Editorial

4 pages, 193 KiB

Open AccessEditorial

by Camila Walters

Children 2021, 8(3), 201; https://doi.org/10.3390/children8030201 - 07 Mar 2021

Viewed by 1364

Anesthesiology is a medical specialty that provides perioperative care for patients undergoing medical interventions requiring sedation or critical monitoring including surgery, imaging, and other diagnostic and therapeutic procedures [...] Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

Research

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8 pages, 222 KiB

Open AccessFeature PaperArticle

Engaging Parents in Analgesia Selection and Racial/Ethnic Differences in Analgesia Given to Pediatric Patients Undergoing Urologic Surgery

by Carl Lo, Patrick A. Ross, Sang Le, Eugene Kim, Matthew Keefer and Alvina Rosales

Children 2020, 7(12), 277; https://doi.org/10.3390/children7120277 - 07 Dec 2020

Cited by 6 | Viewed by 1935

Abstract

Background: Family-centered care aims to consider family preferences and values in care delivery. Our study examines parent decisions regarding anesthesia type (caudal regional block or local anesthesia) among a diverse sample of children undergoing urologic surgeries. Differences in anesthesia type were examined by [...] Read more.

Background: Family-centered care aims to consider family preferences and values in care delivery. Our study examines parent decisions regarding anesthesia type (caudal regional block or local anesthesia) among a diverse sample of children undergoing urologic surgeries. Differences in anesthesia type were examined by known predictors of health disparities, including child race/ethnicity, parental English proficiency, and a proxy for household income. Methods: A retrospective review of 4739 patients (including 25.4% non-Latino/a White, 8.7% non- Latino/a Asians, 7.3% non-Latino/a Black, 23.1% Latino/a, and 35.4% others) undergoing urologic surgeries from 2016 to 2020 using univariate and logistic regression analyses. Results: 62.1% of Latino/a parents and 60.8% of non-Latino/a Black parents did not agree to a regional block. 65.1% of Spanish-speaking parents with limited English Proficiency did not agree to a regional block. Of parents from households below poverty lines, 61.7% did not agree to a caudal regional block. In regression analysis, Latino/a and non- Latino/a Black youth were less likely to receive caudal regional block than non- Latino/a White patients. Conclusions: We found disparities in the use of pediatric pain management techniques. Understanding mechanisms underlying Latino/a and non- Latino/a Black parental preferences may help providers reduce these disparities. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

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7 pages, 218 KiB

Open AccessFeature PaperArticle

Pediatric Anesthesia Specialty Societies and Multi-Institutional Collaborations

by Camila B. Walters, James M. Kynes, Srijaya K. Reddy, Christy J. Crockett, Hannah K. Lovejoy and Amanda N. Lorinc

Children 2020, 7(11), 233; https://doi.org/10.3390/children7110233 - 17 Nov 2020

Cited by 3 | Viewed by 2395

Abstract

Pediatric anesthesiology is a subspecialty of anesthesiology that deals with the high-risk pediatric population. The specialty has made significant advancement in large collaborative efforts to study and increase patient safety, including the creation of international societies, a dedicated journal, special committees and interest [...] Read more.

Pediatric anesthesiology is a subspecialty of anesthesiology that deals with the high-risk pediatric population. The specialty has made significant advancement in large collaborative efforts to study and increase patient safety, including the creation of international societies, a dedicated journal, special committees and interest groups, and multi-institution databases for research and quality improvement. Readily available resources were created to help with the education of future pediatric anesthesiologists as well as continuing medical education. Conclusions: Specialty societies and collaborations in pediatric anesthesia are crucial for continuous improvement in the care of children. They promote research, education, quality improvement, and advocacy at the local, national, and international level. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

6 pages, 175 KiB

Open AccessArticle

Perioperative Considerations in Osteogenesis Imperfecta: A 20-Year Experience with the Use of Blood Pressure Cuffs, Arterial Lines, and Tourniquets

by Kirsten E. Ross, Joseph T. Gibian, Christy J. Crockett and Jeffrey E. Martus

Children 2020, 7(11), 214; https://doi.org/10.3390/children7110214 - 06 Nov 2020

Cited by 4 | Viewed by 1922

Abstract

Osteogenesis imperfecta (OI) is a rare genetic connective-tissue disorder with bone fragility. To avoid iatrogenic fractures, healthcare providers have traditionally avoided using non-invasive blood pressure (NIBP) cuffs and extremity tourniquets in the OI population in the perioperative setting. Here, we hypothesize that these [...] Read more.

