Pediatric Anesthesia最新文献

Background: Effective pain management during peripherally inserted central catheter placement in neonates and pediatric patients remains challenging, often leading to procedural distress and suboptimal outcomes.

Aim: This randomized controlled trial aimed to evaluate the analgesic efficacy of brachial plexus block compared to local infiltration anesthesia during peripherally inserted central catheter placement.

Methods: Seventy patients were randomized into two groups: brachial plexus block (Group B) and local infiltration anesthesia (Group C). Procedural pain was assessed using the Comfort Neo Scale at T = 0 min (puncture) and T = 30 min (30 min after the procedure). Secondary outcomes included the first-attempt success rate, procedure time, number of puncture attempts, and rescue analgesic use. All interventions were performed under ultrasonographic guidance. Continuous data are expressed as medians [interquartile range (IQR)].

Results: The median Comfort Neo Scale scores at T = 0 were significantly lower in Group B (6 [6-6]) than in Group C (30 [30-30]; difference: -24, 95% CI: -24 to -24, p < 0.0001). At T = 30, the scores remained lower in Group B (6 [6-6]) than in Group C (22 [12-30]; difference: -16, 95% CI: -19 to -10, p < 0.0001). Group B also demonstrated shorter procedure times (30 [20-30] vs. 40 [30-50] min; difference: -10 min, 95% CI: -20 to -10, p < 0.0001), higher first-attempt success rates (61% vs. 38%; odds ratio: 0.08, 95% CI: 0.03-0.26, p < 0.0001), and fewer puncture attempts (1 [1-2] vs. 2 [1-3]; difference: -1, 95% CI: -2 to 0, p < 0.001). Rescue analgesic use and pain-related movements were significantly reduced in Group B (odds ratio for pain-related movement: ∞, 95% CI: 109-∞, p < 0.0001).

Conclusions: Brachial plexus block provides superior pain relief and procedural outcomes compared to local infiltration anesthesia during peripherally inserted central catheter placement in neonates and pediatric patients. Its adoption as a standard pain management approach can enhance patient comfort, improve efficiency, and reduce procedural distress. Future studies should explore the broad applicability and long-term benefits of this approach.

Trial registration: Japan Registry of Clinical Trials (jRCT): jRCT1010220045.

Background: Safe and effective anesthesia is critical for the care of pediatric patients with congenital heart disease undergoing cardiac catheterization. Over the past two decades, there has been a significant transition from primarily diagnostic procedures to complex interventional cases, accompanied by a shift from operator-managed sedation to anesthesia administered by a trained anesthesiologist.

Aims: The aim of our study is to explore the incidence of high severity anesthesia related adverse events (ARAE) and whether these rates correlate with Procedural Risk in Congenital Cardiac Catheterization (PREDIC³T) case-type risk categories. Higher risk categories have been shown to correlate with high severity procedural related adverse events.

Methods: A multicenter, retrospective cohort study utilized data collected prospectively in the Congenital Cardiac Catheterization Project on Outcomes (C3PO). This study, encompassing 18 contributing institutions, analyzed data from January 1, 2019 to December 31, 2023. Rates of 17 specific ARAE were stratified via PREDIC³T category.

Results: During the study period, 38, 021 cardiac catheterizations were included in this analysis. A total of 321 ARAE of any severity (level 1-5) were recorded, for an overall rate of 0.8% (CI, 0.7%-0.9%). Of these 321 ARAE, 160 were high severity (level 3bc/4/5), yielding a rate of 0.4%. Rates of high severity ARAE by PREDIC³T risk category (0,1, 2, 3, 4, 5) were found to be 0.2%. 0.4%, 0.5%, 0.3%. 0.8%, and 0.7%, respectively. Multivariable logistic regression analyses identified weight under 10 kg, hemodynamic vulnerability score (HVS) ≥ 1, and PREDIC³T risk category 5 procedures as factors associated with higher odds of experiencing a high severity ARAE.

Conclusions: The overall rate of ARAE, including high severity ARAE, was found to be increased in higher PREDIC³T risk category procedures. Both patient and procedural factors contribute to ARAE in the congenital cardiac catheterization laboratory.

Clinical trial number and registry: Not applicable.

