Pediatric Anesthesia
Meta-Analysis: Daily Sedation Interruption Shortens PICU Stay Without Impacting Mortality or Ventilation Duration in Pediatric MV Patients – JAMA Netw Open
11 Aug, 2024 | 13:19h | UTCStudy Design and Population: This systematic review and meta-analysis included six randomized clinical trials (RCTs) involving 2,810 pediatric patients receiving mechanical ventilation (MV) in the pediatric intensive care unit (PICU). The trials compared the effects of daily sedation interruption (DSI) with continuous intravenous (IV) sedation on clinical outcomes such as MV duration and PICU length of stay.
Main Findings: The analysis found that DSI was associated with a significant reduction in the length of PICU stay (mean difference of -1.45 days, p = 0.03). However, there was no significant difference in the duration of MV between DSI and continuous sedation (mean difference of -0.93 days, p = 0.06). Additionally, there were no significant differences in total sedative doses, adverse events, or mortality between the two groups.
Implications for Practice: The findings suggest that DSI may reduce the length of PICU stay without increasing the risk of adverse events, making it a potentially valuable strategy in managing sedation for pediatric patients on MV. However, further research is needed to explore the long-term neurodevelopmental outcomes associated with DSI.
RCT: Video laryngoscopy improves first-attempt intubation success in neonates compared to direct laryngoscopy – N Engl J Med
11 May, 2024 | 13:37h | UTCStudy Design and Population: This single-center randomized clinical trial investigated the efficacy of video laryngoscopy versus direct laryngoscopy for urgent intubation in neonates. A total of 226 neonates requiring intubation either in the delivery room or neonatal intensive care unit (NICU) were enrolled and stratified by gestational age into two groups: less than 32 weeks and 32 weeks or more. The study primarily focused on the success rate of the first intubation attempt, monitored through exhaled carbon dioxide detection.
Main Findings: The trial included 214 neonates, analyzing the success of intubation on the first attempt. Video laryngoscopy significantly outperformed direct laryngoscopy, achieving a first-attempt success rate of 74% (95% confidence interval [CI], 66 to 82) compared to 45% (95% CI, 35 to 54) in the direct laryngoscopy group. Moreover, the median number of attempts for successful intubation was lower in the video-laryngoscopy group (1 attempt, 95% CI, 1 to 1) versus the direct-laryngoscopy group (2 attempts, 95% CI, 1 to 2). Additionally, neonates in the video laryngoscopy group experienced higher median lowest oxygen saturations and heart rates during intubation.
Implications for Practice: The findings suggest that video laryngoscopy could be more effective than direct laryngoscopy for urgent neonatal intubation, particularly in increasing the likelihood of success on the first attempt. These results recommend reconsidering current intubation techniques in neonatal care settings to incorporate video laryngoscopy, potentially leading to safer and more efficient intubation processes in this vulnerable population.
Reference (link to abstract – $ for full-text):
M-A | Inhaled nitrous oxide for painful procedures in children and youth
22 May, 2023 | 13:29h | UTC
Review | Rapid sequence induction in pediatric anesthesia
4 May, 2023 | 13:26h | UTC
Review | Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery
21 Mar, 2023 | 13:09h | UTCRegional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery – Current Opinion in Anesthesiology (free for a limited period)
M-A | Needle-free pharmacological sedation techniques in pediatric patients for imaging procedures
8 Feb, 2023 | 12:26h | UTC
M-A | Intranasal midazolam vs. intranasal ketamine as sedative premedication in pediatric patients
8 Feb, 2023 | 12:24h | UTC
AHA Statement | Perioperative care for children with congenital heart disease presenting for noncardiac procedures
26 Jan, 2023 | 12:26h | UTCCommentary: AHA Weighs in on Risks of Noncardiac Surgery in Congenital HD Patients – TCTMD
M-A | Enhanced recovery after surgery in children undergoing abdominal surgery
23 Jan, 2023 | 13:12h | UTCEnhanced recovery after surgery in children undergoing abdominal surgery: meta-analysis – BJS Open
AAP Clinical Report | Use of point-of-care ultrasonography in the NICU for diagnostic and procedural purposes
17 Jan, 2023 | 13:32h | UTCUse of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes – Pediatrics
Technical Report: Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes – Pediatrics
News Release: AAP Issues Reports on Point-of-care Ultrasonography Applications in the NICU – American Academy of Pediatrics
Commentary on Twitter
This clinical report describes the current landscape of neonatal point-of-care ultrasonography (POCUS), outlines barriers for implementation, & provides a suggested educational framework for successful implementation of a POCUS program: https://t.co/HuiNI3gBUK #Pediatrics pic.twitter.com/5IDjwoY8dg
— AAP Pediatrics (@aap_peds) November 29, 2022
RCT | Effective dose of ephedrine for treatment of hypotension after induction of anesthesia in neonates and infants less than 6 months of age
17 Jan, 2023 | 13:06h | UTCEffective dose of ephedrine for treatment of hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age: a multicentre randomised, controlled, open label, dose escalation trial – British Journal of Anaesthesia (link to abstract – $ for full-text)
2023 ASA Guidelines for preoperative fasting
15 Jan, 2023 | 20:42h | UTC
Effectiveness of a multidisciplinary program to prevent pressure injuries in children undergoing long-duration surgeries.
3 Nov, 2022 | 13:43h | UTC
M-A | The outcome of post-cardiotomy extracorporeal membrane oxygenation in neonates and pediatric patients.
4 Aug, 2022 | 13:48h | UTC
RCT: Effect of nitric oxide via cardiopulmonary bypass on ventilator-free days in young children undergoing congenital heart disease surgery.
28 Jun, 2022 | 10:55h | UTCEffect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days in Young Children Undergoing Congenital Heart Disease Surgery: The NITRIC Randomized Clinical Trial – JAMA (free for a limited period)
News Release: Nitric oxide does not improve babies’ recovery after heart surgery – University of Zurich
Commentary on Twitter
In this randomized clinical trial, among infants undergoing heart surgery, delivery of nitric oxide into the cardiopulmonary bypass did not increase ventilator-free survival at 28 days. https://t.co/VJzBLPOP6U
— JAMA (@JAMA_current) June 27, 2022