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Sondermann M, Menzel V, Borkowetz A, Baunacke M, Huber J, Eisenmenger N, Thomas C, Boehm K. Treatment trends for undescended testis and impact of guideline changes a medical health care analysis of orchidopexy and cryptorchidism in Germany between 2006 und 2020. World J Urol 2024; 42:386. [PMID: 38918219 PMCID: PMC11199275 DOI: 10.1007/s00345-024-05095-x] [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: 02/02/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The last decades revealed new scientific knowledge regarding the fertility and potential malignancy of undescended testis AQ2(UDT). Accordingly, many guidelines changed their recommendation concerning timing of therapy, with the goal of an earlier time of surgery. METHODS We analyzed the number of new diagnosis and performed surgeries in predefined age groups provided by the obligatory annual reports of German hospitals in the reimbursement.INFO"-tool between 2006 and 2020. RESULTS Overall, 124,741 cases were analyzed. We showed a slight increase in performed surgeries in the first year by 2% per year with a main increase till 2011, a constant number of surgeries between first and 4th year and a decrease of surgeries between 5 and 14th year of living with a main decrease till 2009 by 3% per year. CONCLUSION Even if our results illustrate an increasing adaption of the guideline's recommendation, there is still a significant number of patients who receive later treatment. More research about the reasons and circumstances for the latter is needed.
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Affiliation(s)
- Marcus Sondermann
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Viktoria Menzel
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Johannes Huber
- Department of Urology, Universitätsklinikum Gießen-Marburg, Philipps Universität Marburg, Marburg, Germany
| | | | - Christian Thomas
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Katharina Boehm
- Department of Urology, Universitätsklinikum Carl-Gustav-Carus Dresden, Technische Universität Dresden, Dresden, Germany
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Módolo NSP, Cumino DDO, Lima LC, Barros GAMD. Advancing pediatric anesthesia in Brazil: reflections on research and education. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844535. [PMID: 38936800 DOI: 10.1016/j.bjane.2024.844535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Norma Sueli Pinheiro Módolo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil.
| | - Débora de Oliveira Cumino
- Sabará Hospital Infantil, São Paulo, SP, Brazil; Serviço de Anestesiologia Pediátrica/SAPE, Brazil; Hospital Municipal Menino Jesus, São Paulo, SP, Brazil
| | - Luciana Cavalcanti Lima
- Instituto Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Faculdade Pernambucana de Saúde, Recife, PE, Brazil
| | - Guilherme Antonio Moreira de Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil
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Schifino Wolmeister A, Hansen TG, Engelhardt T. Challenges of organizing pediatric anesthesia in low and middle-income countries. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844525. [PMID: 38906364 DOI: 10.1016/j.bjane.2024.844525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Anelise Schifino Wolmeister
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada; Hospital de Clínicas de Porto Alegre, Departamento de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil.
| | - Tom G Hansen
- Akershus University Hospital, Department of Anesthesia & Intensive Care, Lørenskog, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Thomas Engelhardt
- Montreal Children's Hospital, Department of Anesthesia, Montreal, Canada
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Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, do Nascimento Junior P, Braz MG. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth 2024; 94:111407. [PMID: 38325248 DOI: 10.1016/j.jclinane.2024.111407] [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: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
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Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Jose Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teofilo Augusto A Tiradentes
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Joao Vitor A Soares
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Norma Sueli P Modolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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van der Perk MEM, van der Kooi ALLF, Broer SL, Mensink MO, Bos AME, van de Wetering MD, van der Steeg AFW, van den Heuvel-Eibrink MM. A systematic review on safety and surgical and anesthetic risks of elective abdominal laparoscopic surgery in infants to guide laparoscopic ovarian tissue harvest for fertility preservation for infants facing gonadotoxic treatment. Front Oncol 2024; 14:1315747. [PMID: 38863640 PMCID: PMC11165185 DOI: 10.3389/fonc.2024.1315747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
Background Infertility is an important late effect of childhood cancer treatment. Ovarian tissue cryopreservation (OTC) is established as a safe procedure to preserve gonadal tissue in (pre)pubertal girls with cancer at high risk for infertility. However, it is unclear whether elective laparoscopic OTC can also be performed safely in infants <1 year with cancer. This systematic review aims to evaluate the reported risks in infants undergoing elective laparoscopy regarding mortality, and/or critical events (including resuscitation, circulatory, respiratory, neurotoxic, other) during and shortly after surgery. Methods This systematic review followed the Preferred reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guideline. A systematic literature search in the databases Pubmed and EMbase was performed and updated on February 15th, 2023. Search terms included 'infants', 'intubation', 'laparoscopy', 'mortality', 'critical events', 'comorbidities' and their synonyms. Papers published in English since 2000 and describing at least 50 patients under the age of 1 year undergoing laparoscopic surgery were included. Articles were excluded when the majority of patients had congenital abnormalities. Quality of the studies was assessed using the QUIPS risk of bias tool. Results The Pubmed and Embase databases yielded a total of 12,401 unique articles, which after screening on title and abstract resulted in 471 articles to be selected for full text screening. Ten articles met the inclusion criteria for this systematic review, which included 1778 infants <1 years undergoing elective laparoscopic surgery. Mortality occurred once (death not surgery-related), resuscitation in none and critical events in 53/1778 of the procedures. Conclusion The results from this review illustrate that morbidity and mortality in infants without extensive comorbidities during and just after elective laparoscopic procedures seem limited, indicating that the advantages of performing elective laparoscopic OTC for infants with cancer at high risk of gonadal damage may outweigh the anesthetic and surgical risks of laparoscopic surgery in this age group.
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Affiliation(s)
| | - Anne-Lotte L. F. van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, Rotterdam, Netherlands
| | - Simone L. Broer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Medical Center (UMC) Utrecht, Utrecht, Netherlands
| | | | - Annelies M. E. Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Medical Center (UMC) Utrecht, Utrecht, Netherlands
| | | | | | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Child Health, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Wilms M, Mãrzheuser S, Jenetzky E, Busse R, Nimptsch U. Treatment of Hirschsprung's Disease in Germany: Analysis of National Hospital Discharge Data From 2016 to 2022. J Pediatr Surg 2024:S0022-3468(24)00305-1. [PMID: 38811258 DOI: 10.1016/j.jpedsurg.2024.05.004] [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: 03/12/2024] [Revised: 04/27/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Hirschsprung's disease (HD) is a rare and complex malformation. The corrective operation is challenging and schedulable. The complete care situation for the corrective surgery for HD in Germany is uninvestigated. METHODS For the years 2016-2022, the microdata of the diagnosis-related groups (DRG) -statistics provided by the Research Data Center of the German Federal Statistical Office were accessed. All hospital stays for corrective surgery of HD in patients aged 0-17 were analyzed for patient's comorbidities, treatment characteristics and hospital structures. The occurrence of severe early postoperative complications during the hospital stay were documented. RESULTS The care structure for HD in Germany is decentralized with 109 hospitals performing 1199 corrective surgeries in 7 years. 75% of the participating hospitals performed three or less cases per year and 55 participating hospitals did not perform corrective surgery for HD each year. Early postoperative complications were common with at least one severe early complication in 18.6% of the cases. With an overall low case load per hospital, a volume outcome relationship cannot be established within Germany. Compared to international high volume centers the quality of outcomes for some of the investigated parameters was reduced. Despite the establishing of centers of expertise by the European reference network ERNICA for the treatment of HD no trend towards centralization occurred in Germany. CONCLUSIONS The corrective surgery for HD in Germany is decentralized and results in an overall high rate of early complications. The comparison with international studies from high-volume centers indicates potential for improvement for the corrective surgery of HD. Centralization remains essential for the improvement of care for patients with HD.
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Affiliation(s)
- Miriam Wilms
- Patient Organization for People with Anorectal Malformations and Morbus Hirschsprung (SoMA e.V.), Munich, Germany; University Hospital Düsseldorf, Department of General, Visceral, Thorax and Pediatric Surgery, Düsseldorf, Germany.
| | - Stefanie Mãrzheuser
- University Hospital Rostock, Department of Pediatric Surgery, Rostock, Germany
| | - Ekkehart Jenetzky
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg-University, Mainz, Germany
| | - Reinhard Busse
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
| | - Urike Nimptsch
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
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Lewis H, Brooks K, Bennett T, Greenaway S, Blaise BJ. Use of definition, risks factors, and management of hypoglycemia by UK anesthesiologists. Paediatr Anaesth 2024; 34:477-479. [PMID: 38379456 DOI: 10.1111/pan.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Hannah Lewis
- Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Katherine Brooks
- Department of Anaesthetics, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tom Bennett
- Department of Anaesthetics, University Hospital Southampton, Southampton, UK
| | - Sarah Greenaway
- Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin J Blaise
- Department of Paediatric Anaesthetics, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
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Costa S, Capolupo I, Bonadies L, Quercia M, Betta MP, Gombos S, Tognon C, Cavallaro G, Sgrò S, Pastorino R, Pires Marafon D, Dotta A, Vento G. Current management of surgical neonates: is it optimal or do we need to improve? A national survey of the Italian Society of Neonatology. Pediatr Surg Int 2024; 40:109. [PMID: 38622308 PMCID: PMC11018645 DOI: 10.1007/s00383-024-05680-6] [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] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Few guidelines exist for the perioperative management (PM) of neonates with surgical conditions (SC). This study examined the current neonatal PM in Italy. METHODS We invited 51 neonatal intensive care units with pediatric surgery in their institution to participate in a web-based survey. The themes included (1) the involvement of the neonatologist during the PM; (2) the spread of bedside surgery (BS); (3) the critical issues concerning the neonatal PM in operating rooms (OR) and the actions aimed at improving the PM. RESULTS Response rate was 82.4%. The neonatologist is involved during the intraoperative management in 42.9% of the responding centers (RC) and only when the surgery is performed at the patient's bedside in 50.0% of RCs. BS is reserved for extremely preterm (62.5%) or clinically unstable (57.5%) infants, and the main barrier to its implementation is the surgical-anesthesiology team's preference to perform surgery in a standard OR (77.5%). Care protocols for specific SC are available only in 42.9% of RCs. CONCLUSION Some critical issues emerged from this survey: the neonatologist involvement in PM, the spread of BS, and the availability of specific care protocols need to be implemented to optimize the care of this fragile category of patients.