Osteogenesis imperfecta (OI) is a rare genetic connective-tissue disorder with bone fragility. To avoid iatrogenic fractures, healthcare providers have traditionally avoided using non-invasive blood pressure (NIBP) cuffs and extremity tourniquets in the OI population in the perioperative setting. Here, we hypothesize that these procedures do not lead to iatrogenic fractures or other complications in patients with OI. A retrospective study of all children with OI who underwent surgery at a single tertiary care children’s hospital from 1998 to 2018 was performed. Patient positioning and the use of NIBP cuffs, arterial lines, and extremity tourniquets were documented. Fractures and other complications were recorded. Forty-nine patients with a median age of 7.9 years (range: 0.2–17.7) were identified. These patients underwent 273 procedures, of which 229 were orthopaedic operations. A total of 246 (90.1%) procedures included the use of an NIBP cuff, 61 (22.3%) an extremity tourniquet, and 40 (14.7%) an arterial line. Pediatric patients with OI did not experience any iatrogenic fractures related to hemodynamic monitoring or extremity tourniquet use during the 20-year period of this study. Given the benefits of continuous intra-operative hemodynamic monitoring and extremity tourniquets, we recommend that NIBP cuffs, arterial lines, and tourniquets be selectively considered for use in children with OI. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

10 pages, 227 KiB

Open AccessArticle

by Anjali A. Dixit, Holly Elser, Catherine L. Chen, Marla Ferschl and Solmaz P. Manuel

Children 2020, 7(10), 163; https://doi.org/10.3390/children7100163 - 04 Oct 2020

Cited by 19 | Viewed by 3118

Abstract

Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language [...] Read more.

Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language proficiency influenced pain management in the post-anesthesia care unit (PACU) in a cohort of children who underwent laparoscopic appendectomy at our pediatric hospital in San Francisco. Our primary exposure was English language proficiency, and our primary outcome was administration of any opioid medication in the PACU. Secondary outcomes included the amount of opioid administered in the PACU and whether any pain score was recorded during the patient’s recovery period. Statistical analysis included adjusting for demographic covariates including race in estimating the effect of language proficiency on these outcomes. In our cohort of 257 pediatric patients, 57 (22.2%) had low English proficiency (LEP). While LEP and English proficient (EP) patients received the same amount of opioid medication intraoperatively, in multivariable analysis, LEP patients had more than double the odds of receiving any opioid in the PACU (OR 2.45, 95% CI 1.22–4.92). LEP patients received more oral morphine equivalents (OME) than EP patients (1.64 OME/kg, CI 0.67–3.84), and they also had almost double the odds of having no pain score recorded during their PACU recovery period (OR 1.93, CI 0.79–4.73), although the precision of these estimates was limited by small sample size. Subgroup analysis showed that children over the age of 5 years, who were presumably more verbal and would therefore undergo verbal pain assessments, had over triple the odds of having no recorded pain score (OR 3.23, CI 1.48–7.06). In summary, English language proficiency may affect the management of children’s pain in the perioperative setting. The etiology of this language-related disparity is likely multifactorial and should be investigated further. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

12 pages, 2772 KiB

Open AccessArticle

A Model for a Standardized and Sustainable Pediatric Anesthesia-Intensive Care Unit Hand-Off Process

by Priti G. Dalal, Theodore J. Cios, Theodore K. M. DeMartini, Amit A. Prasad, Meghan C. Whitley, Joseph B. Clark, Leon Lin, Dennis J. Mujsce and Robert E. Cilley

Children 2020, 7(9), 123; https://doi.org/10.3390/children7090123 - 03 Sep 2020

Cited by 4 | Viewed by 3467

Abstract

Background and Objectives: The hand-off process between pediatric anesthesia and intensive care unit (ICU) teams involves the exchange of patient health information and plays a major role in reducing errors and increasing staff satisfaction. Our objectives were to (1) standardize the hand-off process [...] Read more.

