Summary
Background
Few data are available in the literature on risk factors for postoperative vomiting (POV) in children.
Objective
The aim of the study was to establish independent risk factors for ...POV and to construct a pediatric specific risk score to predict POV in children.
Methods
Characteristics of 2392 children operated under general anesthesia were recorded. The dataset was randomly split into an evaluation set (n = 1761), analyzed with a multivariate analysis including logistic regression and backward stepwise procedure, and a validation set (n = 450), used to confirm the accuracy of prediction using the area under the receiver operating characteristic curve (ROCAUC), to optimize sensitivity and specificity.
Results
The overall incidence of POV was 24.1%. Five independent risk factors were identified: stratified age (>3 and <6 or >13 years: adjusted OR 2.46 95% CI 1.75–3.45; ≥6 and ≤13 years: aOR 3.09 95% CI 2.23–4.29), duration of anesthesia (aOR 1.44 95% IC 1.06–1.96), surgery at risk (aOR 2.13 95% IC 1.49–3.06), predisposition to POV (aOR 1.81 95% CI 1.43–2.31), and multiple opioids doses (aOR 2.76 95% CI 2.06–3.70, P < 0.001). A simplified score was created, ranging from 0 to 6 points. Respective incidences of POV were 5%, 6%, 13%, 21%, 36%, 48%, and 52% when the risk score ranged from 0 to 6. The model yielded a ROCAUC of 0.73 95% CI 0.67–0.78 when applied to the validation dataset.
Conclusions
Independent risk factors for POV were identified and used to create a new score to predict which children are at high risk of POV.
Introduction
The COVID‐19 pandemic has prompted the development of anesthesia teleconsultation in many countries. In pediatric anesthesia, data about anesthesia teleconsultation are scarce. The main ...objective of this prospective descriptive study was to provide an evaluation of the feasibility of pediatric anesthesia teleconsultation. Perception of the safety and quality, parental and medical satisfaction were also assessed.
Methods
From September to December 2020, patients undergoing a pediatric anesthesia teleconsultation in Toulouse University Hospital, using the TeleO™ dedicated teleconsultation platform were prospectively included. Feasibility was defined as the rate of anesthesia teleconsultations successfully performed using the TeleO™ platform alone. Questionnaires regarding the quality, safety, and satisfaction were filled in by physicians and families.
Results
A total of 114 children (3 months–17 years) were included in the study. Feasibility was 82%, failure was mainly caused by technical issues. Physicians estimated that the safety and quality of anesthetic preparation were optimal in 100% of cases. Anesthetists were satisfied (VAS ≥70/100) with the medical, technical, and relational (child/parents) aspects of anesthesia teleconsultation in 91%, 64%, and 84%/90% of cases respectively. Almost all parents (97%) stated that they would agree to anesthesia teleconsultation for a future procedure.
Conclusion
In this first assessment, pediatric anesthesia teleconsultation appears to be feasible, with high rates of medical and parental satisfaction. Physicians' perception of the safety and quality of this process were positive. Improving the technical process might be a key determinant to promote further development of pediatric anesthesia teleconsultation.
Introduction
Protective ventilation is now a standard of care in adults. However, management of ventilation is heterogeneous in children and little is known regarding the mechanical ventilation ...parameters actually used during pediatric anesthesia.
Aim
The aim of the study was to assess current ventilatory practices during pediatric anesthesia in France and to compare them with pediatric experts' statements, with a specific focus on tidal volume.
Patients and methods
We conducted a prospective multicenter observational study, regarding the ventilatory management and the mechanical ventilation parameters, over two days (21 and 22 June 2017) in 29 pediatric centers in France. All children undergoing general anesthesia during these 2 days were eligible; those who required extracorporeal circulation or one‐lung ventilation were excluded.
