Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2025
ReviewError Traps in Developing a Pediatric Enhanced Recovery After Surgery (ERAS) Program.
Enhanced recovery after surgery (ERAS) pathways have been shown to improve patient outcomes, increase patient satisfaction, and decrease costs. First created and implemented in the adult population, these pathways are now commonplace and continue to expand in the pediatric realm. ⋯ Key themes include departmental and institutional support, stakeholder engagement, awareness of pathways, data management and dissemination, and long-term maintenance including Plan-Do-Study-Act (PDSA) cycles. Pathway development teams should be aware of these considerations and potential pitfalls, and focusing on them can promote long-term success for a well-designed pathway.
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Paediatric anaesthesia · Feb 2025
ReviewHistorical Development and Experience of Day Surgery in China: From the Perspective of Anesthesiologists.
Day surgery has become the main mode of surgery in American and European countries, but it is still in the early stage in developing countries due to the limitation of medical technology and the backward management concept. At present, day surgery accounts for more than 60% of elective surgery in many countries in Europe and North America and more than 85% in countries such as the United Kingdom and the United States. There are 8469 ambulatory surgery centers in the United States in 2023. In China, the first ambulatory surgery center was established in 2001. In 2018, more than half of the tertiary hospitals (high-level hospitals) in China carried out day surgery, of which 639 hospitals set up ambulatory surgery centers; the proportion of day surgery in elective surgery increased to 12.8%. The annual number of day surgeries exceeded 1.25 million. In 2022, our hospital established an ambulatory surgery center managed by anesthesiologists. Day surgery requires anesthesiologists to participate in the whole process of patient management from preoperative preparation to postoperative recovery. The establishment of ambulatory surgery centers managed by anesthesiologists is of great significance to China, developing countries, and the whole world. ⋯ We call on anesthesiologists, other physicians, surgeons, nurses, and health system managers around the world to promote efficient, low-cost day surgery in developing countries and thereby increase access to surgical treatment for the world's poor.
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Paediatric anaesthesia · Feb 2025
ReviewFocused Review of Enhanced Recovery After Abdominal Trauma Surgery in the Pediatric Population and Development of a Pediatric Enhanced Recovery After Trauma Surgery Pathway.
Traumatic injuries are the leading cause of morbidity and mortality amongst pediatric patients; improving outcomes after pediatric abdominal trauma surgery could be quite impactful. Although enhanced recovery after surgery (ERAS) pathways have been successfully employed in adult trauma patients, there are few studies on pediatric enhanced recovery after abdominal trauma surgery and no consensus post trauma surgery guidelines for children. ⋯ We propose a pediatric enhanced recovery after trauma surgery pathway, which highlights several principles of ERAS pathways (multimodal analgesia, goal-directed fluid therapy, early initiation of nutrition, timely administration of antibiotics, avoidance of hypothermia, DVT prophylaxis, the early removal of drains and indwelling catheters, and patient education).
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Paediatric anaesthesia · Feb 2025
ReviewDesign considerations for development of cuffed endotracheal tube for small airways.
Endotracheal tubes (ETTs) are life-supporting devices that are designed to maintain a patent airway in patients who are unable to sustain an airway due to illness or injury. Patients with small airways, such as neonates and pediatrics, have unique structural and functional features, making it essential that ETT design considers and executes on these particular needs. Though uncuffed ETTs have historically been preferred for patients younger than eight years of age, advances in cuffed ETT design and construction can be utilized to manufacture ETTs that are optimized for the smallest, most fragile airways. The purpose of this article is to discuss certain design features of cuffed ETTs in respect to small airways.
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Paediatric anaesthesia · Feb 2025
ReviewOptimizing the anesthetic care of patients with aromatic l-amino acid decarboxylase deficiency.
Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare autosomal recessive disorder that results in a lack of the monoamine neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine. Patients present with a wide spectrum of symptoms, including motor and autonomic dysfunction, hypotonia, and developmental delay, often before the age of one. Until recently, treatment options were limited to symptom control, but the recent approval of the first gene therapy for AADC deficiency in Europe and the UK has provided an alternative to treating symptoms for this disease. ⋯ Intraoperatively, utmost care must be taken to protect the skin, maintain body temperature, and to prepare for inotropic and/or glycemic support as needed. Postoperative intensive care management is necessary for consideration of postoperative extubation and provision of supportive care. With careful planning, preparation, and vigilance, patients with AADC deficiency can safely undergo anesthesia.