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Jarraya A, Kammoun M, Bouchaira H, Ben Ayed K, Ketata H. Early versus late removal of the I-Gel in paediatric patients with mild upper respiratory tract symptoms undergoing ambulatory ilioinguinal surgery: A prospective observational study. J Perioper Pract 2023:17504589231211445. [PMID: 38112126 DOI: 10.1177/17504589231211445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
The optimal timing of I-Gel removal in children with mild respiratory symptoms remains controversial. Consequently, we tried to assess the impact of early versus late I-Gel removal on the incidence of perioperative respiratory adverse events among children aged one to five years undergoing ambulatory surgery under general anaesthesia with I-Gel airway ventilation. The anaesthesia protocol was the same for all patients. Children were divided into two groups according to the approach of I-Gel removal (early versus late). The incidence of perioperative respiratory adverse events after the I-Gel removal was the main outcome, and a multivariable regression was performed to investigate the implication of the I-Gel removal in perioperative respiratory adverse events. According to our study, the incidence of perioperative respiratory adverse events was not correlated to the timing of I-Gel removal. However, prolonged postoperative oxygen support can be seen when the I-Gel is removed in anaesthetized children.
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Affiliation(s)
- Anouar Jarraya
- Department of Pediatric Anesthesiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Manel Kammoun
- Department of Pediatric Anesthesiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Hasna Bouchaira
- Department of Pediatric Anesthesiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Khadija Ben Ayed
- Department of Pediatric Anesthesiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Hend Ketata
- Department of Pediatric Anesthesiology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
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Park JB, Sohn JY, Kang P, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS, Jang YE. Perioperative Respiratory-Adverse Events Following General Anesthesia Among Pediatric Patients After COVID-19. J Korean Med Sci 2023; 38:e349. [PMID: 38050910 PMCID: PMC10695756 DOI: 10.3346/jkms.2023.38.e349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The perianesthetic morbidity, mortality risk and anesthesia-associated risk after preoperative coronavirus disease 2019 (COVID-19) omicron variant in pediatric patients have not been fully demonstrated. We examined the association between preoperative COVID-19 omicron diagnosis and the incidence of overall perioperative adverse events in pediatric patients who received general anesthesia. METHODS This retrospective study included patients aged < 18 years who received general anesthesia between February 1 and June 10, 2022, in a single tertiary pediatric hospital. They were divided into two groups; patients in a COVID-19 group were matched to patients in a non-COVID-19 group during the omicron-predominant period in Korea. Data on patient characteristics, anesthesia records, post-anesthesia records, COVID-19-related history, symptoms, and mortality were collected. The primary outcomes were the overall perioperative adverse events, including perioperative respiratory adverse events (PRAEs), escalation of care, and mortality. RESULTS In total, 992 patients were included in the data analysis (n = 496, COVID-19; n = 496, non-COVID-19) after matching. The overall incidence of perioperative adverse events was significantly higher in the COVID-19 group than in the non-COVID-19 group (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.89-1.94). The difference was significant for PRAEs (OR, 2.00; 95% CI, 1.96-2.02) but not in escalation of care or mortality. The most pronounced difference between the two groups was observed in instances of high peak inspiratory pressure ≥ 25 cmH2O during the intraoperative period (OR, 11.0; 95% CI, 10.5-11.4). Compared with the non-COVID-19 group, the risk of overall perioperative adverse events was higher in the COVID-19 group diagnosed 0-2 weeks before anesthesia (OR, 6.5; 95% CI, 2.1-20.4) or symptomatic on the anesthesia day (OR, 6.4; 95% CI, 3.30-12.4). CONCLUSION Pediatric patients with the preoperative COVID-19 omicron variant had increased risk of PRAEs. Patients within 2 weeks after COVID-19 or those with symptoms had a higher risk of PRAEs.
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Affiliation(s)
- Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Young Sohn
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
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Saynhalath R, Efune PN, Nakonezny PA, Alex G, Sabers JN, Clintsman LM, Poppino KF, Szmuk P, Sanford EL. Association between preoperative respiratory symptoms and perioperative respiratory adverse events in pediatric patients with positive viral testing. J Clin Anesth 2023; 90:111241. [PMID: 37659165 DOI: 10.1016/j.jclinane.2023.111241] [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: 03/02/2023] [Revised: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
STUDY OBJECTIVE To determine the association between the presence of upper respiratory tract viral infection symptoms and occurrence of perioperative respiratory adverse events (PRAE) in children with positive viral screening, and to analyze the risk of PRAE in children with SARS-CoV-2 compared to non-SARS-CoV-2 infection. DESIGN A prospective cohort study. SETTING A tertiary, freestanding pediatric hospital in Dallas, Texas. PATIENTS Children <18 years of age with positive respiratory viral testing who underwent general anesthesia. INTERVENTION Measurement of incidence of PRAE and severe adverse events during the first 7 postoperative days. MEASUREMENTS The primary outcome was a composite of PRAE: oxygen saturation < 90% for >5 min, supplemental oxygen for >2 h after anesthesia, laryngospasm, and bronchospasm. The secondary outcome was severe adverse events: high flow nasal cannula >6 l of oxygen per minute, admission to the ICU for escalation of respiratory support post-anesthetic, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death. MAIN RESULTS In this convenience sample of 196 children, 83 were symptomatic and 113 were asymptomatic. The risk of PRAE was similar in children with active viral symptoms and asymptomatic children (risk difference: -1.9%; 95% CI: -10.9, 7.9%), but higher among children with documented fever within 48 h of the anesthetic (risk difference: 20.8%; 95% CI: 5.3, 39.7%). The multivariable adjusted odds ratio of PRAE was 0.68 (95% CI: 0.25, 1.85) for symptomatic compared to asymptomatic patients, and 0.46 (95% CI: 0.14, 1.44) for patients with SARS-CoV-2 compared to non-SARS-CoV-2 infection. CONCLUSIONS There was no significant difference in the incidence of PRAE between symptomatic and asymptomatic children with laboratory confirmed viral respiratory infection, and between children with the Omicron variant of SARS-CoV-2 compared to non-SARS-CoV-2 respiratory viruses. However, the risk was increased in children with recent fever.
