Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: A prospective observational study.
The study looks specifically at whether the experience of emergence agitation after anaesthesia in small children will lead to deteriorating behaviour a week post-operatively. This is a fraught area: we know post-operative behavioural regression is a real phenomenon, but ascertaining which factors in the peri-operative journey contribute can be complex. Pre-existing anxiety, pain, prolonged admissions […]
Operations and outcomes of a Hospital-wide Emergency Airway Response Team (HEART) in a quaternary academic children’s hospital.
Background This article looks at the outcome of emergency airway interventions and incidence of airway complications before and after the creation of a formal hospital emergency airway response team (HEART) in a specialist paediatric hospital. Design Retrospective cohort study. Single site. Study period January 2017 to December 2019 HEART: Multidisciplinary team (anesthesiology, ICU physicians, otorhinolaryngology […]
Incidence, characteristics and risk factors for perioperative cardiac arrest and 30-day-mortality in preterm infants requiring non-cardiac surgery.
Summary This is a retrospective observational study that includes 229 preterm infants (age < 37wk) having surgery from the records of 22,650 paediatric anaesthetics in one large German tertiary hospital over 10 years (2008-18). 30-day-mortality was 10.9% (25/229) and perioperative mortality 0.9% (2/229). Risk factors for mortality were perioperative cardiac arrest (OR 12.5), low body […]
Optimal positive end-expiratory pressure to prevent anaesthesia-induced atelectasis in infants: A prospective, randomised, double-blind trial.
Background and Objectives Anaesthesia related atelectasis is common in paediatrics. This study’s main aim was to measure the effects of positive end-expiratory pressure (PEEP) on alveolar recruitment in children by using lung ultrasound measurements. In addition, PEEP effects on the cardiovascular system (CVS) were measured using oesophageal Doppler US (CardioQ doppler system) and on the […]
Effect of positive end-expiratory pressure during anaesthesia induction on non-hypoxic apnoea time in infants: A randomised controlled trial.
Aim Evaluate the effect of positive end-expiratory pressure (PEEP) during anaesthetic induction on non-hypoxic apnoea time in infants Study Design Single centre RCT in a tertiary paediatric hospital. Methods “Normal” infants <1yr age (no neonates, difficult airways etc). Standardised GA (IV induction, SV with sevoflurane in 100% O2 followed by NMB over 2 minutes.) 100% oxygen […]
Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis.
Summary This article is based on 34 studies suitable for meta-analysis out of 36 eligible studies suitable for systematic reviews, which were in turn selected out from 2185 abstracts found through a literature search using Medline, Embase & PsyINFO, and 5 articles from Google Scholar manual search. The combined selected studies have 3406 patients between […]
Renal tissue desaturation and acute kidney injury in infant cardiac surgery: a prospective propensity score-matched cohort study.
This paper purports to show that renal desaturation as measured by near-infrared spectroscopy (NIRS) is a predictor of renal impairment in infants undergoing ventricular septal defect (VSD) repair. There is some published work (mostly small case series) that has shown that low somatic NIRS in neonates/infants is predictive of gastrointestinal ischaemia or renal impairment. This […]
Anatomical In Vitro Investigations of the Pediatric Larynx: A Call for Manufacturer Redesign of Tracheal Tube Cuff Location and Perhaps a Call to Reconsider the Use of Uncuffed Tracheal Tubes.
What An examination of fresh autopsy specimens of Caucasian larynxes aged from newborn to 126 months, to assess airway anatomy and relation of Microcuff endotracheal tubes to laryngeal structures. How 2-part assessment. Firstly, examination and measurement of autopsy larynxes with measurement of AP and transverse diameter of the cricoid outlet, interarytenoid diameter, cricothyroid membrane and […]
Effect of Permissive Mild Hypercapnia on Cerebral Vasoreactivity in Infants: A Randomized Controlled Crossover Trial.
Background PaCO2 is a major regulator of cerebral vascular tone. Hypocapnia can result in poor neonatal neurological outcomes, presumably through decreased cerebral blood flow. The clinical effect of mild hypercapnia is less well known. Study Summary This study investigates whether mild hypercapnia increases cerebral blood flow by calculating Tissue Oxygenation Index (TOI) and Tissue Haemoglobin […]