Background and Objectives: The hand-off process between pediatric anesthesia and intensive care unit (ICU) teams involves the exchange of patient health information and plays a major role in reducing errors and increasing staff satisfaction. Our objectives were to (1) standardize the hand-off process in children’s ICUs, and (2) evaluate the provider satisfaction, efficiency and sustainability of the improved hand-off process. Methods: Following multidisciplinary discussions, the hand-off process was standardized for transfers of care between anesthesia-ICU teams. A pre-implementation and two post-implementation (6 months, >2 years) staff satisfaction surveys and audits were conducted to evaluate the success, quality and sustainability of the hand-off process. Results: There was no difference in the time spent during the sign out process following standardization—median 5 min for pre-implementation versus 5 and 6 min for post-implementation at six months and >2 years, respectively. There was a significant decrease in the number of missed items (airway/ventilation, venous access, medications, and laboratory values pertinent events) post-implementation compared to pre-implementation (p ≤ 0.001). In the >2 years follow-up survey, 49.2% of providers felt that the hand-off could be improved versus 78.4% in pre-implementation and 54.2% in the six-month survey (p < 0.001). Conclusion: A standardized interactive hand-off improves the efficiency and staff satisfaction, with a decreased rate of missed information at the cost of no additional time. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

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8 pages, 203 KiB

Open AccessArticle

The Addition of Intravenous Propofol and Ketorolac to a Sevoflurane Anesthetic Lessens Emergence Agitation in Children Having Bilateral Myringotomy with Tympanostomy Tube Insertion: A Prospective Observational Study

by Brandon d’Eon, Thomas Hackmann and A. Stuart Wright

Children 2020, 7(8), 96; https://doi.org/10.3390/children7080096 - 15 Aug 2020

Cited by 4 | Viewed by 2469

Abstract

The aim of this prospective observational study was to determine if children undergoing bilateral myringotomy and tympanostomy tube insertion with a sevoflurane anesthetic plus intravenous propofol and ketorolac experienced a lower incidence of emergence agitation than those receiving a sevoflurane anesthetic alone. Duration [...] Read more.

The aim of this prospective observational study was to determine if children undergoing bilateral myringotomy and tympanostomy tube insertion with a sevoflurane anesthetic plus intravenous propofol and ketorolac experienced a lower incidence of emergence agitation than those receiving a sevoflurane anesthetic alone. Duration of procedure, length of stay in post-anaesthesia care and level of nursing effort required to care for patients were also assessed. In this study, 49 children younger than 13 years of age received a sevoflurane anesthetic. Fifty-one percent of these patients also received a single injection of propofol 1 mg/kg and ketorolac 0.5 mg/kg at the end of the procedure. Patients were assessed for emergence agitation using the Pediatric Anesthesia Emergence Delirium scale in the post-anaesthesia care unit. Four children receiving a sevoflurane anesthetic alone experienced emergence agitation, while no children receiving propofol and ketorolac experienced emergence agitation (p = 0.05). The length of stay until discharge from the hospital was 6.98 min longer for patients receiving propofol and ketorolac but did not reach statistical significance (p = 0.23). Nurses reported greater ease in caring for patients receiving the propofol and ketorolac injection (recovery questionnaire score 4.50 vs. 3.75, p = 0.002). In this study, adding a single injection of intravenous propofol and ketorolac to the end of a brief sevoflurane anesthetic for bilateral myringotomy with tube insertion was associated with a lower incidence of emergence agitation without significantly increasing the time to discharge from the hospital. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

10 pages, 968 KiB

Open AccessArticle

Robotic Stereotactic Assistance (ROSA) for Pediatric Epilepsy: A Single-Center Experience of 23 Consecutive Cases

by Jonathon H. Nelson, Samantha L. Brackett, Chima O. Oluigbo and Srijaya K. Reddy

Children 2020, 7(8), 94; https://doi.org/10.3390/children7080094 - 07 Aug 2020

Cited by 17 | Viewed by 4092

Abstract

Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA^®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the [...] Read more.

Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA^®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA^® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA^® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA^® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA^® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA^® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

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10 pages, 1610 KiB

Open AccessArticle

Evaluating and Enhancing the Preparation of Patients and Families before Pediatric Surgery

by Christopher Newell, Heather Leduc-Pessah, Lisa Bell-Graham, Nivez Rasic and Kerryn Carter

Children 2020, 7(8), 90; https://doi.org/10.3390/children7080090 - 05 Aug 2020

Cited by 3 | Viewed by 2720

Abstract

Surgery can be a difficult and unfamiliar experience for children and their families. We examined the ability of existing information to help families feel better prepared for surgery at the Alberta Children’s Hospital (ACH) and evaluated the best way to enhance its content [...] Read more.

Surgery can be a difficult and unfamiliar experience for children and their families. We examined the ability of existing information to help families feel better prepared for surgery at the Alberta Children’s Hospital (ACH) and evaluated the best way to enhance its content and accessibility. We developed an online survey for families who have had surgery at ACH. Participants were recruited through pre-existing patient networks and from the ACH Short Stay Unit (SSU) between October 2018 and October 2019. The survey asked participants to evaluate the information available to prepare them for surgery and requested suggestions for improvement. Our survey results show that those who completed the in-person Surgery 101 program felt significantly more prepared for surgery. Of those who did not attend; 40% would have been interested in participating but were unaware that the program existed; and 17% planned to attend but were unable to; due to work or travel distance. Participants felt additional resources via online content or paper handouts would be most valuable. We used this information to prepare an online accessible summary of the Surgery 101 program and tour in the form of a video to reach more Albertan families preparing for surgery for their children Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

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Review

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15 pages, 245 KiB

Open AccessFeature PaperReview

Behavioral and Emotional Disorders in Children and Their Anesthetic Implications

by Srijaya K. Reddy and Nina Deutsch

Children 2020, 7(12), 253; https://doi.org/10.3390/children7120253 - 25 Nov 2020

Cited by 10 | Viewed by 3670

Abstract

While most children have anxiety and fears in the hospital environment, especially prior to having surgery, there are several common behavioral and emotional disorders in children that can pose a challenge in the perioperative setting. These include anxiety, depression, oppositional defiant disorder, conduct [...] Read more.

While most children have anxiety and fears in the hospital environment, especially prior to having surgery, there are several common behavioral and emotional disorders in children that can pose a challenge in the perioperative setting. These include anxiety, depression, oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, post-traumatic stress disorder, and autism spectrum disorder. The aim of this review article is to provide a brief overview of each disorder, explore the impact on anesthesia and perioperative care, and highlight some management techniques that can be used to facilitate a smooth perioperative course. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

11 pages, 225 KiB

Open AccessFeature PaperReview

Hot Topics in Safety for Pediatric Anesthesia

by Amanda N. Lorinc, Camila B. Walters, Hannah K. Lovejoy, Christy J. Crockett and Srijaya K. Reddy

Children 2020, 7(11), 242; https://doi.org/10.3390/children7110242 - 20 Nov 2020

Cited by 9 | Viewed by 4314

Abstract

Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia [...] Read more.

Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

10 pages, 1626 KiB

Open AccessFeature PaperReview

Perioperative Point-of-Care Ultrasound in Children

by Karen Boretsky

Children 2020, 7(11), 213; https://doi.org/10.3390/children7110213 - 06 Nov 2020

Cited by 6 | Viewed by 3247

Abstract

Anesthesiologists and other acute care physicians perform and interpret portable ultrasonography—point-of-care ultrasound (POCUS)—at a child’s bedside, in the perioperative period. In addition to the established procedural use for central line and nerve block placement, POCUS is being used to guide critical clinical decisions [...] Read more.