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Affiliation(s)
- Rita Saynhalath
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
| | - Proshad N Efune
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
| | - Paul A Nakonezny
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
| | - Gijo Alex
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States.
| | - Jessica N Sabers
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States.
| | - Lee M Clintsman
- Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States.
| | - Kiley F Poppino
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
| | - Ethan L Sanford
- Department of Anesthesiology and Pain Management, Division of Pediatric Anesthesia, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Children's Health, 1935 Medical District Drive Dallas, TX 75235, United States; Outcomes Research Consortium, 9500 Euclid Avenue Cleveland, OH 44195, United States.
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Loreau C, Caruselli M, Roncin C, Salvi N, Lenoire A, Allary C, De Queiroz M, Belghiti-Alaoui M, Michel F. Pediatric anesthetic for tracheobronchial foreign body extraction: A survey of practice in France. Paediatr Anaesth 2023; 33:736-745. [PMID: 37300331 DOI: 10.1111/pan.14704] [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: 03/04/2022] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Tracheobronchial foreign body aspiration is a classic pediatric emergency, and its associated morbidity particularly depends on the anesthetic management, which differs according to the center and the practitioner. AIMS The aim of this study was to evaluate the different anesthetic practices for tracheobronchial foreign body extraction. METHODS A survey was sent via email to the member physicians of the Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The survey included 28 questions about the organizational and anesthetic management of an evolving clinical case. RESULTS A total of 151 physicians responded to the survey. Only 13.2% of the respondents reported that their institution had a management protocol, and 21.7% required a computerized tomography scan before the procedure was performed for children who were asymptomatic or mildly symptomatic during the night. There were 56.3% of the respondents who reported that extraction with a rigid bronchoscope is the only procedure usually performed in their institution. Regarding rigid bronchoscopy, 47.0% used combined intravenous-inhalation anesthesia. The objective was to maintain the child on spontaneous ventilation for 63.6% of the respondents, but anesthesia management differed according to the physician's experience. CONCLUSIONS Our study confirms the diversity of practices concerning anesthetic for tracheobronchial foreign body extraction and found reveal differences in practice according to physician experience.
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Affiliation(s)
- Chine Loreau
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Marco Caruselli
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - César Roncin
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Nadège Salvi
- Department of Pediatric Anesthesia and Intensive Care, CHU Necker, Paris, France
- Assistance-Publique - Hôpitaux de Paris, Paris, France
- Centre Université de Paris, Paris, France
| | - Alexandre Lenoire
- Department of Pediatric Anesthesia and Intensive Care, CHU Necker, Paris, France
- Assistance-Publique - Hôpitaux de Paris, Paris, France
- Centre Université de Paris, Paris, France
| | - Chloé Allary
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Mathilde De Queiroz
- Department of Pediatric Anesthesia and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Myriem Belghiti-Alaoui
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Fabrice Michel
- Department of Pediatric Anesthesia and Intensive Care, CHU Timone, Marseille, France
- Assistance-Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Marseille, France
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Do COVID-19 pandemic-related behavior changes affect perioperative respiratory adverse events in children undergoing cardiac interventional catheterization? BMC Anesthesiol 2022; 22:406. [PMID: 36577959 PMCID: PMC9795114 DOI: 10.1186/s12871-022-01951-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The novel coronavirus disease (COVID-19) suddenly broke out in China in December 2019. Pandemic-related behavioral changes can cause perioperative respiratory adverse events in children with congenital heart disease (CHD). Here, we compared the incidence of perioperative respiratory adverse events (PRAEs) in CHD children with and without upper respiratory infection (URI) undergoing the cardiac catheterization before and during the COVID-19 pandemic. METHODS This prospective observational single-center study was based at a tertiary care center in Shanghai, China. A total of 359 children with CHD with and without recent URI were included between January 2019 and March 2021. The overall incidence of PRAEs (laryngospasm, bronchospasm, coughing, airway secretion, airway obstruction, and oxygen desaturation) in non-URI and URI children undergoing elective cardiac catheterization was compared before and during the COVID-19 pandemic. A logistic regression model was fitted to identify the potential risk factors associated with PRAEs. RESULTS Of the 564 children enrolled, 359 completed the study and were finally analyzed. The incidence of URIs decreased substantially during the COVID-19 pandemic (14% vs. 41%, P < 0.001). Meanwhile, the overall PRAEs also significantly declined regardless of whether the child had a recent URI (22.3% vs. 42.3%, P = 0.001 for non-URI and 29.2% vs. 58.7%, P = 0.012 for URI, respectively). Post-operative agitation in children without URI occurred less frequently during the pandemic than before (2.3% vs. 16.2%, P = 0.001). Behaviors before the COVID-19 pandemic (odds ratio = 2.84, 95% confidence interval [CI] 1.76-4.58) and recent URI (odds ratio = 1.79, 95% CI 1.09-2.92) were associated with PRAEs. CONCLUSIONS COVID-19 pandemic-related behavioral changes were associated with a reduction in PRAEs in non-URI and URI children undergoing elective therapeutic cardiac catheterization.