Introduction: Neonates undergoing cardiac surgery face a high risk of neurological injury and neurodevelopmental complications. Transcranial Doppler monitoring is used and validated in adults to measure cerebral blood flow and can provide valuable insights into cerebral perfusion in neonates. Nevertheless, it has not been widely introduced in neonatal cardiac surgery.

Aims: This study aims to evaluate the feasibility of continuous bilateral transcranial Doppler monitoring for assessing cerebral perfusion during neonatal cardiac surgery.

Methods: Continuous transcranial Doppler monitoring was employed during neonatal cardiac surgery with a commercially available transcranial Doppler system and fixation materials. Cerebral blood flow velocity, invasive arterial blood pressure, and other key physiological parameters were measured throughout the procedures.

Results: A total of 44 procedures were monitored. Four were excluded due to storage problems (n = 2), inadequate time to apply the probes (n = 1), and subject drop-out due to lower surgery severity (n = 1). Bilateral sufficient signal quality was obtained in all patients at the start. Unilateral signal deterioration occurred in 1 (2.5%) of left middle cerebral artery measurements and in 3 (7.5%) of right middle cerebral artery measurements. Mean (SD) left/right MCA CBFV were: pre-bypass 17.2 (6.4)/15.4 (6.8) cm/s, during bypass 10.8 (4.0)/10.2 (4.3) cm/s, and post-bypass 18.4 (5.9)/16.1 (5.1) cm/s. Mean (SD) ABP was 38.1 (4.4) mmHg pre-bypass, 38.0 (5.1) mmHg during bypass, and 47.8 (4.7) mmHg post-bypass.

Conclusions: This study demonstrates that bilateral transcranial Doppler monitoring is feasible during neonatal cardiac surgery when performed within the recommended operational safety limits. Transcranial Doppler provides real-time information on cerebral blood flow, complementing existing tools.

Trial registration: ClinicalTrials.gov identifier: NCT04713605.

Background: Telemedicine has emerged as a valuable tool in healthcare, especially in the wake of the COVID-19 pandemic, showcasing high satisfaction rates across various medical fields. But its potential benefits for pre-anesthetic evaluation in children have not been widely studied.

Method: This pilot randomized controlled trial involves 70 pediatric patients aged 3-12 years compares telemedicine (Group T) with conventional, that is, in-person assessments (Group C), with the primary outcome being the number of visits required for pre-anesthetic checkup, while secondary outcomes include cancellation rates on the day of surgery, duration of consultation, parent/guardian satisfaction rates and concordance of pre-anesthesia checkups between anaesthesiologists.

Result: Telemedicine demonstrated comparable effectiveness to in-person assessments, with no statistically significant difference in the number of visits required for anesthesia clearance (mean visits: 1.54; 95% CI: 1.27-1.81 in group T vs. 1.69; 95% CI: 1.42-1.96 in group C). Surgical cancellations or delays occurred in fewer than one case per group. The duration required for primary anesthesia clearance during the initial session in Group T took longer (17 min 22 s; 95% CI: 15 min 25 s-19 min 20s) than in Group C (13 min 19 s; 95% CI: 11 min 47 s-14 min 50s). This difference may be attributed to parental/guardian unfamiliarity with Zoom and the challenges of home-based assessments, but high satisfaction scores (mean total 5-point likert satisfaction score = 20.74 ± 1.93 out of 25) suggest acceptance among parents/guardians. Concordance rates between anaesthesiologists for medical history, investigations, documentation, ASA status, and anesthesia plan were high (> 85% of cases) using telemedicine except for airway assessment as it was in agreement in only 45.7% of cases.

Conclusion: Telemedicine is offering similar clinical outcomes, high parental satisfaction, and greater accessibility and thus underscores its potential to enhance accessibility and convenience in pediatric pre-anesthesia evaluations without compromising clinical quality.

Trial registration: Clinical trial number: CTRI/2022/11/047193.

Introduction: Pediatric musculoskeletal and cancer surgeries often lead to significant postoperative pain. Augmented reality (AR), a non-pharmacological approach to pain modulation, has been insufficiently studied for its potential role in reducing opioid use following major surgery in children.