Anesthesiologists and other acute care physicians perform and interpret portable ultrasonography—point-of-care ultrasound (POCUS)—at a child’s bedside, in the perioperative period. In addition to the established procedural use for central line and nerve block placement, POCUS is being used to guide critical clinical decisions in real-time. Diagnostic point-of-care applications most relevant to the pediatric anesthesiologist include lung ultrasound for assessment of endotracheal tube size and position, pneumothorax, pleural effusion, pneumonia, and atelectasis; cardiac ultrasound for global cardiac function and hydration status, and gastric ultrasound for aspiration risk stratification. This article reviews and discusses select literature regarding the use of various applications of point-of-care ultrasonography in the perioperative period. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

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Other

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7 pages, 373 KiB

Open AccessCase Report

Hypoglossal Nerve Stimulator Placement for Pediatric Trisomy 21 Patients with Refractory Obstructive Sleep Apnea: A Case Series

by Joelle B. Karlik, Nikhila Raol and Laura Gilbertson

Children 2020, 7(8), 81; https://doi.org/10.3390/children7080081 - 24 Jul 2020

Cited by 6 | Viewed by 2975

Abstract

Background: Hypoglossal nerve stimulators (HNS) are an increasingly popular form of upper airway stimulation for obstructive sleep apnea (OSA) in adults who are unable to tolerate positive pressure treatment. However, HNS use is currently limited in the pediatric population. Case presentation: We present [...] Read more.

Background: Hypoglossal nerve stimulators (HNS) are an increasingly popular form of upper airway stimulation for obstructive sleep apnea (OSA) in adults who are unable to tolerate positive pressure treatment. However, HNS use is currently limited in the pediatric population. Case presentation: We present a case series detailing the anesthetic management of three pediatric trisomy 21 patients receiving HNS for refractory obstructive sleep apnea. The patients tolerated the procedure well and experienced no complications. The average obstructive apnea–hypopnea index (AHI) change was 87.4% with the HNS. Conclusions: Proper anxiolysis, safe and controlled induction, multimodal analgesia, and minimization of post-operative respiratory compromise are all necessary to ensure anesthetic and surgical success. After a tailored anesthetic regimen, proper device placement and close follow-up, our patients had a marked improvement in obstructive symptoms. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

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6 pages, 194 KiB

Open AccessFeature PaperBrief Report

Dexmedetomidine as an Opioid-Sparing Agent in Pediatric Craniofacial Surgery

by Srijaya K. Reddy, Jacob J. Jones, Heather Gordish-Dressman and Sophie R. Pestieau

Children 2020, 7(7), 68; https://doi.org/10.3390/children7070068 - 01 Jul 2020

Cited by 7 | Viewed by 3209

Abstract

Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive [...] Read more.

Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive surgery would result in reduced opioid requirements, pain, sedation scores, and opioid-induced side effects compared to patients who did not receive dexmedetomidine. All patients who underwent craniofacial reconstructive surgery at our institution from July 2013 to June 2017 were retrospectively evaluated. The primary outcome measure was mean postoperative morphine equivalent requirements. Secondary outcome measures included incidence of opioid-related side effects, pain scores, and hospital length of stay. Thirty-nine patients received dexmedetomidine intraoperatively while 41 patients did not. There was no difference in postoperative opioid requirements or pain scores between the two cohorts. However, patients who received higher doses of dexmedetomidine (4.7 mcg/kg) intraoperatively exhibited significantly lower rescue medication requirements for nausea and vomiting postoperatively. Contrary to the hypothesis, dexmedetomidine was not associated with reduced postoperative opioid requirements or pain scores in children undergoing craniofacial reconstructive surgery. However, our findings do suggest that dexmedetomidine may be beneficial in reducing side effects such as postoperative nausea and vomiting. A randomized controlled trial would be necessary to verify these findings. Full article

(This article belongs to the Special Issue Pediatric Anesthesia)

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