Pediatric Anesthesia最新文献

Background: Neonatal resuscitation airway training can be difficult as there is no feedback on the face mask technique. "JUNO" is a training respiratory function monitor that provides feedback on mask leak, ventilatory rate, and tidal volume.

Objective: To evaluate whether the use of the JUNO improves face mask ventilation techniques in manikin models.

Methods: We conducted an observational cross-over study with our unit staff. Following instructions, each participant performed a single-person technique, followed by a two-person technique with no JUNO feedback. This was repeated with JUNO feedback visible. A similar sequence was performed both in term and preterm manikins, giving a total of 8 sequences. Each participant was instructed to perform 1 min of positive pressure ventilation providing 30 inflations/minute for all of the simulations. Each of the simulation data underwent a data cleaning process.

Results: Thirty-eight subjects provided a total of 304 sequences of positive pressure ventilation. A total of 13 354 inflations were analyzed. The feedback group had significantly lower rates of inflations with leak >60%, lower rates of excessive tidal volumes, lower mean leak percentage, and a lower mean inspiratory tidal volumes. When analyzed based on the technique (single person and two-person), similar positive results were noted in the "feedback group", across all the strata of staff. All of the staff reported that JUNO improved their ventilation technique and would recommend it for staff training.

Conclusions: The use of JUNO significantly improved mask ventilation consistently across manikin types, staff roles, and techniques (either single- or two-person).

Background: Trauma-induced coagulopathy (TIC) is associated with negative outcomes. Pediatric TIC has been described most often in older children. Children undergo normal developmental hemostasis, but it is unknown how this process impacts the risk of TIC across childhood.

Aims: To understand variations in coagulation testing and TIC across pediatric age groups.

Methods: We evaluated testing patterns of coagulation studies at presentation and over the first 72 h of hospitalization by pediatric age group at a large, Level I trauma center, 2015-2020. The frequency of TIC was determined using published, age-specific reference ranges and controlling for injury severity. We performed subgroup analyses of those with isolated severe traumatic brain injury (TBI) and those who presented directly from the scene of injury.

Results: Data from 2409 pediatric patients were available; 333 patients had isolated severe TBI. Children <1 year were least likely to be tested for TIC at presentation and over the first 72 h, even among the most injured. Fibrinogen testing was uncommon, regardless of injury severity. TIC was common: 22% of patients had TIC at presentation and 35% by 72 h. Greater injury severity was associated with TIC. Children 1-4 and 5-9 years had a higher frequency of TIC at presentation and over 72 h compared to older children in the least injured cohort. We saw no difference in frequency of TIC between age groups in the subset with isolated severe TBI. Using age-specific criteria, patients most often met TIC criteria by INR/PT, followed by platelet count, and least commonly by aPTT. The presence of TIC was associated with in-hospital mortality (OR 4.10, 95% CI 2.06-8.17).

Conclusions: Significant sampling bias exists in clinical data collection among injured children and adolescents. Contrary to previous reports and using age-specific TIC criteria, younger children are not at lower risk of TIC than older children when controlling for injury severity.

Background: Posterior spinal instrumentation and fusion is an established surgical procedure for the correction of adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring is standard practice for this procedure. Anesthetic agents can have different, but significant, effects on neurophysiological monitoring outcomes.

Aim: To determine if intravenous lidocaine infusion therapy has an impact on the intraoperative neurophysiological monitoring during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis.

Methods: Following ethical approval, we conducted a retrospective review of charts and the archived intraoperative neurophysiological data of adolescents undergoing posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Intraoperative neurophysiological monitoring data included the amplitude of motor evoked potentials and the amplitude and latency of somatosensory evoked potentials. A cohort who received intraoperative lidocaine infusion were compared to those who did not.

Results: Eighty-one patients were included in this analysis, who had surgery between February 4, 2016 and April 22, 2021: 39 had intraoperative intravenous lidocaine infusion and 42 did not. Based on hourly snapshot data, there was no evidence that lidocaine infusion had a detrimental effect on the measured change from baseline for MEP amplitudes in either lower (mean difference 41.9; 95% confidence interval -304.5 to 388.3; p = .182) or upper limbs (MD -279.0; 95% CI -562.5 to 4.4; p = .054). There was also no evidence of any effect on the measured change from baseline for SSEP amplitudes in either lower (MD 16.4; 95% CI -17.7 to 50.5; p = .345) or upper limbs (MD -2.4; 95% CI -14.5 to 9.8; p = .701). Finally, there was no evidence of a difference in time to first reportable neurophysiological event (hazard ratio 1.13; 95% CI 0.61 to 2.09; p = .680).

Conclusions: Data from these two cohorts provide preliminary evidence that intravenous lidocaine infusion has no negative impact on intraoperative neurophysiological monitoring during PSIF for adolescent idiopathic scoliosis.

Background: Procedural sedation and analgesia are required for painful hemato-oncological procedures such as lumbar and bone marrow punctures. At our institution, sedation with propofol and alfentanil is usually provided by Physician Assistants in Anesthesia. We evaluated the adverse events during the PSA program for children, provided by Physician Assistants in Anesthesia.

Patients and methods: We included pediatric patients meeting our criteria for deep sedation by a Physician Assistants in Anesthesia, scheduled for a hemato-oncological procedure at the Amalia Children's Hospital at the Radboudumc Nijmegen. The primary outcome was oxygen desaturation below 92% for more than 20 s. We prospectively collected data on demographics, current health problems, type of procedure, need for airway interventions, and hypotension.

Results: We collected data from 437 sedation sessions involving 71 patients. No oxygen desaturation below 92% lasting longer than 20 s occurred. In 2 cases, a jaw thrust was performed. No invasive airway techniques (oropharyngeal cannula, laryngeal mask, or intubation) were required. A significant drop in mean arterial pressure was seen in 2 out of 437 cases (0.5%). There was no occurrence of cardiopulmonary resuscitation or other adverse events such as aspiration or laryngeal spasm.

Conclusions: Sedation and analgesia for short painful procedures in selected pediatric hemato-oncological units with a dedicated protocol may be safely provided by trained and certified Physician Assistants in Anesthesia.