventriculoperitoneal (VP) shunt placement. We share our experience of the perioperative management for pulmonary artery banding (PAB) and patent ductus arteriosus ligation as a part of staged cardiac corrective surgery, followed by VP shunt to relieve hydrocephalus in the single setting. Our management was focused on the preservation of the normal cerebral and cardiac physiology to prevent rise in intracranial pressure and pulmonary artery pressure. A multidisciplinary team, consisting of cardiac- and neuroanesthesiologists and cardiac and neurosurgeons, was involved in management of the case. Diligent maintenance of airway, stable hemodynamics, meticulous ventilation, along with postoperative ICU management helped in the successful outcome of this unique case.
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Affiliation(s)
- Shraya Banerjee
- Neuroanaesthesia and Critical Care, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Nidhi Gupta
- Neuroanaesthesia and Critical Care, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Deepa Sarkar
- Cardiac Anaesthesia, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Kalyanpury J. Choudhury
- Neuroanaesthesia and Critical Care, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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16
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Multisystem inflammatory syndrome in children during the coronavirus disease pandemic of 2019: a review of clinical features and acute phase management. J Anesth 2021; 35:563-570. [PMID: 34052944 PMCID: PMC8164829 DOI: 10.1007/s00540-021-02952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
The current coronavirus disease of 2019 (COVID-19) pandemic has presented unique health challenges in the pediatric population. Compared to adults, the most significant change in viral disease manifestation is encompassed by the multisystem inflammatory syndrome in children (MIS-C). MIS-C is a new inflammatory syndrome which develops 2–4 weeks after COVID-19 exposure, with evidence suggesting it is a post-infectious immune reaction. We describe its epidemiology, pathophysiology, diagnosis (which varies based on definition used) and treatment options based on published recommendations. A systematic literature search we conducted through MEDLINE yielded 518 abstracts and identified five studies that reported more than 100 cases of MIS-C and their mortality. Most cases developed multiorgan dysfunction, including cardiovascular, dermatologic, neurological, renal, and respiratory issues, and required intensive care unit (ICU) admission. Many patients admitted to the ICU needed inotrope support and invasive mechanical ventilation, and the most severe cases required extracorporeal membrane oxygenation support. Most clinicians treated MIS-C with intravenous immunoglobulin, systemic steroids, and biological therapies. Overall mortality was low (2–3%) in all studies. Further research is needed to: understand if early intervention can prevent its progression; optimize its treatment; and improve outcomes of this new syndrome for the patients who develop MIS-C.
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17
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Sen I, Dave N, Bhardwaj N, Juwarkar C, Beegum S. Specialised training in paediatric anaesthesia: Need of the hour. Indian J Anaesth 2021; 65:17-22. [PMID: 33767498 PMCID: PMC7980246 DOI: 10.4103/ija.ija_1445_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022] Open
Abstract
Paediatric anaesthesia is an upcoming speciality which is gaining wide interest and can be a career choice for the new trainees. The need to develop paediatric anaesthesia as a speciality was realised with the progress in the field of paediatric surgery. The profile of the 'patient' encountered by a paediatric anaesthesiologist spans from an extremely premature neonate on the fringes of survival, to a full-grown adolescent equivalent to an adult. Perioperative morbidity and mortality are 2-3 times higher in infants and neonates compared to adults particularly in middle and low-income countries. The anatomical, physiological, pharmacological variations and presence of congenital cardiac, pulmonary and metabolic diseases in young children make perioperative management challenging. Special expertise and training are required for anaesthetic management of these preverbal children. In India, 3-years DM and 1-year Fellowship courses in paediatric anaesthesia are now available for specialisation. An ideal paediatric anaesthesia training centre should have substantial paediatric and neonatal patient load with exclusive intensive care facility. Paediatric anaesthesiologists, having knowledge of several facets of paediatrics and anaesthesia are capable of coordinating with health care professionals performing procedures outside the operating room. Paediatric anaesthesia, as a career thus offers a great opportunity to enhance quality and safety of anaesthesia in this high-risk surgical population. Persistent coordinated team efforts improve patient outcomes, reduce stress at work and increase job satisfaction.
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Affiliation(s)
- Indu Sen
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandini Dave
- Department of Anaesthesia, NH SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chitra Juwarkar
- Department of Anaesthesiology, Goa Medical College, Bambolim, Goa, India
| | - Shamshad Beegum
- Department of Anaesthesiology and Critical Care, Government Medical College, Thrissur, Kerala, India
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