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Effect of high-flow nasal and buccal oxygenation on safe apnea time in children with open mouth: A randomized controlled trial. 高流量鼻腔和口腔充氧对张口呼吸儿童安全呼吸暂停时间的影响:随机对照试验。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-28 DOI: 10.1111/pan.14982
Sang-Hwan Ji, Jung-Bin Park, Pyoyoon Kang, Young-Eun Jang, Eun-Hee Kim, Ji-Hyun Lee, Hee-Soo Kim, Jin-Tae Kim

Background: High-flow nasal oxygenation is reported to prolong duration of apnea while maintaining adequate oxygen saturation with the mouth closed. Also, buccal oxygenation is known to have similar effects in obese adults. We compared the effect of these two methods on prolongation of acceptable apnea time in pediatric patients with their mouth open.

Methods: Thirty-eight patients, aged 0-10 years were randomly allocated to either the high-flow nasal oxygenation group (n = 17) or the buccal oxygenation group (n = 21). After induction of anesthesia including neuromuscular blockade, manual ventilation was initiated until the expiratory oxygen concentration reached 90%. Subsequently, ventilation was paused, and the patient's head was extended, and mouth was opened. The HFNO group received 2 L·min-1·kg-1 of oxygen, and the BO group received 0.5 L·min-1·kg-1 of oxygen. We set a target apnea time according to previous literature. When the apnea time reached the target, we defined the case as "success" in prolongation of safe apnea time and resumed ventilation. When the pulse oximetry decreased to 92% before the target apnea time, it was recorded as "failure" and rescue ventilation was given.

Results: The success rate of safe apnea prolongation was 100% in the high-flow nasal oxygenation group compared to 76% in the buccal oxygenation group (p = .04). Oxygen reserve index, end-tidal or transcutaneous carbon dioxide partial pressure, and pulse oximetry did not differ between groups.

Conclusion: High-flow nasal oxygenation is effective in maintaining appropriate arterial oxygen saturation during apnea even in children with their mouth open and is superior to buccal oxygenation. Buccal oxygenation may be a good alternative when high-flow nasal oxygenation is not available.

背景:据报道,高流量鼻腔吸氧可延长呼吸暂停的持续时间,同时在闭口状态下保持足够的氧饱和度。此外,颊吸氧对肥胖成人也有类似效果。我们比较了这两种方法对延长儿童患者张口时可接受的呼吸暂停时间的影响:38 名 0-10 岁的患者被随机分配到高流量鼻腔吸氧组(17 人)或口腔吸氧组(21 人)。在进行包括神经肌肉阻滞在内的麻醉诱导后,开始手动通气,直到呼气氧浓度达到 90%。随后,暂停通气,患者头部伸展,张开嘴巴。HFNO 组接受 2 L-min-1-kg-1 氧气,BO 组接受 0.5 L-min-1-kg-1 氧气。我们根据以往的文献设定了目标呼吸暂停时间。当呼吸暂停时间达到目标时,我们将该病例定义为延长安全呼吸暂停时间 "成功",并恢复通气。当脉搏血氧饱和度在目标呼吸暂停时间前下降到 92% 时,我们将其记录为 "失败",并进行抢救性通气:结果:高流量鼻腔吸氧组安全延长呼吸暂停时间的成功率为 100%,而口腔吸氧组为 76%(P = .04)。氧储备指数、潮气末或经皮二氧化碳分压以及脉搏氧饱和度在各组之间没有差异:结论:高流量鼻腔吸氧能有效维持呼吸暂停期间适当的动脉血氧饱和度,即使儿童张开嘴巴也是如此,而且效果优于口腔吸氧。当无法使用高流量鼻腔吸氧时,口腔吸氧可能是一个很好的替代方法。
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引用次数: 0
Overcoming anesthetic challenges in a child with Michel's aplasia undergoing auditory brainstem implantation. 克服听觉脑干植入术中米歇尔氏发育不全患儿的麻醉难题。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-07 DOI: 10.1111/pan.14962
Ashwini Reddy, Nidhi Panda, Babita Ghai, Naresh K Panda, Mohan Kameswaran, Madubhushi Chakravarthy Vasudevan
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引用次数: 0
Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) for nephrectomy in children. 在儿童肾切除术中采用经软骨周入路的改良胸腹神经阻断术(M-TAPA)。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-06-26 DOI: 10.1111/pan.14959
Hande Gurbuz, Mursel Ekinci, Ahmet Kaciroglu
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引用次数: 0
Packaging-induced distortion of tracheal tubes: Implications on airway management. 包装引起的气管导管变形:对气道管理的影响。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-01 DOI: 10.1111/pan.14954
Armanullah Khan, Vishnu Narayanan, Renu Sinha
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引用次数: 0
Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real-world data. 采用阿片类药物稀释麻醉方案优化小儿扁桃体切除术的疗效:从真实世界的数据中学习并不断改进。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-30 DOI: 10.1111/pan.14979
Jennifer L Chiem, Amber M Franz, Elizabeth E Hansen, Shilpa T Verma, Taylor F Stanzione, Leah K Bezzo, Michael J Richards, Sanjay R Parikh, John P Dahl, Daniel K Low, Lynn D Martin