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Karlsson J, Johansen M, Engelhardt T. SARS-CoV-2 airway reactivity in children: more of the same? Anaesthesia 2022; 77:956-958. [PMID: 35587812 PMCID: PMC9347779 DOI: 10.1111/anae.15760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 01/11/2023]
Affiliation(s)
- J. Karlsson
- Department of Paediatric Peri‐operative Medicine and Intensive CareKarolinska University HospitalStockholmSweden,Department of Paediatric AnaesthesiaMontreal Children's HospitalQuebecCanada
| | - M. Johansen
- Department of Paediatric AnaesthesiaMontreal Children's HospitalQuebecCanada
| | - T. Engelhardt
- Department of Paediatric AnaesthesiaMontreal Children's HospitalQuebecCanada
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Shen F, Zhang Q, Xu Y, Wang X, Xia J, Chen C, Liu H, Zhang Y. Effect of Intranasal Dexmedetomidine or Midazolam for Premedication on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomy and Adenoidectomy: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2225473. [PMID: 35943745 PMCID: PMC9364121 DOI: 10.1001/jamanetworkopen.2022.25473] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IMPORTANCE Perioperative respiratory adverse events (PRAEs) are the most common complication during pediatric anesthesia, and they may be affected by the administration of preoperative sedatives. OBJECTIVE To investigate the effect of intranasal dexmedetomidine or midazolam used for premedication on the occurrence of PRAEs. DESIGN, SETTING, AND PARTICIPANTS This single-center, double-blind, randomized clinical trial was conducted among children aged 0 to 12 years undergoing elective tonsillectomy and adenoidectomy from October 2020 to June 2021 at Children's Hospital of Xuzhou Medical University, Xuzhou, China. Data analysis was performed from June to October 2021. INTERVENTIONS Children were randomly assigned to 3 groups: the midazolam group received intranasal midazolam (0.1 mg/kg), and the dexmedetomidine group received intranasal dexmedetomidine (2.0 μg/kg) for premedication. The normal saline group received intranasal 0.9% saline for control. MAIN OUTCOMES AND MEASURES The primary outcome was the difference in the incidence of PRAEs among the 3 groups. The secondary outcomes were the frequency of the individual PRAEs, including the incidence of such events during the induction and recovery periods, postoperative emergence delirium, postoperative pain score, sedation success rate, and heart rate values. RESULTS A total of 384 children (median [IQR] age, 7 [5-10] years; 227 boys [59.1%]) were enrolled and randomized; 373 data sets were available for intention-to-treat analysis (124 children in the midazolam group, 124 children in the dexmedetomidine group, and 125 children in the normal saline group). After the data were adjusted for age, sex, American Society of Anesthesiologists physical status, body mass index, obstructive sleep apnea, upper respiratory tract infection, and passive smoking, children in the midazolam group were more likely to experience PRAEs than those in the normal saline group (70 of 124 children [56.5%] vs 51 of 125 children [40.8%]; adjusted odds ratio [aOR], 1.99; 95% CI, 1.18-3.35), whereas the dexmedetomidine group had a significantly lower PRAEs incidence than the normal saline group (30 of 124 children [24.2%] vs 51 of 125 children [40.8%]; aOR, 0.45; 95% CI, 0.26-0.78). Compared with the dexmedetomidine group, the midazolam group had a higher risk of PRAEs (aOR, 4.44; 95% CI, 2.54-7.76), but no other serious clinical adverse events were observed. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, intranasal midazolam used for premedication was associated with increased incidence of PRAEs, whereas premedication with intranasal dexmedetomidine was associated with reduced incidence of PRAEs. Where clinically appropriate, anesthesiologists should consider using intranasal dexmedetomidine for sedation in children undergoing tonsillectomy and adenoidectomy. TRIAL REGISTRATION Chinese Clinical Trial Register Identifier: ChiCTR2000038359.
