Pediatric Anesthesia最新文献

Background: Respiratory adverse events increase morbidity and mortality rates throughout the perioperative period. It also account for most of the critical incidents in pediatric anesthesia. The incidence of these events in Ethiopian health care is unknown.

Objectives: This study aimed to determine the incidence of perioperative respiratory adverse events and associated factors among pediatric surgical patients from June 2022 to April 2023, at three selected north-west Ethiopian hospitals.

Methods: A hospital-based prospective cohort study was conducted among pediatric surgical patients who had undergone a variety of surgeries. A total of 424 patients were included, including elective and emergency cases.

Results: 138 (32.5%, 95% CI: 28.3-36.9) patients developed perioperative respiratory adverse events. Variables that showed association with respiratory adverse events included ketamine maintenance of anesthesia, history of allergy, having moderate to severe pain level, history of active upper respiratory tract infection, above neck procedures, and endotracheal intubation.

Conclusion: Perioperative respiratory adverse events incidence was high compared with other studies. Clinicians need to give careful attention to patients with a history of allergy, moderate to severe pain, upper respiratory tract infection, ENT surgery, intravenous anesthesia maintenance, and endotracheal intubation to decrease adverse respiratory events.

Background: Effective communication is crucial in perioperative healthcare settings. However, language barriers hinder this communication. In the United States, 8% of individuals over age 5 have a non-English language preference (NELP). Lack of language concordance between patients and healthcare clinicians has been linked to poorer healthcare metrics and outcomes. Despite these challenges, limited research has focused specifically on language barriers in perioperative settings, and few studies have captured experiential data from both caregivers and clinicians.

Aims: This study aimed to explore whether language discordance between clinicians and caregivers is associated with lower perceived quality of care by either caregivers or clinicians. We also explored whether the interpreting modality impacts perceptions of care by either caregivers or clinicians.

Methods: This study employed a mixed-methods approach, composed of 9-item 5-point Likert scale questionnaires and explanatory sequential semi-structured interviews of caregivers and clinicians in a large academic medical center. We analyzed caregiver quantitative data using a Mann-Whitney U test. Interview transcripts from caregivers and clinicians underwent thematic analysis.

Results: The caregiver and clinician participant response rates were 60% and 69%, respectively. Analysis of caregiver surveys revealed no significant differences between NELP and ELP caregiver responses. Clinician survey analysis revealed significant discrepancies between awareness of interpretation services and true availability of these services in perioperative areas. Major themes identified in caregiver interviews included informational quality, trust, perceived understanding, and overall satisfaction. Major themes identified in clinician interviews included communication barriers, system improvement suggestions, and communication facilitators.

Conclusions: This study underscores the importance of preoperative patient/caregiver education to ensure adequate comprehension and understanding in the perioperative setting, particularly within NELP populations. Additionally, the results suggest that in-person interpretation services may improve patient and clinician satisfaction.

Introduction: Healthcare contributes significantly to global plastic waste, with single-use disposable (SUD) materials being a major culprit. Reusable anesthesia machine breathing circuits are used in many parts of the world. Their adoption in the United States (US) remains limited, driven by institutional policies and fear of litigation.

Methods: This perspective piece reflects on our single institution multi-site experience using a variety of anesthesia machine breathing circuits, including SUD and reusable, with both daily and weekly circuit changes for pediatric anesthesia care in the US.

Results: We report survey results on the attitudes and opinions of a pediatric anesthesia team regarding the sustainability and costs of these products, as well as the results of anonymous safety concern reporting during the October 2022 and January 2025 observation period. In our pediatric ambulatory surgery setting, weekly changes of reusable circuits with individual patient filters proved to be a safe alternative to daily changes or SUD circuits. Challenges to reusable circuit use were identified through reporting and survey data and included supply chain constraints and buildup of water vapor if circuits were not properly drained. We estimated plastic waste reduction to be 27.8 kg per week (84% reduction) compared to SUD and 17.5 kg (53% reduction) compared to daily reusable circuit changes.

Discussion: We did not complete a full cost analysis or perform microbiologic studies as this has been previously reported. Monitoring for water vapor buildup within the reusable anesthesia breathing circuit and vigilance in performing a leak test prior to patient use remain key patient safety components. Our experience demonstrates the feasibility of reusable anesthesia circuit use with appropriate protocols.

Background: Caudal epidural block is commonly used in pediatric surgeries but may fail due to anatomical variations or operator experience. Early recognition of block effectiveness is useful for timely pain management, improving outcomes and analgesic strategies.

Aims: This study aimed to assess the ability of infrared thermography to determine caudal block success in children.