Results
A total of 701 children were included; median IQR age was 60 24‐120 months. Among the patients in whom controlled ventilation was used, 254/515 (49.3%) had an expired tidal volume >8 mL/kg and 44 children (8.8%) an expired tidal volume ≥10 mL/kg. Lower weight and use of a supraglottic airway device were significantly associated with provision of a tidal volume ≥10 mL/kg (odds ratio 0.94, 95% confidence interval 0.92; 0.97, P < .001 and 2.28 1.20; 4.31, P = .012, respectively). The positive end‐expiratory pressure was set at a median IQR of 4 3‐5 cmH2O; it was <3 cmH2O in 15.7% of children and not used in 56/499 (9.3%). Among intubated children, 57 (18.3%) received a tidal volume < 10 mL/kg with a positive end‐expiratory pressure ≥3 cmH2O in association with recruitment maneuvers.
Conclusions
Ventilatory practices in children were heterogenous, and a large proportion of children were not ventilated as it is currently recommended by some experts.
To provide French guidelines about "Airway management during paediatric anaesthesia".
A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société ...Française d’Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d’Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded.
The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology.
The SFAR Guideline panel provides 17 statements on “airway management during paediatric anaesthesia”. After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts’ opinions. No recommendation could be provided for 3 questions.
Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
The aim of the study was to evaluate early minimal enteral feeding (MEF) and gradual enteral nutrition increment on neonatal outcome of gastroschisis.
An intervention group was prospectively assessed ...and compared with an observational historical control group. The prospective study relied on a new protocol of enteral nutrition. According to the new protocol, MEF was initiated 5 days after bowel reintegration and milk amounts were increased 12 mL/kg/day. In the control group, enteral nutrition was delayed until resolution of postoperative ileus, and increment of feeding was not systematized.
Twenty-two patients were included in the MEF group and compared with 51 control patients. Infants in the control group had lower gestational age (36 vs 35 gestational weeks GW, P=0.03) and birth weight (2465 vs 2200 g, P=0.05). Time to first enteral nutrition (5 vs 11.5 days, P=0.0005) was significantly shorter in the MEF group. All patients in this group were fully enteral fed at day 60, though 30.4% of patients in the control group still needed parenteral nutrition at day 60 (P=0.004). Incidence of nosocomial infection was reduced (9% of patients vs 40%, P=0.016) and hospital stay tended to be shorter in the MEF group (40 vs 54.5 days, P=0.08). In the univariate analysis, factors influencing the length of parenteral nutrition during the 2 periods were the severity of perivisceritis and new nutritional protocol. In the multivariate analysis, only nutritional protocol was significantly associated with the length of parenteral nutrition (P=0.038).
Early MEF and controlled increase of nutritional elements after bowel reintegration significantly improved outcome of gastroschisis in newborns.
•What is already known: The practice of paediatric anaesthesia is highly variable in Europe. The participation of French centres to the APRICOT study allows comparison with other practices in ...Europe.•What this article adds: The current study describes the epidemiologic and perianaesthetic data of the population of children anaesthetised in the French centres that participated to APRICOT and determine some key points for improving perioperative safety.•Implications for translation: a wider spread of some key elements about safety during perioperative management in children has to be undertaken.
Analysing national patients’ profile and organisation of human resources are important for improving the perioperative quality of care. The aim of the current study was to achieve these goals using the French data from the APRICOT study.
Data from the French centres that participated to the APRICOT study were extracted and analysed. The primary goal of the study was to describe patients’ characteristics, procedures and perioperative anaesthetic management in France, and compare them to the results of the European APRICOT trial. Secondary outcomes were the description of major perioperative complications and the determination of human resources organisation possibly associated with these perioperative complications.
Overall 3535 procedures collected in 20 facilities (17 teaching hospitals, one community hospital and two private institutions) were analysed. Comparison between the French and European APRICOT cohorts found differences related to the more specialised French centres participating to the study. Overall complications (respiratory complications, haemodynamic instability, cardiac arrest, drug errors, and anaphylactic reactions) were observed in 6.4% 95% CI: 5.6; 6.3 of cases. Multivariate analysis identified the anaesthesiologist's experience of<15 years and the absence of an anaesthetic nurse as human factors independently associated with an increased risk for perioperative complications.