Methods: In this pilot trial, we randomly assigned pediatric patients undergoing major surgery, in a 1:1 ratio, to an AR versus non-AR scavenging game postoperatively. Randomization was stratified according to the study site. The primary endpoint was the rate of persistent opioid use measured at 90 days after hospital discharge. Secondary endpoints included pain intensity, opioid use, inpatient ambulation or "out of bed", movement, length of stay, and adverse events. We considered the trial a success if the rate of opioid use at 90 days postoperatively was significantly lower in the AR arm than in the non-AR arm.

Results: A total of 66 patients underwent randomization (n = 33 in each arm). The median age of each group was 12 years old. There were more females (72.7%) in the AR group than in the non-AR group (48.5%). Most patients (80%) had undergone oncological surgeries. The primary endpoint was met in over 95% of the patients. The overall rate of opioid use was low in both groups of patients (AR: 6.1% and non-AR: 9.7%) and did not reach statistical significance (p = 0.667). There were no statistically significant differences in secondary outcomes.

Conclusion: In conclusion, this pilot study does not support the use of AR aimed at reducing the rate of persistent opioid use following pediatric surgery.

Background: Dexmedetomidine is an a₂-adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has gained remarkable attention in the adult and pediatric population predominantly because of its minimal respiratory depression. However, in the pediatric population, very limited information is available regarding the action of intravenous dexmedetomidine on neuromuscular blockade and on anesthesia induction. The aim of this study was to investigate the impact of dexmedetomidine on rocuronium-induced neuromuscular blockade and on anesthesia induction with propofol in children.

Material and method: A total of 60 children undergoing elective surgery, ages 4-12 years, were enrolled in the study. Before the induction of anesthesia with propofol, 30 children received dexmedetomidine 0.5 μg/kg given over 10 min (group D). Another group of 30 children received the same volume of N/S 0.9% over 10 min as well (group P). We recorded time to achieve TOF = 0 from the end of rocuronium infusion, time for BIS < 60 from the end of propofol infusion, intubation conditions, haemodynamic changes, intubation attempts, and adverse effects.

Results: The onset time of rocuronium was significantly lower in group D compared to group P (177.8 s, 95% CI 161.1-194.0 s vs 205 s, 95% CI 188.0-222.0 s; p = 0.021). Time for BIS to reach a value < 60 (34.3 s, 95% CI 29.1-39.6 s for group D vs 33.2 s, 95% CI 27.2-39.2 s for group P, p = 0.772) was unaffected by dexmedetomidine infusion. Intubation conditions showed a more stable haemodynamic response in group D (systolic, diastolic, mean arterial pressure, and heart rate were significantly lower in group D at intubation). No difference was found regarding intubation attempts and adverse effects.

Conclusion: Our results showed that dexmedetomidine infusion before induction of anesthesia with propofol reduced the onset time of rocuronium and provided a better hemodynamic profile during endotracheal intubation in children.

Trial registration: The study protocol was registered in ClinicalTrials.gov (NCT03923075).

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: The challenges of nasotracheal intubation (NTI) often arise from the misalignment of the oral, pharyngeal, and laryngeal axes. We sought to assess the success and complication rate of an economically reusable J-shaped stainless-steel guidewire for NTI during dental treatment in children.

Materials and methods: Pediatric patients undergoing dental treatment under general anesthesia who were nasally intubated during January 2016-December 2023 were retrospectively analyzed. The following variables were collected: details of relative position between endotracheal tube (ETT) tip and glottis, peri-intubation vital signs, and incidence of related complications. The primary observation indicator was the bullseye probability, defined as the probability of the ETT directly aligning with the glottis after glottic exposure.

Results: Data were obtained from 692 pediatric patients. The bullseye probability was 49.4%. The probability of ETT tip pointing toward the tongue base was 11.3%, and the probability of ETT tip pointing toward the esophageal entrance was 1.9%. The probability of ETT tip being at the same horizontal plane with glottis was 86.8%. Additional assistance was required to advance the tube smoothly in 48.4% of cases. The total intubation time was 63.1 (Q1-Q3, 54.3-72.3) s with a 100% overall success rate. The incidence of severe lip and mucosal trauma was 0.7%.

Conclusions: The J-shaped stainless-steel guidewire is a suitable and economic auxiliary tool to assist NTI for outpatient dental procedures in children. The occurrence of severe lip and mucosal trauma was lower than reported in other studies.