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Pediatrics anesthesia

Ahmad S Azhar
OBJECTIVES: To assess the safety and effectiveness of transthoracic echocardiography (TTE) in monitoring transcatheter closure of atrial septal defect (ASD), in comparison with conventional technique using transesophageal echocardiography (TEE).  Methods: A retrospective review of all cases of transcatheter closure of isolated ostium secundum ASDs operated from 2005 to 2015, at the Pediatric Interventional Cardiology Department, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia...
November 2016: Saudi Medical Journal
Takaki Emura, Kenji Hosoda, Shota Harai, Noboru Oyachi, Takeyuki Suzuki, Ken Takada, Koji Kobayashi, Hisatake Ikeda
BACKGROUND: Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION: A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis...
October 19, 2016: Journal of Medical Case Reports
Chang Amber Liu, Jinghu Sui, Charles J Coté, Thomas A Anderson
BACKGROUND AND OBJECTIVES: Caudal anesthesia is a common and effective regional anesthesia technique in pediatric patients. The addition of epinephrine to local anesthetics in caudal anesthesia is a frequent practice; however, changes in hemodynamic and cardiac parameters produced by epinephrine in caudal anesthesia are not well studied. Using data collected with the ICON noninvasive cardiac output monitor, we examined the hemodynamic changes associated with the administration of epinephrine containing local anesthetics during caudal anesthesia in children...
October 11, 2016: Regional Anesthesia and Pain Medicine
John F Gamble, Dinesh J Kurian, Andrea G Udani, Nathaniel H Greene
We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation...
2016: Case Reports in Pediatrics
Eugene T H Ek, Sophia K Paul, Robert N Hotchkiss
BACKGROUND: The role of elbow contracture release in the very young is unclear, with existing studies reporting conflicting results. This study evaluated the long-term results after open elbow contracture release in patients aged younger than 18 years. METHODS: Between 1994 and 2012, 32 patients underwent open elbow contracture release at a mean age of 13.8 years (range, 5-18 years), and their outcomes were reviewed. The primary cause was traumatic in 30 patients (4 radial head/neck fractures, 5 intra-articular distal humeral fractures, 11 extra-articular distal humeral fractures, 10 complex fracture-dislocations), and the mean time from the index injury to contracture release was 16...
October 14, 2016: Journal of Shoulder and Elbow Surgery
Kirsten C Odegard, Robert Vincent, Rahul G Baijal, Suanne M Daves, Robert G Gray, Alexander J Javois, Barry A Love, Philip Moore, David Nykanen, Lori Q Riegger, Scott G Walker, Elizabeth C Wilson
Current practice of sedation and anesthesia for patients undergoing pediatric and congenital cardiac catheterization laboratory (PCCCL) procedures is known to vary among institutions, a multi-society expert panel with representatives from the Congenital Heart Disease Council of the Society for Cardiovascular Angiography and Interventions, the Society for Pediatric Anesthesia and the Congenital Cardiac Anesthesia Society was convened to evaluate the types of sedation and personnel necessary for procedures performed in the PCCCL...
October 3, 2016: Anesthesia and Analgesia
Karen Thomson, Sophie R Pestieau, Janish J Patel, Heather Gordish-Dressman, Ariana Mirzada, Zeev N Kain, Matthew E Oetgen
BACKGROUND: The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS). METHODS: A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population...
October 3, 2016: Anesthesia and Analgesia
Renée J Roberts, Ashley E Wilson, Zenaide Quezado
Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign)...
October 3, 2016: Anesthesia and Analgesia
Sofia Geralemou, Tong J Gan
PURPOSE OF REVIEW: Postoperative and postdischarge nausea and vomiting have profound impact on the efficient delivery of quality healthcare. In addition to patient dissatisfaction, physical morbidities as well as unplanned hospital admissions may result. It is important to risk stratify and intervene on patients at risk. The aim of this review is to explore the benefits and shortcomings of the scoring systems commonly used today. RECENT FINDINGS: Two widely-used risk stratification systems identify and score patient-, anesthesia-, and surgery-related risk factors for postoperative/postdischarge nausea and vomiting in the adult population...
September 29, 2016: Current Opinion in Anaesthesiology
Angela Galeotti, Annelyse Garret Bernardin, Vincenzo D'Antò, Gianmaria Fabrizio Ferrazzano, Tina Gentile, Valeria Viarani, Giorgio Cassabgi, Tiziana Cantile
Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients. Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score...
2016: BioMed Research International
Marc A Auerbach, Marjorie Lee White, Sweta Bhargava, Pavan Zaveri, Elizabeth B Seelbach, Rebekah A Burns, Renuka Mehta, Brett McAninch, Daniel Fein, Todd P Chang, David O Kessler
OBJECTIVES: Few published studies describe graduating pediatric residents' procedural skills or success rates. This information would help guide supervisors' decisions about graduating residents' preparedness, training, and supervision needs. This study aimed to measure success rates for graduating pediatric residents performing infant lumbar puncture (LP) during the final months of their training and to describe their experiences performing and supervising infant LPs during the course of their training...
October 6, 2016: Pediatric Emergency Care
M J Paldino, F Golriz, M L Chapieski, W Zhang, Z D Chu
BACKGROUND AND PURPOSE: The biologic basis for intelligence rests to a large degree on the capacity for efficient integration of information across the cerebral network. We aimed to measure the relationship between network architecture and intelligence in the pediatric, epileptic brain. MATERIALS AND METHODS: Patients were retrospectively identified with the following: 1) focal epilepsy; 2) brain MR imaging at 3T, including resting-state functional MR imaging; and 3) full-scale intelligence quotient measured by a pediatric neuropsychologist...
