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Measurement Properties of the Pediatric Anesthesia Emergence Delirium Scale: A Confirmatory Factor Analysis-Based Study.
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-29 DOI: 10.1111/pan.15046
Jenny Ringblom, Ingrid Wåhlin, Marie Proczkowska, Laura Korhonen, Kristofer Årestedt

Background: Emergence delirium is a well-known and common problem in children recovering from anesthesia. The five-item Pediatric Anesthesia Emergence Delirium scale is one of the most commonly used instruments for assessing this condition, but the scale has been questioned regarding its latent structure, i.e., whether its items cover just one underlying construct. It has been suggested that the scale's first three items might identify emergence delirium better than the last two.

Aim: The aim of this study was to evaluate the measurement properties of the Pediatric Anesthesia Emergence Delirium scale with a focus on its latent structure and cutoff scores, using appropriate statistical methods for ordinal data.

Methods: A total of 350 children under 7 years of age, undergoing adenoidectomy, with or without additional tonsillotomy or minor procedures like paracentesis, tongue-tie release, or cerumen removal, were enrolled in the study. At the recovery unit, emergence delirium and pain were registered.

Results: The confirmatory factor analyses demonstrated that the two-factor model, including emergence delirium-specific behaviors (first three items) and emergence delirium-nonspecific behaviors (last two items), established an excellent model fit according to the χ2 goodness-of-fit statistics, Root Mean Square Error of Approximation, Comparative Fit Index, Tucker-Lewis Index, and Standardized Root Mean Square Residual. The ordinal alpha of 0.98 and the ordinal omega of 0.96 supported the internal consistency reliability of the emergence delirium-specific behaviors. The convergent validity was supported due to a strong correlation between emergence delirium-nonspecific behaviors and the Face, Legs, Activity, Cry, and Consolability scale. The receiver-operating characteristic curve analyses resulted in two tentative cutoff scores for emergence delirium-specific behaviors¸ ≥ 6 and ≥ 8.

Conclusion: The Pediatric Anesthesia Emergence Delirium scale's first three items are a more valid and reliable measure of emergence delirium than its original five items.

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引用次数: 0
Best abstracts from the APAGBI Annual Scientific Meeting 2024. APAGBI 2024 年度科学会议最佳摘要。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-25 DOI: 10.1111/pan.15039
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引用次数: 0
Error Traps in Developing a Pediatric Enhanced Recovery After Surgery (ERAS) Program. 制定儿科术后康复强化计划(ERAS)的错误陷阱。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-23 DOI: 10.1111/pan.15042
Christian M Taylor, Emily L Weisberg, Nichole M Doyle, Todd A Glenski

Enhanced recovery after surgery (ERAS) pathways have been shown to improve patient outcomes, increase patient satisfaction, and decrease costs. First created and implemented in the adult population, these pathways are now commonplace and continue to expand in the pediatric realm. While there are many proven benefits to ERAS pathways, there continue to be challenges to their proper implementation and long-term success. This article aims to explore common challenges in pediatric ERAS development and implementation, along with strategies to avoid potential pitfalls. Key themes include departmental and institutional support, stakeholder engagement, awareness of pathways, data management and dissemination, and long-term maintenance including Plan-Do-Study-Act (PDSA) cycles. Pathway development teams should be aware of these considerations and potential pitfalls, and focusing on them can promote long-term success for a well-designed pathway.

事实证明,加强术后恢复(ERAS)途径可以改善患者的治疗效果、提高患者满意度并降低成本。这些路径最初是在成人群体中创建和实施的,现在已经很普遍,并将继续在儿科领域推广。虽然 ERAS 途径有许多已被证实的好处,但其正确实施和长期成功仍面临挑战。本文旨在探讨儿科 ERAS 发展和实施过程中的常见挑战,以及避免潜在陷阱的策略。关键主题包括部门和机构的支持、利益相关者的参与、对路径的认识、数据管理和传播,以及包括计划-实施-研究-行动(PDSA)周期在内的长期维护。路径开发团队应该意识到这些注意事项和潜在的陷阱,关注这些事项可以促进精心设计的路径取得长期成功。
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引用次数: 0
Cautious Consideration of Intraoperative Methadone Use in Pediatric Surgery: A Commentary. 谨慎考虑在小儿外科手术中使用美沙酮:评论。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-20 DOI: 10.1111/pan.15043
Yu-Yuan Hung, Lien-Chung Wei
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引用次数: 0
Design considerations for development of cuffed endotracheal tube for small airways. 开发用于小气道的袖带式气管导管的设计考虑因素。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-19 DOI: 10.1111/pan.15033
Seamus Maguire, Daniel Wade, James Curley, Sean Morris