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Affiliation(s)
- Fangming Shen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qin Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yahui Xu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xinghe Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jiayi Xia
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chao Chen
- The Children’s Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - He Liu
- Department of Anesthesiology, Huzhou Central Hospital, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, Zhejiang, China
| | - Yueying Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Abbasi S, Siddiqui KM, Qamar-Ul-Hoda M. Adverse Respiratory Events After Removal of Laryngeal Mask Airway in Deep Anesthesia Versus Awake State in Children: A Randomized Trial. Cureus 2022; 14:e24296. [PMID: 35607531 PMCID: PMC9123356 DOI: 10.7759/cureus.24296] [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] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background The advent of the laryngeal mask airway (LMA) has reduced respiratory events in comparison to the conventional endotracheal tubes. Any manipulation under a light plane of anesthesia predisposes to increased airway sensitivity followed by adverse events. The reduced airway sensitivity in the deeply anesthetized state makes LMA removal feasible. In the past, the respective advantages and disadvantages of extubation in two planes of anesthesia have led to conflicting results. The primary objective of this study is to compare the incidence of adverse respiratory events at the time of LMA removal, in deeply anesthetized and awake groups. Our secondary objective was to record the management of complications. Materials and methods We conducted a prospective randomized control trial in 106 American Society of Anesthesiologists (ASA) I and II patients undergoing lower umbilical surgeries over a period of one year. The demographic details and intraoperative and postoperative variables, i.e., airway obstruction, laryngospasm, peripheral oxygen desaturations, cough, straining and vomiting, along with corrective measures were recorded by the primary research assistant in both groups. Regarding the management of peripheral oxygen desaturation (less than 90%), airway obstruction, and laryngospasm, 100% fractional inspired oxygen support and chin lift/jaw thrust were used. Results The average age was 32.58±15.81 months. The demographic characteristics of the patients were not significant between the two groups. The rate of adverse respiratory events like laryngospasm and airway obstruction was relatively high in the deep group but not statistically significant between the groups. A total of 7 (6.6%) patients had laryngospasm, 21 (20%) had airway obstruction, 16 (15%) had a cough and 11 (10%) patients had observed peripheral oxygen desaturation (less than 90%) between both groups. Conclusion We concluded that adverse respiratory events could happen in both awake and deep planes of anesthesia after the removal of LMA in children. Furthermore, both techniques have an acceptably low frequency of complications, and it does not affect the current clinical practice.
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Affiliation(s)
- Shemila Abbasi
- Anaesthesiology, The Aga Khan University Hospital, Karachi, PAK
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Dahmani S, Laffargue A, Dadure C, De Queiroz M, Julien-Marsollier F, Michelet D, Veyckemans F, Amory C, Ludot H, Bert D, Godart J, Laffargue A, Dupont H, Urbina B, Baujard C, Roulleau P, Staiti G, Bordes M, Nouette Gaulain K, Hamonic Y, Semjen F, Jacqmarcq O, Lejus-Bourdeau C, Magne C, Petry L, Ros L, Zang A, Bennis M, Coustets B, Fesseau R, Constant I, Khalil E, Sabourdin N, Audren N, Descarpentries T, Fabre F, Legrand A, Druot E, Orliaguet G, Sabau L, Uhrig L, De La Briere F, Jonckheer K, Mission JP, Scordo L, Couchepin C, Dadure C, De La Arena P, Hertz L, Pirat P, Sola C, Bellon M, Depret-Donatien V, Lesage A. Epidemiology and complications of anaesthesia in the French centres that participated to NECTARINE: A secondary analysis. Anaesth Crit Care Pain Med 2022; 41:101036. [PMID: 35181529 DOI: 10.1016/j.accpm.2022.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Neonatal and infant anaesthesia are associated with a high risk of perioperative complications. The aim of the current study was to describe those risks in France using the French data from the NECTARINE study. MATERIAL AND METHODS Data from the French centres that participated to the NECTARINE study were analysed. The primary goal of the study was the description of patients' characteristics, procedures and perioperative management and their comparison with the results of the European NECTARINE study. Secondary outcomes were the description of major perioperative complications and death. RESULTS Overall, 926 procedures collected in 15 centres (all teaching hospitals) were analysed. Comparison between the French and European NECTARINE cohorts found few differences related to patients' characteristics and procedures. The rate of interventions for critical events (respiratory, haemodynamic, and metabolic) was similar between the two cohorts. Near-infrared spectroscopy monitoring was used in 12% of procedures. Nearly none of the thresholds for these interventions met the published standards. By day 30, complications (respiratory, haemodynamic, metabolic, renal, and liver failure) and death were observed in 14.4% [95% CI 11.6 - 16.4] % and 1.8% [95 % CI 1.1 - 2.9] of cases, respectively. DISCUSSION Although the health status of the patients in the French cohort was less severe, procedures, management and postoperative complications and mortality rates were similar to the European cohort. However, thresholds for interventions were often inadequate in both cohorts. Efforts should be undertaken to improve the knowledge and use of new monitoring devices in this population.
