Pediatric Anesthesia最新文献

Aims: Tunneled noncuffed central venous catheters (tncCVCs) have been used in pediatric populations for years. This study examines whether their use is efficacious and explores the reasons for complications and failure.

Methods: This 6-year case series examines the success rate of tncCVCs inserted in patients less than 2 years old receiving intravenous antibiotics in a single institution and the reasons for device complications and failure.

Results: Three hundred and thirty-one devices were inserted into 311 patients. Median patient age was 0.7 years (IQR 0.15-1.27) and median weight 7.8 kg (4.8-10.6). Median CVC dwell time was 13 (IQR 9.2-18.2) days. The success rate in completing prescribed treatment with the device was 94.9%, with 17 failures. Thirteen failures were due to accidental dislodgement (3.9% of all comers, 77% of failures). A large majority (79%) of patients received outpatient antibiotic therapy. Patients with any history of previous CVC insertion were more likely to have failed devices. All neonatal patient devices successfully completed treatment. A total of 55 different proceduralists inserted the devices.

Conclusions: Success rates for tncCVCs when used in infants to complete a median of 13 days of antibiotic therapy on a single device appear acceptable.

Ultrasound (US) guidance has become an essential skill for peripheral intravenous (PIV) placement in children. It may be used as a primary approach or as a rescue technique after failed attempts, particularly in children with difficult intravenous access (DiVA). An increasing amount of literature shows the benefit of using US guidance for PIV placement in children with DiVA. With more consistent availability of US machines across many institutions, their use for PIV placement is becoming commonplace, with several types of clinicians performing the procedure. Novice proceduralists and those in training may encounter technical challenges that may impede successful PIV cannulation. Having strategies to avoid, troubleshoot, and overcome technical challenges is essential for improving the technique of US guidance for PIV access. The purpose of this review was to summarize the literature around the most common technical challenges that arise when performing US-guided PIV placement in children and practical strategies that may improve cannulation success. We also highlight US-guided PIV placement considerations specific to special populations, including premature neonates, pediatric burns, epidermolysis bullosa, and those receiving bleomycin sclerotherapy.

Background: Needle-related procedures are among the most frequent and distressing experiences for children. The Buzzy device, which combines cold and vibration, has emerged as one of the best non-pharmacological tools to reduce procedural pain and anxiety. However, its effectiveness may vary substantially across age groups, a factor not consistently addressed in prior literature. This stands in sharp contrast to pain assessment, where age-specific tools are routinely applied, while comparable rigor is lacking for non-pharmacological interventions.

Methods: We conducted a Bayesian reanalysis of the most recent systematic review and meta-analysis on the Buzzy device in pediatrics, including sixteen randomized controlled trials reporting pain outcomes and six reporting anxiety outcomes. Bayesian hierarchical random-effects models were applied, and study-level covariates were examined through meta-regression. Posterior distributions, credible intervals (CrIs), and Bayes factors (BFs) served to quantify the strength of evidence.

Results: Buzzy significantly reduces pain (SMD -1.05, 95% CrI -1.41 to -0.70) and anxiety (SMD -1.59, 95% CrI -2.65 to -0.54). Age emerged as a significant moderator of pain reduction: children aged 7 years or older showed stronger benefit (posterior probability = 97.9%; BF = 13.9). In contrast, no meaningful associations were observed with sex distribution, procedure type, or risk of bias. For anxiety, the age effect was inconclusive, reflecting limited study numbers and wide credible intervals.

Conclusion: This Bayesian reanalysis confirms the effectiveness of Buzzy for pediatric procedural pain while highlighting age as a key determinant. The device appears more beneficial in children aged 7 years or older, supporting its preferential use in school-aged populations, where the greatest clinical benefit is observed.

The field of pediatric cardiac anesthesia faces a critical workforce shortage. Survival of children with congenital heart disease (CHD) has improved dramatically, increasing both lifetime procedural demand and case complexity. At the same time, the supply of fellowship-trained pediatric cardiac anesthesiologists is shrinking due to an aging workforce, declining fellowship recruitment, financial disincentives, and concerns about work-life balance and professional culture. The resulting mismatch between demand and supply threatens access to care and risks moral injury and attrition within the specialty. At our institution, workforce pressures necessitated the redistribution of some CHD care to general pediatric anesthesiologists through the Special Cardiac Care Anesthesia (SCCA) model. As this team expanded, members themselves recognized a pressing need for structured education in congenital cardiac physiology and anesthetic implications. In response, the Cardiac Basics curriculum was developed to provide accessible, foundational cardiac content for anesthesiologists, fellows, advanced practice providers, and intensivists. The program was designed with three goals: (1) to provide essential cardiac knowledge, (2) to deliver material in a format accessible to diverse learners, and (3) to foster a psychologically safe environment where all participants could ask questions and engage openly. The curriculum uses weekly topic guides, brief interactive didactic sessions, and case-based reinforcement. It has been well received, with strong participation across learner groups and overwhelmingly positive feedback highlighting clarity, brevity, and clinical applicability. Educational innovations such as Cardiac Basics represent a pragmatic and scalable strategy to address the pediatric cardiac anesthesia workforce crisis. By equipping a broader group of providers with the skills to care safely for selected CHD patients, such curricula can serve as a critical "force multiplier" while longer term solutions-fellowship recruitment, pipeline repair, and cultural change-are pursued.

Background: Congenital long QT syndrome (LQTS) and Catecholaminergic Polymorphic ventricular Tachycardia (CPVT) are inherited arrhythmogenic disorders leading to an increased risk of life-threatening arrhythmias. Left cardiac sympathetic denervation (LCSD), currently performed by video-assisted thoracoscopic surgery (VATS) is a well-established treatment for patients not fully protected by drugs. Peri-operative pain management represents a challenge.