October 13, 2016: AJNR. American Journal of Neuroradiology
Robert H Friesen
Pediatric cardiac anesthesia has developed over the past eight decades into a specialty delivering complex clinical care and contributing remarkable scientific progress. The history of this development can be traced through journal articles that mark the strides of the specialty. This article discusses journal articles, chosen by the author, that he considers had a significant impact on the practice of pediatric cardiac anesthesia or are of historical interest.
October 13, 2016: Paediatric Anaesthesia
Mohamed M Abu Elyazed, Shaimaa F Mostafa, Mohammad A Abdullah, Gehan M Eid
BACKGROUND: Transversus abdominis plane block (TAP) is a compartmental block of the anterior abdominal wall. Surgical trauma produces multisystem reactions. Anesthetic techniques can modify the neuroendocrine surgical stress response. AIM: The aim of this study was to evaluate the effect of TAP block on the modification of the surgical neuroendocrine stress response as well as its analgesia effect in children undergoing open inguinal hernia repair. METHOD: Sixty children aged 3-10 years undergoing elective unilateral open inguinal hernia repair were randomized into group I (general anesthesia) or group II (received TAP block after induction of general anesthesia)...
October 12, 2016: Paediatric Anaesthesia
J Ulrici, G Hempel, M Sasse, J Vollrath, C Höhne
BACKGROUND: Overweight and obesity are increasing problems in pediatric anesthesia. This observational study was designed to examine how airway-related complications occur in overweight children and adolescents during general anesthesia and if this is a relevant problem in Germany. METHODS: From October 2008 until August 2009, at the university clinic in Leipzig, 504 in- and outpatients, aged 2-18 years, ASA I-III, undergoing elective procedures (ENT and pediatric surgery), were observed...
October 10, 2016: Der Anaesthesist
Pokket Sirisreetreerux, Kathy M Lue, Thammasin Ingviya, Daniel A Friedlander, Heather N Di Carlo, Paul D Sponseller, John P Gearhart
PURPOSE: A successful primary bladder exstrophy closure provides the best opportunity for patients to achieve a functional closure and urinary continence regardless of the method of repair. Use of osteotomy during initial closure has significantly improved success rates, however failures can still occur. This study aimed to identify factors that contribute to a failed primary exstrophy closure with osteotomy. MATERIALS AND METHODS: A prospectively-maintained institutional database was reviewed for classic bladder exstrophy patients who were primarily closed with osteotomy at our institution or referred after primary closure from 1990 to 2015...
October 5, 2016: Journal of Urology
Mineto Kamata, Corey Stiver, Aymen Naguib, Dmitry Tumin, Joseph D Tobias
OBJECTIVES: The objectives of this study were to evaluate the effect of ventricular morphology on perioperative outcomes during Fontan surgery. DESIGN: Retrospective cohort study. SETTING: Single standing, not-for-profit pediatric hospital. PARTICIPANTS: A total of 72 patients who underwent Fontan surgery using cardiopulmonary bypass without aortic cross-clamp between January 1, 2009 and December 31, 2014. INTERVENTIONS: None...
July 19, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Ji Young Kim, Yu Rim Shin, Hae Keum Kil, Mi Ran Park, Jong Wha Lee
BACKGROUND Rotational thromboelastometry (ROTEM®) is a point-of-care test for coagulation, enabling physicians to make a swift decision. The aim of this investigation was to establish reference intervals of thromboelastometric evaluation for coagulation in pediatric patients with congenital heart diseases (CHD). MATERIAL AND METHODS As baseline data, 3 assays of ROTEM® (INTEM, EXTEM, and FIBTEM) were measured after anesthesia induction. ROTEM® parameters were clotting time (CT), amplitude at 10 min (A10), clot formation time (CFT), a angle, maximal clot firmness (MCF), clot lysis index at 60 min (LI60), and maximal clot elasticity (MCE)...
October 6, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
J William Sparks, Mary Landrigan-Ossar, Amy Vinson, Jennifer Dearden, Andres T Navedo, David B Waisel, Robert S Holzman
The Accreditation Council for Graduate Medical Education requires medical training programs to monitor, track, and formally document a fellow's performance. If deficiencies are found, programs are expected to prepare and implement an effective plan of action for improvement and to ensure that graduates acquire the personal and professional attributes of an independent physician. We revised our evaluation policy and instituted a remediation protocol in 2008. Since that time, 130 pediatric anesthesia fellows have graduated...
November 2016: Journal of Clinical Anesthesia
Ricardo Riveros, Stephen Kimatian, Pilar Castro, Vipul Dhumak, Hooman Honar, Edward J Mascha, Daniel I Sessler
STUDY OBJECTIVE: To assess professionalism in anesthesiology residents, it is important to obtain evaluations from people with whom they interact on daily basis. The purpose of this study was to evaluate the effect of a Multisource feedback (MSF) on resident's professional behavior and to assess the effect of faculty feedback on resident performance. DESIGN: This study was a two-group randomized clinical trial. SETTING: Residents were recruited from Cleveland Clinic Children's Hospital...
November 2016: Journal of Clinical Anesthesia
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