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Affiliation(s)
- Souhayl Dahmani
- French NECTARINE Trial Group, France; Paris Diderot University (Paris VII), Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; FHU I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France.
| | - Anne Laffargue
- Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Christophe Dadure
- Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France; Institut de Neurosciences de Montpellier, Unité INSERM U1051, Montpellier, France
| | - Mathilde De Queiroz
- Department of Anaesthesia and Intensive Care, University Hospital of Lyon, Lyon, France
| | - Florence Julien-Marsollier
- French NECTARINE Trial Group, France; Paris Diderot University (Paris VII), Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; FHU I2-D2, INSERM U1141, Robert Debré University Hospital, Paris, France
| | - Daphné Michelet
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Department of Anaesthesia and Intensive Care, University Hospital of Reims, Reims, France
| | - Francis Veyckemans
- Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Catherine Amory
- French NECTARINE Trial Group, France; American Memorial Hospital CHU Reims, Reims, France
| | - Hugues Ludot
- French NECTARINE Trial Group, France; American Memorial Hospital CHU Reims, Reims, France
| | - Dina Bert
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Juliette Godart
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Anne Laffargue
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Jeanne de Flandre University Hospital, Lille, France
| | - Hervé Dupont
- French NECTARINE Trial Group, France; CHU Amiens Picardie, Amiens, France
| | - Benjamin Urbina
- French NECTARINE Trial Group, France; CHU Amiens Picardie, Amiens, France
| | - Catherine Baujard
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Roulleau
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Giuseppe Staiti
- French NECTARINE Trial Group, France; CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Maryline Bordes
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | | | - Yann Hamonic
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | - François Semjen
- French NECTARINE Trial Group, France; CHU de Bordeaux, Bordeaux, France
| | | | | | - Cécile Magne
- French NECTARINE Trial Group, France; CHU de Nantes, Nantes, France
| | - Léa Petry
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Lilica Ros
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Aurélien Zang
- French NECTARINE Trial Group, France; CHU Nancy, Nancy, France
| | - Mehdi Bennis
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Bernard Coustets
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Rose Fesseau
- French NECTARINE Trial Group, France; CHU Toulouse, Toulouse, France
| | - Isabelle Constant
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Eliane Khalil
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Nada Sabourdin
- French NECTARINE Trial Group, France; Hôpital Armand-Trousseau AP-HP, Paris, France
| | - Noémie Audren
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Thomas Descarpentries
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Fanny Fabre
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Aurélien Legrand
- French NECTARINE Trial Group, France; Hôpital couple enfant, CHU Grenoble Alpes, Grenoble, France
| | - Emilie Druot
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Gilles Orliaguet
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Lucie Sabau
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Lynn Uhrig
- French NECTARINE Trial Group, France; Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - François De La Briere
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Karin Jonckheer
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Jean-Paul Mission
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Lucia Scordo
- French NECTARINE Trial Group, France; Fondation Lenval - Hôpital pour enfants, Nice, France
| | - Caroline Couchepin
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Christophe Dadure
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Pablo De La Arena
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Laurent Hertz
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Philippe Pirat
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Chrystelle Sola
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Lapeyronie University Hospital, Montpellier, France
| | - Myriam Bellon
- French NECTARINE Trial Group, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Anne Lesage
- French NECTARINE Trial Group, France; Teaching Hospital of Caen, Caen, France
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10
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Templeton TW, Sommerfield D, Hii J, Sommerfield A, Matava CT, von Ungern-Sternberg BS. Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia-Part 2: Anesthesia-related risk and treatment options. Paediatr Anaesth 2022; 32:217-227. [PMID: 34897894 DOI: 10.1111/pan.14376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/17/2022]
Abstract
Perioperative respiratory adverse events are the most common cause of critical events in children undergoing anesthesia and surgery. While many risk factors remain unmodifiable, there are numerous anesthetic management decisions which can impact the incidence and impact of these events, especially in at-risk children. Ongoing research continues to improve our understanding of both the influence of risk factors and the effect of specific interventions. This review discusses anesthesia risk factors and outlines strategies to reduce the rate and impact of perioperative respiratory adverse events with a chronologic based inquiry into anesthetic management decisions through the perioperative period from premedication to postoperative disposition.
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Affiliation(s)
- Thomas Wesley Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Aine Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, Termerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
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11
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Ma L, Yu X, Zhang J, Shen J, Zhao Y, Li S, Huang Y. Risk factors of postoperative pulmonary complications after primary posterior fusion and hemivertebra resection in congenital scoliosis patients younger than 10 years old: a retrospective study. BMC Musculoskelet Disord 2022; 23:89. [PMID: 35081918 PMCID: PMC8790897 DOI: 10.1186/s12891-022-05033-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative pulmonary complications are common and associated with morbidity and mortality. Congenital scoliosis is a failure of vertebral formation and/or segmentation arising from abnormal vertebral development. Posterior fusion and osteotomy are necessary for these patients to prevent deterioration of spine deformity. The incidence of postoperative pulmonary complications in this specific group of patients, especially young children were unknown. Methods A retrospective study was conducted and electronic medical records of early-onset scoliosis patients who had primary posterior fusion and hemivertebra resection at our institution from January 2014 to September 2019 were reviewed. The demographic characteristics, the intraoperative and postoperative parameters were collected to identify the predictors of postoperative pulmonary complications. Results A total of 174 patients (57.5% boys) with a median age of 3 years old were included for analysis. Eighteen patients (10.3%) developed perioperative pulmonary complications and pneumonia (n=13) was the most common. History of recent upper respiratory infection was not related to postoperative pulmonary complications. Multifactorial regression analysis showed thoracoplasty was the only predictive risk factor of postoperative pulmonary complications. Conclusions For congenital scoliosis patients younger than 10 years old, thoracoplasty determine the occurrence of postoperative pulmonary complications. Both surgeons and anesthesiologists should pay attention to patients undergoing thoracoplasty and preventive measures are necessary.
