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Zhang Q, Xu J, Huang Q, Gong T, Li J, Cui Y. Risk factors for delayed extubation after pediatric perineal anaplasty in patients less than 1 year of age: a retrospective study. BMC Pediatr 2024; 24:307. [PMID: 38711038 DOI: 10.1186/s12887-024-04781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Anorectal malformation is a common congenital problem occurring in 1 in 5,000 births and has a spectrum of anatomical presentations, requiring individualized surgical treatments for normal growth. Delayed extubation or reintubation may result in a longer intensive care unit (ICU) stay and hospital stay, increased mortality, prolonged duration of mechanical ventilation, increased tracheostomy rate, and higher hospital costs. Extensive studies have focused on the role of risk factors in early extubation during major infant surgery such as Cardiac surgery, neurosurgery, and liver surgery. However, no study has mentioned the influencing factors of delayed extubation in neonates and infants undergoing angioplasty surgery. MATERIALS AND METHODS We performed a retrospective study of neonates and infants who underwent anorectal malformation surgery between June 2018 and June 2022. The principal goal of this study was to observe the incidence of delayed extubation in pediatric anorectal malformation surgery. The secondary goals were to identify the factors associated with delayed extubation in these infants. RESULTS We collected data describing 123 patients who had anorectal malformations from 2019 to 2022. It shows that 74(60.2%) in the normal intubation group and 49(39.8%) in the longer extubation. In the final model, anesthesia methods were independently associated with delayed extubation (P < 0.05). CONCLUSION We found that the anesthesia method was independently associated with early extubation in neonates and infants who accepted pediatric anorectal malformation surgery.
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Affiliation(s)
- Qianqian Zhang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Jing Xu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Qinghua Huang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Tianqing Gong
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Jia Li
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Yu Cui
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China.
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Cai BB, Wang DP. Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000657. [PMID: 38025904 PMCID: PMC10668248 DOI: 10.1136/wjps-2023-000657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Postoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery. Methods In this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children's hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs. Results Totally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery. Conclusion Identifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.
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Affiliation(s)
- Bin Bin Cai
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hang Zhou, China
| | - Dong Pi Wang
- Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hang Zhou, China
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Hofmann A, Haider M, Promm M, Neissner C, Badelt G, Rösch WH. Delayed primary closure of bladder exstrophy without osteotomy: 12 year experience in a safe and gentle alternative to neonatal surgery. J Pediatr Surg 2022; 57:303-308. [PMID: 35000729 DOI: 10.1016/j.jpedsurg.2021.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Successful primary closure of bladder exstrophy is of utmost importance for bladder capacity and urinary continence. We evaluated our concept of delayed primary closure that challenges the role of neonatal surgery, pelvic osteotomy, and perioperative pain management. MATERIAL AND METHODS We reviewed the medical records of patients with classic bladder exstrophy (CBE) who had undergone delayed primary closure without osteotomy at our institution between January 2008 and May 2020. Data to be analyzed included patient demographics, intraoperative pelvic laxity, blood transfusion, postoperative ventilation time, requirement of pain medication, time to full feeds, length of ICU stay, postoperative complications, and total hospital stay. RESULTS 66 patients (44 boys) met the inclusion criteria. Mean age at surgery was 64.8 days (SD±24.7). Pelvic approximation < 5 mm was possible in 66 (100%) patients. Blood transfusion was required by 31 (47%) patients. 14 (21.2%) patients needed postoperative ventilation for a mean time of 2.7 h. 45 (68.2%) children required intravenous opioids in addition to an epidural catheter. Oral feeding started on average 17.6 h after surgery. Mean ICU stay was 1.3 day. The initial success rate of delayed closure was 93.9%. None of the patients had bladder dehiscence. Girls developed more often minor postoperative complications than boys (m/f: 12 [27.3%] vs. 8 [36.4%]. Mean overall time of hospitalization was 19 days (13-34 d). CONCLUSION Delayed primary closure of CBE without osteotomy but with continuous epidural blockage is a safe and promising procedure that has crucial advantages in the pre- and postoperative management of CBE. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Aybike Hofmann
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Steinmetzstr. 1-3, Regensburg 93049, Germany.