Endotracheal tubes (ETTs) are life-supporting devices that are designed to maintain a patent airway in patients who are unable to sustain an airway due to illness or injury. Patients with small airways, such as neonates and pediatrics, have unique structural and functional features, making it essential that ETT design considers and executes on these particular needs. Though uncuffed ETTs have historically been preferred for patients younger than eight years of age, advances in cuffed ETT design and construction can be utilized to manufacture ETTs that are optimized for the smallest, most fragile airways. The purpose of this article is to discuss certain design features of cuffed ETTs in respect to small airways.

气管内导管(ETT)是一种生命支持设备,旨在为因疾病或受伤而无法维持气道通畅的患者维持通畅的气道。新生儿和儿科等气道狭小的患者具有独特的结构和功能特征,因此 ETT 的设计必须考虑并满足这些特殊需求。尽管无袖带 ETT 一直以来都是 8 岁以下患者的首选,但可以利用袖带 ETT 设计和结构方面的进步,制造出最适合最小、最脆弱气道的 ETT。本文旨在讨论针对小气道的带袖带式 ETT 的某些设计特点。
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引用次数: 0
Is NRfit "Fit" for Caudal. NRfit 是否 "适合 "Caudal。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-15 DOI: 10.1111/pan.15041
Jennifer Coe, Su Ying Ong, Alastair Baxter
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引用次数: 0
Editor's picks for the pediatric anesthesia article of the day: August 2024. 编辑精选的每日儿科麻醉文章:2024年8月
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-12 DOI: 10.1111/pan.15032
Melissa Brooks Peterson, Myron Yaster, Justin L Lockman
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引用次数: 0
Protocol development and feasibility of the PEACH in Asia study: A pilot study on PEri-anesthetic morbidity in CHildren in Asia. 亚洲 PEACH 研究的方案制定和可行性:亚洲儿童PEACH麻醉发病率试点研究。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-09 DOI: 10.1111/pan.15034
Soichiro Obara, Choon Looi Bong, Zehra Serpil Ustalar Ozgen, Shemila Abbasi, Ekta Rai, Evangeline K Villa, Andi Ade W Ramlan, Raihanita Zahra, Christopher Kapuangan, Komang Ayu Ferdiana, Ina Ismiarti Shariffuddin, Vivian Yuen, Elsa Varghese, Josephine S K Tan, Norifumi Kuratani

Background: Comprehensive data on pediatric anesthesia outcomes, particularly severe critical events (SCEs), are scarce in Asia. This highlights the need for standardized research to assess anesthesia safety and quality in the diverse settings.

Aims: The PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study.

Methods: This multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study.

Results: The pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2-16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource-limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e-CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing).

Conclusions: The PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e-CRF technical difficulties, and ensuring consistent institutional support.