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Affiliation(s)
- Simonetta Costa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Catholic University of Sacred Heart, Rome, Italy.
| | - Irma Capolupo
- Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Michele Quercia
- Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Section, University of Bari Aldo Moro, Policlinico Hospital, Bari, Italy
| | - Maria Pasqua Betta
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico Rodolico San Marco, Catania, Italy
| | - Sara Gombos
- Unit of Pediatrics, Santobono-Pausillipon Hospital, Naples, Italy
| | - Costanza Tognon
- Anesthesiology Pediatric Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Sgrò
- Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
| | - Denise Pires Marafon
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Dotta
- Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart, Rome, Italy
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Leonardsen ACL, Haugen AS, Raeder J, Finjarn TJ, Isern E, Aakre EK, Bruun AMG, Hennum K, Ramstad JP, Sand T, Monsen SA. The 2024 revision of the Norwegian standard for the safe practice of anaesthesia. Acta Anaesthesiol Scand 2024; 68:567-574. [PMID: 38317613 DOI: 10.1111/aas.14381] [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: 01/07/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
The Norwegian standard for the safe practice of anaesthesia was first published in 1991, and revised in 1994, 1998, 2005, 2010 and 2016 respectively. The 1998 version was published in English for the first time in Acta Anaesthesiologica Scandinavica in 2002. It must be noted that this is a national standard, reflecting the specific opportunities and challenges in a Norwegian setting, which may be different from other countries in some respects. A feature of the Norwegian healthcare system is the availability, on a national basis, of specifically highly trained and qualified nurse anaesthetists. Another feature is the geography, with parts of the population living in remote areas. These may be served by small, local emergency hospitals. Emergency transport of patients to larger hospitals is not always achievable when weather conditions are rough. These features and challenges were considered important when designing a balanced and consensus-based national standard for the safe practice of anaesthesia, across Norwegian clinical settings. In this article, we present the 2024 revision of the document. This article presents a direct translation of the complete document from the Norwegian original.
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Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Department of Health, Care and Organisation, Ostfold University College, Østfold, Norway
- Department of Anaesthesia, Ostfold Hospital Trust, Moss, Norway
- Department of Health and Social Sciences, University of Southeastern Norway, Norway
| | - Arvid Steinar Haugen
- Institute of Health Sciences, Acute and Critical Care, Oslo Metropolitan University, Oslo, Norway
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Johan Raeder
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Erik Isern
- Department of Anaesthesiology, St. Olavs Hospital, Trondheim, Norway
| | - Elin K Aakre
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | | | | | | | - Tina Sand
- Department of Anaesthesiology, Nord University Hospital, Tromsø, Norway
| | - Svein Arne Monsen
- Department of Anaesthesiology, Helgelandssykehuset, Nordland, Norway
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Pardessus P, Tournié E, Bezia D, Julien-Marsollier F, Dahmani S. Cardiac Output Monitoring Using Electrical Cardiometry Can Predict Changes in Cerebral Saturation in Infants. J Cardiothorac Vasc Anesth 2024; 38:1060-1061. [PMID: 38360422 DOI: 10.1053/j.jvca.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Pierre Pardessus
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Elise Tournié
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Delphine Bezia
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Florence Julien-Marsollier
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France
| | - Souhayl Dahmani
- Université de Paris, Paris, France; Department of Anaesthesia and Intensive Care. Robert Debré Hospital, Paris, France; DHU PROTECT, Robert Debré Hospital, Paris, France.
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Nelson O, Rintoul NE, Tan JM, Simpao AF, Chuo J, Hedrick HL, Duran MS, Makeneni S, Devine M, Cao L, Stricker PA. Surgical neonates: A retrospective review of procedures and postoperative outcomes at a quaternary children's hospital. Paediatr Anaesth 2024; 34:354-365. [PMID: 38146211 DOI: 10.1111/pan.14827] [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: 04/19/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Neonates have a high incidence of respiratory and cardiac perioperative events. Disease severity and indications for surgical intervention often dovetail with an overall complex clinical course and predispose these infants to adverse long-term neurodevelopmental outcomes and increased length of stay. Our aims were to describe severe and nonsevere early postoperative complications to establish a baseline of care outcomes and to identify subgroups of surgical neonates and procedures for future prospective studies. METHODS Electronic health record data were examined retrospectively for a cohort of patients who had general anesthesia from January 26, 2015 to August 31, 2018. Inclusion criteria were full-term infants with postmenstrual age less than 44 weeks or premature infants less than 60 weeks postmenstrual age undergoing nonimaging, noncardiac surgery. Severe postoperative complications were defined as mortality, reintubation, positive blood culture, and surgical site infection. Nonsevere early postoperative outcomes were defined as hypoglycemia, hyperglycemia, hypothermia, hyperthermia, and readmission within 30 days. RESULTS About 2569 procedures were performed in 1842 neonates of which 10.9% were emergency surgeries. There were 120 postoperative severe complications and 965 nonsevere postoperative outcomes. Overall, 30-day mortality was 1.8% for the first procedure performed, with higher mortality seen on subgroup analysis for patients who underwent exploratory laparotomy (10.3%) and congenital lung lesion resection (4.9%). Postoperative areas for improvement included hyperglycemia (13.9%) and hypothermia (7.9%). DISCUSSION The mortality rate in our study was comparable to other studies of neonatal surgery despite a high rate of emergency surgery and a high prevalence of prematurity in our cohort. The early outcomes data identified areas for improvement, including prevention of postoperative glucose and temperature derangements. CONCLUSIONS Neonates in this cohort were at risk for severe and nonsevere adverse postoperative outcomes. Future studies are suggested to improve mortality and adverse event rates.
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Affiliation(s)
- Olivia Nelson
- Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natalie E Rintoul
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan M Tan
- Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology Critical Care Medicine, Children's Hospital of Los Angeles and the Keck School of Medicine at the University of Southern California, and the Spatial Science Institute at the University of Southern California, Los Angeles, California, USA
| | - Allan F Simpao
- Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Chuo
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly L Hedrick
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa S Duran
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Spandana Makeneni
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew Devine
- Department of Data and Analytics, Information Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lusha Cao
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Paul A Stricker
- Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Lambert EM, Ramaswamy U, Gowda SH, Spielberg DR, Hagan JL, Xiao E, Liu S, Villafranco N, Raynor T, Baijal RG. Perioperative and Long-Term Outcomes in Infants Undergoing a Tracheostomy from a Neonatal Intensive Care Unit. Laryngoscope 2024; 134:1945-1954. [PMID: 37767870 DOI: 10.1002/lary.31058] [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: 04/27/2023] [Revised: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The purpose of this study was to identify risk factors for perioperative complications and long-term morbidity in infants from the neonatal intensive care unit (NICU) presenting for a tracheostomy. METHODS This single-center retrospective cohort study included infants in the NICU presenting for a tracheostomy from August 2011 to December 2019. Primary outcomes were categorized as either a perioperative complication or long-term morbidity. A severe perioperative complication was defined as having either (1) an intraoperative cardiopulmonary arrest, (2) an intraoperative death, (3) a postoperative cardiopulmonary arrest within 30 days of the procedure, or (4) a postoperative death within 30 days of the procedure. Long-term morbidities included (1) the need for gastrostomy tube placement within the tracheostomy hospitalization and (2) the need for diuretic therapy, pulmonary hypertensive therapy, oxygen, or mechanical ventilation at 12 and 24 months following the tracheostomy. RESULTS One-hundred eighty-three children underwent a tracheostomy. The mean age at tracheostomy was 16.9 weeks while the mean post-conceptual age at tracheostomy was 49.7 weeks. The incidence of severe perioperative complications was 4.4% (n = 8) with the number of pulmonary hypertension medication classes preoperatively (OR: 3.64, 95% CI: (1.44-8.94), p = 0.005) as a significant risk factor. Approximately 81% of children additionally had a gastrostomy tube placed at the time of the tracheostomy, and 62% were ventilator-dependent 2 years following their tracheostomy. CONCLUSION Our study provides critical perioperative complications and long-term morbidity data to neonatologists, pediatricians, surgeons, anesthesiologists, and families in the expected course of infants from the NICU presenting for a tracheostomy. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1945-1954, 2024.
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Affiliation(s)
- Elton M Lambert
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Uma Ramaswamy
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Sharada H Gowda
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - David R Spielberg
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Joseph L Hagan
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Emily Xiao
- Baylor College of Medicine, Houston, Texas, U.S.A
| | - Sean Liu
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Natalie Villafranco
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Tiffany Raynor
- Division of Pediatric Otolaryngology, Derpartment of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
| | - Rahul G Baijal
- Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, U.S.A
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13
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Dagher K, Benvenuti C, Virag K, Habre W. The Incidence of Postoperative Complications Following Lumbar and Bone Marrow Punctures in Pediatric Anesthesia: Insights From APRICOT. J Pediatr Hematol Oncol 2024; 46:165-171. [PMID: 38447107 PMCID: PMC10956654 DOI: 10.1097/mph.0000000000002849] [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: 10/05/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Bone marrow aspiration and lumbar puncture are procedures frequently performed in pediatric oncology. We aimed at assessing the incidence and risk factors of perioperative complications in children undergoing these procedures under sedation or general anesthesia. METHODS Based on the APRICOT study, we performed a secondary analysis, including 893 children undergoing bone marrow aspiration and lumbar puncture. The primary outcome was the incidence of perioperative complications. Secondary outcomes were their risk factors. RESULTS We analyzed data of 893 children who underwent 915 procedures. The incidence of severe adverse events was 1.7% and of respiratory complications was 1.1%. Prematurity (RR 4.976; 95% CI 1.097-22.568; P = 0.038), intubation (RR: 6.80, 95% CI 1.66-27.7; P =0.008), and emergency situations (RR 3.99; 95% CI 1.14-13.96; P = 0.030) increased the risk for respiratory complications. The incidence of cardiovascular instability was 0.4%, with premedication as risk factor (RR 6.678; 95% CI 1.325-33.644; P =0.021). CONCLUSION A low incidence of perioperative adverse events was observed in children undergoing bone marrow aspiration or lumbar puncture under sedation and/or general anesthesia, with respiratory complications being the most frequent. Careful preoperative assessment should be undertaken to identify risk factors associated with an increased risk, allowing for appropriate adjustment of anesthesia management.
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Affiliation(s)
| | - Claudia Benvenuti
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Kathy Virag
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Walid Habre
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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14
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Chen DX, Tan ZM, Lin XM. General Anesthesia Exposure in Infancy and Childhood: A 10-year Bibliometric Analysis. J Perianesth Nurs 2024:S1089-9472(23)01072-9. [PMID: 38520467 DOI: 10.1016/j.jopan.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 03/25/2024]
Abstract
PURPOSE Heated discussions have divided health care providers and policymakers on the risks versus benefits of general anesthesia in pediatric populations. We conducted this study to provide a comprehensive bibliometric analysis of general anesthesia in this specific population over the past decade. DESIGN We summarized and quantitatively analyzed the studies related to general anesthesia in children and infants over the past decade. METHODS Using the Web of Science Core Collection as the data source, we analyzed the literature using CiteSpace software, focusing on authors, countries, institutions, keywords, and references to identify hotspots and predict research trends. FINDINGS A total of 2,364 publications on pediatric anesthesia were included in the analysis. The number of related publications and citations steadily increased from 2013 to 2022. The United States was the leading country in terms of output, and University of Toronto was the primary contributing institution. Co-citation analysis revealed that over the past decade research has mainly focused on the long-term adverse effects of general anesthesia on neurodevelopment and acute perioperative crisis events. Keyword analysis identified infant sedation and drug selection and compatibility as promising areas for development. In addition, improving the quality of perioperative anesthesia will be a major research focus in the future. CONCLUSIONS Recent research in pediatric anesthesia has focused on mitigating the adverse effects of general anesthesia in infants and young children and studying the pharmacological compatibility of anesthetics. Our study results would assist researchers and clinicians in understanding the current research status and optimizing clinical practice in this field.
