Pediatric Anesthesia最新文献

Background: The NEonate and Children audiT of Anesthesia pRactice IN Europe (NECTARINE) study, led by the ESAIC Clinical Trials Network, collected prospective data on 5609 children up to 60 weeks postmenstrual age undergoing 6542 anesthetic procedures across 165 centers in 31 European countries (ESAIC_CTN_NECTARINE). While the study provides comprehensive European data, healthcare systems, perioperative practices, and organizational standards vary considerably between countries. Germany was selected a priori for a dedicated subcohort analysis due to its substantial contribution (10.3% of the total dataset) and notable differences to other European countries in the absence of a centralization and national training program in pediatric anesthesia. This focused evaluation aimed to benchmark national data against European findings, identify country-specific strengths and weaknesses, and support targeted quality improvement and guideline development within the German healthcare system.

Aims: To compare the incidence, nature, and consequences of perioperative critical events between the German and non-German NECTARINE cohorts and to assess practice-related risk factors and outcomes.

Methods: Data from 14 German centers were analyzed using mixed-effects logistic regression to examine associations between critical events and 30-day morbidity and mortality. Perioperative management practices and risk profiles were compared with those from the rest of the European cohort.

Results: The German cohort showed a significantly higher rate of critical events (47.0% vs. 33.9%, p < 0.001), with cardiovascular instability being most frequent (82.6%). Within German centers, the occurrence of a critical event nearly tripled the risk of postoperative complications within 30 days (OR: 2.85; 95% CI: 1.67-4.87). ASA status and number of surgeries were also significant predictors of morbidity.

Conclusions: This prospectively defined subanalysis demonstrates that perioperative outcomes and practice patterns in Germany differ from European averages, particularly regarding the frequency of critical events, thresholds for intervention, staffing ratios, and complication profiles. These insights highlight the need for targeted interventions in German pediatric anesthesia, contribute to contextualizing European data, and offer baseline data for future cross-border quality initiatives and trials.

Trial registration: ClinicalTrails.gov NCT02350348.

Background: Injection pressure control is one of the several monitoring options when performing a peripheral nerve block (PNB). To date, no data is available in children regarding injection pressure during a PNB. The aim of this blinded prospective observational study was to measure the maximal pressure for each injection during PNBs in a pediatric population.

Methods: Children scheduled for PNB were eligible for inclusion. During the performance of the block, injection pressures were measured using the CompuFlo device. Factors likely to influence these pressures and the rate of injections exceeding the threshold of 750 mmHg were also recorded.

Results: In total, 175 pressure injection measurements, recorded in 47 patients, were analyzed. The mean maximum injection pressure was 515 [95% CI: 478-551] mmHg. The pressure exceeded the threshold of 750 mmHg in 16% of injections. Factors influencing injection pressure were operator experience, needle diameter, PNBs in restricted diffusion space or lack of injection precision, and incorrect ultrasound injection positions.

Conclusion: Pressure does not appear to be the main factor prompting the operator to continue or stop the injection. Other parameters likely to influence injection pressures still seem to be useful and integrated when learning to perform PNBs.

Background: Pulmonary complications occur at a notably high frequency following pediatric cardiac surgery, among which atelectasis is highly prevalent. Current research is inadequate regarding the development and risk factors for atelectasis in children.

Aims: To investigate the incidence of atelectasis on the first day after right subaxillary small-incision congenital heart disease surgery and to identify risk factors for atelectasis.

Methods: This study retrospectively collected data on children who underwent elective surgery (procedures: atrial septal defect repair, ventricular septal defect repair, or combined procedures in the left lateral decubitus position) at our hospital. Lung ultrasound findings on postoperative day one were collected to evaluate the incidence of atelectasis. Univariate screening followed by multivariable linear regression modeling was performed to identify risk factors for atelectasis.

Results: A total of 254 children were included in the data collection, with a median [IQR] age of 37.0 [23.0-58.0] months. The optimal model identified the following independent risk factors for atelectasis: younger age (β = -0.03, 95% CI: -0.04 to -0.02, p < 0.001), higher BMI (β = 0.55, 95% CI: 0.41-0.69, p < 0.001), prolonged anesthesia duration (β = 0.01, 95% CI: 0.004-0.02, p = 0.001), sufentanil dose > 2.0 μg·kg^-1·h^-1 (β = 1.45, 95% CI: 1.01-1.89, p < 0.001), and higher doses of cisatracurium (β = 1.17, 95% CI: 0.65-1.69, p < 0.001), and atelectasis showed an aggravating trend (β = 0.16, 95% CI: 0.09-0.23, p < 0.001). The model demonstrated satisfactory goodness-of-fit (R² = 0.699, adjusted R² = 0.691, F-statistic = 89.068).

Conclusion: The identified independent risk factors for atelectasis include younger age, higher BMI, prolonged anesthesia duration, sufentanil dose exceeding 2.0 μg·kg^-1·h^-1 and higher doses of cisatracurium, with the severity of atelectasis progressively worsening over time.

Background: Telemedicine has emerged as a valuable tool in healthcare, especially in the wake of the COVID-19 pandemic, showcasing high satisfaction rates across various medical fields. But its potential benefits for pre-anesthetic evaluation in children have not been widely studied.

Method: This pilot randomized controlled trial involves 70 pediatric patients aged 3-12 years compares telemedicine (Group T) with conventional, that is, in-person assessments (Group C), with the primary outcome being the number of visits required for pre-anesthetic checkup, while secondary outcomes include cancellation rates on the day of surgery, duration of consultation, parent/guardian satisfaction rates and concordance of pre-anesthesia checkups between anaesthesiologists.

Result: Telemedicine demonstrated comparable effectiveness to in-person assessments, with no statistically significant difference in the number of visits required for anesthesia clearance (mean visits: 1.54; 95% CI: 1.27-1.81 in group T vs. 1.69; 95% CI: 1.42-1.96 in group C). Surgical cancellations or delays occurred in fewer than one case per group. The duration required for primary anesthesia clearance during the initial session in Group T took longer (17 min 22 s; 95% CI: 15 min 25 s-19 min 20s) than in Group C (13 min 19 s; 95% CI: 11 min 47 s-14 min 50s). This difference may be attributed to parental/guardian unfamiliarity with Zoom and the challenges of home-based assessments, but high satisfaction scores (mean total 5-point likert satisfaction score = 20.74 ± 1.93 out of 25) suggest acceptance among parents/guardians. Concordance rates between anaesthesiologists for medical history, investigations, documentation, ASA status, and anesthesia plan were high (> 85% of cases) using telemedicine except for airway assessment as it was in agreement in only 45.7% of cases.

Conclusion: Telemedicine is offering similar clinical outcomes, high parental satisfaction, and greater accessibility and thus underscores its potential to enhance accessibility and convenience in pediatric pre-anesthesia evaluations without compromising clinical quality.

Trial registration: Clinical trial number: CTRI/2022/11/047193.

The purpose of this concise review is to provide a practical approach to inpatient management of pediatric patients with central diabetes insipidus due to arginine vasopressin deficiency (AVP-D), as well as provide recommendations specific to the perianesthetic period. AVP-D poses significant challenges in perianesthetic management. A multidisciplinary approach to the perianesthetic management of AVP-D can optimize patient outcomes and reduce the risk of complications. Implementing structured protocols that address fluid management, medication dosing, and postoperative care is essential for enhancing safety and optimizing perianesthetic outcomes in this patient population.