背景:在亚洲,有关儿科麻醉结果,尤其是严重危急事件(SCE)的综合数据非常缺乏。目的:亚洲 PEACH 试验研究旨在测试在亚洲各地麻醉实践中调查 SCEs 的标准化方案的可行性,评估数据采集流程,并确定主要研究的样本量:这项多中心试点研究涉及九个亚洲国家的十家机构,包括接受诊断或外科手术的出生至 15 岁的儿童。采用标准化定义收集 SCE 数据。该研究评估了主要研究的可行性并估算了所需样本量:试点研究共招募了 330 名患者,SCE 发生率为 12.4%(95% CI:9.2-16.4%)。7.0%的病例观察到呼吸系统事件,4.9%的病例观察到心血管不稳定,0.6%的病例观察到用药错误。根据试点研究中观察到的 SCE 发生率,主要研究估计至少需要 10 958 名患者的样本量。试点研究证明了研究方案的可行性,但也发现了一些挑战,尤其是在资源有限的环境中。这些挑战包括数据收集带来的巨大负担、电子病例报告表(e-CRFs)的技术问题、各机构患者入组情况的差异(每个机构入组 4 到 86 名患者不等)以及数据采集不完整(24.8% 的身高数据和 9.7% 的处置数据缺失):亚洲 PEACH 试验研究成功验证了亚洲儿科麻醉中 SCE 的调查方案。应对试点研究中发现的挑战对于生成可靠数据以改善该地区儿科麻醉安全至关重要。需要解决的关键问题包括:改进数据收集方法、解决 e-CRF 技术难题以及确保机构的持续支持。
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引用次数: 0
Factors associated with the use of regional anesthesia for calcaneal osteotomy in pediatric patients: A single-center, retrospective cohort study. 儿科患者小腿截骨术中使用区域麻醉的相关因素:单中心回顾性队列研究。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-09 DOI: 10.1111/pan.15030
Benjamin Y Andrew, Kayla E Pfaff, Sarah Jooste, Lisa M Einhorn

Background: Despite known disparities in pediatric perioperative outcomes, few studies have examined factors associated with the use of regional anesthesia for pediatric orthopedic surgery.

Aims: This investigation aimed to determine if minority and developmental disability status were associated with the allocation of peripheral nerve blocks in calcaneal osteotomy.

Methods: We conducted a single-center, retrospective study of records of patients <18 years who underwent calcaneal osteotomy from 2013 to 2022. Regional technique was classified into three groups: popliteal-sciatic single-shot block, popliteal-sciatic catheter, and no block. Patients were classified as either nonminority (white, non-Hispanic) or minority. Developmental disability status was defined based on medical history and classified as binary. Anesthesiologists were classified as "regional" or "nonregional" based on clinical expertise. A Bayesian hierarchical multinomial model with random intercepts for patients and surgeons was used to investigate the association of minority status, developmental disability, and anesthesiologist expertise with block selection.

Results: We analyzed 287 cases in 225 patients; of these, 55% occurred in minority patients and 28% occurred in patients with developmental disability. Catheters were placed in 45% of cases, single shot blocks in 41%, and no block in 14%. Minority and nonminority patients had a similar likelihood of receiving of any block. Patients with developmental disability had a -22% absolute difference of receiving any block (95% credible interval [-38%, -7%]) compared to those without developmental disability (55% vs. 77%), an effect primarily driven by a lower rate of catheter placement in these children. Regional anesthesiologists were more likely to place catheters (23% absolute increase; 36% vs. 13%) and more likely to perform any block in children with developmental disability (30% absolute increase; 67% vs. 37%) than nonregional anesthesiologists.

Conclusions: Decision-making surrounding the placement of regional anesthesia techniques is complex. In this study, developmental disability status and anesthesiologist experience were associated with a difference in the use of regional anesthesia in patients undergoing calcaneal osteotomy.