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Affiliation(s)
- Dong X Chen
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Chengdu, Sichuan Province, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Zhi M Tan
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Xue M Lin
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Chengdu, Sichuan Province, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China.
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15
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de Graaff JC, Frykholm P, Engelhardt T, Schindler E, Kovesi T, Simic D, Malagon I, Woodman N, Courtman S, Najafi N, Claussen NG, Karlsson J, Bonhomme F, Laffargue A, Vutskits L. Pediatric anesthesia in Europe: Variations within uniformity. Paediatr Anaesth 2024. [PMID: 38415881 DOI: 10.1111/pan.14873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
Organization of healthcare strongly differs between European countries and results in country-specific requirements in postgraduate medical training. Within the European Union (EU), the European Board of Anaesthesiology has set recommendations of training for the Specialty of Anaesthesiology including standards for Postgraduate Medical Specialist training including a description for providing service in pediatric anesthesia. However, these standards are advisory and not mandatory. Here we aimed to review the current state and associated challenges of pediatric anesthesia training in Europe. We report an important country-specific variability both in training and regulations of practice of pediatric anesthesia in the EU and in the United Kingdom. The requirements for training in pediatric anesthesia varies between nothing specified (Belgium) or providing anesthesia with direct supervision to a minimum of 50 cases below 5 years of age (Germany) to 3-6 month clinical practice in a specialized pediatric hospital (France). Likewise, the regulations for providing anesthesia to children varies from no regulations at all (Belgium) to age specific requirements and centralization of all children below 4 years of age to specified centers (United Kingdom). Officially recognized pediatric anesthesia fellowship programs are not available in most countries of Europe. It remains unclear if and how country-specific differences in pediatric anesthesia training are associated with clinical outcomes in pediatric perioperative care. There is converging interest and support for the establishment of a European pediatric anesthesia curriculum.
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Affiliation(s)
- Jurgen C de Graaff
- Department of Anesthesia, Adrz-Erasmus MC, Goes, The Netherlands
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Peter Frykholm
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Thomas Engelhardt
- Department of Anesthesia, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Ehrenfried Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Tamas Kovesi
- Department of Paediatric Anaesthesia, Department of Anaesthesiology and Intensive Therapy, University of Pecs Medical School, Pécs, Hungary
| | - Dusica Simic
- Medical faculty University of Belgrade, University Children's Hospital, Belgrade, Serbia
| | - Ignacio Malagon
- Department of Anesthesia Radboud UMC, Nijmegen, The Netherlands
| | | | - Simon Courtman
- Department of Anaesthesia, University Hospital Plymouth, Plymouth, UK
| | - Nadia Najafi
- Department of Anesthesiology and Perioperative Medicine, University Hospital of Brussels, Brussels, Belgium
| | - Nicola Groes Claussen
- Pediatric Anesthesia Section, Department of Anesthesia and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jacob Karlsson
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Fanny Bonhomme
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne Laffargue
- Department of Pediatric Anesthesia, University Hospital of Lille, Lille, France
| | - Laszlo Vutskits
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
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16
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Sbaraglia F, Cuomo C, Della Sala F, Festa R, Garra R, Maiellare F, Micci DM, Posa D, Pizzo CM, Pusateri A, Spano MM, Lucente M, Rossi M. State of the Art in Pediatric Anesthesia: A Narrative Review about the Use of Preoperative Time. J Pers Med 2024; 14:182. [PMID: 38392615 PMCID: PMC10890671 DOI: 10.3390/jpm14020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
This review delves into the challenge of pediatric anesthesia, underscoring the necessity for tailored perioperative approaches due to children's distinctive anatomical and physiological characteristics. Because of the vulnerability of pediatric patients to critical incidents during anesthesia, provider skills are of primary importance. Yet, almost equal importance must be granted to the adoption of a careful preanesthetic mindset toward patients and their families that recognizes the interwoven relationship between children and parents. In this paper, the preoperative evaluation process is thoroughly examined, from the first interaction with the child to the operating day. This evaluation process includes a detailed exploration of the medical history of the patient, physical examination, optimization of preoperative therapy, and adherence to updated fasting management guidelines. This process extends to considering pharmacological or drug-free premedication, focusing on the importance of preanesthesia re-evaluation. Structural resources play a critical role in pediatric anesthesia; components of this role include emphasizing the creation of child-friendly environments and ensuring appropriate support facilities. The results of this paper support the need for standardized protocols and guidelines and encourage the centralization of practices to enhance clinical efficacy.
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Affiliation(s)
- Fabio Sbaraglia
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Christian Cuomo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Filomena Della Sala
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rossano Festa
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rossella Garra
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Federica Maiellare
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Daniela Maria Micci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Domenico Posa
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cecilia Maria Pizzo
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Angela Pusateri
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michelangelo Mario Spano
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Monica Lucente
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco Rossi
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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17
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Colori A, Ackwerh R, Chang YC, Cody K, Dunlea C, Gains JE, Gaunt T, Gillies CMS, Hardy C, Lalli N, Lim PS, Soto C, Gaze MN. Paediatric radiotherapy in the United Kingdom: an evolving subspecialty and a paradigm for integrated teamworking in oncology. Br J Radiol 2024; 97:21-30. [PMID: 38263828 PMCID: PMC11027255 DOI: 10.1093/bjr/tqad028] [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: 08/18/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 01/25/2024] Open
Abstract
Many different malignancies occur in children, but overall, cancer in childhood is rare. Survival rates have improved appreciably and are higher compared with most adult tumour types. Treatment schedules evolve as a result of clinical trials and are typically complex and multi-modality, with radiotherapy an integral component of many. Risk stratification in paediatric oncology is increasingly refined, resulting in a more personalized use of radiation. Every available modality of radiation delivery: simple and advanced photon techniques, proton beam therapy, molecular radiotherapy, and brachytherapy, have their place in the treatment of children's cancers. Radiotherapy is rarely the sole treatment. As local therapy, it is often given before or after surgery, so the involvement of the surgeon is critically important, particularly when brachytherapy is used. Systemic treatment is the standard of care for most paediatric tumour types, concomitant administration of chemotherapy is typical, and immunotherapy has an increasing role. Delivery of radiotherapy is not done by clinical or radiation oncologists alone; play specialists and anaesthetists are required, together with mould room staff, to ensure compliance and immobilization. The support of clinical radiologists is needed to ensure the correct interpretation of imaging for target volume delineation. Physicists and dosimetrists ensure the optimal dose distribution, minimizing exposure of organs at risk. Paediatric oncology doctors, nurses, and a range of allied health professionals are needed for the holistic wrap-around care of the child and family. Radiographers are essential at every step of the way. With increasing complexity comes a need for greater centralization of services.
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Affiliation(s)
- Amy Colori
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Raymond Ackwerh
- Department of Anaesthetics, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Yen-Ch’ing Chang
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Kristy Cody
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Cathy Dunlea
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Jennifer E Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Trevor Gaunt
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Callum M S Gillies
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Claire Hardy
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Narinder Lalli
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Pei S Lim
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
| | - Carmen Soto
- Department of Paediatric Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, United Kingdom
- Department of Oncology, UCL Cancer Institute, University College London, London, WC1E 6DD, United Kingdom
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18
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Ninke T, Eifer A, Dieterich HJ, Groene P. [Characteristics of the fetal and infant respiratory system : What the pediatric anesthetist should know]. DIE ANAESTHESIOLOGIE 2024; 73:65-74. [PMID: 38189808 DOI: 10.1007/s00101-023-01364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/09/2024]
Abstract
Respiratory complications are the most frequent incidents in pediatric anesthesia after cardiac events. The pediatric respiratory physiology and airway anatomy are responsible for the particular respiratory vulnerability in this stage of life. This article explains the aspects of pulmonary embryogenesis relevant for anesthesia and their impact on the respiration of preterm infants and neonates. The respiratory distress syndrome and bronchopulmonary dysplasia are highlighted as well as the predisposition to apnea of preterm infants and neonates. Due to the anatomical characteristics, the low size ratios and the significantly shorter apnea tolerance, airway management in children frequently represents a challenge. This article gives useful assistance and provides an overview of formulas for calculating the appropriate tube size and depth of insertion. Finally, the pathophysiology and adequate treatment of laryngospasm are explained.
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Affiliation(s)
- T Ninke
- Klinik für Anaesthesiologie, Campus Innenstadt, LMU Klinikum, LMU München, Nußbaumstraße 20, 80336, München, Deutschland.
| | - A Eifer
- Klinik für Anaesthesiologie, Campus Innenstadt, LMU Klinikum, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - H-J Dieterich
- Klinik für Anaesthesiologie, Campus Innenstadt, LMU Klinikum, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - P Groene
- Klinik für Anaesthesiologie, Campus Innenstadt, LMU Klinikum, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
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19
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Aldous SJ, Casey DT, DeSarno M, Whitaker EE. Characterization of infant spinal anesthesia using surface electromyography: An observational study. Paediatr Anaesth 2024; 34:42-50. [PMID: 37788137 DOI: 10.1111/pan.14774] [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: 08/09/2023] [Revised: 09/13/2023] [Accepted: 09/23/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND As the risks of general anesthesia in infants become clearer, pediatric anesthesiologists are seeking alternatives. Though infant spinal anesthesia is one such alternative, its use is limited by its perceived short duration. Prior studies investigating infant spinal anesthesia are open to interpretation and may not have accurately characterized block onset or density. Surface electromyography is a passive, noninvasive modality that can measure the effects of neural blockade. AIMS To quantitatively describe the onset, density, and duration of infant spinal anesthesia using surface electromyography. METHODS In this observational study, 13 infants undergoing lower abdominal surgery received spinal anesthesia (0.5% bupivacaine with clonidine). Surface electromyography collected continuous data at T2, right T8, left T8, and L2. Data were processed in MATLAB. Onset, density, and duration were defined as the mean derivative within the first 30 s after block administration, the maximum difference in signal compared with preblock baseline, and the time elapsed between block administration and the return of a persistent signal to 50% above the maximum difference, respectively. RESULTS Mean patient age and weight were 7.5 ± 2.6 months and 8.0 ± 2.2 kg, respectively. All patients were male. There was a statistically significant difference in the average rate of spinal anesthesia onset (mean percent decrease per second [95% confidence interval]) between myotomes (F (3, 35) = 7.42, p < .001): T2 = 15.93 (9.23, 22.62), right T8 = 20.98 (14.52, 27.44), left T8 = 17.92 (11.46, 24.38), L2 = 32.92 (26.46, 39.38). There was a statistically significant difference in mean surface electromyography signal (mean decibels, 95% confidence interval) across both pre- and postspinal anesthesia Timepoints between myotomes (F (3, 36) = 32.63, p < .0001): T2 = 45.05 (38.92, 51.18), Right T8 = 41.26 (35.12, 47.39), Left T8 = 43.07 (36.93, 49.20), L2 = 22.79 (16.65, 28.92). Within each myotome, there was statistically significant, near complete attenuation of sEMG signal due to spinal anesthesia: T2 mean (pre-post) difference: mean decibels (95% confidence interval) = 39.53 (28.87, 50.20), p < .0001, right T8 = 51.97 (41.30, 62.64), p < .0001, left T8 = 46.09 (35.42, 56.76), p < .0001, L2 = 44.75 (34.08, 55.42), p < .0001. There was no statistically significant difference in mean (pre-post) differences between myotomes. The mean duration of spinal anesthesia lasted greater than 90 min and there was no statistical difference between myotomes. There were also no statistically significant associations between age and weight and onset or duration. CONCLUSIONS Surface electromyography can be used to characterize neural blockade in children. Importantly, these results suggest that awake infant spinal anesthesia motor block lasts, conservatively, 90 min. This exploratory study has highlighted the potential for expanding awake infant spinal anesthesia to a broader range of procedures and the utility of surface electromyography in studying regional anesthesia techniques.