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Affiliation(s)
- Lulu Ma
- Department of Anesthesiology, Peking Union Medical College Hospital, No 1, Shuaifu Yuan, Dongcheng District, Beijing, 100730, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, No 1, Shuaifu Yuan, Dongcheng District, Beijing, 100730, China.
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, No 1, Shuaifu Yuan, Dongcheng District, Beijing, 100730, China.
| | - Jianxiong Shen
- Department of Orthopedics, Peking Union Medical College Hospital, No 1, Shuaifu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yu Zhao
- Department of Orthopedics, Peking Union Medical College Hospital, No 1, Shuaifu Yuan, Dongcheng District, Beijing, 100730, China
| | - Shugang Li
- Department of Orthopedics, Peking Union Medical College Hospital, No 1, Shuaifu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, No 1, Shuaifu Yuan, Dongcheng District, Beijing, 100730, China
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12
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Zhang Q, Shen F, Wei Q, Liu H, Li B, Zhang Q, Zhang Y. Development and Validation of a Risk Nomogram Model for Perioperative Respiratory Adverse Events in Children Undergoing Airway Surgery: An Observational Prospective Cohort Study. Risk Manag Healthc Policy 2022; 15:1-12. [PMID: 35023976 PMCID: PMC8747787 DOI: 10.2147/rmhp.s347401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to explore the associated risk factors of perioperative respiratory adverse events (PRAEs) in children undergoing airway surgery and establish and validate a nomogram prediction model for PRAEs. Patients and Methods This study involved 709 children undergoing airway surgery between November 2020 and July 2021, aged ≤18 years in the affiliated hospital of Xuzhou Medical University. They were divided into training (70%; n = 496) and validation (30%; n = 213) cohorts. The least absolute shrinkage and selection operator (LASSO) was used to develop a risk nomogram model. Concordance index values, calibration plot, decision curve analysis, and the area under the curve (AUC) were examined. Results PRAEs were found in 226 of 496 patients (45.6%) and 88 of 213 patients (41.3%) in the training and validation cohorts, respectively. The perioperative risk factors associated with PRAEs were age, obesity, degree of upper respiratory tract infection, premedication, and passive smoking. The risk nomogram model showed good discrimination power, and the AUC generated to predict survival in the training cohort was 0.760 (95% confidence interval, 0.695–0.875). In the validation cohort, the AUC of survival predictions was 0.802 (95% confidence interval, 0.797–0.895). Calibration plots and decision curve analysis showed good model performance in both datasets. The sensitivity and specificity of the risk nomogram model were calculated, and the result showed the sensitivity of 69.5% and 64.8% and specificity of 73.3% and 81.6% for the training and validation cohorts, respectively. Conclusion The present study showed the proposed nomogram achieved an optimal prediction of PRAEs in patients undergoing airway surgery, which can provide a certain reference value for predicting the high-risk population of perioperative respiratory adverse events and can lead to reasonable preventive and treatment measures.
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Affiliation(s)
- Qin Zhang
- Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Fangming Shen
- Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Qingfeng Wei
- Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - He Liu
- Department of Anesthesiology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; Huzhou Central Hospital, Huzhou City, Zhejiang Province, People's Republic of China
| | - Bo Li
- Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Qian Zhang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
| | - Yueying Zhang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China
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13
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Tong C, Liu P, Zhang K, Liu T, Zheng J. A novel nomogram for predicting respiratory adverse events during transport after interventional cardiac catheterization in children. Front Pediatr 2022; 10:1044791. [PMID: 36340703 PMCID: PMC9631021 DOI: 10.3389/fped.2022.1044791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The rate and predictors of respiratory adverse events (RAEs) during transport discharged from operating room after interventional cardiac catheterization in children remain unclear. This study aimed to investigate the incidence and predictors, and to construct a nomogram for predicting RAEs during transport in this pediatric surgical treatment. METHODS This prospective cohort study enrolled 290 consecutive pediatric patients who underwent ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA) between February 2019 and December 2020. Independent predictors were used to develop a nomogram, and a bootstrap resampling approach was used to conduct internal validation. Composite RAEs were defined as the occurrence of at least 1 complication regarding laryngospasm, bronchospasm, apnea, severe cough, airway secretions, airway obstruction, and oxygen desaturation. RESULTS The rate of RAEs during transport was 23.1% (67 out of 290). Multivariate analysis identified age (vs. ≤3 years, adjusted odds ratio (aOR) = 0.507, 95% confidence interval (CI), 0.268-0.958, P = 0.036), preoperative upper respiratory tract infections (URI, aOR = 2.335, 95% CI, 1.223-4.460, P = 0.01), type of surgery (vs. VSD, for ASD, aOR = 2.856, 95% CI, 1.272-6.411, P = 0.011; for PDA, aOR = 5.518, 95% CI, 2.425-12.553, P < 0.001), morphine equivalent (vs. ≤0.153 mg/kg, aOR = 2.904, 95% CI, 1.371-6.150, P = 0.005), atropine usage (aOR = 0.463, 95% CI, 0.244-0.879, P = 0.019), and RAEs during extubation to transport (aOR = 5.004, 95% CI, 2.633-9.511, P < 0.001) as independent predictors of RAEs during transport. These six candidate predictors were used to develop a nomogram, which showed a C-statistic value of 0.809 and good calibration (P = 0.844). Internal validation revealed similarly good discrimination (C-statistic, 0.782; 95% CI, 0.726-0.837) and calibration. Decision curve analysis (DCA) also demonstrated the clinical usefulness of the nomogram. CONCLUSION The high rate of RAEs during transport reminds us of the need for more medical care and attention. The proposed nomogram can reliably identify pediatric patients at high risk of RAEs during transport and guide clinicians to make proper transport plans. Our findings have important and meaningful implications for RAEs risk prediction, clinical intervention and healthcare quality control.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Peiwen Liu
