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Schnuck JK, Acker SN, Kelley-Quon LI, Lee JH, Shew SB, Fialkowski E, Ignacio RC, Melhado C, Qureshi FG, Russell KW, Rothstein DH. Decision-Making in Pleural Drainage Following Lung Resection in Children: A Western Pediatric Surgery Research Consortium Survey. J Pediatr Surg 2024:S0022-3468(24)00009-5. [PMID: 38355336 DOI: 10.1016/j.jpedsurg.2024.01.006] [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: 11/02/2023] [Revised: 12/07/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Studies of adults undergoing lung resection indicated that selective omission of pleural drains is safe and advantageous. Significant practice variation exists for pleural drainage practices for children undergoing lung resection. We surveyed pediatric surgeons in a 10-hospital research consortium to understand decision-making for placement of pleural drains following lung resection in children. METHODS Faculty surgeons at the 10 member institutions of the Western Pediatric Surgery Research Consortium completed questionnaires using a REDCap survey platform. Descriptive statistics and bivariate analyses were used to characterize responses regarding indications and management of pleural drains following lung resection in pediatric patients. RESULTS We received 96 responses from 109 surgeons (88 %). Most surgeons agreed that use of a pleural drain after lung resection contributes to post-operative pain, increases narcotic use, and prolongs hospitalization. Opinions varied around the immediate use of suction compared to water seal, and half routinely completed a water seal trial prior to drain removal. Surgeons who completed fellowship within the past 10 years left a pleural drain after wedge resection in 45 % of cases versus 78 % in those who completed fellowship more than 10 years ago (p = 0.001). The mean acceptable rate of unplanned post-operative pleural drain placement when pleural drainage was omitted at index operation was 6.3 % (±4.6 %). CONCLUSIONS Most pediatric surgeons use pleural drainage following lung resection, with recent fellowship graduates more often omitting it. Future studies of pleural drain omission demonstrating low rates of unplanned postoperative pleural drain placement may motivate practice changes for children undergoing lung resection. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Jamie K Schnuck
- Department of General Surgery, University of Washington, Seattle, WA, USA
| | - Shannon N Acker
- Department of General Surgery, Children's Hospital Colorado, Denver, CO, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Justin H Lee
- Department of General Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Stephen B Shew
- Department of General Surgery, Lucile Packard Children's Hospital, Stanford, CA, USA
| | | | - Romeo C Ignacio
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Caroline Melhado
- Department of Surgery, University of California San Francisco School of Medicine, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, University of Texas Southwestern and Children's Medical Center, Dallas, TX, USA
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - David H Rothstein
- Department of General Surgery, University of Washington, Seattle, WA, USA; Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA.
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Öztürk L, Yiğit H. Preoperative preparation and postoperative care in children in thoracic surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S1-S9. [PMID: 38584787 PMCID: PMC10995681 DOI: 10.5606/tgkdc.dergisi.2024.25708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/24/2023] [Indexed: 04/09/2024]
Abstract
Anesthesia for pediatric patients undergoing thoracic surgery continues to be distinctive due to differing anatomical and physiological characteristics compared to adults. Adequate preoperative preparation, appropriate tool selection for providing one-lung ventilation, perioperative pain management, and a multidisciplinary approach can ensure higher quality postoperative care. In this review, the perioperative anesthesia management for pediatric patients undergoing thoracic surgery will be discussed, starting from the preoperative preparation phase. Additionally, the issues related to the application and management of one-lung ventilation will also be assessed.
