Pediatric Anesthesia最新文献

Background: Retrograde autologous priming and venous antegrade priming replace the cardiopulmonary bypass circuit crystalloid with patient blood to mitigate hemodilution. However, their effectiveness in pediatric patients, particularly when analyzed as continuous variables, remains unclear.

Aims: We aimed to evaluate the effects of autologous priming techniques on blood conservation and patient safety during pediatric cardiac surgery.

Methods: This retrospective cohort study included 191 patients (age 0-14 years; weight > 6 kg) who underwent repair of ventricular and/or atrial septal defects. The primary endpoint was the correlation between the priming volume reduction rate (proportion of priming solution replaced) and the hematocrit retention ratio (hematocrit immediately after cardiopulmonary bypass initiation divided by pre-bypass hematocrit). Secondary outcomes, including transfusion rates, regional cerebral oxygen saturation, and lactate levels, were compared between a retrograde autologous priming group (n = 144) and a control group (n = 47). All patients underwent venous antegrade priming.

Results: The priming volume reduction rate correlated positively with the hematocrit retention ratio (Spearman's ρ = 0.545, p < 0.001). Multiple regression confirmed this independent association: a 0.1 increase in the priming volume reduction rate corresponded to a 0.5% absolute increase in hematocrit at bypass initiation. The retrograde autologous priming group had a significantly higher transfusion-free surgery rate (93.1% vs. 76.6%; relative risk ratio 1.22; p = 0.005). Regarding safety and the postoperative course, no significant intergroup differences were found in trends in regional cerebral oxygen saturation (Time × retrograde autologous priming interaction) or in lactate levels. Similarly, intensive care unit and hospital lengths of stay did not differ significantly between groups. Safety analyses suggested no evidence of cerebral perfusion suppression during retrograde autologous priming.

Conclusion: These findings suggest that even partial retrograde autologous priming is effective to mitigate hemodilution and is independently associated with improved hematocrit retention and a significant reduction in transfusion risk after initiation of cardiopulmonary bypass in pediatric patients.

Trial registration: This study was registered with the UMIN Clinical Trials Registry, Japan, prior to commencement (Trial ID: R000067879).

Background: Non-intubated spontaneous ventilation anesthesia is increasingly used in adult thoracoscopic surgery, but pediatric evidence remains limited.

Aims: To compare perioperative outcomes between two anesthetic regimens in children undergoing thoracoscopic anatomical lung lesion resection: a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia and a conventional endotracheal intubation anesthesia.

Methods: This single-center retrospective cohort study included children undergoing thoracoscopic anatomical lung lesion resection for pulmonary sequestration or congenital pulmonary airway malformation between April 2024 and May 2025. Children received either a conventional endotracheal intubation anesthesia or a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia. One-to-one propensity score matching was performed. The primary outcome was the overall incidence of postoperative pulmonary complications before discharge. Secondary outcomes were conversion to endotracheal intubation, intraoperative lowest peripheral oxygen saturation, highest end-tidal carbon dioxide, postanesthesia care unit length of stay, chest tube indwelling time, and postoperative length of hospital stay. Other perioperative variables were exploratory.

Results: Among 198 eligible children, 50 matched pairs were analyzed. Postoperative pulmonary complications occurred in 6 of 50 children (12.0%) in the endotracheal intubation group and in 0 of 50 children (0%) in the non-intubated spontaneous ventilation group (absolute risk reduction 12.0%, 95% confidence interval 3.0-21.0; p = 0.027). In a sensitivity analysis using Firth's logistic regression model adjusting for thoracic paravertebral block, the non-intubated regimen remained associated with a lower observed incidence of postoperative pulmonary complications (adjusted odds ratio 0.06, 95% confidence interval 0.0004-0.76; p = 0.029). No child in the non-intubated spontaneous ventilation group required conversion to endotracheal intubation. Secondary outcomes showed modest between-group differences in unadjusted analyses. However, after Holm-Bonferroni adjustment, adjusted p values for secondary outcomes ranged from 0.060 to 0.208.

Conclusion: In this retrospective propensity-score-matched pediatric cohort, a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia was feasible and was not associated with worse perioperative outcomes than a conventional endotracheal intubation anesthesia. A lower observed incidence of postoperative pulmonary complications was noted. Given regimen-level differences, prospective studies with standardized analgesia are needed to confirm safety and potential benefits.

Background: Infants with ventricular septal defect (VSD) and concurrent respiratory compromise exhibit significant heterogeneity in their recovery after surgical repair. Objective tools for preoperative risk stratification are lacking.

Aims: The primary aim of this study was to determine if preoperative hemodynamic data, acquired noninvasively using Electrical Cardiometry (EC), could predict prolonged mechanical ventilation (PMV) in infants undergoing VSD repair.

