Pediatric Anesthesia最新文献

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.

Background: The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is widely used to classify patient comorbidities prior to surgery and is often used as a marker of perioperative risk. Since its inception in 1941, it has undergone modifications to adapt to changing clinical needs and to improve its reliability. In 2020, a version of the ASA-PS was released with pediatric-specific case examples.

Aim: To explore inter-rater reliability in ASA-PS scoring in the pediatric population.

Methods: This single-center retrospective study evaluated the assigned ASA-PS scores of 364 patients at a quaternary pediatric hospital. Each patient was assigned three ASA-PS scores-one by the case anesthetist and one each by two independent consultant anesthetists using the ASA guidance issued in 2020. Concordance was measured between the assigned scores, and potential reasons for discordant scores were identified.

Results: There was strong concordance of ASA-PS scores between the two independently scoring anesthetists (weighted kappa coefficient 0.76), but only moderate concordance between the case anesthetist and the independent anesthetists (weighted kappa coefficient 0.5). Where there was a discrepancy, the case anesthetist had usually underscored the ASA-PS by 1 point. Patients who had symptomatic cardiac disease, abnormal body mass index for age, an oncologic state, brain malformation, or a difficult airway were more likely to be assigned an incorrect ASA-PS score.

Conclusions: Moderate inter-rater variability exists in the assignment of ASA-PS scores in the pediatric population, and many patients are being underscored. Use of ASA guidance to assist with pediatric ASA-PS scoring improves the reliability of scoring and may improve accurate communication of perioperative risk.

Background: Pediatric preassessment is recommended for all children undergoing general anesthesia. It has the potential to improve safety and quality outcomes for both the patient and the organization.

Aims: This study aimed to establish the proportion of children who underwent preassessment before general anesthesia, the format of that preassessment, and the impact of preassessment on outcomes such as on-the-day cancelation, and patient anxiety.

Methods: This multi-center prospective observational cohort study outlines preassessment delivery in the UK and its effect on outcome. Invitation to participate was via Pediatric Anesthetic Trainee Research Network. Data collected included demographic data, details of the patient's preassessment, and their outcome.

Results: Data were verified from 96 hospitals on 6818 patients between 1 and 16 years old having elective procedures under general anesthetic. The proportion of children ≤ 16 years old who received preassessment was 60.1% (4082 children). There was a large variation in the delivery of preassessment with the majority being nurse-led. The perioperative journey of most children proceeded as planned (6454 patients, 94.6% of cases). There was a significant difference in the proportion of children with perioperative anxiety between those who did (12.0%, n = 482) and did not (16.5%, n = 438) have a preassessment (p < 0.001). Preassessment did not make a statistically significant difference to overall cancelation rates. The most common reasons for cancelation were intercurrent illness and anxiety. A greater proportion of procedures were delayed or canceled if anxiety was identified as a perioperative challenge: 20.8% (n = 191) compared to 3.6% (n = 210, p < 0.001).

Conclusion: These data suggest that improved outcomes could be achieved through a reduction in anxiety. A service offering screening calls in the days before surgery could prevent on-the-day cancelation due to intercurrent illness. The priorities for preassessment in children require further clarification and standardization nationally to maximize the potential benefits from services.