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Affiliation(s)
- Levent Öztürk
- Department of Anesthesiology and Reanimation, Bilkent City Hospital, Ankara, Türkiye
| | - Hülya Yiğit
- Department of Anesthesiology and Reanimation, Bilkent City Hospital, Ankara, Türkiye
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Ray S, Kaur A, Dias R, Parmar U. Extraluminal FOGARTY® in congenital lobar emphysema: Maneuvering the odds. Saudi J Anaesth 2024; 18:160-162. [PMID: 38313713 PMCID: PMC10833020 DOI: 10.4103/sja.sja_689_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Swarup Ray
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Amrit Kaur
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Raylene Dias
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Uditi Parmar
- Department of Paediatric Anaesthesia, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Arora P, Singha SK, Mujahid OM, Kumari S, Prakashbabu A. Mode of Mechanical Ventilation in a Case of Venolymphatic Malformation: Spontaneous-Saves, Positive-Precludes. Turk J Anaesthesiol Reanim 2023; 51:358-361. [PMID: 37587682 PMCID: PMC10440486 DOI: 10.4274/tjar.2023.221115] [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: 11/02/2022] [Accepted: 03/20/2023] [Indexed: 08/18/2023] Open
Abstract
Mediastinal venolymphatic malformations (VLM) are rare tumours, with very few reported cases in the literature. Arising often from the anterior mediastinum, VLM manifests symptoms based on invaded surrounding structures. Masses from the anterior and superior mediastinum pose an anaesthetic challenge for airway and hemodynamic management. A 7-month-old male child presented with a progressively growing mass over the left anterior chest wall for one month, about 4x4 cm, with diffuse margins and now expanded to involve the root of the neck and into the axilla. The patient was free from any apparent systemic illness. The breathing difficulty worsened in the past week with noisy respiration associated with feeding difficulty and hence sought medical admission to the paediatrics emergency unit. In conclusion, such huge mediastinal masses are managed better under spontaneous ventilation with an adequate surgical depth of anaesthesia to maintain appropriate respiratory compliance and necessitate lower peak inspiratory pressure. Given rare cases reported in the literature, similar topics would help choose the modus of ventilation and their safe management.
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Affiliation(s)
- Prateek Arora
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Subrata Kumar Singha
- Department of Anaesthesia & Critical Care, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Omer Md Mujahid
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Snigdha Kumari
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Abinaya Prakashbabu
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences (AIIMS), Raipur, India
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Gebreselassie HA, Tadesse MM, Woldeselassie HG. Thoracotomy in Children: Review from a Low-Income Country. Pediatric Health Med Ther 2023; 14:99-106. [PMID: 36937243 PMCID: PMC10019342 DOI: 10.2147/phmt.s398368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/09/2023] [Indexed: 03/13/2023] Open
Abstract
Background Thoracotomy is indicated for several congenital and acquired disorders in children. It is among the surgical procedures which require a well-trained and dedicated surgical, anesthesia and critical care team which can be difficult to assemble in a low-income country setup. As the pattern and outcome of thoracotomy in children remained unreported from such setting, this study aims to shed light on this matter. Methodology A descriptive cross-sectional review was conducted. Children who have undergone thoracotomy for non-cardiac pathologies were included in the study. Demographic and clinical data were collected by chart review. Frequencies and percentages were used to describe categorical variables while mean, median, standard deviation and interquartile range were calculated for continuous variables. Results A total of 68 patients were operated on in the study period, out of which 44 (64.7%) were males. The mean ages of the children at the time of diagnosis and procedure were 4.05 ± 3.9 years and 4.14 ± 4.03 years, respectively. The most common indication for thoracotomy was pulmonary hydatid cyst (17; 25%) followed by congenital lobar emphysema (11; 16.2%). Muscle sparing posterolateral thoracotomy was the most common approach in 66 (97.1%) patients. The analgesic medications that were used in the post-operative period were paracetamol, diclofenac, ibuprofen, tramadol and morphine. Combined analgesics were administered in two-thirds of the patients while a single analgesic was used in the rest of the children. No regional blocks were administered post operatively as pediatric size catheters were not available. The morbidity and mortality rates were found to be 11.8% and 8.8%, respectively. Conclusion The most common indication for thoracotomy in this study was pulmonary hydatid cyst. The provision of post-thoracotomy analgesia in our institution is suboptimal as evidenced by no use of regional blocks and poor practice of administering multimodal analgesia. Thoracotomy was associated with fairly high morbidity and mortality.
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Affiliation(s)
- Hana Abebe Gebreselassie
- Department of Surgery, Pediatrics Surgery Unit, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Hanna Getachew Woldeselassie
- Department of Surgery, Pediatrics Surgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
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