Introduction: This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan-Do-Study-Act cycles.

Methods: From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure-specific perioperative Plan-Do-Study-Act cycles, three procedure-specific postoperative prescription Plan-Do-Study-Act cycles, and four general ambulatory surgical center enhanced recovery Plan-Do-Study-Act cycles. We analyzed data from the medical record using statistical process control charts. The primary outcome measure was the percent of patients requiring intravenous opioid in the post anesthesia care unit. Secondary outcomes included maximum post anesthesia care unit pain score, the percent of patients requiring treatment for nausea and/or vomiting in the post anesthesia care unit, and the number of postoperative opioid prescription dosages. Balancing measures were average post anesthesia care unit length of stay, percent of patients with prolonged Post Anesthesia Care Unit length of stay (>120 min), and 30-day reoperation rate.

Results: A total of 5654 tonsillectomy with or without adenoidectomy cases were performed at our ambulatory surgical center from 2015 to 2023. The incidence of intravenous opioid administered in the post anesthesia care unit initially rose with opioid free anesthesia launch, but subsequently decreased below the target of 10%. Maximum post anesthesia care unit pain scores rose from mean 3.6 to 4.5, but subsequently returned to the baseline of 3.5, while the incidence of postoperative nausea and/or vomiting improved. The average post anesthesia care unit length of stay increased by 10 min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30-day reoperation rates were unchanged.

Conclusions: The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay.

导言:这项质量改进计划旨在通过数据驱动的 "计划-实施-研究-行动"(Plan-Do-Study-Act)周期,不断改进儿科门诊手术中心扁桃体切除术(带或不带腺样体切除术)的阿片类药物稀释麻醉方案,从而优化手术效果:从 2015 年 1 月 1 日到 2023 年 12 月 12 日,我们的标准化扁桃体切除术方案经历了 9 个特定手术围手术期的 Plan-Do-Study-Act 循环、3 个特定手术术后处方的 Plan-Do-Study-Act 循环和 4 个普通门诊手术中心增强恢复的 Plan-Do-Study-Act 循环。我们使用统计过程控制图分析了病历中的数据。主要结果是需要在麻醉后护理病房静脉注射阿片类药物的患者比例。次要结果包括麻醉后护理单元的最大疼痛评分、需要在麻醉后护理单元接受恶心和/或呕吐治疗的患者百分比以及术后阿片类药物处方剂量的数量。平衡指标包括麻醉后护理病房平均住院时间、麻醉后护理病房住院时间过长(>120 分钟)患者的百分比以及 30 天再手术率:从2015年到2023年,我们的非卧床手术中心共进行了5654例扁桃体切除术合并或不合并腺样体切除术。麻醉后护理单元静脉注射阿片类药物的发生率最初随着无阿片类药物麻醉的启动而上升,但随后下降到10%的目标值以下。麻醉后护理单元的最大疼痛评分从平均 3.6 分上升到 4.5 分,但随后又恢复到 3.5 分的基线,而术后恶心和/或呕吐的发生率则有所改善。不使用阿片类药物麻醉后,麻醉后护理单元的平均住院时间增加了10分钟;但是,麻醉后护理单元的长期住院时间和30天再手术率没有变化:结论:通过不断改进我们的阿片类药物稀释麻醉方案,围手术期和家庭阿片类药物的使用量减少了,麻醉后护理单元的最大疼痛评分稳定了,术后恶心和呕吐率提高了,而麻醉后护理单元的平均住院时间仅略有增加。
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引用次数: 0
Effect of positive end expiratory pressure on non-hypoxic apnea time and atelectasis during induction of anesthesia in infant: A randomized controlled trial. 呼气末正压对婴儿麻醉诱导期间非缺氧性呼吸暂停时间和肺不张的影响:随机对照试验。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-09 DOI: 10.1111/pan.14965
Eun-Hee Kim, Jung-Bin Park, Pyoyoon Kang, Sang-Hwan Ji, Young-Eun Jang, Ji-Hyun Lee, Jin-Tae Kim, Hee-Soo Kim