The current study identified some important differences between the French and the whole APRICOT cohort in terms of preoperative evaluation, surgical specialties involved, and monitoring of neuromuscular blockade. It confirms that, in France, the presence of an anaesthetic nurse and an experienced anaesthesiologist prevents anaesthetic complications.
Gestion des voies aeriennes de l’enfant Dadure, Christophe; Sabourdin, Nada; Veyckemans, Francis ...
Anesthésie & Réanimation,
September 2019, Letnik:
5, Številka:
5
Journal Article
Recenzirano
Odprti dostop
À ce jour, plus de 50 % des événements critiques périopératoires de l’enfant sont d’origine respiratoire. La bonne gestion des voies aériennes de l’enfant lors d’une anesthésie générale fait partie ...des préoccupations majeures des anesthésistes-réanimateurs. Les objectifs de ces recommandations formalisées d’experts étaient d’apporter une modification ou amélioration des pratiques cliniques répondant aux évolutions techniques dans la gestion des voies aériennes supérieures de tout enfant, mais également de valider au niveau national des connaissances reconnues dans la littérature ou auprès de sociétés savantes internationales. Par ailleurs, un point particulier a abordé la gestion des VAS de l’enfant enrhumé, potentiel facteur de risque en anesthésie pédiatrique. Parmi les recommandations, les experts recommandent l’utilisation préférentielle des dispositifs supraglottiques lors des interventions superficielles de courte durée avec monitorage de la pression du coussinet si possible. L’utilisation de sonde à ballonnet est préférable lors de l’intubation trachéale avec monitorage de la pression du ballonnet. L’intubation doit être systématique pour une chirurgie d’amygdalectomie chez l’enfant. La place des vidéolaryngoscopes est précisée lors de l’intubation difficile. L’utilisation des curares est redéfinie que ce soit durant l’induction à séquence rapide ou lors d’une anesthésie classique avec intubation orotrachéale. Pour l’enfant enrhumé, les experts recommandent l’utilisation préférentielle, si possible, du masque facial comparé à la sonde d’intubation ou dispositif supraglottique et, pour l’enfant de moins de 6 ans, la nébulisation de salbutamol avant l’anesthésie générale. Le but final de ces recommandations est d’envisager une diminution de la morbi-mortalité respiratoire de l’anesthésie des enfants par une amélioration des pratiques cliniques quotidiennes.
To provide French guidelines about “Airway management during paediatric anaesthesia”.
A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d’anesthésie-réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association des anesthésistes réanimateurs pédiatriques d’expression francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded.
The panel focused on 7 questions: (1) Supraglottic Airway devices; (2) Cuffed endotracheal tubes; (3) Videolaryngoscopes; (4) Neuromuscular blocking agents; (5) Rapid sequence induction; (6) Airway device removal; (7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology.
The SFAR Guideline panel provides 17 statements on “airway management during paediatric anaesthesia”. After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1±), 6 have a low level of evidence (Grade 2±) and 5 are experts’ opinions. No recommendation could be provided for 3 questions.
Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
Abstract Background Management of patients with total intestinal aganglionosis (TIA) is a medical challenge because of their dependency on parenteral nutrition (PN). Intestinal transplantation (ITx) ...represents the only alternative treatment for patients with irreversible intestinal failure for achieving intestinal autonomy. Methods Among 66 patients who underwent ITx in our center, 12 had TIA. They received either isolated ITx (n = 4) or liver-ITx (LITx, n = 8) after 10 to 144 months of total PN. All grafts included the right colon. Results After a median follow-up of 57 months, the survival rate was 62.5% in the LITx group and 100% in the ITx patients. The graft survival rate was 62.5% in the LITx group and 75% in the ITx group. All the surviving patients were fully weaned from total PN, after a median of 57 days. Pull through of the colon allograft was carried out in all patients. Fecal continence is normal in all but one of the surviving children. Conclusion These results suggest that ITx with colon grafting should be the preferred therapeutic option in TIA. Early referral to a transplantation center after diagnosis of TIA is critical to prevent PN-related cirrhosis and thereby to permit ITx, which is associated with a good survival rate.
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