Pediatric Anesthesia最新文献

Background: Sickle cell disease (SCD) is an inherited hemoglobinopathy affecting approximately 100 000 Americans, disproportionately affecting Black individuals. Sickling of hemoglobin S red blood cells due to conditions in the perioperative period including hypoxemia, hypothermia, surgical stress, and pain can reduce organ perfusion and lead to adverse outcomes including pain crisis, acute chest syndrome, and stroke.

Aims: This study evaluates perioperative outcomes and risk factors for sickle cell crisis in children with SCD undergoing common inpatient surgical procedures.

Methods: A retrospective cohort was created using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) 2003-2019. Hospital admissions for children < 18 years of age undergoing a selected group of surgical procedures (cholecystectomy, appendectomy, congenital cardiac surgery, and posterior spinal fusions) commonly requiring inpatient stay were included. Diagnoses and procedures were identified using ICD-9/ICD-10 codes. Perioperative outcomes included post-operative length of stay (LOS), blood transfusions, hematologic, and infectious complications. Children with SCD were compared to those without SCD using multivariable Poisson regression to adjust for surgical procedure and sociodemographic, clinical, and hospital characteristics.

Results: Of 5 75 005 children studied, 2357 (0.4%) had SCD. Relative to children without SCD, those with SCD had a longer post-operative LOS (adjusted incidence rate ratio [aIRR]: 1.29; 95% CI [1.26-1.32], p < 0.001). Children with SCD hospitalized for a surgical procedure were also more likely to receive a blood transfusion (adjusted risk ratio [aRR]: 13.1; 95% CI [12.1-14.2], p < 0.001). Significantly increased associated risks of hematologic and infectious complications, however, were not observed. Of children with SCD, 17.5% experienced a sickle cell crisis during hospitalization. The odds of sickle cell crisis in non-elective admissions were more than three times as high as in elective admissions (aOR 3.36; 95% CI [2.46-4.60], p < 0.001). Children with sickle cell crisis had a longer post-operative hospital stay (aIRR: 1.58; 95% CI [1.49-1.67]) than those without a crisis.

Conclusions: The perioperative course in children with SCD was associated with longer postoperative length of stay and higher blood transfusion rates relative to those without SCD undergoing similar surgical procedures. Perioperative sickle cell crisis was present in more than one out of six admissions, more common in non-elective admissions, and is associated with excess length of stay.

The purpose of this concise review is to provide a practical approach to inpatient management of pediatric patients with central diabetes insipidus due to arginine vasopressin deficiency (AVP-D), as well as provide recommendations specific to the perianesthetic period. AVP-D poses significant challenges in perianesthetic management. A multidisciplinary approach to the perianesthetic management of AVP-D can optimize patient outcomes and reduce the risk of complications. Implementing structured protocols that address fluid management, medication dosing, and postoperative care is essential for enhancing safety and optimizing perianesthetic outcomes in this patient population.

Background: The NEonate and Children audiT of Anesthesia pRactice IN Europe (NECTARINE) study, led by the ESAIC Clinical Trials Network, collected prospective data on 5609 children up to 60 weeks postmenstrual age undergoing 6542 anesthetic procedures across 165 centers in 31 European countries (ESAIC_CTN_NECTARINE). While the study provides comprehensive European data, healthcare systems, perioperative practices, and organizational standards vary considerably between countries. Germany was selected a priori for a dedicated subcohort analysis due to its substantial contribution (10.3% of the total dataset) and notable differences to other European countries in the absence of a centralization and national training program in pediatric anesthesia. This focused evaluation aimed to benchmark national data against European findings, identify country-specific strengths and weaknesses, and support targeted quality improvement and guideline development within the German healthcare system.

Aims: To compare the incidence, nature, and consequences of perioperative critical events between the German and non-German NECTARINE cohorts and to assess practice-related risk factors and outcomes.

Methods: Data from 14 German centers were analyzed using mixed-effects logistic regression to examine associations between critical events and 30-day morbidity and mortality. Perioperative management practices and risk profiles were compared with those from the rest of the European cohort.

Results: The German cohort showed a significantly higher rate of critical events (47.0% vs. 33.9%, p < 0.001), with cardiovascular instability being most frequent (82.6%). Within German centers, the occurrence of a critical event nearly tripled the risk of postoperative complications within 30 days (OR: 2.85; 95% CI: 1.67-4.87). ASA status and number of surgeries were also significant predictors of morbidity.

Conclusions: This prospectively defined subanalysis demonstrates that perioperative outcomes and practice patterns in Germany differ from European averages, particularly regarding the frequency of critical events, thresholds for intervention, staffing ratios, and complication profiles. These insights highlight the need for targeted interventions in German pediatric anesthesia, contribute to contextualizing European data, and offer baseline data for future cross-border quality initiatives and trials.

Trial registration: ClinicalTrails.gov NCT02350348.

