Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2020
A systematic review of outcomes reported inpediatric perioperative research: A report from the Pediatric Perioperative Outcomes Group.
The Pediatric Perioperative Outcomes Group (PPOG) is an international collaborative of clinical investigators and clinicians within the subspecialty of pediatric anesthesiology and perioperative care which aims to use COMET (Core Outcomes Measures in Effectiveness Trials) methodology to develop core outcome setsfor infants, children and young people that are tailored to the priorities of the pediatric surgical population. Focusing on four age-dependent patient subpopulations determined a priori for core outcome set development: i) neonates and former preterm infants (up to 60 weeks postmenstrual age); ii) infants (>60 weeks postmenstrual age - <1 year); iii) toddlers and school age children (>1-<13 years); and iv) adolescents (>13-<18 years), we conducted a systematic review of outcomes reported in perioperative studies that include participants within age-dependent pediatric subpopulations. Our review of pediatric perioperative controlled trials published from 2008 to 2018 identified 724 articles reporting 3192 outcome measures. ⋯ Patient-centered outcomes, heath care utilization, and bleeding/transfusion related outcomes were less often reported. In most studies, outcomes were measured in the immediate perioperative period, with the duration often restricted to the post-anesthesia care unit or the first 24 postoperative hours. The outcomes identified with this systematic review will be combined with patient centered outcomes identified through a subsequent stakeholder engagement study to arrive at a core outcome set for each age-specific group.
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Paediatric anaesthesia · Jul 2020
Randomized Controlled TrialLung protective ventilation in infants undergoing cardiopulmonary bypass surgery for congenital heart disease: a prospective randomized controlled trial.
Lung protective ventilation (LPV) has been applied to surgical adults with normal pulmonary function for optimizing mechanical ventilation and reducing postoperative pulmonary complications. Few studies have reported the use of LPV in infants undergoing cardiac surgery with cardiopulmonary bypass (CPB). ⋯ LPV could be used safely in infants undergoing CPB in that it can improve oxygenation, alveolar aeration, and dynamic compliance, and reduce driving pressure, pulmonary shunting, and dead space. Its effect on oxygenation, pulmonary gas exchange, and pulmonary compliance was relatively short, and had less impact on postoperative pulmonary complications and prognosis.
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Paediatric anaesthesia · Jul 2020
ReviewPerioperative apnea in infants with hypertrophic pyloric stenosis: a systematic review.
Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis. ⋯ Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.
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Paediatric anaesthesia · Jul 2020
ReviewAnesthetic concerns for pediatric patients in the era of COVID-19.
After a novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported in China in December 2019, the disease quickly reached pandemic level. On January 30, 2020, the World Health Organization (WHO) declared that the SARS-CoV-2 outbreak constituted a Public Health Emergency of International Concern. ⋯ Several articles with recommendations on the anesthetic management of adult patients with COVID-19 have been published, but no specific recommendations for pediatric anesthesiologists have been made yet. This article addresses specific concerns for the anesthetic management of the pediatric population with COVID-19.
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Paediatric anaesthesia · Jul 2020
Observational StudyThe association between preoperative anaemia and postoperative morbidity in paediatric surgical patients: A secondary analysis of a prospective observational cohort study.
The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs). ⋯ Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.