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Affiliation(s)
- Samuel J Aldous
- Department of Anesthesiology, University of Vermont, Burlington, Vermont, USA
| | - Dylan T Casey
- Department of Medicine and Vermont Complex Systems Center, University of Vermont, Burlington, Vermont, USA
| | - Michael DeSarno
- Biomedical Sciences Research Core, University of Vermont, Burlington, Vermont, USA
| | - Emmett E Whitaker
- Department of Anesthesiology, Neurological Sciences, and Pediatrics, University of Vermont, Burlington, Vermont, USA
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20
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Nelson O, Wang JT, Matava CT, Stricker PA. Registries in pediatric anesthesiology: A brief history and a new way forward. Paediatr Anaesth 2024; 34:7-12. [PMID: 37794755 DOI: 10.1111/pan.14775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Abstract
Clinical registries are multicenter prospective observational datasets that have been used to examine current perioperative practices in pediatric anesthesia. These datasets have proven useful in quantifying the incidence of rare adverse outcomes. Data from registries can highlight associations between severe patient safety events and patient and procedure-related risk factors. Registries are an effective tool to delineate practices and outcomes in niche patient populations. They have been used to quantify uncommon complications of medications and procedures. Registries can be used to generate knowledge and to support quality improvement. Multicenter engagement can promote best clinical practices and foster professional networks. Registries are limited by their observational nature, which entails a lack of randomization as well as selection and treatment bias. The maintenance of registries over time can be challenging due to difficulties in modifying the included variables, collaborator fatigue, and continued outlay of resources to maintain the database and onboard new sites. These latter issues can lead to decreased data quality. In this article, we discuss key insights from several pediatric anesthesia registries and propose a new type of registry that addresses some shortcomings of the current paradigm.
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Affiliation(s)
- Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jue T Wang
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul A Stricker
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Puri S, Sen IM, Bhardwaj N, Yaddanapudi S, Mathew PJ, Bandyopadhyay A, Samujh R, Dogra S, Kumar P. Postoperative outcome of neonatal emergency surgeries in a tertiary care institute-A prospective observational study. Paediatr Anaesth 2023; 33:1075-1082. [PMID: 37483171 DOI: 10.1111/pan.14731] [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: 03/14/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
AIMS Neonatal surgical mortality continues to be high in developing countries. A better understanding of perioperative events and optimization of causative factors can help in achieving a favorable outcome. The present study was designed to evaluate the perioperative course of surgical neonates and find out potential factors contributing to postoperative mortality. METHODS This prospective observational study enrolled neonates, undergoing emergency surgical procedures in a tertiary care institute. Primary outcome was 6 weeks postsurgical mortality. The babies were observed till discharge and subsequently followed up telephonically for 6 weeks after surgery. Multivariable logistic regression analysis of various parameters was performed. RESULTS Out of the 324 neonates who met inclusion criteria, 278 could be enrolled. The median age was 4 days. Sixty-two (27.7%) neonates were born before 37 weeks period of gestation (POG), and 94 (41.8%) neonates weighed below 2.5 kg. The most common diagnoses was trachea-esophageal fistula (29.9%) and anorectal malformation (14.3%). The median duration of hospital stay for survivors was 14 days. The in-hospital mortality was 34.8%. Mortality at 6 weeks following surgery was 36.2%. Five independent risk factors identified were POG < 34 weeks, preoperative oxygen therapy, postoperative inotropic support postoperative mechanical ventilation, and postoperative leukopenia. In neonates where invasive ventilation was followed by non-invasive positive pressure ventilation in the postoperative period, risk of postoperative surgical mortality was significantly reduced. CONCLUSION Present study identified preterm birth, preoperative oxygen therapy, postoperative positive pressure ventilation, requirement of inotropes, and postoperative leukopenia as independent predictors of 6-week mortality. The possibility of early switch to noninvasive positive pressure ventilation was associated with a reduction in neonatal mortality.
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Affiliation(s)
- Sunaakshi Puri
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Mohini Sen
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J Mathew
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjishnujit Bandyopadhyay
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivani Dogra
- Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Department of Neonatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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van den Berg J, Johansen M, Disma N, Engelhardt T, Hansen TG, Veyckemans F, Zielinska M, de Graaff JC. Perioperative anaesthetic management and short-term outcome of neonatal repair of oesophageal atresia with or without tracheo-oesophageal fistula in Europe: A sub-analysis of the neonate and children audit of anaesthesia practice in Europe (NECTARINE) prospective multicenter observational study. Eur J Anaesthesiol 2023; 40:936-945. [PMID: 37779460 DOI: 10.1097/eja.0000000000001905] [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: 10/03/2023]
Abstract
BACKGROUND Oesophageal atresia with or without a tracheo-oesophageal fistula is a congenital abnormality that usually requires surgical repair within the first days of life. OBJECTIVE Description of the perioperative anaesthetic management and outcomes of neonates undergoing surgery for oesophageal atresia with or without a tracheo-oesophageal fistula, included in the 'neonate and children audit of anaesthesia practice in Europe' (NECTARINE) database. DESIGN Sub-analyses of prospective observational NECTARINE study. SETTING European multicentre study. PATIENTS Neonates who underwent surgery for oesophageal atresia with or without a tracheo-oesophageal fistula in the NECTARINE cohort were selected. MAIN OUTCOME MEASURES Incidence rates with 95% confidence intervals were calculated for peri-operative clinical events which required a predetermined intervention, postoperative complications, and mortality. RESULTS One hundred and three neonates undergoing a first surgical intervention for oesophageal atresia with or without a tracheo-oesophageal fistula repair were identified. Their median gestational age was 38 weeks with a median birth weight of 2840 [interquartile range 2150 to 3150] grams. Invasive monitoring was used in 66% of the procedures. The incidence of perioperative clinical events was 69% (95% confidence interval 59 to 77%), of 30-day postoperative complications 47% (95% confidence interval 38 to 57%) and the 30- and 90 days mortality rates were 2.1% and 2.6%, respectively. CONCLUSION Oesophageal atresia with or without a tracheo-oesophageal fistula repair in neonates is associated with a high number of perioperative interventions in response to clinical events, a high incidence of postoperative complications, and a substantial mortality rate.
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Affiliation(s)
- Johanneke van den Berg
- From the Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands (M.JVDB), Division of Pediatric Anaesthesia, Montreal Children's Hospital, McGill University Centre, Montreal, Canada (MJ), Unit for Research & Innovation, Department of Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy (ND), Department of Anaesthesia, Montreal Children's Hospital, Montreal, QC, Canada (TE), Department of Anaesthesia, Akershus University Hospital and Oslo University, Oslo, Norway (TGH), Clinique d'Anesthésie-Réanimation pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France (FV), Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland (MZ), Department of Anesthesiology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands, Adrz-EramusMC, Goes, The Netherlands (JCDG)
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23
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Sigurdsson TS, Snaebjornsdottir S, Sigurdsson MI. Incidence of hypoglycaemia in fasting children after induction of anaesthesia for elective procedures: a descriptive observational study. Eur J Anaesthesiol 2023; 40:950-952. [PMID: 37431301 PMCID: PMC10624402 DOI: 10.1097/eja.0000000000001882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Affiliation(s)
- Theodor S Sigurdsson
- From the Department of Anaesthesiology and Intensive Care Medicine, Landspítalinn University Hospital of Iceland (TSS, SS, MIS) and Faculty of Medicine, University of Iceland, Reykjavik, Iceland (TSS, MIS)
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24
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Veyckemans F, Sola C, de Graaff JC, Becke-Jakob K, Zielinska M, Hansen TG, Walker SM, Disma N, Habre W. Epidemiology and outcomes of inguinal surgery with or without regional anaesthesia in neonates and small infants: A subanalysis of the NECTARINE database. Eur J Anaesthesiol 2023; 40:956-959. [PMID: 37357905 DOI: 10.1097/eja.0000000000001870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Affiliation(s)
- Francis Veyckemans
- From the UCLouvain, Brussels, Belgium (FV), Department of Anaesthesia and Critical Care Medicine, Paediatric Anaesthesia Unit, Montpellier University Hospital, Institute of Functional Genomics (IGF), University of Montpellier, CNRS, INSERM, Montpellier, France (CS), Department of Anesthesia, Adrz-Erasmus MC, Goes, The Netherlands (JCdG), Department of Anaesthesia and Intensive Care, Cnopf Children's Hospital - Hospital Hallerwiese, Nürnberg, Germany (KB), Department of Paediaric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland (MZ), Department of Anaesthesia & Intensive Care, Akershus University Hospital and Olso University, Oslo, Norway (TGH), Department of Anaesthesia and Pain Management, Great Ormond Street Hospital NHS Foundation Trust, London, UK (SMW), Unit for Research in Anaesthesia, IRCCS, Istituto G Gaslini, Genova, Italy (ND), and Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland (WH)
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25
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van den Bunder FAIM, Stevens MF, van Woensel JBM, van de Brug T, van Heurn LWE, Derikx JPM. Perioperative Hypoxemia and Postoperative Respiratory Events in Infants with Hypertrophic Pyloric Stenosis. Eur J Pediatr Surg 2023; 33:485-492. [PMID: 36417975 DOI: 10.1055/a-1984-9803] [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: 11/25/2022]
Abstract
BACKGROUND Normalization of metabolic alkalosis is an important pillar in the treatment of infantile hypertrophic pyloric stenosis (IHPS) because uncorrected metabolic alkalosis may lead to perioperative respiratory events. However, the evidence on the incidence of respiratory events is limited. We aimed to study the incidence of peroperative hypoxemia and postoperative respiratory events in infants undergoing pyloromyotomy and the potential role of metabolic alkalosis. MATERIALS AND METHODS We retrospectively reviewed all patients undergoing pyloromyotomy between 2007 and 2017. All infants received intravenous fluids preoperatively to correct metabolic abnormalities close to normal. We assessed the incidence of perioperative hypoxemia (defined as oxygen saturation [SpO2] < 90% for > 1min) and postoperative respiratory events. Additionally, the incidence of difficult intubations was evaluated. We performed a multivariate logistic regression analysis to evaluate the association between admission or preoperative serum pH values, bicarbonate or chloride, and peri- and postoperative hypoxemia or respiratory events. RESULTS Of 406 included infants, 208 (51%) developed 1 or more episodes of hypoxemia during the perioperative period, of whom 130 (32%) experienced it during induction, 43 (11%) intraoperatively, and 112 (28%) during emergence. About 7.5% of the infants had a difficult intubation and 17 required more than 3 attempts by a pediatric anesthesiologist. Three patients developed respiratory insufficiency and 95 postoperative respiratory events were noticed. We did not find a clinically meaningful association between laboratory values reflecting metabolic alkalosis and respiratory events. CONCLUSIONS IHPS frequently leads to peri- and postoperative hypoxemia or respiratory events and high incidence of difficult tracheal intubations. Preoperative pH, bicarbonate, and chloride were bad predictors of respiratory events.