背景:目的:本调查旨在确定少数民族和发育障碍状况是否与小腿截骨术中外周神经阻滞的分配有关:结果:我们分析了 22 个病例中的 287 个病例:我们对 225 名患者的 287 个病例进行了分析;其中 55% 的病例发生在少数族裔患者身上,28% 的病例发生在发育障碍患者身上。45%的病例放置了导管,41%的病例进行了单次阻断,14%的病例未进行阻断。少数族裔和非少数族裔患者接受任何阻滞的可能性相似。与无发育障碍的患者(55% 对 77%)相比,有发育障碍的患者接受任何阻滞的绝对差异为-22%(95% 可信区间 [-38%, -7%]),这种影响主要是由于这些儿童的导管置入率较低。与非区域麻醉医生相比,区域麻醉医生更有可能为发育障碍儿童放置导管(绝对增加 23%;36% 对 13%),更有可能为他们进行任何阻滞(绝对增加 30%;67% 对 37%):结论:围绕区域麻醉技术的决策非常复杂。在这项研究中,发育障碍状况和麻醉师经验与小腿截骨术患者使用区域麻醉的差异有关。
{"title":"Factors associated with the use of regional anesthesia for calcaneal osteotomy in pediatric patients: A single-center, retrospective cohort study.","authors":"Benjamin Y Andrew, Kayla E Pfaff, Sarah Jooste, Lisa M Einhorn","doi":"10.1111/pan.15030","DOIUrl":"https://doi.org/10.1111/pan.15030","url":null,"abstract":"<p><strong>Background: </strong>Despite known disparities in pediatric perioperative outcomes, few studies have examined factors associated with the use of regional anesthesia for pediatric orthopedic surgery.</p><p><strong>Aims: </strong>This investigation aimed to determine if minority and developmental disability status were associated with the allocation of peripheral nerve blocks in calcaneal osteotomy.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective study of records of patients <18 years who underwent calcaneal osteotomy from 2013 to 2022. Regional technique was classified into three groups: popliteal-sciatic single-shot block, popliteal-sciatic catheter, and no block. Patients were classified as either nonminority (white, non-Hispanic) or minority. Developmental disability status was defined based on medical history and classified as binary. Anesthesiologists were classified as \"regional\" or \"nonregional\" based on clinical expertise. A Bayesian hierarchical multinomial model with random intercepts for patients and surgeons was used to investigate the association of minority status, developmental disability, and anesthesiologist expertise with block selection.</p><p><strong>Results: </strong>We analyzed 287 cases in 225 patients; of these, 55% occurred in minority patients and 28% occurred in patients with developmental disability. Catheters were placed in 45% of cases, single shot blocks in 41%, and no block in 14%. Minority and nonminority patients had a similar likelihood of receiving of any block. Patients with developmental disability had a -22% absolute difference of receiving any block (95% credible interval [-38%, -7%]) compared to those without developmental disability (55% vs. 77%), an effect primarily driven by a lower rate of catheter placement in these children. Regional anesthesiologists were more likely to place catheters (23% absolute increase; 36% vs. 13%) and more likely to perform any block in children with developmental disability (30% absolute increase; 67% vs. 37%) than nonregional anesthesiologists.</p><p><strong>Conclusions: </strong>Decision-making surrounding the placement of regional anesthesia techniques is complex. In this study, developmental disability status and anesthesiologist experience were associated with a difference in the use of regional anesthesia in patients undergoing calcaneal osteotomy.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of infusion line connection and infusion line characteristics on start-up fluid delivery from syringe infusion pumps used for microinfusion. 输液管连接和输液管特性对用于微量输液的注射输液泵启动输液的影响。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-07 DOI: 10.1111/pan.15031
Markus Weiss, Pedro David Wendel-Garcia, Vincenzo Cannizzaro, Maren Kleine-Brueggeney

Background: Connecting an infusion line to a closed stopcock results in pressurization of fluid within the syringe infusion pump assembly leading to flow irregularities when opening the stopcock and activating the pump.

Aims: It was the purpose of this study to assess the extent of pressurization under different conditions and its impact on start-up fluid delivery.

Methods: Intraluminal pressures and start-up fluid delivery at 1 mL/h flow rate were assessed with connection of the infusion line 1 min (delayed connection) or immediately after purging (immediate connection) using two different infusion lines made from polyvinylchloride (PVC) or polyethylene (PE).

Results: Delayed connection resulted in an increase of intraluminal pressures from zero to 5.1 [4.5 to 5.7] mmHg with the PVC line and from zero to 47.1 [44.8 to 49.3] mmHg with the PE line (mean difference 42.0 [95% CI 39.3-44.7] mmHg; p < .0001). Immediate connection resulted in an increase of intraluminal pressures from zero to 44.3 [41.8-46.8] mmHg with the PVC line and from zero to 61.3 [57.2-65.4] mmHg with the PE line (mean difference 17.0 [95% CI 11.8-22.2] mmHg; p < .0001). The increase in intraluminal pressures was significantly higher with PE lines for both delayed and immediate connection when compared to the PVC lines (mean difference 29.5 [95% CI 19.3-39.7] mmHg; p < .0001). Related fluid volumes delivered at 10 s and 360 s after starting the pump ranged from -252% to 1321% (10 s) of expected infusion volumes and from 59% to 129% (360 s), respectively.

