Pediatric Anesthesia最新文献

Background: Cerebral palsy, a neurologic disorder caused by damage to the developing brain, is a leading cause of childhood disability. Due to musculoskeletal, movement, and secondary impairments, children with cerebral palsy often require surgical care. With the growing cost of surgical care, many children with cerebral palsy are scheduled for surgery in an ambulatory setting. Whether cerebral palsy increases the risk of unanticipated admission (a critical quality indicator of care) following ambulatory surgery has not been characterized. Our objective was to determine the association of cerebral palsy with unanticipated admission following pediatric ambulatory surgery.

Methods: We used the Pediatric Health Information System (PHIS) database to evaluate a retrospective cohort of children (< 18 years) who underwent scheduled ambulatory operations between January 1, 2010 and December 31, 2022. The primary outcome was unanticipated admission. Using log-binomial regression models, we estimated the relative risk and 95% confidence intervals for unanticipated admission, comparing patients with and without cerebral palsy. To account for confounding variables, we performed a 1:1 propensity score matching without replacement.

Results: A total of 1 954 108 children underwent ambulatory surgeries during the study period. Of these, 4.1% required unanticipated admission. The overall incidence of unanticipated admission was significantly higher among children with cerebral palsy than in those without (9.8% vs. 4.0%; p < 0.001). This association remained significant after multivariable adjustment (relative risk: 1.73; 95% CI: 1.59-1.87, p < 0.001).

Conclusion: Although cerebral palsy is not a contraindication for ambulatory surgery in children, it is significantly associated with the risk of unanticipated hospital admissions. This underscores the need for careful preoperative clinical site of care selection in this vulnerable patient population.

Level of evidence: Level II.

Background: Arterial catheters are commonly used for hemodynamic monitoring and blood sampling in critically ill children, with the radial artery being the typical site. When radial cannulation is not feasible, alternative sites like the axillary artery may be utilized. However, the safety and sustainability of axillary arterial catheters compared to radial catheters in this population remain unclear.

Aims: This study aims to assess the safety and sustainability of axillary arterial catheters compared to radial arterial catheters in pediatric intensive care unit patients.

Methods: We conducted a retrospective, case-control study at a university-affiliated tertiary care pediatric intensive care unit. Patients aged 18 years or younger with axillary arterial catheters from January 2007 to December 2023 were compared to patients of similar ages with radial catheters.

Results: A computerized chart review identified 306 patients with axillary catheters, compared to 306 randomly selected patients with radial catheters. The rate of catheter site replacement was identical in both groups (40 out of 306). The median duration of axillary catheter use was 34 h longer (95% CI: 24-48; p < 0.001). Only one patient in the axillary group (0.33%) experienced a vascular complication, recovering fully after intervention. Patients with axillary catheters were characterized by a higher Pediatric Index of Mortality 3 scores, Vasoactive-Inotropic Scores, and PICU mortality rates.

Conclusions: In this critically ill pediatric cohort, axillary arterial catheters were used longer and in a more severely ill population than radial catheters. Despite these differences, both catheter types demonstrated comparable safety and sustainability profiles.

Introduction: Airway management of infants is challenging, and video laryngoscopes can help reduce intubation attempts and improve glottic visualization. In this study, we compared the Besdata video laryngoscope with the Miller laryngoscope in neonates and infants 6 months of age.

Methods: After obtaining informed written consent from the parents, we randomized 80 infants scheduled for elective surgery requiring endotracheal intubation into two groups, Group DL and Group VL. We used a direct laryngoscope with a Miller blade in group DL and a Besdata video laryngoscope with a Miller blade in group VL. We compared the time taken for intubation, glottis visualization time, percentage of glottic opening (POGO) score, Cormack Lehane (CL) grades, first attempt success rate, need for external laryngeal manipulation, and complications between the two groups.

