Pediatric Anesthesia最新文献

Background: Sevoflurane and propofol, the common anesthetic agents, have been under evaluation for emergence delirium in children. This pilot study examined how frontal cortex blood flow during sevoflurane and propofol anesthesia relates to emergence delirium in children aged 3-10 using functional near-infrared spectroscopy (fNIRS).

Methods: Seventy-four children, undergoing urologic and orthopedic surgeries, were randomly assigned to either propofol (n = 37) or sevoflurane (n = 37) after obtaining approval from the institute ethics committee, written informed parental consent, assent, and registration in a clinical trial registry. Children with perinatal hypoxia, preterm birth, seizures, developmental disorders, psychiatric illness, or electrolyte imbalances were excluded. Anesthesia was induced and maintained per standard protocols, and pain was managed using paracetamol, ketorolac, and caudal analgesia. fNIRS readings were recorded at induction and reversal. Postoperatively, emergence delirium was assessed using the PAED and Cornell Assessment of Pediatric Delirium (CAPD) scales. Data were collected using a 20-channel fNIRS system and analyzed with NIRStar software.

Results: Frontal cortex fNIRS demonstrated agent-specific cortical patterns during anesthesia induction, with distinct neural activity differences related to ED. Under propofol, children without ED demonstrated greater left frontal activation (channel 4; t = 2.30, p < 0.005), whereas those with ED showed deactivation; extubation showed no differences. Sevoflurane induction revealed that children without delirium showed greater deactivation in multiple frontal channels-channel 13 (right medial/superior frontal gyri; t = -2.252, p < 0.05), channel 2 (left middle/superior frontal gyri; t = -2.252, p < 0.05), and channel 17 (right superior/middle frontal gyri; t = -3.15, p < 0.05), while no differences were observed during extubation. ED was more frequent with sevoflurane (18.9%) compared to propofol (5.4%). Sevoflurane was linked to significantly less deactivation (more activation) in frontal brain regions in children with emergence delirium, compared to propofol during both induction, notable in channel 4 (left middle and superior frontal gyrus) (t = -5.756, p < 0.005) and extubation notable in channel 2 (left middle and superior frontal gyri) (t = -6.877, p < 0.05).

Conclusion: The increased frontal cortical activation with sevoflurane may contribute to a higher incidence of emergence delirium in children compared to propofol.

Trial registration: Clinical trial registry: CTRI/2022/04/041573; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NjQ3NTM.

Background: The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is widely used to classify patient comorbidities prior to surgery and is often used as a marker of perioperative risk. Since its inception in 1941, it has undergone modifications to adapt to changing clinical needs and to improve its reliability. In 2020, a version of the ASA-PS was released with pediatric-specific case examples.

Aim: To explore inter-rater reliability in ASA-PS scoring in the pediatric population.

Methods: This single-center retrospective study evaluated the assigned ASA-PS scores of 364 patients at a quaternary pediatric hospital. Each patient was assigned three ASA-PS scores-one by the case anesthetist and one each by two independent consultant anesthetists using the ASA guidance issued in 2020. Concordance was measured between the assigned scores, and potential reasons for discordant scores were identified.

Results: There was strong concordance of ASA-PS scores between the two independently scoring anesthetists (weighted kappa coefficient 0.76), but only moderate concordance between the case anesthetist and the independent anesthetists (weighted kappa coefficient 0.5). Where there was a discrepancy, the case anesthetist had usually underscored the ASA-PS by 1 point. Patients who had symptomatic cardiac disease, abnormal body mass index for age, an oncologic state, brain malformation, or a difficult airway were more likely to be assigned an incorrect ASA-PS score.

Conclusions: Moderate inter-rater variability exists in the assignment of ASA-PS scores in the pediatric population, and many patients are being underscored. Use of ASA guidance to assist with pediatric ASA-PS scoring improves the reliability of scoring and may improve accurate communication of perioperative risk.

Background: Pediatric preassessment is recommended for all children undergoing general anesthesia. It has the potential to improve safety and quality outcomes for both the patient and the organization.

Aims: This study aimed to establish the proportion of children who underwent preassessment before general anesthesia, the format of that preassessment, and the impact of preassessment on outcomes such as on-the-day cancelation, and patient anxiety.

Methods: This multi-center prospective observational cohort study outlines preassessment delivery in the UK and its effect on outcome. Invitation to participate was via Pediatric Anesthetic Trainee Research Network. Data collected included demographic data, details of the patient's preassessment, and their outcome.

Results: Data were verified from 96 hospitals on 6818 patients between 1 and 16 years old having elective procedures under general anesthetic. The proportion of children ≤ 16 years old who received preassessment was 60.1% (4082 children). There was a large variation in the delivery of preassessment with the majority being nurse-led. The perioperative journey of most children proceeded as planned (6454 patients, 94.6% of cases). There was a significant difference in the proportion of children with perioperative anxiety between those who did (12.0%, n = 482) and did not (16.5%, n = 438) have a preassessment (p < 0.001). Preassessment did not make a statistically significant difference to overall cancelation rates. The most common reasons for cancelation were intercurrent illness and anxiety. A greater proportion of procedures were delayed or canceled if anxiety was identified as a perioperative challenge: 20.8% (n = 191) compared to 3.6% (n = 210, p < 0.001).

Conclusion: These data suggest that improved outcomes could be achieved through a reduction in anxiety. A service offering screening calls in the days before surgery could prevent on-the-day cancelation due to intercurrent illness. The priorities for preassessment in children require further clarification and standardization nationally to maximize the potential benefits from services.