Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2023
Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity.
Postoperative pneumonia increases the risk of postsurgical mortality, making it a serious healthcare-associated complication. Children with preoperative neuromuscular impairments have a higher risk of postoperative pneumonia. Obesity is also a risk factor for postoperative pulmonary complications, including pneumonia. Moreover, obesity is increasingly prevalent among children living with a neurological diagnosis. Whether obesity increases the risk of postoperative pneumonia among children with neurologic diseases remains largely unknown. Therefore, we assessed the risk of postoperative pneumonia among children with neurologic diagnoses based on their obesity status. ⋯ Childhood obesity buffered the association between neurologic disorders and postoperative pneumonia, consistent with an 'obesity paradox'. Further research exploring the underlying mechanisms for the obesity paradox in children with neurologic disorders is warranted.
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Paediatric anaesthesia · Feb 2023
Case ReportsUnsuspected severe tracheal stenosis and tracheomalacia after correction surgery for congenital scoliosis: A case report.
Tracheal stenosis and tracheomalacia in patients with congenital scoliosis are serious and rare conditions caused by congenital dysplasia, postintubation injury, trauma, and tracheal tumor. Anesthesia of a child with tracheal stenosis is challenging for anesthesiologists. We describe an 8-year-old female patient developed severe tracheal stenosis and tracheomalacia after growing rod implantation for congenital scoliosis. Comprehensive assessment of preoperative pulmonary function and airway morphology, which can be neglected clinically, should be performed in congenital scoliosis patients.
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Paediatric anaesthesia · Feb 2023
Randomized Controlled TrialImpact of intravenous dexamethasone on the initiation and recovery of atracurium in children: A double-blinded randomized controlled trial.
Chronic steroid intake has been associated with attenuation of neuromuscular block. Despite some promising animal and adult studies, the effect of a single dose of intravenous dexamethasone on neuromuscular blockers is not well established. Thus, the present study aimed to demonstrate the effect of dexamethasone given at the time of induction for the prevention of PONV on the action of neuromuscular blockers in children undergoing elective surgery. ⋯ Application of a single bolus dose (0.15 mg/kg) of dexamethasone during induction does not attenuate atracurium-induced neuromuscular blockade in children.
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Paediatric anaesthesia · Feb 2023
Meta AnalysisModeling iatrogenic intraoperative hyperthermia from external warming in children: a pooled analysis from two prospective observational studies.
Maintenance of normothermia is an important quality metric in pediatric anesthesia. While inadvertent hypothermia is effectively prevented by forced-air warming, this therapeutic approach can lead to iatrogenic hyperthermia in young children. ⋯ In children, external warming by forced-air needs to be closely monitored and adjusted in a timely manner to avoid iatrogenic hyperthermia especially during long procedures, in young age, higher surface-area-to-weight ratio, and higher baseline temperature.