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Liu
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
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14
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McGuire SR, Doyle NM. Update on the safety of anesthesia in young children presenting for adenotonsillectomy. World J Otorhinolaryngol Head Neck Surg 2021; 7:179-185. [PMID: 34430825 PMCID: PMC8356117 DOI: 10.1016/j.wjorl.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022] Open
Abstract
Tonsillectomy with and without adenoidectomy is a frequently performed surgical procedure in children. Although a common procedure, it is not without significant risk. It is critical for anesthesiologists to consider preoperative, intraoperative, and postoperative patient factors and events to optimize safety, especially in young children. In the majority of cases, the indication for adenotonsillectomy in young children is obstructive breathing. Preoperative evaluation for patient comorbidities, especially obstructive sleep apnea, risk factors for a difficult airway, and history of recent illness are crucial to prepare the patient for surgery and develop an anesthetic plan. Communication and collaboration with the otolaryngologist is key to prevent and treat intraoperative events such as airway fires or hemorrhage. Postoperative analgesia planning is critical for safe pain control especially for those patients with a history of obstructive sleep apnea and opioid sensitivity. In young children, it is important to also consider the impact of anesthetic medications on the developing brain. This is an area of continuing research but needs to be weighed when planning for surgical treatment and when discussing risks and benefits with patients' families.
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Affiliation(s)
- Stephanie R. McGuire
- Corresponding author. Department of Anesthesiology, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
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15
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Yang Y, Zhang Y, Yang Y, Chen X, Mou Y, Liu L, Sun Y, Tang N, Song X. Risk factors analysis and intervention of lung dysfunction in children with obstructive sleep apnea: A retrospective case series study. Int J Pediatr Otorhinolaryngol 2021; 146:110772. [PMID: 34022655 DOI: 10.1016/j.ijporl.2021.110772] [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: 01/12/2021] [Revised: 03/31/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish an optimized airway management process to improve preoperative lung dysfunction in obstructive sleep apnea (OSA). METHODS The study included 483 children (319 males and 164 females; 6y to14y years) with OSA who underwent an adenotonsillectomy from November 2017 to December 2018. Children with OSA and who had abnormal airway function were identified by lung function test, and the risk factors for abnormal lung function were assessed. Next, the children received individualized atomization intervention based on the severity of their abnormal lung function, and the improvement in lung function was evaluated. RESULTS Lung function tests revealed that 45 patients had obstructive ventilation dysfunction, and histories of chronic cough or asthma were identified as risk factors for perioperative abnormal lung function. The FEV1% pre exceeded 80% after 2 days of atomization intervention in 27 of 28 mild cases, 4 of 13 moderate cases, but in none of the 4 moderate-severe cases. After 4 days of atomization intervention, the FEV1%pre of the remaining 14 patients in the three groups all increased up to 80%. Other indicators of lung function (e.g., FEV1/FVC% pre, MEF50% pre, MEF25% pre, and MMEF% pre) were also greatly improved following the improvement of FEV1% pre. No perioperative airway complications occurred. CONCLUSIONS Prior to performing surgery on children with OSA and who have risk factors associated with abnormal lung function, it is potentially beneficial to establish an optimized airway management process to improve lung function before adenotonsillectomy.
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Affiliation(s)
- Yujuan Yang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yu Zhang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yanyan Yang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xiumei Chen
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yakui Mou
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Liping Liu
- Department of Allergy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuemei Sun
- Department of Allergy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ningbo Tang
- Department of Allergy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xicheng Song
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
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16
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Michelet D, Truchot J, Du Fayet De La Tour C, Benichou C, Berdji A, Delivet H, Ceccaldi PF, Plaisance P, Julien-Marsollier F, Dahmani S. The impact of psychological factors on the management of intraoperative haemodynamic events in children. Anaesth Crit Care Pain Med 2020; 39:785-791. [PMID: 33010488 DOI: 10.1016/j.accpm.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Paediatric anaesthesia requires specific theoretical knowledge and practical training. Non-technical skills and psychological factors might influence learning and practice. The aim of this study was to assess personality type and decision-making styles of paediatric anaesthesiology residents during the management of simulated intraoperative life-threatening cases. METHOD Residents in anaesthesiology (between 4 and 5 years of training) participated in a simulated hypoxic cardiac arrest in the operating theatre. Their performance was evaluated using a score derived from international recommended management algorithm. They were asked to answer self-assessment questionnaires regarding both their personality (the five personality factors) and their decision-making style. Correlations between performance and personality were investigated. RESULTS Thirty-eight residents participated in the simulation session and 36 accepted to answer the questionnaires. Good management scoring was positively correlated with agreeableness and conscientiousness personality traits but was negatively correlated with avoidance and spontaneous decision-making styles. DISCUSSION The current study identified personality traits and decision-making styles that might influence the management of critical situations during paediatric anaesthesia. The proper identification of these factors might allow targeted personalised training to improve knowledge mobilisation and translation in the clinical context.
