Anesthetic Neurotoxicity in Congenital Hand Surgery: An Overview of the Evidence and Advice for Counseling Parents

Pediatric Wide-Awake Local Anesthesia No-Tourniquet Technique Hand Surgery: A Practical Approach

Pediatric wide-awake local anesthesia no-tourniquet technique (WALANT) hand surgery is feasible for the treatment of the spectrum of pediatric hand surgeries, which can include traumatic injuries and congenital hand differences. The key component for success is identifying the appropriate patient for this technique, with the typical patient frequently being >10 years of age. The discussion with the patient and adequate preparation for maximum efficiency become key for patient and surgeon comfort. Here we describe a practical approach for successfully performing this valuable technique for the pediatric population.

Comparing Results of Syndactyly Operated Children Younger and Older Than 1 Year

INTRODUCTION

Syndactyly has a cosmetic, functional, and psychosocial impact, and surgical treatment is indicated in most cases. This study aimed to retrospectively identify whether patients undergoing surgical release of syndactyly younger than 1 year presented different results compared with those operated older than 1 year.

METHODS

Patients were assessed through photographic records by 3 independent specialist surgeons for the quality of scar, presence of web creep, rotational, flexion-extension, and lateral flexion deformities using the Withey score.

RESULTS

Thirty-four patients were included in the study, totaling 51 commissures operated. The score was higher in the group operated younger than 1 year (5.83 ± 2.39) compared with the group older than 1 year (3.94 ± 1.93), being statistically significant, with a P value of 0.011.

CONCLUSIONS

Children with syndactyly operated younger than 1 year have worse postoperative outcomes measured by the Withey score than those operated older than 1 year.

Risk of Attention Deficit Hyper Activity Disorder After Early Exposure to General Anesthesia; A Case Control Study

Background: Over the past decade, following the discovery that developing brain of immature animals was affected by anesthetic agents, the safety of general anesthesia (GA) in early life has been questioned. Objectives: We investigated the association between anesthesia exposure in children and ADHD development. Methods: This case-control study was conducted at pediatric psychology clinic of our institution and a pediatric neurology private clinic during 2019. Firstly the responsible resident of anesthesiology separated new ADHD cases. Then a questionnaire was filled out through an almost 10 minute’s telephone interview. Finally, frequency distribution of GA was compared between ADHD cases and controls. Results: Finally, the data from 210 children were analyzed. Among 105 ADHD cases, 19% had a history of a procedure requiring GA while it was 3.8% in control group. Comparing the two groups a significant difference was observed regarding the age of receiving GA (P = 0.004), gender (P < 0.001), the history of receiving GA (P = 0.001) and the number of anesthesia exposures (P = 0.001). According to logistic regression analysis, male gender (P = 0.001) OR 3.11 (95CI = 1.63 - 5.93) and age (P = 0.003) OR 0.92 (95CI = 0.87 - 0.97) were significant predictors of early exposure to GA and ADHD development. Conclusions: It was revealed that early exposure to GA might be a risk factor for later developing ADHD. Boys might be more sensitive to the long term adverse effects of anesthetic agents than girls. Further prospective well-planned studies are needed to confirm these findings.

Gastrocutaneous fistulae in children - A systematic review and meta-analysis of epidemiology and treatment options

BACKGROUND

Gastrostomy tubes are a common adjunct to the care of vulnerable pediatric patients. This study systematically evaluates the epidemiology and risk-factors for gastrocutaneous fistulae (GCF) after gastrostomy removal in children and reviews treatment options focusing on nonoperative management (NOM).

METHODS

After protocol registration (CRD-42017059565), multiple databases were searched. Studies describing epidemiology in children and GCF treatment at any age were included. Critical appraisal was performed (MINORS risk-of-bias assessment tool). One-sided meta-analysis was executed to estimate efficacy of therapeutic adjuncts using a random-effects model.

RESULTS

Sixteen articles evaluating pediatric GCF were identified. 44% defined GCF as persistence >1month which occurred in 31±7% of cases. Risk factors for pediatric GCF include age at gastrostomy, timing of removal, open technique, and fundoplication. Mean MINORS score was 0.60±0.16. Seventeen additional studies were identified reporting 142 patients undergoing NOM (endoscopic, systemic, and local therapies), and one pediatric comparative study was identified. Overall aggregate proportion of GCF closure after any NOM is 77% (80% success rate in local/systemic therapies; 75% success rate in endoscopic approaches). No adverse events were reported.

CONCLUSION

Persistent GCF complicates the management of gastrostomies in 1/3 of children with predictable risk factors. Several treatment options exist that obviate the need for general anesthesia. Their efficacy is unclear. Further prospective investigations are clearly warranted.

LEVEL OF EVIDENCE

III - Systematic Review and Meta-Analysis Based on Retrospective Case Control Studies.