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Affiliation(s)
- Fenne A I M van den Bunder
- Department of Pediatric surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands
| | - Markus F Stevens
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Job B M van Woensel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Tim van de Brug
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands
| | - Joep P M Derikx
- Department of Pediatric surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands
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Wittenmeier E, Schmidtmann I, Heese P, Müller P, Didion N, Kriege M, Komorek Y, Pirlich N. Early warning for SpO 2 decrease by the oxygen reserve index in neonates and small infants. Paediatr Anaesth 2023; 33:923-929. [PMID: 37551627 DOI: 10.1111/pan.14743] [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: 11/16/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Continuously assessing the oxygenation levels of patients to detect and prevent hypoxemia can be advantageous for safe anesthesia, especially in neonates and small infants. The oxygen reserve index (ORI) is a new parameter that can assess oxygenation through a relationship with arterial oxygen partial pressure (PaO2 ). The aim of this study was to examine whether the ORI provides a clinically relevant warning time for an impending SpO2 (pulse oximetry hemoglobin saturation) reduction in neonates and small infants. METHODS ORI and SpO2 were measured continuously in infants aged <2 years during general anesthesia. The warning time and sensitivity of different ORI alarms for detecting impending SpO2 decrease were calculated. Subsequently, the agreement of the ORI and PaO2 with blood gas analyses was assessed. RESULTS The ORI of 100 small infants and neonates with a median age of 9 months (min-max, 0-21 months) and weight of 8.35 kg (min-max, 2-13 kg) were measured. For the ORI/PaO2 correlation, 54 blood gas analyses were performed. The warning time and sensitivity of the preset ORI alarm during the entire duration of anesthesia were 84 s (25th-75th percentile, 56-102 s) and 55% (95% CI 52%-58%), and those during anesthesia induction were 63 s (40-82 s) and 56% (44%-68%), respectively. The positive predictive value of the preset ORI alarm were 18% (95% CI 17%-20%; entire duration of anesthesia) and 27% (95% CI 21%-35%; during anesthesia induction). The agreement of PaO2 intervals with the ORI intervals was poor, with a kappa of 0.00 (95% CI = [-0.18; 0.18]). The weight (p = .0129) and height (p = .0376) of the infants and neonates were correlated to the correct classification of the PaO2 interval with the ORI interval. CONCLUSIONS The ORI provided an early warning time for detecting an impending SpO2 decrease in small infants and neonates in the defined interval in this study. However, the sensitivity of ORI to forewarn a SpO2 decrease and the agreement of the ORI with PaO2 intervals in this real-life scenario were too poor to recommend the ORI as a useful early warning indicator for this age group.
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Affiliation(s)
- Eva Wittenmeier
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Irene Schmidtmann
- Biostatistician, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | - Pascal Heese
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Pascal Müller
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Nicole Didion
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Marc Kriege
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Yannick Komorek
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Nina Pirlich
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Hoffmann C, Snow A, Chedid C, Abi Shadid C, Miyasaka EA. Quadratus Lumborum Block as a Cornerstone for Neonatal Intestinal Surgery Enhanced Recovery (ERAS): A Case Series. Local Reg Anesth 2023; 16:165-171. [PMID: 37841495 PMCID: PMC10576531 DOI: 10.2147/lra.s403567] [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: 07/16/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose Neonates present unique challenges for pediatric surgical teams. To optimize outcomes, it is imperative to standardize perioperative care by using early extubation and multimodal analgesic techniques. The quadratus lumborum (QL) block provides longer duration and superior pain relief than other single-injection abdominal fascial plane techniques. The purpose of this case series was to report our initial experience with QL blocks in neonatal patients treated with intestinal ERAS. Patients and Methods Ten neonates requiring intestinal surgery at a single tertiary care center who received QL blocks between December 2019 and April 2022 for enhanced recovery were studied. Bilateral QL blocks were performed with 0.5 mL/kg of 0.25% ropivacaine per side with an adjuvant of 1 mcg/kg of dexmedetomidine. Results Gestational age at birth ranged from 32.2 to 41 weeks. The median age, weight, and American Society of Anesthesiologists (ASA) score at the time of surgery was 5 days [range 7.5 hours, 60 days], 2.84 kg [range 1.5, 4.5], and 3, respectively. Bilateral QL blocks were performed without complications in all patients. Two patients were outside the neonatal range from birth to surgery, but were under 42 weeks gestational age when corrected for prematurity. All patients were extubated with well-controlled pain, and no patient required reintubation within the first 24 hours. Postoperatively, median cumulative morphine equivalents were 0.16 mg/kg [range 0, 0.79] and six patients received scheduled acetaminophen. Morphine (0.1 mg/kg) was administered to patients with a modified neonatal infant pain scale (NIPS) score greater than or equal to 4, and pain was reassessed 1 hour after administration (Appendix). Conclusion When developing intestinal ERAS protocols, Bilateral QL blocks may be considered for postoperative analgesia in the neonatal population. Further prospective studies are required to validate this approach in neonates.
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Affiliation(s)
| | - Angela Snow
- Pediatric Anesthesiology, Nemours Children’s Hospital, Wilmington, DE, USA
| | - Celine Chedid
- Pediatric Anesthesiology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| | - Carol Abi Shadid
- Pediatric Anesthesiology, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
| | - Eiichi A Miyasaka
- Pediatric Surgery, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
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28
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Salaün JP, Beaufils R, Chagnot A, Alexandre C, Petit T, Hanouz JL, Orliaguet G. Evaluation of quality of care in neonatal anesthesia using a bundle of intraoperative parameters. Paediatr Anaesth 2023; 33:823-828. [PMID: 37422704 DOI: 10.1111/pan.14719] [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: 03/06/2022] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Maintenance of physiological homeostasis is key in the safe conduct of pediatric anesthesia. Achieving this goal is especially difficult in neonatal surgery. AIMS The first aim was to document the absolute number of seven intraoperative parameters monitored during anesthesia in neonates undergoing gastroschisis surgery. The second aims were to determine the frequency of monitoring of each of these intraoperative parameters as well as the proportion of cases in which each parameter was both monitored and maintained within a pre-defined range. METHODS This retrospective observational analysis includes data from 53 gastroschisis surgeries performed at Caen University Hospital (2009-2020). Seven intraoperative parameters were analyzed. First, we assessed if the intraoperative parameters were monitored or not. Second, when monitored, we assessed if these parameters were maintained within a pre-defined range, based on the current literature and on local agreement. RESULTS The median [first-third Q], range (min-max) number of intraoperative parameters monitored during the 53 gastroschisis surgeries was 6 [5-6], range (4-7). There were no missing data for the automatically recorded ones such as arterial blood pressure, heart rate, end-tidal CO2, and oxygen saturation. Temperature was monitored in 38% of the patients, glycemia in 66%, and natremia in 68% of the cases. Oxygen saturation and heart rate were maintained within the pre-defined range in 96% and 81% of the cases respectively. The blood pressure (28%) and temperature (30%) were instead the least often maintained within the pre-defined range. CONCLUSION Although a median of six out of the seven selected intraoperative parameters were monitored during gastroschisis repair, only two of them (oxygen saturation and heart rate) were maintained within the pre-defined range more than 80% of the time. It might be of interest to extend physiologic age- and procedure-based approach to the development of specific preoperative anesthetic planning.
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Affiliation(s)
- Jean-Philippe Salaün
- Department of Anesthesiology and Critical Care Medicine, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen, France
| | - Roxane Beaufils
- Department of Anesthesiology and Critical Care Medicine, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
| | - Audrey Chagnot
- Normandie Univ, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen-Normandie (BB@C), GIP Cyceron, Caen, France
| | - Cénéric Alexandre
- Department of Neonatology, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
| | - Thierry Petit
- Department of Pediatric surgery, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, CHU Caen Normandie, Caen University Hospital, 14000 Caen, France
- EA 4650, Caen Normandy University, UNICAEN, Caen, France
| | - Gilles Orliaguet
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre-Université de Paris, Paris, France
- Pharmacologie et Évaluation des Thérapeutiques Chez l'enfant et la Femme Enceinte EA 7323, Université de Paris, Paris, France
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29
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Taverner F, Krishnan P, Baird R, von Ungern‐Sternberg BS. Perioperative management of infant inguinal hernia surgery; a review of the recent literature. Paediatr Anaesth 2023; 33:793-799. [PMID: 37449338 PMCID: PMC10947457 DOI: 10.1111/pan.14726] [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: 04/24/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Inguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high-risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. Despite a large volume of literature in the area of infant inguinal hernia surgery, there remains much debate amongst anesthetists, surgeons and neonatologists regarding the optimal perioperative management of these patients. The questions asked by clinicians include; when should the surgery occur, how should the surgery be performed (open or laparoscopic), how should the anesthesia be conducted, including regional versus general anesthesia and airway devices used, and what impact does anesthesia choice have on the developing brain? There is a paucity of evidence in the literature on the concerns, priorities or goals of the parents or caregivers but clearly their opinions do and should matter. In this article we review the current clinical surgical and anesthesia practice and evidence for infants undergoing inguinal hernia surgery to help clinicians answer these questions.
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Affiliation(s)
- Fiona Taverner
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Department of Anaesthesia and Pain ManagementFlinders Medical CentreAdelaideSouth AustraliaAustralia
| | - Prakash Krishnan
- Department of AnesthesiaBC Children's HospitalVancouverBritish ColumbiaCanada
- Department of Anesthesiology, Pharmacology and Therapeutics UBCVancouverBritish ColumbiaCanada
| | - Robert Baird
- Division of Pediatric SurgeryBC Children's HospitalVancouverBritish ColumbiaCanada
| | - Britta S. von Ungern‐Sternberg
- Department of Anaesthesia and Pain MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
- Division of Emergency Medicine, Anaesthesia and Pain MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Perioperative Medicine Team, Perioperative Care ProgramTelethon Kids InstituteNedlandsWestern AustraliaAustralia
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30
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Abstract
Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant challenges to experienced neonatologists and paediatric anaesthesiologists, and increased difficulty can be due to anatomical abnormalities, physiological instability or increased situational stress. Neonatal airway obstruction is under recognised, and should be considered an emergency until the diagnosis and physiological implications are understood. When multiple types of difficulties are present or there are multiple levels of anatomical obstruction, the challenge increases exponentially. In these situations, preparation, multi-disciplinary teamwork and a consistent hospital-wide approach will help to reduce errors and morbidity.