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Affiliation(s)
- Daphné Michelet
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France; Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France
| | - Jennifer Truchot
- Emergency Department, Lariboisière University Hospital, 75010 Paris, France; Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France
| | - Charlotte Du Fayet De La Tour
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Candy Benichou
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Abdellouahabe Berdji
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Honorine Delivet
- Emergency Department, Robert Debré Hospital, 75019 Paris, France
| | - Pierre-Francois Ceccaldi
- Gynaecology and Obstetrics Department, Beaujon Hospital, 92110 Clichy, France; Ilumens Department of Simulation in Healthcare, Paris Diderot University (Paris 7), Université de Paris, Paris, France
| | - Patrick Plaisance
- Emergency Department, Lariboisière University Hospital, 75010 Paris, France; Ilumens Department of Simulation in Healthcare, Paris Diderot University (Paris 7), Université de Paris, Paris, France
| | - Florence Julien-Marsollier
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of Anaesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, 75019 Paris, France; UMR INSERM U 676.Robert Debré University Hospital, 75019 Paris, France.
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17
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Zhang K, Wang S, Li M, Wu C, Sun L, Zhang S, Bai J, Zhang M, Zheng J. Anesthesia timing for children undergoing therapeutic cardiac catheterization after upper respiratory infection: a prospective observational study. Minerva Anestesiol 2020; 86:835-843. [PMID: 32251574 DOI: 10.23736/s0375-9393.20.14293-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to analyze anesthesia timing and perioperative respiratory adverse event (PRAE) risk factors in children undergoing therapeutic cardiac catheterization after upper respiratory tract infection (URI). METHODS We prospectively included children for elective therapeutic cardiac catheterization. Parents or legal guardians were asked to complete a questionnaire on the child's demographics, tobacco exposure, and URI symptoms. PRAEs (laryngospasm, bronchospasm, coughing, airway secretion, airway obstruction, and oxygen desaturation) as well as details of anesthesia management were recorded. RESULTS Of 332 children, 201 had a history of URI in the preceding eight weeks. The occurrence rate of PRAEs in children with URI≤two weeks reached the highest proportion, which was higher than that in children without URI (66.3% vs. 46.6%, P=0.007). The overall incidence of PRAEs in children with URI in 3-8 weeks was significantly lower than that in children with URI in the recent ≤two weeks (49.0% vs. 66.3%, P=0.007), and similar to that in the control group (49.0% vs. 46.6%). Multivariate analysis showed association between PRAEs and type of congenital heart disease (CHD) (P<0.001), anesthesia timing (P=0.007), and age (P=0.021). Delayed schedule (two weeks after URI) minimized the risk of PRAEs to the level comparable to that observed in children without URI (OR, 1.11; 95% CI: 0.64-1.91; P=0.707). CONCLUSIONS If treatment is not urgent, a pediatric patient at a high risk of PRAEs will be benefit from the postponement of an interventional operation by at least two weeks after URI.
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Affiliation(s)
- Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Siyuan Wang
- Department of Anesthesiology, Health Science Center
| | - Mengqi Li
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Chi Wu
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Liping Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Sen Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Mazhong Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China - .,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
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Michel F, Constant I. Critical events in paediatric anaesthesia: Lessons learned from the APRICOT study's French data. Anaesth Crit Care Pain Med 2020; 38:599-600. [PMID: 31785707 DOI: 10.1016/j.accpm.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Fabrice Michel
- Anesthésie Réanimation Pédiatrique Hôpital Timone 2 AP-HM-Aix Marseille Université-UMR 7268 ADES, 13385 Marseille, France.
| | - Isabelle Constant
- Service d'Anesthésie-Réanimation et médecine périopératoire, Hôpital Armand Trousseau, DMU DREAM, Sorbonne Université, AP-HP, 75012, Paris, France
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19
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Dahmani S, Laffargue A, Dadure C, Veyckemans F. Description of practices and complications in the French centres that participated to APRICOT: A secondary analysis. Anaesth Crit Care Pain Med 2019; 38:637-645. [DOI: 10.1016/j.accpm.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
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20
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Michelet D, Julien-Marsollier F, Bahaji M, Dahmani S. Potential beneficial effect of pre-operative nebulisation of corticosteroids in children with upper respiratory tract infection. Eur J Anaesthesiol 2019; 36:796-797. [PMID: 31483344 DOI: 10.1097/eja.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Daphné Michelet
- From the Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité (DM, FJ-M, MB, SD), Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité (DM, FJ-M, MB, SD) and DHU PROTECT, Inserm U1141, Robert Debré University Hospital, Paris, France (DM, FJ-M, SD)
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