| | - Maximilian Haider
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Steinmetzstr. 1-3, Regensburg 93049, Germany
| | - Martin Promm
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Steinmetzstr. 1-3, Regensburg 93049, Germany
| | - Claudia Neissner
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Steinmetzstr. 1-3, Regensburg 93049, Germany
| | - Gregor Badelt
- Department of Pediatric Anesthesiology, Clinic St. Hedwig, Steinmetzstr. 1-3, Regensburg 93049, Germany
| | - Wolfgang H Rösch
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, Steinmetzstr. 1-3, Regensburg 93049, Germany
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Julien-Marsollier F, Cholet C, Coeffic A, Dupont T, Gauthier T, Loiselle M, Brouns K, Bonnard A, Biran V, Brasher C, Dahmani S. Intraoperative cerebral oxygen saturation and neurological outcomes following surgical management of necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis: Predictive factors of neurological complications following neonatal necrotizing enterocolitis. Paediatr Anaesth 2022; 32:421-428. [PMID: 34984774 DOI: 10.1111/pan.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1 year following surgery for necrotizing enterocolitis. MATERIAL AND METHODS The study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents, and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow-up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics, and univariable and multivariable statistics. RESULTS The study included 32 patients with no prior clinical neurological complications, of which 25 had normal cerebral imaging. Severe neurological complications occurred in nine patients at 1 year: Intraventricular hemorrhage (N = 2) and Periventricular leukomalacia (N = 7). However, preoperative cerebral imaging was lacking in seven patients. Consequently, the observed neurological complications at 1 year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥36% from baseline as the only factor associated with the occurrence of those complications. CONCLUSION Intraoperative decrease of cerebral oxygen saturation below ≥36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis.
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Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Clementine Cholet
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Adrien Coeffic
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Thibault Dupont
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Thibault Gauthier
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Maud Loiselle
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Kelly Brouns
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Arnaud Bonnard
- Department of general and urological surgery, Robert Debré University Hospital, Paris, France
| | - Valerie Biran
- Université de Paris, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France.,Department of Neonatology, Robert Debré University Hospital, Paris, France
| | - Christopher Brasher
- Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.,Anesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Integrated Critical Care, University of Melbourne, Australia
| | - Souhayl Dahmani
- Université de Paris, Paris, France.,Department of Anesthesia and Intensive care, Robert Debré University Hospital, Paris, France.,University Hospital Federation I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
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5
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Dahmani S, Laffargue A, Dadure C, De Queiroz M, Julien-Marsollier F, Michelet D, Veyckemans F, Amory C, Ludot H, Bert D, Godart J, Laffargue A, Dupont H, Urbina B, Baujard C, Roulleau P, Staiti G, Bordes M, Nouette Gaulain K, Hamonic Y, Semjen F, Jacqmarcq O, Lejus-Bourdeau C, Magne C, Petry L, Ros L, Zang A, Bennis M, Coustets B, Fesseau R, Constant I, Khalil E, Sabourdin N, Audren N, Descarpentries T, Fabre F, Legrand A, Druot E, Orliaguet G, Sabau L, Uhrig L, De La Briere F, Jonckheer K, Mission JP, Scordo L, Couchepin C, Dadure C, De La Arena P, Hertz L, Pirat P, Sola C, Bellon M, Depret-Donatien V, Lesage A. Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis. Anaesth Crit Care Pain Med 2022; 41:101036. [PMID: 35181529 DOI: 10.1016/j.accpm.2022.101036] [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: 05/30/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Neonatal and infant anaesthesia are associated with a high risk of perioperative complications. The aim of the current study was to describe those risks in France using the French data from the NECTARINE study. MATERIAL AND METHODS Data from the French centres that participated to the NECTARINE study were analysed. The primary goal of the study was the description of patients' characteristics, procedures and perioperative management and their comparison with the results of the European NECTARINE study. Secondary outcomes were the description of major perioperative complications and death. RESULTS Overall, 926 procedures collected in 15 centres (all teaching hospitals) were analysed. Comparison between the French and European NECTARINE cohorts found few differences related to patients' characteristics and procedures. The rate of interventions for critical events (respiratory, haemodynamic, and metabolic) was similar between the two cohorts. Near-infrared spectroscopy monitoring was used in 12% of procedures. Nearly none of the thresholds for these interventions met the published standards. By day 30, complications (respiratory, haemodynamic, metabolic, renal, and liver failure) and death were observed in 14.4% [95% CI 11.6 - 16.4] % and 1.8% [95 % CI 1.1 - 2.9] of cases, respectively. DISCUSSION Although the health status of the patients in the French cohort was less severe, procedures, management and postoperative complications and mortality rates were similar to the European cohort. However, thresholds for interventions were often inadequate in both cohorts. Efforts should be undertaken to improve the knowledge and use of new monitoring devices in this population.