Conclusions: Both, timing of infusion line connection after purging and infusion line characteristics considerably affect intraluminal pressures and start-up fluid delivery when connecting a new syringe infusion pump assembly to a closed stopcock. Consecutive alterations in drug administration can have considerable hemodynamic consequences when dealing with catecholamine infusions in critically ill patients.

背景:目的:本研究旨在评估不同条件下的加压程度及其对启动输液的影响:方法:使用聚氯乙烯(PVC)或聚乙烯(PE)制成的两种不同输液管,在连接输液管 1 分钟(延迟连接)或吹扫后立即连接(立即连接)的情况下,以 1 mL/h 的流速对腔内压力和启动输液进行评估:延迟连接导致 PVC 输液管的管腔内压力从零升高至 5.1 [4.5 至 5.7] mmHg,PE 输液管的管腔内压力从零升高至 47.1 [44.8 至 49.3] mmHg(平均差 42.0 [95% CI 39.3-44.7] mmHg;p 结论:两种输液管的连接时间不同:在将新的注射器输液泵组件连接到封闭的止塞时,吹扫后连接输液管路的时间和输液管路的特性都会对管腔内压力和启动输液造成很大影响。在危重病人输注儿茶酚胺时,连续改变给药方式会对血液动力学产生重大影响。
{"title":"Effect of infusion line connection and infusion line characteristics on start-up fluid delivery from syringe infusion pumps used for microinfusion.","authors":"Markus Weiss, Pedro David Wendel-Garcia, Vincenzo Cannizzaro, Maren Kleine-Brueggeney","doi":"10.1111/pan.15031","DOIUrl":"https://doi.org/10.1111/pan.15031","url":null,"abstract":"<p><strong>Background: </strong>Connecting an infusion line to a closed stopcock results in pressurization of fluid within the syringe infusion pump assembly leading to flow irregularities when opening the stopcock and activating the pump.</p><p><strong>Aims: </strong>It was the purpose of this study to assess the extent of pressurization under different conditions and its impact on start-up fluid delivery.</p><p><strong>Methods: </strong>Intraluminal pressures and start-up fluid delivery at 1 mL/h flow rate were assessed with connection of the infusion line 1 min (delayed connection) or immediately after purging (immediate connection) using two different infusion lines made from polyvinylchloride (PVC) or polyethylene (PE).</p><p><strong>Results: </strong>Delayed connection resulted in an increase of intraluminal pressures from zero to 5.1 [4.5 to 5.7] mmHg with the PVC line and from zero to 47.1 [44.8 to 49.3] mmHg with the PE line (mean difference 42.0 [95% CI 39.3-44.7] mmHg; p < .0001). Immediate connection resulted in an increase of intraluminal pressures from zero to 44.3 [41.8-46.8] mmHg with the PVC line and from zero to 61.3 [57.2-65.4] mmHg with the PE line (mean difference 17.0 [95% CI 11.8-22.2] mmHg; p < .0001). The increase in intraluminal pressures was significantly higher with PE lines for both delayed and immediate connection when compared to the PVC lines (mean difference 29.5 [95% CI 19.3-39.7] mmHg; p < .0001). Related fluid volumes delivered at 10 s and 360 s after starting the pump ranged from -252% to 1321% (10 s) of expected infusion volumes and from 59% to 129% (360 s), respectively.</p><p><strong>Conclusions: </strong>Both, timing of infusion line connection after purging and infusion line characteristics considerably affect intraluminal pressures and start-up fluid delivery when connecting a new syringe infusion pump assembly to a closed stopcock. Consecutive alterations in drug administration can have considerable hemodynamic consequences when dealing with catecholamine infusions in critically ill patients.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Pediatric Anesthesia
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