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Affiliation(s)
- Toby Kane
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Neonatology, Royal Children's Hospital, Parkville, Australia.
| | - Anastasia Pellicano
- Department of Neonatology, Royal Children's Hospital, Parkville, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, Australia
| | - Stefano Sabato
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, Australia; Anaesthetics, Murdoch Children's Research Institute, Parkville, Australia
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31
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Opfermann P, Schmid W, Obradovic M, Kraft F, Zadrazil M, Marhofer D, Marhofer P. Sex differences in pediatric caudal epidural anesthesia under sedation without primary airway instrumentation. PLoS One 2023; 18:e0288431. [PMID: 37440538 DOI: 10.1371/journal.pone.0288431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
STUDY OBJECTIVE To identify sex differences associated with caudal epidurals, the most commonly used technique of pediatric regional anesthesia, based on individually validated data of ultrasound-guided blocks performed between 04/2014 and 12/2020. METHODS Prospectively collected and individually validated data of a cohort of children aged between 0-15 years was analyzed in a retrospective observational study. We included pediatric surgeries involving a primary plan of caudal epidural anesthesia under sedation (without airway instrumentation) and a contingency plan of general anesthesia. Sex-specific rates were analyzed for overall failure of the primary anesthesia plan, for residual pain, for block-related technical complications and for critical respiratory events. We used Fisher´s exact tests and multivariable logistic regressions were used to evaluate sex-specific associations. RESULTS Data from 487 girls and 2060 boys ≤15 years old (ASA status 1 to 4) were analyzed. The primary-anesthesia-plan failure rate was 5.5% (95%CI 3.8%-7.8%) (N = 27/487) among girls and 4.7% (95%CI 3.9%-5.7%) (N = 97/2060) among boys (p = 0.41). Residual pain was the main cause of failure, with rates of 4.5% (95%CI 2.9-6.6%) (N = 22/487) among girls and 3.0% (95%CI 2.3-3.8%) (N = 61/2060) among boys (p = 0.089). Block-related technical complications were seen at rates of 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls vs 2.5% (95%CI 0.5-2.7%) (N = 51/2060) among boys and, hence, significantly more often among male patients (p = 0.023). Male sex was significantly associated with higher odds (adjusted OR: 3.18; 95% CI: 1.12-9; p = 0.029) for such technical complications regardless of age, ASA status, gestational week at birth or puncture attempts. Critical respiratory events occurred at a 1.7% (95%CI 1.2%-2.3%) rate (N = 35/2060) twice as high among boys as 0.8% (95%CI 0.3%-1.9%) (N = 4/487) among girls (p = 0.21). CONCLUSIONS While the the primary-anesthesia-plan failure rate was equal for girls and boys, technical complications and respiratory events are more likely to occur in boys.
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Affiliation(s)
- Philipp Opfermann
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna,Vienna, Austria
| | - Werner Schmid
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna,Vienna, Austria
| | - Mina Obradovic
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna,Vienna, Austria
| | - Felix Kraft
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna,Vienna, Austria
| | - Markus Zadrazil
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna,Vienna, Austria
| | - Daniela Marhofer
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna,Vienna, Austria
| | - Peter Marhofer
- Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna,Vienna, Austria
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Hansen TG, Vieri J, Børke WB, Castellheim AG. Outcome following anaesthesia in infancy in the Nordic countries: Subgroup analysis of the NECTARINE study. Acta Anaesthesiol Scand 2023; 67:714-723. [PMID: 36918742 DOI: 10.1111/aas.14236] [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: 01/17/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION The neonate and children audit of anaesthesia practice in Europe (NECTARINE) prospective observational study reported an incidence of 35.2% of critical events requiring intervention during 6542 anaesthetics in 5609 infants up to 60 weeks postmenstrual age (PMA) from 165 centres in 31 European countries. METHODS Sub-analysis of the cohort from the Nordic countries (8% of the entire cohort) was conducted. Secondary aims were to describe the Nordic countries' anaesthetic practices and compare morbidity and mortality with the overall European cohort. RESULTS Eleven Nordic centres recruited 447 infants (66% males, 37.3% born preterm and 45% had congenital anomalies) undergoing anaesthesia for 530 surgical or non-surgical procedures at 25-60 weeks PMA. Perioperative critical events triggered interventions in 228/530 (43%) cases. Hypotension (12.6%) or hypoxaemia (11.7%) were more common in younger patients and those with co-morbidities. Hypo/hypercapnia occurred in 1.5%/4.7% of cases. More than two attempts for intubation were required in 13 (2.9%) infants (max three attempts). Distribution of ASA-Physical Status Scores was similar to the total European cohort (40% was ASA > 2). A total of 236/530 (44.5%) patients were admitted to the postoperative intensive care unit. Thirty-day morbidity (complications in 87/447 = 19.5%) and mortality (8/447, 1.8%) did not differ from the overall European cohort. Hospital re-admissions were significant up to 90 days (98/447 = 21.9%). CONCLUSIONS In Nordic countries, anaesthesia in young infant children is resource-demanding, and perioperative critical events and co-morbidities are common. Thirty-day morbidity and mortality data in the Nordic countries did not differ from the overall European cohort.
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Affiliation(s)
- Tom G Hansen
- Department of Anaesthesiology and Intensive Care - Paediatrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research - Anaesthesiology, University of Southern Denmark, Odense, Denmark
| | - Jenny Vieri
- Department of Prehospital Emergency Care, Pain Management and Anaesthesiology, Tampere University Hospital, Tampere, Finland
| | - Wenche Bakken Børke
- Division of Emergencies and Critical Care Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Albert Gyllencreutz Castellheim
- Department of Anaesthesiology and Intensive Care Medicine, Queen Silvia Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fuchs A, Franzmeier L, Cheseaux-Carrupt M, Kaempfer M, Disma N, Pietsch U, Huber M, Riva T, Greif R. Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study. Front Med (Lausanne) 2023; 10:1198078. [PMID: 37396914 PMCID: PMC10309035 DOI: 10.3389/fmed.2023.1198078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Little is known about intraoperative cardiac arrest during anesthesia care. In particular, data on characteristics of cardiac arrest and neurological survival are scarce. Methods We conducted a single-center retrospective observational study evaluating anesthetic procedures from January 2015 until December 2021. We included patients with an intraoperative cardiac arrest and excluded cardiac arrest outside of the operating room. The primary outcome was the return of spontaneous circulation (ROSC). Secondary outcomes were sustained ROSC over 20 min, 30-day survival, and favorable neurological outcome according to Clinical Performance Category (CPC) 1 and 2. Results We screened 228,712 anesthetic procedures, 195 of which met inclusion criteria and were analyzed. The incidence of intraoperative cardiac arrest was 90 (CI 95% 78-103) in 100,000 procedures. The median age was 70.5 [60.0; 79.4] years, and two-thirds of patients (n = 135; 69.2%) were male. Most of these patients with cardiac arrest had ASA physical status IV (n = 83; 42.6%) or V (n = 47; 24.1%). Cardiac arrest occurred more frequently (n = 104; 53.1%) during emergency procedures than elective ones (n = 92; 46.9%). Initial rhythm was pre-dominantly non-shockable with pulseless electrical activity mostly. Most patients (n = 163/195, 83.6%; CI 95 77.6-88.5%) had at least one instance of ROSC. Sustained ROSC over 20 min was achieved in most patients with ROSC (n = 147/163; 90.2%). Of the 163 patients with ROSC, 111 (68.1%, CI 95 60.4-75.2%) remained alive after 30 days, and most (n = 90/111; 84.9%) had favorable neurological survival (CPC 1 and 2). Conclusion Intraoperative cardiac arrest is rare but is more likely in older patients, patients with ASA physical status ≥IV, cardiac and vascular surgery, and emergency procedures. Patients often present with pulseless electrical activity as the initial rhythm. ROSC can be achieved in most patients. Over half of the patients are alive after 30 days, most with favorable neurological outcomes, if treated immediately.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lea Franzmeier
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Marie Cheseaux-Carrupt
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Martina Kaempfer
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicola Disma
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Urs Pietsch
- Department of Emergency Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- ERC Research Net, Niel, Belgium
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Kimoto Y, Hirano T, Kuratani N, Cavanaugh D, Mason KP. Remimazolam as an Adjunct to General Anesthesia in Children: Adverse Events and Outcomes in a Large Cohort of 418 Cases. J Clin Med 2023; 12:3930. [PMID: 37373624 DOI: 10.3390/jcm12123930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Remimazolam was first approved in 2020 as a general anesthetic for adults and still does not have pediatric labeling. Our study will be the first pilot program that administers remimazolam as an adjunct to a general endotracheal anesthetic in children. Between August 2020 and December 2022, electronic medical records were collected for all children who received remimazolam during anesthesia. The remimazolam dosing regimen was extrapolated from the adult package insert, with intravenous induction doses of 12 mg/kg/h administered until the desired effect was achieved. Subsequent infusions were given at a rate of 1-2 mg/kg/h, accompanied by intermittent boluses of 0.2 mg/kg, with all dosing adjustments made according to the anesthesiologist's clinical discretion. A total of 418 children (mean 4.6 yrs, 68.7% ASA 1 and 2) underwent surgeries which averaged 81.2 min. A total of 75.2% of patients had greater than a 20% change (increase or decrease) in MAP (lowest or highest) from baseline, and 203 (49.3%) patients had greater than a 30% change (increase or decrease) in MAP (lowest or highest) from baseline. A total of 5% received ephedrine to treat unanticipated hemodynamic variability. Discharge criteria were met within an average of 13.8 min after arrival at the post-anesthesia care unit. Remimazolam may offer the benefits of rapid recovery following general endotracheal anesthesia. The risk of hemodynamic variability which necessitates and responds to ephedrine should be anticipated.
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Affiliation(s)
- Yoshitaka Kimoto
- Department of Anesthesiology, Kurume University School of Medicine, Kurume 830-0011, Japan
- Department of Anaesthesia, Saitama Children's Medical Center, Saitama 330-8777, Japan
| | - Tatsuya Hirano
- Department of Anaesthesia, National Hospital Organization Saitama Hospital, Saitama 351-0102, Japan
| | - Norifumi Kuratani
- Department of Anaesthesia, Saitama Children's Medical Center, Saitama 330-8777, Japan
| | - David Cavanaugh
- Boston Biostatistical Consulting, North Reading, MA 01864, USA
| | - Keira P Mason
- Department of Anaesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA
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Machotta A, Hansen TG, Weiss M. Children's rights - the basis of quality in pediatric anesthesia. Curr Opin Anaesthesiol 2023; 36:295-300. [PMID: 36815521 DOI: 10.1097/aco.0000000000001256] [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: 02/24/2023]
Abstract
PURPOSE OF REVIEW In 1989, the United Nations passed the 'Convention on the Rights of the Child' (UNCRC) and, among others claimed the highest attainable standard of health for children and consequently the highest level of safety and quality in paediatric anaesthesia. SAFETOTS (Safe Anesthesia For Every Tot, www.safetots.org ), an initiative of international active paediatric anaesthetists, has derived 10 rights, the '10 R' of children undergoing anaesthesia care, which are critical for the well being of the child. RECENT FINDINGS The current situation in paediatric anaesthesia care in Europe does not always meet the requirements demanded by the UNCRC. Anaesthesia-related complications in children are still persistent. Anaesthesiologists are frequently asked to provide care for newborns, infants and small children without having sufficient child-specific expertise, resulting in an increased morbidity and mortality. SUMMARY This article will explain these statutes of children's rights and their implications for everyday paediatric anaesthesia. Furthermore, it will also express the institutional and political changes that are needed to guarantee children their right to enjoy the highest attainable standard of health.