Aim: To assess the impact of a multimodal approach for perioperative pain management including combined regional anesthesia on postoperative pain scores, opioid requirements and neuropathic pain incidence in pediatric LQTS and CPVT patients undergoing VATS-LCSD.

Methods: A retrospective analysis was conducted on consecutive children undergoing VATS-LCSD at a single center from 2021 to March 2025. Per protocol, they all received Erector Spinae Plane (ESP) and Serratus Plane (SP) block. A perifascial catheter was placed following ESP for continuous local anesthetic infusion.

Results: 15 patients were enrolled (median age 6.9 years, IQR 4.3-9.8, median weight 24 kg, IQR 18.3-35.5). Most (13, 87%) had LQTS and almost one third had a high-risk genotype. There were no major complications. There was only 1 case (7%) of accidental removal of the ESP catheter, in whom prophylactic morphine was used. Pain scores, as assessed by VAS, were below 2 in all patients; none needed additional doses of opioids nor ketorolac or developed neuropathic pain postoperatively.

Conclusions: Our results support the use of a combined regional anesthesia protocol for peri-operative pain management in pediatric channelopathy patients undergoing VATS-LCSD. This approach may improve overall quality of care for this vulnerable population.

Background: The increasing utilization of magnetic resonance imaging (MRI) in pediatric populations necessitates strategies to mitigate the risks and logistical challenges associated with sedation. Sedation in pediatric MRI procedures poses significant risks and can increase healthcare costs. Therefore, alternative methods to facilitate successful unsedated scans are essential.

Aims: This study evaluates the impact of audiovisual MRI (AV-MRI) technology along with predictive patient factors to perform a diagnostic MRI without sedation. Additionally, image quality with motion artifacts was evaluated in sedated patients, versus unsedated patients with AV-MRI.

Methods: We analyzed pediatric MRI records from November 2015 to March 2017, comparing data before and after the introduction of AV-MRI. A total of 1167 scans were included, 590 before and 577 after AV-MRI implementation, matched based on age and type of MRI performed. The patient factors that were evaluated for successful unsedated scans include age, sex, AV-MRI vs. non-AV-MRI, procedure category, developmental delay, cerebral palsy, autism, ADD/ADHD, anxiety, behavioral problems, psychological disease, malignancy, seizures, use of an interpreter and first vs. subsequent MRI. Additionally, motion artifacts were examined in 102 pediatric patients who specifically underwent brain MRI scans utilizing a 4-point scale, comparing those completed with and without sedation.

Results: Post-implementation of AV assistance, there was a significant increase in unsedated MRI success rates (odds ratio 3.68, 95% CI: 2.24, 5.62, p < 0.001). Age was a strong predictor of success, with older children more likely to complete scans without sedation (OR 3.2, 95% CI: 1.02, 10.31, p = 0.046). Female children were more likely to complete unsedated scans compared to males. Children with behavioral issues were less likely to complete an unsedated scan. Motion artifact analysis showed more motion in unsedated scans, but all were diagnostic.

Conclusions: AV-MRI technology increases the success rate of sedation-free MRI in pediatric patients, reducing risks and healthcare costs without compromising diagnostic quality. Age and sex are important predictors of success. The study advocates for the broader adoption of AV-MRI and similar technologies to minimize sedation use, thereby improving safety and operational efficiency in pediatric radiology. Future research should explore additional patient factors influencing sedation-free MRI success and extend motion artifact analysis to other MRI procedures.

Introduction: Lidocaine is widely used in pediatric anesthesia for airway topicalization to modulate undesirable airway and circulatory reflexes, yet its effectiveness remains unclear. Therefore, we aimed to perform a meta-analysis evaluating the impact of topical lidocaine on respiratory adverse events in children undergoing airway management.

Methods: PubMed, Embase, and Cochrane databases were systematically searched for studies comparing topical lidocaine with placebo, no intervention, or intravenous lidocaine for pediatric airway management. Statistical analysis was performed using R (version 4.4.1). Odds ratios (ORs) were used for binary outcomes and mean differences for continuous outcomes, with 95% confidence intervals (CIs) computed using a random-effects model.

Results: Fourteen randomized controlled trials comprising 1937 pediatric patients were included, of whom 917 (47%) received airway topicalization. In those receiving topical lidocaine, there was a significant reduction in the incidence of laryngospasm (OR 0.50; 95% CI 0.27 to 0.95; p = 0.033), desaturation (OR 0.49; 95% CI 0.25 to 0.98; p = 0.043), and sore throat (OR 0.31; 95% CI 0.16 to 0.58; p < 0.001). However, no significant differences were observed for bronchospasm (OR 0.50; 95% CI 0.11 to 2.35; p = 0.382), cough (OR 0.56; 95% CI 0.28 to 1.11; p = 0.099), severe cough (OR 1.30; 95% CI 0.18 to 9.51; p = 0.793), hoarseness (OR 1.41; 95% CI 0.17 to 11.96; p = 0.754), vomiting (OR 1.95; 95% CI 0.47 to 7.99; p = 0.355), and heart rate (beats/min) (MD 0.08; 95% CI -6.31 to 6.47; p = 0.98).

Conclusion: Our findings suggest that topical lidocaine may reduce the incidence of undesirable airway reflexes such as laryngospasm, desaturation, and sore throat in children undergoing airway management. However, its benefit for other perioperative respiratory adverse events requires further investigation, especially in high-risk populations.

Trial registration: PROSPERO registration number: CRD42024614863.