Pediatric Anesthesia最新文献

Background: The field of pediatric anesthesiology faces an impending shortage of fellowship-trained physicians. Despite this projection, fewer anesthesiology residents are opting to pursue a fellowship. To better understand the current perspective and motivation of trainees to pursue a career in pediatric anesthesiology, we surveyed anesthesiology residents across the United States.

Aims: Our primary aims were to assess the understanding of the current workforce shortage as well as explore the impact of both exposure and characteristics of the anesthesia resident rotation on the decision to pursue pediatric anesthesiology fellowship.

Methods: A 25-question Qualtrics survey was distributed to members of the Pediatric Anesthesia Leadership Council and Education Committee within the Society for Pediatric Anesthesia and to anesthesiology residency program directors based in the United States.

Results: The survey received 201 responses. Of the respondents, 29% were in Clinical Anesthesia Year 3, 25% in Year 2, 19% in Year 1, and 10% in their intern year. The analysis revealed that self-reported adequate exposure to high-acuity cases and advanced procedures (arterial lines, central lines, and nerve blocks) significantly increased the likelihood of planning to pursue pediatric anesthesiology fellowship (adjusted Odd Ratio 8.47, 95% Confidence Interval, 1.65-43.4). Perceptions of faculty teaching, mentor availability, planned practice environment, and the presence of fellowship programs at the institution were not significantly associated with intentions to pursue pediatric anesthesiology fellowship.

Conclusions: The journey toward specializing in pediatric anesthesiology is influenced by a complex interplay of factors. Among these, enhanced exposure to challenging cases and advanced procedures during the residency phase is emerging as a critical element. Such exposure not only equips residents with the necessary skills and confidence to handle complex pediatric anesthesia cases but also plays a pivotal role in attracting more trainees to this essential subspecialty.

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: 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.

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.