Introduction: This study aimed to assess the impact of positive-end-expiratory pressure (PEEP) on the non-hypoxic apnea time in infants during anesthesia induction with an inspired oxygen fraction of 0.8.

Methods: This age stratified randomized controlled trial included patients under 1 year of age. Preoxygenation was performed using an inspired oxygen fraction of 0.8 for 2 min. Inspired oxygen fraction of 0.8 was administered via a face mask with volume-controlled ventilation at a tidal volume of 6 mL.kg-1, with or without 7 cmH2O of PEEP. Tracheal intubation was performed after 3 min of ventilation; however, it was disconnected from the breathing circuit. Ventilation was resumed once the pulse oximetry readings reached 95%. The primary outcome was the non-hypoxic apnea time, defined as the time from the cessation of ventilation to achieving a pulse oximeter reading of 95%. The secondary outcome measures included the degree of atelectasis assessed by ultrasonography and the presence of gastric air insufflation.

Results: Eighty-four patients were included in the final analysis. In the positive end-expiratory pressure group, the atelectasis score decreased (17.0 vs. 31.5, p < .001; mean difference and 95% CI of 11.6, 7.5-15.6), while the non-hypoxic apnea time increased (80.1 s vs. 70.6 s, p = .005; mean difference and 95% CI of -9.4, -16.0 to -2.9), compared to the zero end-expiratory pressure group, among infants who are 6 months old or younger, not in those aged older than 6 months.

Discussion: The application of positive end-expiratory pressure reduced the incidence of atelectasis and extended the non-hypoxic apnea time in infants who are 6 months old or younger. However, it did not affect the incidence of atelectasis nor the non-hypoxic apnea time in patients aged older than 6 months.

简介:本研究旨在评估正呼气压力(PEEP)对婴儿在吸入氧分数为 0.8 的麻醉诱导期间非缺氧性呼吸暂停时间的影响:这项年龄分层随机对照试验包括 1 岁以下的患者。用 0.8 的吸氧分数进行预吸氧 2 分钟。在潮气量为 6 mL.kg-1 的情况下,通过面罩进行 0.8 分贝的吸氧,同时进行容积控制通气,带或不带 7 cmH2O 的 PEEP。通气 3 分钟后进行气管插管,但气管插管与呼吸回路断开。一旦脉搏血氧饱和度读数达到 95%,即恢复通气。主要结果是非缺氧性呼吸暂停时间,即从停止通气到脉搏血氧仪读数达到 95% 的时间。次要结果指标包括通过超声波检查评估的无肺泡程度和是否存在胃充气:84名患者被纳入最终分析。在呼气末正压组,肺不张评分下降(17.0 vs. 31.5,p 讨论):对 6 个月或 6 个月以下的婴儿使用呼气末正压可减少肺不张的发生率,延长非缺氧性呼吸暂停时间。但是,对 6 个月以上的患者来说,气胸发生率和非缺氧性呼吸暂停时间均不受影响。
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引用次数: 0
Perioperative management in pediatric domino liver transplantation for metabolic disorders: A narrative review. 小儿多米诺肝移植治疗代谢紊乱的围手术期管理:综述。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-09 DOI: 10.1111/pan.14967
Ahmed Uslu, Nedim Çekmen, Adnan Torgay, Mehmet Haberal