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Affiliation(s)
- Souhayl Dahmani
- French NECTARINE Trial Group, France; Paris Diderot University (Paris VII), Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; FHU I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France.
| | - Anne Laffargue
- Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Christophe Dadure
- Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France; Institut de Neurosciences de Montpellier, Unité INSERM U1051, Montpellier, France
| | - Mathilde De Queiroz
- Department of Anaesthesia and Intensive Care, University Hospital of Lyon, Lyon, France
| | - Florence Julien-Marsollier
- French NECTARINE Trial Group, France; Paris Diderot University (Paris VII), Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; FHU I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Daphné Michelet
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Department of Anaesthesia and Intensive Care, University Hospital of Reims, Reims, France
| | - Francis Veyckemans
- Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Catherine Amory
- French NECTARINE Trial Group, France; American Memorial Hospital CHU Reims, Reims, France
| | - Hugues Ludot
- French NECTARINE Trial Group, France; American Memorial Hospital CHU Reims, Reims, France
| | - Dina Bert
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Juliette Godart
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Anne Laffargue
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Hervé Dupont
- French NECTARINE Trial Group, France; CHU Amiens Picardie, Amiens, France
| | - Benjamin Urbina
- French NECTARINE Trial Group, France; CHU Amiens Picardie, Amiens, France
| | - Catherine Baujard
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Roulleau
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Giuseppe Staiti
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Maryline Bordes
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | | | - Yann Hamonic
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | - François Semjen
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | | | | | - Cécile Magne
- French NECTARINE Trial Group, France; CHU de Nantes, Nantes, France
| | - Léa Petry
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Lilica Ros
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Aurélien Zang
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Mehdi Bennis
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Bernard Coustets
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Rose Fesseau
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Isabelle Constant
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Eliane Khalil
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Nada Sabourdin
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Noémie Audren
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Thomas Descarpentries
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Fanny Fabre
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Aurélien Legrand
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Emilie Druot
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Gilles Orliaguet
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Lucie Sabau
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Lynn Uhrig
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - François De La Briere
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Karin Jonckheer
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Jean-Paul Mission
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Lucia Scordo
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Caroline Couchepin
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Christophe Dadure
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Pablo De La Arena
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Laurent Hertz
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Philippe Pirat
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Chrystelle Sola
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Myriam Bellon
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Anne Lesage
- French NECTARINE Trial Group, France; Teaching Hospital of Caen, Caen, France
