Pediatric Anesthesia最新文献

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.

Background: Single ventricle congenital heart disease patients palliated to Fontan physiology lack a ventricle to generate pulmonary blood flow. Positive pressure mechanical ventilation reduces pulmonary blood and therefore cardiac output as compared to regular, negative pressure ventilation. There is controversy as to whether lower or higher tidal volumes are optimal for mechanical ventilation.

Aim: This crossover trial aimed to determine whether higher versus lower tidal volumes would be optimal for systemic cardiac output.

Methods: The authors recruited Fontan patients < 18 years old presenting for cardiac catheterization who would require intubation and positive pressure ventilation. Patients were randomized to begin in either a high (10 mL/kg) or low (6 mL/kg) tidal volume strategy. Pressures and blood gases were obtained, the patient was transitioned to the alternate ventilation strategy, and the catheterization procedures were repeated. The authors derived a clinically significant difference of 0.7 L/min/m². Paired comparisons of systemic cardiac index, pulmonary blood flow, and vascular resistances were made between the high and low tidal volume conditions.

Results: Thirty patients underwent the complete study protocol. Three out of nine (33%) patients who had a higher cardiac index in the high tidal volume strategy met the significant difference threshold compared to 8/19 (42%) of those who had a higher cardiac index in the low tidal volume strategy (Cohen's h = 0.186). There was no statistically significant difference in cardiac index between low (3.19 L/min/m², 95% CI 2.76-3.62 L/min/m²) and high (2.96 L/min/m², 95% CI 2.53-3.39 L/min/m²) tidal volume strategies, p = 0.062.

Conclusion: While there was no significant difference in cardiac index between the two ventilation strategies in the direct comparison, we did obtain data showing lower tidal volume may be favorable for maintaining cardiac index for some Fontan patients requiring positive pressure ventilation.

Background: The bispectral index (BIS) represents a promising tool for monitoring the depth of hypnosis. However, its utility in guiding sevoflurane administration during general anesthesia in pediatric patients is not well known.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials comparing BIS-guided versus standard practice sevoflurane administration in pediatric patients. PubMed/MEDLINE, Embase, and the Cochrane Central Register of Clinical Trials were searched for trials published up to May 2025. Analyses were conducted using RevMan 5.4.1., and heterogeneity was assessed using the I² statistic.

Results: We included nine studies randomizing a total of 730 pediatric patients, of whom 359 (49.2%) were managed with BIS monitoring. BIS-guided anesthesia was associated with significantly lower mean end-tidal sevoflurane concentrations, both during the maintenance phase (MD -0.46; 95% CI: -0.62 to -0.29; p < 0.00001) and at the end of surgery (MD -0.31; 95% CI: -0.47 to -0.14; p = 0.0003). Furthermore, the BIS-guided group experienced a shorter time to airway removal (MD -1.69 min; 95% CI: -2.84 to -0.55 min; p = 0.004) and a shorter time to post-anesthesia care unit discharge (MD -11.82 min; 95% CI: -17.80 to -5.84 min; p = 0.0001). No significant difference was observed in Pediatric Anesthesia Emergence Delirium score between groups (MD -0.35; 95% CI: -1.90 to 1.19; p = 0.65).

Conclusions: BIS-guided monitoring offers a strategy to reduce end-tidal sevoflurane concentrations, shortening time to airway removal and post-anesthesia care unit discharge in pediatric patients undergoing sevoflurane anesthesia.

Study registration: PROSPERO, review no. CRD420251067409.

Background: Dental rehabilitation under general anesthesia (GA) is often required for children who are unable to cooperate during standard dental procedures. Accurately estimating the duration of these cases is challenging, particularly when preoperative X-rays are unavailable. Efficient scheduling and optimal operating room (OR) utilization rely on precise time predictions; however, existing predictive models, including EPIC's analytics, frequently overlook patient- and case-specific factors, resulting in suboptimal OR efficiency.

Aims: This study aimed to identify preoperative, patient-specific factors that influence the duration of pediatric dental rehabilitation under GA and to develop an age-based predictive equation to improve procedure time estimation.

Methods: A retrospective review was conducted on 255 dental rehabilitation cases performed under general anesthesia (GA) between January 2022 and December 2023. Collected data included patient demographics, treatment details, availability of radiographs, and operating room (OR) time metrics. Statistical analysis was performed to assess the influence of preoperative factors on procedure duration. An age-based fitted equation was developed, and its predictive accuracy compared with that of EPIC's analytics system.

Results: Age was the strongest patient-specific predictor of procedure duration (p < 0.001, R² = 50.73%), correlating with both dentition type and the extent of dental restoration required. The age-based fitted equation substantially outperformed EPIC's analytics, particularly in the 3-5 and 13-18 age groups, improving prediction accuracy by 42% and 114%, respectively. The fitted equation was Y = 84-4.5X + 0.6X², where Y represents procedure time and X represents age. Other patient-specific variables, including weight, BMI, and ASA classification, demonstrated minimal influence.

Conclusions: Developing an age-specific fitted equation based on site-specific operating room (OR) data improves procedure time prediction for pediatric dental rehabilitation under GA. This model supports more precise scheduling, better resource allocation, and improved patient access to care, providing a valuable framework for efficiency in the OR.

"Cannot Intubate, Cannot Oxygenate" is a rare but life-threatening situation that requires immediate recognition, advanced airway management, and ultimately emergency front-of-neck access. All airway practitioners caring for children should be prepared to face these situations. The aim of this review was to provide a concise summary of the latest evidence and to propose a streamlined protocol for pediatric emergency front-of-neck access in the intensive care setting. The strength of our protocol is that we have set explicit time limits for front-of-neck access attempts and incorporated extracorporeal membrane oxygenation to achieve the best possible survival and neurological outcomes. No evidence-based consensus exists on the best practice, although organization of local protocols and equipment, as well as regular and comprehensive training, is crucial to bolster clinician confidence and improve patient outcomes.