Results: The median (interquartile range, IQR) time taken for intubation was 36.0 s (30.5-39.0) versus 35.0 s (28.0-40.0) (p = 0.35), similar in both groups. The median difference (95% confidence interval, CI) was 0.0 s [-4.0 to 5.0]. The median (IQR) time for glottic visualization was 13.0 s (10.0-15.5) versus 10.0 s (8.0-12.0), and the median difference (95% CI) was 2.0 s [1-6] in group DL and group VL, respectively, showing shorter time with a video laryngoscope. We also found better POGO scores and decreased need for optimal external laryngeal manipulation with a Besdata video laryngoscope. The first attempt intubation success rate, use of bougie, and complications were similar in both groups.

Conclusion: The Besdata video laryngoscope with a zero-size Miller blade has shown a similar intubation time when compared with a conventional laryngoscope in neonates and infants of 6 months of age. The first attempt intubation success rate was also comparable between the two groups. However, the Besdata video laryngoscope is associated with comparatively better glottic visualization.

Trial registration: Clinical Trial Registry of India (CTRI; www.ctri.nic.in): CTRI/2021/012/038787.

Background: Midface advancements in children with syndromic craniosynostosis present challenges for anesthesiologists and intensive care teams.

Aims: This study reviewed the perioperative airway management protocol for immediate tracheal extubation after midface surgery at our tertiary center over the past 10 years.

Methods: A retrospective cohort study was performed to obtain information on respiratory disorders, surgical and anesthetic management, airway support, and respiratory complications following le Fort III (LF3) and monobloc (MB) with distraction. Patients with a tracheostomy were excluded.

Results: Thirty-two patients (12 LF3, 20 MB) were included. All were immediately extubated with a median of 25 min after surgery. Immediate extubation was performed in young patients (n = 8/32, < 5 years old), in patients with severe OSA (n = 6/32, median oAHI 23/h), with difficult airways (n = 5/32, Cormack-Lehane airway grade ≥ 3), with significant intraoperative blood loss (n = 32, median 46 mL/kg), and with long operative times (n = 32, median 223 min). The majority of patients received no or only oxygen support in the first hours after extubation (n = 29/32) and could be discharged from the pediatric intensive care unit to the surgical ward after 1 day (n = 30/32). A 5-month-old patient with MB required intermittent oxygen and Guedel airway throughout his hospitalization due to airway obstruction at the tongue base combined with supine positioning to allow external traction.

Conclusions: Despite the pre-existing airway disorder, the extent of the procedure and the effect of anesthesia on airway tone, all patients were extubated immediately after midface advancement, with only one young patient needing prolonged postoperative support. Immediate extubation is feasible following midface advancement in patients with syndromic craniosynostosis. Further prospective randomized trials are needed to demonstrate superiority to delayed extubation.

Background: A total of 80% of children experience postoperative pain following discharge. Effective postoperative pain management involves reliable caregiver pain assessment and/or child self-report of pain. Unfortunately, caregiver and child ratings of postoperative pain are not always consistent (i.e., concordant). This study aimed to identify postoperative pain concordance among caregiver-child dyads and predictors for postoperative pain discordance.

Methods: Children and their caregivers completed preoperative baseline demographic, anxiety, and distress measures. Postoperatively, children and caregivers completed pain severity ratings using the Child Health Rating Inventories (CHRIS 2.0). On the basis of postoperative pain scores, caregiver-child dyads were classified as overestimators (i.e., caregivers rated pain as higher than children), in agreement, or underestimators (i.e., caregivers rated pain as lower than children).

Results: A large proportion of dyads disagreed on pain ratings (n = 104; 44%), with 64 (27%) caregivers classified as overestimators and 40 (17%) caregivers classified as underestimators. Caregivers were more likely to underestimate male children's pain, β = 1.238, OR = 3.35 (95% CI: 1.26, 9.43), p = 0.16, and Spanish-speaking Latinx caregivers were more likely to underestimate children's pain, β = 2.27, OR = 9.63 (95% CI: 2.35, 39.37), p = 0.002.

Conclusion: Although most caregiver-child dyads agreed with pain ratings, 44% of the dyads disagreed. Among those who disagreed, males from Spanish-speaking Latinx households were at greatest risk of having their pain underestimated by their caregiver, which could be explained by the influence of intersecting social identities on pain beliefs, expression, and behaviors. Future studies should explore how pain discrepancies influence postoperative recovery outcomes for Latinx children.