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Shafa A, Shatabi H, Moghadam N, Habibzade M. Comparison the effects of using two methods of fluid therapy with normal saline or 5% dextrose in half amount of normal saline solution on blood glucose and plasma electrolytes during and after neonatal surgeries: A randomized controlled trial. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_131_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Michelet D, Truchot J, Du Fayet De La Tour C, Benichou C, Berdji A, Delivet H, Ceccaldi PF, Plaisance P, Julien-Marsollier F, Dahmani S. The impact of psychological factors on the management of intraoperative haemodynamic events in children. Anaesth Crit Care Pain Med 2020; 39:785-791. [PMID: 33010488 DOI: 10.1016/j.accpm.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Paediatric anaesthesia requires specific theoretical knowledge and practical training. Non-technical skills and psychological factors might influence learning and practice. The aim of this study was to assess personality type and decision-making styles of paediatric anaesthesiology residents during the management of simulated intraoperative life-threatening cases. METHOD Residents in anaesthesiology (between 4 and 5 years of training) participated in a simulated hypoxic cardiac arrest in the operating theatre. Their performance was evaluated using a score derived from international recommended management algorithm. They were asked to answer self-assessment questionnaires regarding both their personality (the five personality factors) and their decision-making style. Correlations between performance and personality were investigated. RESULTS Thirty-eight residents participated in the simulation session and 36 accepted to answer the questionnaires. Good management scoring was positively correlated with agreeableness and conscientiousness personality traits but was negatively correlated with avoidance and spontaneous decision-making styles. DISCUSSION The current study identified personality traits and decision-making styles that might influence the management of critical situations during paediatric anaesthesia. The proper identification of these factors might allow targeted personalised training to improve knowledge mobilisation and translation in the clinical context.
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Affiliation(s)
- Daphné Michelet
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France; Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France
| | - Jennifer Truchot
- Emergency Department, Lariboisière University Hospital, 75010 Paris, France; Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France
| | - Charlotte Du Fayet De La Tour
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Candy Benichou
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Abdellouahabe Berdji
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Honorine Delivet
- Emergency Department, Robert Debré Hospital, 75019 Paris, France
| | - Pierre-Francois Ceccaldi
- Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France; Ilumens Department of Simulation in Healthcare, Paris Diderot University (Paris 7), Université de Paris, Paris, France
| | - Patrick Plaisance
- Emergency Department, Lariboisière University Hospital, 75010 Paris, France; Ilumens Department of Simulation in Healthcare, Paris Diderot University (Paris 7), Université de Paris, Paris, France
| | - Florence Julien-Marsollier
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France; UMR INSERM U 676.Robert Debré University Hospital, 75019 Paris, France.
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8
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Abstract
Perioperative risk of morbidity and mortality for neonates is significantly higher than that for older children and adults. At particular risk are neonates born prematurely, neonates with major or severe congenital heart disease, and neonates with pulmonary hypertension. Presently no consensus exists regarding the safest anesthetic regimen for neonates. Regional anesthesia appears to be safe, but does not reduce the overall risk of postoperative apnea. Former preterm infants require postoperative observation for apnea. The anesthesiologist caring for the neonate for major surgery should be knowledgeable of the unique physiology of the neonate and maintain the highest level of vigilance throughout.
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Affiliation(s)
- Calvin C Kuan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H3582, Stanford, CA 94305, USA.