Background: Suicide is a leading cause of death among US youth. Universal suicide risk screening can identify youth with unmet mental health needs, enabling interventions and linkage to services, yet screening is not widely implemented in perioperative and procedural settings.

Aims: We retrospectively assessed implementation of universal suicide risk screening for youth in perioperative and procedural areas of a pediatric health system by examining screening completion rates, positivity rates, and demographic and clinical factors associated with screening.

Methods: We conducted a retrospective cross-sectional study of universal suicide risk screening among youth 10-21 years of age in perioperative and procedural areas of an academic children's hospital and two affiliated ambulatory surgical centers, using electronic health record data from August 2022 to February 2025. We described rates of screening completion using Ask Suicide-Screening Questions (ASQ) and screening positivity rates. We used multivariable logistic regression to examine factors associated with (1) screening completion and (2) positive screens.

Results: Among 15 204 perioperative and procedural encounters (median age 14 [interquartile range 12, 16], 45% female), 13 566 (89.2%) had at least one ASQ item completed. Of these encounters, 494 (3.6%) had positive screens and 7 (0.1%) had screens indicating imminent risk. Adjusted odds of screening completion were lower among youth aged 10-12 than 13-15 years (adjusted odds ratio [aOR] 0.69, 95% CI 0.61-0.78) and those who preferred a language other than English or Spanish versus those who preferred English (aOR 0.55, 95% CI 0.41-0.75). Adjusted odds of positive screens were higher among females than males (aOR 2.49, 95% CI 2.06-3.03) and lower in ambulatory surgical centers than the children's hospital (aOR 0.26, 95% CI 0.14-0.42).

Conclusions: Universal suicide risk screening can be implemented in perioperative and procedural areas, with positive screens in about 1 in 28 encounters. These settings represent an underutilized opportunity to identify at-risk youth.

Background: Injection pressure control is one of the several monitoring options when performing a peripheral nerve block (PNB). To date, no data is available in children regarding injection pressure during a PNB. The aim of this blinded prospective observational study was to measure the maximal pressure for each injection during PNBs in a pediatric population.

Methods: Children scheduled for PNB were eligible for inclusion. During the performance of the block, injection pressures were measured using the CompuFlo device. Factors likely to influence these pressures and the rate of injections exceeding the threshold of 750 mmHg were also recorded.

Results: In total, 175 pressure injection measurements, recorded in 47 patients, were analyzed. The mean maximum injection pressure was 515 [95% CI: 478-551] mmHg. The pressure exceeded the threshold of 750 mmHg in 16% of injections. Factors influencing injection pressure were operator experience, needle diameter, PNBs in restricted diffusion space or lack of injection precision, and incorrect ultrasound injection positions.

Conclusion: Pressure does not appear to be the main factor prompting the operator to continue or stop the injection. Other parameters likely to influence injection pressures still seem to be useful and integrated when learning to perform PNBs.

Background: Pulmonary complications occur at a notably high frequency following pediatric cardiac surgery, among which atelectasis is highly prevalent. Current research is inadequate regarding the development and risk factors for atelectasis in children.

Aims: To investigate the incidence of atelectasis on the first day after right subaxillary small-incision congenital heart disease surgery and to identify risk factors for atelectasis.

Methods: This study retrospectively collected data on children who underwent elective surgery (procedures: atrial septal defect repair, ventricular septal defect repair, or combined procedures in the left lateral decubitus position) at our hospital. Lung ultrasound findings on postoperative day one were collected to evaluate the incidence of atelectasis. Univariate screening followed by multivariable linear regression modeling was performed to identify risk factors for atelectasis.

Results: A total of 254 children were included in the data collection, with a median [IQR] age of 37.0 [23.0-58.0] months. The optimal model identified the following independent risk factors for atelectasis: younger age (β = -0.03, 95% CI: -0.04 to -0.02, p < 0.001), higher BMI (β = 0.55, 95% CI: 0.41-0.69, p < 0.001), prolonged anesthesia duration (β = 0.01, 95% CI: 0.004-0.02, p = 0.001), sufentanil dose > 2.0 μg·kg^-1·h^-1 (β = 1.45, 95% CI: 1.01-1.89, p < 0.001), and higher doses of cisatracurium (β = 1.17, 95% CI: 0.65-1.69, p < 0.001), and atelectasis showed an aggravating trend (β = 0.16, 95% CI: 0.09-0.23, p < 0.001). The model demonstrated satisfactory goodness-of-fit (R² = 0.699, adjusted R² = 0.691, F-statistic = 89.068).

Conclusion: The identified independent risk factors for atelectasis include younger age, higher BMI, prolonged anesthesia duration, sufentanil dose exceeding 2.0 μg·kg^-1·h^-1 and higher doses of cisatracurium, with the severity of atelectasis progressively worsening over time.

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.