Methods: We conducted a retrospective study of 51 infants. EC monitoring (ICON) was performed from admission to the day before surgery. A composite risk score was developed using Principal Component Analysis (PCA) of clinical characteristics and EC-derived hemodynamic parameters. The predictive performance of this score for PMV (defined as ≥ 12 h) was assessed using correlation and receiver operating characteristic (ROC) curve analysis. Leave-One-Out Cross-Validation (LOOCV) was used to assess the model's stability.

Results: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the change in the Index of Contractility (∆ICON) were identified as key parameters correlating with clinical classifications of cardiac dysfunction (r = 1.517 and 1.470, OR = 4.560 and 4.350 respectively, p < 0.05). A PCA-derived composite score was identified as a potential predictor of PMV with r = -0.522 in correlation (p < 0.001) and AUC = 0.856 (SE = 0.857, SP = 0.773, LOOCV AUC = 0.830), outperforming individual clinical variables alone.

Conclusions: A composite risk score integrating individual data and EC hemodynamics monitoring can effectively identify infants at high risk for PMV following VSD repair. This approach may provide a valuable tool for perioperative management and resource allocation.

Background: Emergence delirium (ED) is a common complication in pediatric anesthesia. Although intranasal dexmedetomidine (DEX) is widely used, its application is constrained by a slow onset, residual risk of ED in some patients, and risks such as bradycardia and hypotension. Esketamine (ESK), an NMDA receptor antagonist, may provide a faster onset and reduce these side effects.

Objective: This study compared the efficacy and safety of intranasal DEX-ESK combination versus DEX alone as premedication for anesthesia induction in pediatric patients undergoing surgery.

Methods: Electronic databases (PubMed, Web of Science, Scopus, CINAHL, and Embase) were systematically searched for randomized controlled trials (RCTs). The primary outcomes included the ED incidence and the onset of sedation. Secondary outcomes included mask acceptance score, FLACC pain score, post-anesthesia care unit (PACU) length of stay, and adverse events. A random-effects model generated pooled effect estimates-risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. Prediction intervals were also reported to reflect the expected range of effects in future similar studies. Trial Sequential Analysis was performed. The certainty of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Results: Five RCTs encompassing 466 pediatric patients were included in the quantitative synthesis. The DEX-ESK combination was associated with a reduction in ED incidence (RR = 0.58; 95% CI: 0.35-0.97; p = 0.04) and a shorter time to sedation onset (MD = -3.95 min; 95% CI: -4.77 to -3.14; p < 0.01). Secondary analyses demonstrated improved mask acceptance (MD = -0.77; 95% CI: -1.27 to -0.27; p < 0.01), reduced FLACC pain scores (MD = -0.36; 95% CI: -0.70 to -0.02; p = 0.04), and shorter PACU length of stay (MD = -1.83 min; 95% CI: -2.75 to -0.91; p < 0.01). Adverse event incidence did not differ significantly between groups.

Conclusion: The intranasal DEX-ESK combination was associated with improved outcomes compared with DEX monotherapy for pediatric premedication including reductions in ED incidence, a modest acceleration in sedation onset, improved mask acceptance, and slightly shorter PACU length of stay, without an increased risk of adverse events. This combination may represent a feasible and safe premedication option for pediatric patients.

Trial registration: PROSPERO: CRD420251236740.

Background: The choice of a central venous catheter (CVC) lumen to connect the central venous pressure (CVP) measurement line varies by facility. However, if the CVP values differ based on the connected CVC lumen, this variation could significantly affect the interpretation of the CVP measurements, raising major concerns regarding circulatory management of the patient.

Aims: This study aimed to determine whether a difference exists in the CVP values between the proximal and distal lumens of the CVC in small pediatric patients undergoing cardiac surgery.

Methods: Seventeen pediatric patients with congenital heart disease, aged 1 to 31 months, who underwent cardiac surgery between November 2022 and November 2023, were included in this study. The CVC was inserted via the right internal jugular vein or right supraclavicular approach. Separate transducers were connected to the proximal and distal lumens. The CVP values from each were recorded simultaneously throughout the surgery. Differences were examined in the following phases: (1) after general anesthesia induction, (2) after initiation of cardiopulmonary bypass (CPB), and (3) after weaning from CPB.

Results: No statistically significant differences were observed in A-wave pressure, X-descent pressure, or mean CVP values measured from the distal and proximal lumens after general anesthesia induction or after weaning from CPB. The distal lumen showed significantly lower pressure than the proximal lumen after CPB initiation.

Conclusions: Our findings revealed no significant difference in the CVP values between the proximal and distal lumens of the CVC in small pediatric patients; moreover, the proximal lumen provided reliable CVP values, even during CPB. These findings support connecting the CVP line to the proximal lumen, offering the great advantage of early detection of CVC slippage through changes in the CVP values and waveforms.

Trial registration: This study was registered in the UMIN Clinical Trials Registry (registration number: UMIN000052944).