| | - Susanna J Shaw
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H3582, Stanford, CA 94305, USA
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9
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Long JB, Fiedorek MC, Oraedu O, Austin TM. Neonatal intensive care unit patients recovering in the post anesthesia care unit: An observational analysis of postextubation complications. Paediatr Anaesth 2019; 29:1186-1193. [PMID: 31587412 DOI: 10.1111/pan.13750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonatal patients are at higher risk in the perioperative period than older infants and children. Extubation as an early goal for noenatal intensive care unit patients presenting for surgery is undergoing a renaissance period, and an exploration of adverse events following selection for extubation immediately after general anesthesia has not specifically been undertaken in this population. AIMS The objective of this study is to determine the adverse events most commonly encountered in neonatal intensive care unit patients recovering from anesthesia in the post anesthesia care unit, quantify the risk of event occurrence, and identify risk factors that may increase the risk of postoperative adverse events. METHODS All neonatal intensive care unit patients presenting to the operating room 6/1/2014-5/31/2018 who recovered in the post anesthesia care unit were included for analysis. Univariate analyses were conducted utilizing the Wilcoxon rank-sum test or Fisher exact test. Due to the low event rate, a small-sample generalized estimating equation model was created with a major event composite as the outcome and explanatory variables with P values < .1 on univariate analysis. Statistically significant continuous variables were then dichotomized based on Youden index. RESULTS There were 707 operative cases in 607 patients. There were 81 total events recorded, and 64/81 were considered to be major events; all of which were respiratory. The risk of any postoperative event was 11.5%, major respiratory event requiring intervention by a nurse or provider was 9.1%, and reintubation was 0.8%. Birth weight < 1.58 kg (OR 3.71; 95% CI 2.11-6.53; P < .001) and postmenstrual age at surgery <41 weeks (OR 3.20; 95% CI 1.54-6.63; P < .001) were strongly associated with an increased risk of a major postoperative respiratory event. CONCLUSION The most important factors associated with major events in the post anesthesia care unit following extubation of neonatal intensive care unit patients were birth weight < 1.58 kg and postmenstrual age at surgery < 41 weeks. A patient with both features has a 7-fold increase in the odds of a major respiratory event in the post anesthesia care unit. Careful consideration of the postoperative ventilation and monitoring strategy must be given to patients with low birth weight (<1.58 kg) or who are <41 weeks postmenstrual age at the time of surgery.
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Affiliation(s)
- Justin B Long
- Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael C Fiedorek
- Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - O'Dez Oraedu
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Thomas M Austin
- Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
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Lee KC, Eisig SB, Chuang SK, Perrino MA. Neonatal Mandibular Distraction Does Not Increase Inpatient Complications. Cleft Palate Craniofac J 2019; 57:99-104. [DOI: 10.1177/1055665619864735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The purpose of this study was to determine whether performing mandibular distraction osteogenesis (MDO) during the neonatal period increased inpatient complications as measured through health-care burden. Materials and Methods: This was a retrospective cohort study of the Kids’ Inpatient Database from 2000 to 2011. Infants receiving MDO prior to 12 months of age were included. The primary study predictor was distraction age, classified as either neonatal or non-neonatal. Secondary predictors were patient demographics, hospitalization characteristics, diagnoses, and procedures. The outcomes were the number of procedures performed, postoperative length of stay (pLOS), hospital charges, and the discharge transfer rate. Outcomes were compared between the primary predictors using χ2 and independent 2-sample t tests. Multiple linear and logistic regression models were created using clinically relevant predictors to assess the independent effect of neonatal age on each outcome. Results: The study sample contained 102 patients, of who 50 (49.0%) were distracted in the neonatal period. Neonatal MDO patients were more likely to have a cleft palate (86.0% vs 55.8%; P < .001) and present with feeding difficulties (38.0% vs 19.2%; P = .036) that were treated through total parenteral nutrition (26.0% vs 9.6%; P = .030) but otherwise did not have significantly different characteristics compared to non-neonatal patients. The multiple regression models confirmed that neonatal age did not influence any of the study outcomes, although other secondary predictors were found to influence the pLOS, hospital charges, and number of inpatient procedures. Conclusions: Neonatal MDO was not associated with increased complications. At experienced centers, neonatal status should not be considered a contraindication to treatment.
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Affiliation(s)
- Kevin C. Lee
- Division of Oral and Maxillofacial Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Sidney B. Eisig
- Division of Oral and Maxillofacial Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Sung-Kiang Chuang
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Brockton Oral and Maxillofacial Surgery Inc, Brockton, MA, USA
- Department of Oral and Maxillofacial Surgery, Good Samaritan Medical Center, Brockton, MA, USA
| | - Michael A. Perrino
- Division of Oral and Maxillofacial Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Bellon M, Skhiri A, Julien-Marsollier F, Malbezin S, Thierno D, Hilly J, ElGhoneimi A, Bonnard A, Michelet D, Dahmani S. Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management. Anaesth Crit Care Pain Med 2018; 37:453-457. [DOI: 10.1016/j.accpm.2017.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/14/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
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