Domino liver transplantation and domino-auxiliary partial orthotopic liver transplantation are emerging techniques that can expand the liver donor pool and provide hope for children with liver disease. The innovative technique of domino liver transplantation has emerged as a pioneering strategy, capitalizing on structurally preserved livers from donors exhibiting single enzymatic defects within a morphologically normal context, effectively broadening the donor pool. Concurrently, the increasingly prevalent domino-auxiliary partial orthotopic liver transplantation method assumes a critical role in bolstering available donor resources. These advanced transplantation methods present a unique opportunity for pediatric patients who, despite having structurally and functionally intact livers and lacking early signs of portal hypertension or extrahepatic involvement, do not attain priority on conventional transplant lists. Utilizing optimal clinical conditions enhances posttransplant outcomes, benefiting patients who would otherwise endure extended waiting periods for traditional transplantation. The perioperative management of children undergoing these procedures is complex and requires careful consideration of some factors, including clinical and metabolic conditions of the specific metabolic disorder, and the need for tailored perioperative management planning. Furthermore, the prudent consideration of de novo disease development in the recipient assumes paramount significance when selecting suitable donors for domino liver transplantation, as it profoundly influences prognosis, mortality, and morbidity. This narrative review of domino liver transplantation will discuss the pathophysiology, clinical evaluation, perioperative management, and prognostic expectations, focusing on perioperative anesthetic considerations for children undergoing domino liver transplantation.

多米诺肝移植(Domino liver transplantation)和多米诺辅助部分正位肝移植(domino-auxiliary partial orthotopic liver transplantation)是一种新兴技术,可扩大肝脏供体库,为肝病患儿带来希望。多米诺肝移植这一创新技术是一种开创性的策略,它利用在形态正常的情况下表现出单一酶缺陷的供体的肝脏结构保存,有效地扩大了供体库。与此同时,日益盛行的主辅助部分正位肝移植方法在增加可用供体资源方面发挥着至关重要的作用。这些先进的移植方法为小儿患者提供了独特的机会,尽管他们的肝脏结构和功能完好,也没有门静脉高压或肝外受累的早期症状,但在传统的移植名单中却无法获得优先权。利用最佳的临床条件可提高移植后的疗效,使原本需要长时间等待传统移植手术的患者受益。接受这些手术的儿童的围手术期管理非常复杂,需要仔细考虑一些因素,包括特定代谢紊乱的临床和代谢状况,以及制定有针对性的围手术期管理计划的必要性。此外,在选择合适的多米诺肝移植供体时,慎重考虑受体新发疾病的发展具有重要意义,因为这对预后、死亡率和发病率有深远影响。这篇关于多米诺肝移植的叙述性综述将讨论病理生理学、临床评估、围手术期管理和预后预期,重点是接受多米诺肝移植的儿童的围手术期麻醉注意事项。
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引用次数: 0
Perioperative Management of Pediatric Combined Heart and Liver Transplantation: A 17 year single center experience. 小儿心肝联合移植的围手术期管理:17年的单中心经验
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-08 DOI: 10.1111/pan.14977
Manchula Navaratnam, Emma Xi Li, Sharon Chen, Tristan Margetson, Olga Wolke, Michael Ma, Noelle H Ebel, C Andrew Bonham, Chandra Ramamoorthy

Background: An increasing number of centers are undertaking combined heart and liver transplantation in adult and pediatric patients with congenital heart disease.

Aim: The primary aim of this study was to describe the perioperative management of a single center cohort, identifying challenges and potential solutions.

Methods: We conducted a retrospective review of all patients undergoing combined heart and liver transplantation at Stanford Children's Hospital from 2006 to 2022. Preoperative information included cardiac diagnosis, hemodynamics, and severity of liver disease. Intraoperative data included length of surgery, cardiopulmonary bypass time, and blood products transfused. Postoperative data included blood products transfused in the intensive care unit, time to extubation, length of intensive care unit stay, survival outcomes and 30-day adverse events.