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Affiliation(s)
- Andreas Machotta
- Department of Anaesthesiology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Tom G Hansen
- Department of Anaesthesiology and Intensive Care, Division of Surgery, Akershus University Hospital Oslo, Norway and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital, Zürich, Switzerland
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Jöhr M. A new view on old problems in paediatric anaesthesia: premedication, postoperative agitation and dosing. Curr Opin Anaesthesiol 2023; 36:311-317. [PMID: 36745083 DOI: 10.1097/aco.0000000000001236] [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: 02/07/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to discuss recent developments in paediatric anaesthesia, which have evolved in an undulating fashion. RECENT FINDINGS The role and efficacy of pharmacological premedication is reevaluated. The anxiolytic and sedative properties of midazolam and α 2 -agonists have now been defined more precisely. Both classes of drugs have their unique profile, and there is no reason to condemn one or the other. Midazolam is an excellent anxiolytic, whereas dexmedetomidine is superior in the postoperative period and for sedation during diagnostic imaging.A total intravenous technique with propofol is often considered to be the standard for the prevention of emergence agitation; but alternatives do exist, such as a co-medication with dexmedetomidine or opioids. In clinical reality, a multimodal approach may often be advisable.The theoretical basis for propofol dosing has recently been adapted. In contrast to previous beliefs, the context-sensitive half-life of propofol seems to be quite short beyond the first year of life. SUMMARY Midazolam and dexmedetomidine are not interchangeable; each compound has its pros and cons. As an anxiolytic drug, midazolam indisputably deserves its place, whereas dexmedetomidine is a better sedative and particularly beneficial in the postoperative period. New data will allow more precise age-adapted dosing of propofol.
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Affiliation(s)
- Martin Jöhr
- Paediatric Anaesthesia, Luzerner Kantonsspital, Luzern Switzerland
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Olbrecht VA, Engelhardt T, Tobias JD. Beyond mortality: definitions and benchmarks of outcome standards in paediatric anaesthesiology. Curr Opin Anaesthesiol 2023; 36:318-323. [PMID: 36745075 DOI: 10.1097/aco.0000000000001246] [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: 02/07/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review the evolution of safety and outcomes in paediatric anaesthesia, identify gaps in quality and how these gaps may influence outcomes, and to propose a plan to address these challenges through the creation of universal outcome standards and a paediatric anaesthesia designation programme. RECENT FINDINGS Tremendous advancements in the quality and safety of paediatric anaesthesia care have occurred since the 1950 s, resulting in a near absence of documented mortality in children undergoing general anaesthesia. However, the majority of data we have on paediatric anaesthesia outcomes come from specialized academic institutions, whereas most children are being anaesthetized outside of free-standing children's hospitals. SUMMARY Although the literature supports dramatic improvements in patient safety during anaesthesia, there are still gaps, particularly in where a child receives anaesthesia care and in quality outcomes beyond mortality. Our goal is to increase equity in care, create standardized outcome measures in paediatric anaesthesia and build a verification system to ensure that these targets are accomplished. The time has come to benchmark paediatric anaesthesia care and increase quality received by all children with universal measures that go beyond simply mortality.
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Affiliation(s)
- Vanessa A Olbrecht
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and the Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine
- Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Thomas Engelhardt
- Department of Paediatric Anaesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and the Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine
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Wittenmeier E, Komorek Y, Engelhard K. Current hemoglobin thresholds in pediatric anesthesia - guidelines and studies. Curr Opin Anaesthesiol 2023; 36:301-310. [PMID: 36794871 DOI: 10.1097/aco.0000000000001253] [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: 02/17/2023]
Abstract
PURPOSE OF REVIEW The use of restrictive transfusion triggers to avoid unnecessary transfusions is one important pillar of Patient Blood Management (PBM). For the safe application of this principle in pediatric patients, anesthesiologists need evidence-based guidelines for hemoglobin (Hb) transfusions thresholds in this specially vulnerable age-group. RECENT FINDINGS This review outlines recent prospective and observational studies examining transfusion thresholds in pediatrics. Recommendations to use transfusion triggers in the perioperative or intensive care setting are summarized. SUMMARY Two high-quality studies confirmed that the use of restrictive transfusion triggers in preterm infants in the intensive care unit (ICU) is reasonable and feasible. Unfortunately, no recent prospective study could be found investigating intraoperative transfusion triggers. Some observational studies showed wide variability in Hb levels before transfusion, a tendency toward restrictive transfusion practices in preterm infants, and liberal transfusion practices in older infants. Although there are comprehensive and useful guidelines for clinical practice in pediatric transfusion, most of them do not cover the intraoperative period in particular because of a lack of high-quality studies. This lack of prospective randomized trials focusing on intraoperative transfusion management remains a major problem for the application of pediatric PBM.
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Affiliation(s)
- Eva Wittenmeier
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
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Disma N, Asai T. Preventing difficult facemask ventilation in children: all is well that starts well. Br J Anaesth 2023:S0007-0912(23)00190-3. [PMID: 37183099 DOI: 10.1016/j.bja.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023] Open
Abstract
Difficult facemask ventilation at induction of general anaesthesia can trigger hypoxaemia and inadequate ventilation if not immediately identified and adequately treated. For this reason, identification of predisposing conditions before induction of anaesthesia and causes of poor facemask ventilation are critical to avoid the subsequent complications. In a recently published secondary analysis of the Paediatric Difficult Intubation (PeDI) registry, the incidence and risk factors for difficult facemask ventilation in children with difficult tracheal intubation was described, as highlighted in the editorial.
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Affiliation(s)
- Nicola Disma
- Unit for Research in Anaesthesia, Department of Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Centre, Koshigaya, Saitama, Japan
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Marchesini V, Disma N. Outcomes in pediatric anesthesia: towards a universal language. Curr Opin Anaesthesiol 2023; 36:216-221. [PMID: 36728715 DOI: 10.1097/aco.0000000000001232] [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: 02/03/2023]
Abstract
PURPOSE OF REVIEW The identification of valid, well defined and relevant outcomes is fundamental to provide a reliable and replicable measure that can be used to improve quality of clinical care and research output. The purpose of this review is to provide an update on what the pediatric anesthesia research community is pursuing on standardized and validated outcomes. RECENT FINDINGS Several initiatives by different research groups have been established during the last years. They all aim to find validated outcomes using the standardized methodology of COMET ( https://www.comet-initiative.org/ ). These initiatives focus on clinical and research outcomes on the field of anesthesia, perioperative medicine, pain and sedation in pediatric age. SUMMARY Clinical outcomes are measurements of changes in health, function or quality of life and they help evaluating quality of care. In order for them to be relevant in quantifying quality improvement, they need to be well defined, standardized and consistent across trials. A great effort from researchers has been made towards the identification of set of outcomes with these features.
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Affiliation(s)
- Vanessa Marchesini
- Pediatric Intensive Care Unit, Royal Melbourne Children's Hospital, Parkville
- Anesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Nicola Disma
- Unit for Research in Anesthesia, Department of Pediatric Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
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de Graaff JC, Frykholm P. Ephedrine to treat intraoperative hypotension in infants: what is the target? Br J Anaesth 2023; 130:510-515. [PMID: 36906461 DOI: 10.1016/j.bja.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
Off-label use of medications in paediatric anaesthesia is common practice, owing to the relative paucity of evidence-based dosing regimens in children. Well-performed dose-finding studies, especially in infants, are rare and urgently needed. Unanticipated effects can result when paediatric dosing is based on adult parameters or local traditions. A recent dose-finding study on ephedrine highlights the uniqueness of paediatric dosing in comparison with adult dosing. We discuss the problems of off-label medication use and the lack of evidence for various definitions of hypotension and associated treatment strategies in paediatric anaesthesia. What is the aim of treating hypotension associated with anaesthesia induction: restoring the MAP to awake baseline values or elevating it above a provisional hypotension threshold?
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Affiliation(s)
| | - Peter Frykholm
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
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Becke-Jakob K, Disma N, Hansen TG. Practical and societal implications of the potential anesthesia-induced neurotoxicity: The safetots perspective. Best Pract Res Clin Anaesthesiol 2023; 37:63-72. [PMID: 37295855 DOI: 10.1016/j.bpa.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/01/2023] [Accepted: 04/19/2023] [Indexed: 06/12/2023]
Abstract
Key elements for safe and high-quality care in pediatric anesthesia are personal and institutional competence, perioperative maintenance of physiological homeostasis, prevention, prompt recognition, and appropriate treatment of critical situations as well as the reassurance of the parents and respecting the children's rights. Training in pediatric anesthesia should take place within the framework of harmonized curricular structures. International quality assessment and improvement projects should be encouraged and supported by collaborations. Healthy communication and providing information in a balanced way to the public and all stakeholders is an important task for pediatric anesthesia societies and individuals. The Safetots.org initiative was established to emphasize the role of the conduct of anesthesia to prevent harm, promote quality in the perioperative period, and provide safe and high-quality clinical care. This initiative considers that the prevention of complications and other well-known risk factors of perioperative care, as well as the quality of anesthesia management, have a far more important impact on outcomes following anesthesia and surgery than anesthetic drugs themselves.
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Affiliation(s)
- Karin Becke-Jakob
- Department of Anaesthesiology, Paediatric Anaesthesiology and Intensive Care, Cnopf Children's Hospital - Hospital Hallerwiese, Nürnberg, Germany.
| | - Nicola Disma
- Department of Anaesthesia, Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Tom Giedsing Hansen
- Department of Anaesthesiology and Intensive Care, Akershus University Hospital, Lørenskog Norway, and Faculty of Medicine, The University of Oslo, Oslo, Norway
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Kagan MS, Wang JT, Pier DB, Zurakowski D, Jennings RW, Bajic D. Infant Perioperative Risk Factors and Adverse Brain Findings Following Long-Gap Esophageal Atresia Repair. J Clin Med 2023; 12:jcm12051807. [PMID: 36902591 PMCID: PMC10003188 DOI: 10.3390/jcm12051807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 02/26/2023] Open
Abstract
Recent findings implicate brain vulnerability following long-gap esophageal atresia (LGEA) repair. We explored the relationship between easily quantifiable clinical measures and previously reported brain findings in a pilot cohort of infants following LGEA repair. MRI measures (number of qualitative brain findings; normalized brain and corpus callosum volumes) were previously reported in term-born and early-to-late premature infants (n = 13/group) <1 year following LGEA repair with the Foker process. The severity of underlying disease was classified by an (1) American Society of Anesthesiologist (ASA) physical status and (2) Pediatric Risk Assessment (PRAm) scores. Additional clinical end-point measures included: anesthesia exposure (number of events; cumulative minimal alveolar concentration (MAC) exposure in hours), length (in days) of postoperative intubated sedation, paralysis, antibiotic, steroid, and total parenteral nutrition (TPN) treatment. Associations between clinical end-point measures and brain MRI data were tested using Spearman rho and multivariable linear regression. Premature infants were more critically ill per ASA scores, which showed a positive association with the number of cranial MRI findings. Clinical end-point measures together significantly predicted the number of cranial MRI findings for both term-born and premature infant groups, but none of the individual clinical measures did on their own. Listed easily quantifiable clinical end-point measures could be used together as indirect markers in assessing the risk of brain abnormalities following LGEA repair.