Methods: In this prospective observational study, children (2-12 years) undergoing infra-umbilical surgery received a caudal block after the induction of general anesthesia. FLIR C2 thermal camera was used to assess skin temperature at the dorsum of the foot, little toe, and suprapubic area at the baseline and 2, 5, 10, and 15 min after the block. Temperature change (Δ) was calculated as the difference from baseline. The primary outcome was the ability of Δ temperature at 10 min to detect a successful block, assessed via the area under the receiver operating characteristics curve (AUC).

Results: Data from 143 patients were analyzed; 29/143 (20%) patients had failed block. In the successful block group, the temperature increased over time and was significantly higher than that of the failed block group at 10 and 15 min. At 10 min, the AUC (95% confidence interval) for detecting successful block was higher at the dorsum of the foot (0.92 [0.86-0.96]) and little toe (0.87 [0.81-0.92]) compared to the suprapubic area (0.74 [0.66-0.81]). The positive predictive value for Δ temperature at the dorsum of the foot and little toe for detecting successful block was 95%-96% with cut-offs of 1.2°C and 1.4°C, respectively.

Conclusion: In anesthetized children undergoing infra-umbilical surgeries, infrared thermography can accurately confirm successful caudal block. Ten minutes after the block, an increase in the skin temperature by 1.2°C-1.4°C at the dorsum of the foot and little toe can confirm block success with 95%-96% accuracy.

Background: Pulmonary hydatid disease (PH) remains a significant health challenge in children from endemic regions. The anesthetic and surgical management of PH is complex, particularly in the presence of ruptured cysts, which pose risks such as airway obstruction and anaphylaxis.

Methods: A 10-year retrospective cohort study was conducted on children ≤ 18 years undergoing surgery for PH at our tertiary care center between January 2012 and December 2022. Data were collected from medical records, operative notes, and imaging reports.

Results: There were 37 cases with diagnosis of pulmonary hydatid disease in last decade, we have included 28 children with complete records. Three had bilateral disease, totaling 31 procedures. Ruptured cysts were noted in 12 cases. Common symptoms included cough, fever, and hemoptysis. One lung ventilation (OLV) was achieved in 96% of cases with DLT (45%), Arndt blocker (33%) and Fogarty blocker (13%) commonly used. Complications included desaturation (75%), transient bradycardia (29%), and three major perioperative events, all in children with ruptured cysts. The mean OLV duration was longer in complicated cases (3.42 vs. 2.3 h, p = 0.019). Postoperative air leaks occurred in 10 children, with three requiring re-surgery. All patients were extubated on-table, with mean length of stay of 7 days and no long-term morbidity or mortality.

Conclusion: OLV is critical in minimizing spillage and facilitating surgical management in pediatric PH. The incidence of intraoperative complications was higher in those with bilateral Pulmonary hydatid disease. The duration of One Lung Ventilation (OLV) and hospital stay was prolonged in those with complicated pulmonary hydatid cyst.

Background: Integrating evidence-based findings into perioperative medicine is key to allowing improvements in care. The perioperative environment involves multiple stakeholders and processes that require coordination to deliver high-quality care. Various barriers can challenge the implementation of changes in this setting, but key facilitators may enable them. This research explored barriers and facilitators to implementing new practices and innovations in the pediatric perioperative ecosystem, as experienced by pediatric anesthetists returning to work in a sub-Saharan African country.

Methods: This was a mixed methods study following an explanatory sequential design. A survey was sent to 28 fellowship-trained pediatric anesthetists identified through fellowship leads of established programs, who had returned to work in sub-Saharan Africa post-fellowship. Respondents were invited to participate in interviews. Reflexive thematic analysis was used to represent the experiences described by the participants, and to categorize barriers and facilitators.

Results: Seventeen anesthetists from 10 countries responded to the survey (response rate 17/28, 61%). All respondents indicated that they had encountered barriers to change implementation (17/17, 100%), and 12/15 (80%) indicated that facilitators that enabled change existed. Resource constraints were the main barrier, followed by resistant behaviors by individuals and at the organizational level. Ten anesthetists were subsequently interviewed. Respondents attempted to bring about change in a variety of areas, including operational logistics, patient safety, clinical practice, and organizational culture. Key barriers were encountered at individual, environmental and organizational levels. Key enablers included personal traits such as persistence and adaptability, ongoing mentorship, supportive leadership, and the strategic contextualization of skills.

Conclusion: Fellows experience significant challenges when attempting to implement changes based on the knowledge and skills acquired during advanced training. Facilitators enabling successful change implementation exist. Including training in leadership and change management in fellowship programs may better prepare those from sub-Saharan Africa to introduce their envisioned improvements to the perioperative environment upon their return.