Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2024
Review Meta AnalysisIncidence of emergence agitation in children undergoing sevoflurane anesthesia compared to isoflurane anesthesia: An updated systematic review and meta-analysis.
Emergence agitation is a complex syndrome of altered consciousness after emergence from anesthesia. It can result in injury to patients and staff and is associated with other postoperative complications. Sevoflurane has been associated with emergence agitation, potentially due to low tissue solubility and therefore speed of emergence. Prior meta-analyses comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics did not demonstrate a statistically significant difference. Given the publication of additional relevant studies not included in prior meta-analyses as well as improved diagnosis of emergence agitation, we aim to perform an updated, comprehensive meta-analysis comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics in children. ⋯ The risk of emergence agitation in children after maintenance anesthesia with sevoflurane is significantly greater than with isoflurane; we did not find evidence of prolonged emergence or postanesthetic length of stay. When possible, isoflurane should be considered for maintenance anesthesia over sevoflurane in patients at high risk of emergence agitation.
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Paediatric anaesthesia · Apr 2024
A pragmatic methodology to extract anesthetic and physiological data from the electronic health record.
Traditional manual methods of extracting anesthetic and physiological data from the electronic health record rely upon visual transcription by a human analyst that can be labor-intensive and prone to error. Technical complexity, relative inexperience in computer coding, and decreased access to data warehouses can deter investigators from obtaining valuable electronic health record data for research studies, especially in under-resourced settings. We therefore aimed to develop, pilot, and demonstrate the effectiveness and utility of a pragmatic data extraction methodology. ⋯ We describe a pragmatic data extraction methodology that does not require additional software or coding skills intended to enhance the ease, speed, and accuracy of data collection that could assist in clinician investigator-initiated research and quality/process improvement projects.
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Paediatric anaesthesia · Apr 2024
Case ReportsUnanticipated difficult airway after prolonged use of a laryngeal mask airway.
The laryngeal mask airway (LMA) is recognized as a safe alternative to endotracheal intubation for short-term airway maintenance. In this case report we present the case of a term neonate with upper airway obstruction which was managed with a deflated LMA for 7 consecutive days. Despite previous reports of extended LMA use in neonates without complications, this patient experienced significant pharyngeal mucosal injury and edema, leading to difficulty with subsequent intubation attempts.