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Affiliation(s)
- Mackenzie Shea Kagan
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
| | - Jue Teresa Wang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
- Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Danielle Bennett Pier
- Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
- Department of Neurology, Division of Pediatric Neurology, Massachusetts General Hospital, 55 Fruit Street, Wang 708, Boston, MA 021114, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
- Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Russell William Jennings
- Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
- Department of Surgery, Esophageal and Airway Treatment Center, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
- Department of Anaesthesia, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-(617)-355-7737; Fax: +1-(618)-730-0894
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Salaün JP, Chagnot A, Cachia A, Poirel N, Datin-Dorrière V, Dujarrier C, Lemarchand E, Rolland M, Delalande L, Gressens P, Guillois B, Houdé O, Levard D, Gakuba C, Moyon M, Naveau M, Orliac F, Orliaguet G, Hanouz JL, Agin V, Borst G, Vivien D. Consequences of General Anesthesia in Infancy on Behavior and Brain Structure. Anesth Analg 2023; 136:240-250. [PMID: 36638508 DOI: 10.1213/ane.0000000000006233] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND One in 7 children will need general anesthesia (GA) before the age of 3. Brain toxicity of anesthetics is controversial. Our objective was to clarify whether exposure of GA to the developing brain could lead to lasting behavioral and structural brain changes. METHODS A first study was performed in mice. The behaviors (fear conditioning, Y-maze, and actimetry) and brain anatomy (high-resolution magnetic resonance imaging) of 6- to 8-week-old Swiss mice exposed or not exposed to GA from 4 to 10 days old were evaluated. A second study was a complementary analysis from the preexisting APprentissages EXécutifs et cerveau chez les enfants d'âge scolaire (APEX) cohort to assess the replicability of our data in humans. The behaviors (behavior rating inventory of executive function, emotional control, and working memory score, Backward Digit Span, and Raven 36) and brain anatomy (high-resolution magnetic resonance imaging) were compared in 102 children 9 to 10 years of age exposed or not exposed to a single GA (surgery) during infancy. RESULTS The animal study revealed chronic exacerbated fear behavior in the adult mice (95% confidence interval [CI], 4-80; P = .03) exposed to postnatal GA; this was associated with an 11% (95% CI, 7.5-14.5) reduction of the periaqueductal gray matter (P = .046). The study in humans suggested lower emotional control (95% CI, 0.33-9.10; P = .06) and a 6.1% (95% CI, 4.3-7.8) reduction in the posterior part of the right inferior frontal gyrus (P = .019) in the children who had been exposed to a single GA procedure. CONCLUSIONS The preclinical and clinical findings of these independent studies suggest lasting effects of early life exposure to anesthetics on later emotional control behaviors and brain structures.
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Affiliation(s)
- Jean-Philippe Salaün
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France.,Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France
| | - Audrey Chagnot
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France
| | - Arnaud Cachia
- Université de Paris, LaPsyDé, CNRS, Paris, France.,Institut Universitaire de France, Paris, France
| | - Nicolas Poirel
- Université de Paris, LaPsyDé, CNRS, Paris, France.,Institut Universitaire de France, Paris, France.,GIP Cyceron, Caen, France
| | - Valérie Datin-Dorrière
- Université de Paris, LaPsyDé, CNRS, Paris, France.,GIP Cyceron, Caen, France.,Department of Neonatology, CHU Caen, Caen University Hospital, Caen, France
| | - Cléo Dujarrier
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France
| | - Eloïse Lemarchand
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France
| | - Marine Rolland
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France.,Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France
| | | | | | | | - Olivier Houdé
- Université de Paris, LaPsyDé, CNRS, Paris, France.,Institut Universitaire de France, Paris, France.,GIP Cyceron, Caen, France
| | - Damien Levard
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France
| | - Clément Gakuba
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France.,Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France
| | - Marine Moyon
- Université de Paris, LaPsyDé, CNRS, Paris, France
| | - Mikael Naveau
- CNRS, GIP Cyceron, Normandie Université, Caen, France
| | - François Orliac
- Université de Paris, LaPsyDé, CNRS, Paris, France.,GIP Cyceron, Caen, France
| | - Gilles Orliaguet
- Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP, Centre - Université de Paris, France, Université de Paris, Paris, France
| | - Jean-Luc Hanouz
- Department of Anesthesiology and Critical Care Medicine, CHU Caen, Caen University Hospital, Caen, France.,Caen Normandy University, Unicaen, Caen, France
| | - Véronique Agin
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France
| | - Grégoire Borst
- Université de Paris, LaPsyDé, CNRS, Paris, France.,Institut Universitaire de France, Paris, France
| | - Denis Vivien
- From the Normandie Universite UNICAEN, INSERM, GIP Cyceron, Institut Blood and Brain @Caen-Normandie, Physiopathology and Imaging of Neurological Disorders, Caen, France.,Department of Clinical Research, CHU Caen, Caen University Hospital, Caen, France
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Szostek AS, Saunier C, Elsensohn MH, Boucher P, Merquiol F, Gerst A, Portefaix A, Chassard D, De Queiroz Siqueira M. Effective dose of ephedrine for treatment of hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age: a multicentre randomised, controlled, open label, dose escalation trial. Br J Anaesth 2023; 130:603-610. [PMID: 36639328 DOI: 10.1016/j.bja.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The recommended dose of ephedrine in adults (0.1 mg kg-1) frequently fails to treat hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age. The aim of this study was to determine the optimal dose of ephedrine in this population for the treatment of hypotension after induction of general anaesthesia with sevoflurane. METHODS We conducted a multicentre, prospective, randomised, open-label, controlled, dose-escalation trial. Subjects were randomised if presenting a >20% change from baseline in MAP. Six cohorts of 20 subjects each were enrolled. Ten subjects in the first cohort received 0.1 mg kg-1 i. v. (reference dose). For each subsequent cohort, 10 subjects were assigned to the next higher dose (consecutively 0.6, 0.8, 1, 1.2, and 1.4 mg kg-1 i. v.), and the other subjects were assigned to one or more doses already investigated in previous cohorts. The primary outcome was the return of MAP to >80% of baseline at least once within 10 min after ephedrine administration. RESULTS A total of 119 infants (25% females), with a mean age (standard deviation) of 2.7 (1.3) months, received their allocated dose of ephedrine. The optimal dose of ephedrine was 1.2 mg kg-1, with a percentage of success of 65.5% (95% confidence interval, 35.6-86.4). The doses of ephedrine investigated did not induce adverse events. CONCLUSIONS Doses of ephedrine much higher (∼10-fold) than those used in adults are necessary in neonates and infants for the treatment of hypotension after induction of general anaesthesia with sevoflurane. CLINICAL TRIAL REGISTRATION NCT02384876.
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Affiliation(s)
- Anne-Sara Szostek
- Department of Paediatric Anaesthesia, Hospices Civils de Lyon, Bron, France
| | - Clarisse Saunier
- Department of Epidemiology, Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Bron, France
| | - Mad-Hélénie Elsensohn
- Department of Biostatistics, Hospices Civils de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Pierre Boucher
- Department of Paediatric Anaesthesia, Hospices Civils de Lyon, Bron, France
| | - Fanette Merquiol
- Department of Anaesthesia, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Adeline Gerst
- Department of Anaesthesia, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Portefaix
- Department of Epidemiology, Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Bron, France; Department of Biostatistics, Hospices Civils de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Dominique Chassard
- Department of Anaesthesia, Hospices Civils de Lyon, Université Lyon 1, Bron, France.
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Anesthesia and neurodevelopment after 20 years: where are we now and where to next? Can J Anaesth 2023; 70:10-15. [PMID: 36536154 DOI: 10.1007/s12630-022-02352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 12/23/2022] Open
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47
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Knottenbelt G. Anaesthesia for surgery in infancy. ANAESTHESIA & INTENSIVE CARE MEDICINE 2022. [DOI: 10.1016/j.mpaic.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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48
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Andropoulos DB, Dunbar BS. Neuroprotective Strategies in Anesthesia-Induced Neurotoxicity. Best Pract Res Clin Anaesthesiol 2022. [DOI: 10.1016/j.bpa.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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49
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Special considerations in the premature and ex-premature infant. ANAESTHESIA & INTENSIVE CARE MEDICINE 2022. [DOI: 10.1016/j.mpaic.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Disma N, Engelhardt T, Hansen TG, de Graaff JC, Virag K, Habre W. Neonates undergoing pyloric stenosis repair are at increased risk of difficult airway management: secondary analysis of the NEonate and Children audiT of Anaesthesia pRactice IN Europe. Br J Anaesth 2022; 129:734-739. [PMID: 36085092 DOI: 10.1016/j.bja.2022.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Hypertrophic pyloric stenosis in otherwise healthy neonates frequently requires urgent surgical procedure but anaesthesia care may result in respiratory complications, such as hypoxaemia, pulmonary aspiration of gastric contents, and postoperative apnoea. The primary aim was to study whether or not the incidence of difficult airway management and of hypoxaemia in neonates undergoing pyloric stenosis repair was higher than that in neonates undergoing other surgeries. METHODS Data on neonates and infants undergoing anaesthesia and surgery for pyloric stenosis were extracted from the NEonate and Children audiT of Anesthesia pRactice In Europe (NECTARINE) database, for secondary analysis. RESULTS We identified 310 infants who had anaesthesia for surgery for pyloric stenosis. Difficult airway management (more than two attempts at laryngoscopy) was higher in children with pyloric stenosis when compared with the entire NECTARINE cohort (7.9% [95% confidence interval {CI}, 5.22-11.53] vs 4.4% [95% CI, 1.99-6.58]; relative risk [RR]=1.81 [95% CI, 1.21-2.69]; P=0.004), whereas transient hypoxaemia with oxygen saturation <90% was comparable between the two cohorts. Postoperative complications occurred in 16 children (5.6%) within the 30-day follow-up. No mortality was reported at 30 and 90 days. CONCLUSIONS Children undergoing surgery for pyloric stenosis had a higher incidence of difficult intubation compared with the entire NECTARINE cohort. CLINICAL TRIAL REGISTRATION NCT02350348.
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Affiliation(s)
- Nicola Disma
- Unit for Research and Innovation, Department of Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy.
| | - Thomas Engelhardt
- Department of Anaesthesia, Montreal Children's Hospital, Montreal, Canada
| | - Tom G Hansen
- Department of Clinical Research - Anaesthesiology, University of Southern Denmark, Odense, Denmark
| | - Jurgen C de Graaff
- Department of Anaesthesiology, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, the Netherlands
| | - Katalin Virag
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland; Unit for Anaesthesiological Research, University of Geneva, Geneva, Switzerland
| | - Walid Habre
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland; Unit for Anaesthesiological Research, University of Geneva, Geneva, Switzerland
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