Results: Eighteen patients underwent en bloc combined heart and liver transplantation at Stanford Children's Hospital from 2006 to 2022, and the majority 15 (83%) were transplanted for failing Fontan circulation with Fontan Associated Liver Disease. Median surgical procedure time was 13.4 [11.5, 14.5] h with a cardiopulmonary bypass time of 4.3 [3.9, 5.8] h. Median total blood products transfused in the operating room post cardiopulmonary bypass was 89.4 [63.9, 127.0] mLs/kg. Nine patients (50%) had vasoplegia during cardiopulmonary bypass. Activated prothrombin complex concentrates were used post cardiopulmonary bypass in 15 (83%) patients with a 30-day thromboembolism rate of 22%. Median time to extubation was 4.0 [2.8, 6.5] days, median intensive care unit length of stay 20.0 [7.8, 48.3] days and median hospital length of stay 54.0 [30.5, 68.3] days. Incidence of renal replacement therapy was 11%; however, none required renal replacement therapy by the time of hospital discharge. Neurological events within 30 days were 17% and the 30 day and 1 year survival was 89%.

Conclusions: Perioperative challenges include major perioperative bleeding, unstable hemodynamics, and end organ injury including acute kidney injury and neurological events. Successful outcomes for en bloc combined heart and liver transplantation are possible with careful multidisciplinary planning, communication, patient selection, and integrated peri-operative management.

背景:越来越多的中心正在为成人和儿童先天性心脏病患者进行心肝联合移植手术。目的:本研究的主要目的是描述一个单一中心队列的围手术期管理,找出挑战和潜在的解决方案:我们对 2006 年至 2022 年期间在斯坦福儿童医院接受心肝联合移植手术的所有患者进行了回顾性研究。术前信息包括心脏诊断、血液动力学和肝病严重程度。术中数据包括手术时间、心肺旁路时间和输血产品。术后数据包括在重症监护室输注的血液制品、拔管时间、重症监护室住院时间、生存结果和30天不良事件:2006年至2022年期间,斯坦福大学儿童医院共为18名患者进行了心脏和肝脏的整体联合移植手术,其中15人(83%)因丰坦循环衰竭合并丰坦相关肝病而接受移植手术。手术时间中位数为13.4 [11.5, 14.5]小时,心肺旁路时间为4.3 [3.9, 5.8]小时。心肺旁路术后手术室输血总量中位数为89.4 [63.9, 127.0]毫升/千克。九名患者(50%)在心肺旁路过程中出现血管痉挛。15名患者(83%)在心肺旁路术后使用了活性凝血酶原复合物浓缩物,30天血栓栓塞率为22%。拔管时间中位数为 4.0 [2.8, 6.5] 天,重症监护室住院时间中位数为 20.0 [7.8, 48.3] 天,住院时间中位数为 54.0 [30.5, 68.3] 天。肾脏替代治疗的发生率为11%;但是,没有人在出院时需要进行肾脏替代治疗。30天内发生神经系统事件的比例为17%,30天和1年存活率为89%:围手术期面临的挑战包括围手术期大出血、血流动力学不稳定以及包括急性肾损伤和神经系统事件在内的终末器官损伤。通过多学科的精心策划、沟通、患者选择和围手术期综合管理,心脏和肝脏的整体联合移植手术是有可能取得成功的。
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引用次数: 0
Confirmatory, intraoperative, transesophageal echocardiography in an infant with congenital coronary artery anomalies: A case report. 先天性冠状动脉畸形婴儿术中经食道超声心动图确诊:病例报告。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-15 DOI: 10.1111/pan.14961
Nadia S du Plessis, Reitumetse Tladi, Edwin W Turton
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引用次数: 0
Supplement: Abstracts from Asian Society of Paediatric Anaesthesiologists (ASPA) Conference held on 11-14 July 2024 Borneo Convention Centre, Kuching, Sarawak, Malaysia. 补编:2024 年 7 月 11-14 日在马来西亚沙捞越古晋婆罗洲会议中心举行的亚洲儿科麻醉医师学会(ASPA)会议摘要。
IF 1.7 4区 医学 Q2 ANESTHESIOLOGY Pub Date : 2024-11-01 DOI: 10.1111/pan.15001
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引用次数: 0
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Pediatric Anesthesia
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