Pediatric liver transplantation in Australia and New Zealand: The case for a collaborative anesthetic database.
CONCLUSIONS: Combining the anesthetic liver transplant data from all sites in a single registrywould expand data collection and generate broadly applicable findings. We propose the establishment of an Australasian pediatricanesthetic liver transplant database. PMID: 33222407 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - November 21, 2020 Category: Anesthesiology Authors: Paterson NAB, Lee-Archer P, Shirley A, Lee J Tags: Paediatr Anaesth Source Type: research

Ask the Question, Be the Solution: Fostering Wellbeing Through Contextualized Assessment and Strategy Development.
This articledescribes the development and implementation of a unique assessment strategy to identify the driving factors hindering wellbeing in our general anesthesiology division.We describe how collected data allowed us to identify important areas for improvement, build community, and target novel interventions to ultimately improve the wellbeing of our division for all members. This manuscript does not describe survey results in any detail, but rather aims to present a creative application of the Hawthorne Effect as it applies to understanding physician wellbeing. PMID: 33217761 [PubMed - as supplied by publisher] ...
Source: Paediatric Anaesthesia - November 20, 2020 Category: Anesthesiology Authors: Petrini LA, Thottathil P, Shih G, Henderson A, Pasquariello C, Black SA Tags: Paediatr Anaesth Source Type: research

Audit of Blood Product Utilization in the Care of Injured Children.
CONCLUSIONS: Theoverall blood product needs in the pediatric trauma population are low (1.56%). Selected populations requiring higher rates of need include infants younger than one year, and children with thoracic and vascular injuries . Understanding transfusion patterns is important to optimize resource allocation. PMID: 33190350 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - November 15, 2020 Category: Anesthesiology Authors: McGovern PE, Wu L, Rao S, Ahumada L, Friedman DF, Nance ML, Gálvez JA Tags: Paediatr Anaesth Source Type: research

Intraoperative Dextrose Rate during Exploratory Laparotomies in Neonates and the Incidence of Postoperative Hyperglycemia: A Retrospective Observational Study.
The objective of this study is to assess the association between halving the preoperative maintenance dextrose rate and postoperative euglycemia in neonatal intensive care unit patients undergoing exploratory laparotomies. METHODS: Neonatal intensive care unit patients who underwent exploratory laparotomy under general anesthesia from 1/1/2014 to 11/21/2019 were included in this analysis. Hyperglycemia and hypoglycemia were defined as> 150 mg/dL and
Source: Paediatric Anaesthesia - November 15, 2020 Category: Anesthesiology Authors: Kolesky SE, Nyshadham S, Williams HO, Trinh TA, Tucker AJ, Lam H, Austin TM Tags: Paediatr Anaesth Source Type: research

A quality improvement initiative to improve management ofprocedural pain in preterm neonates.
Abstract BACKGROUND: Neonates managed in neonatal intensive care units (NICU)undergo several invasive procedures. However, neonatal procedural pain is not well recognized and managed in most neonatal units. AIMS: To decrease the severity of procedural pain in preterm neonates (
Source: Paediatric Anaesthesia - November 14, 2020 Category: Anesthesiology Authors: Anne RP, Deshabhotla S, Ahmed SW, Ahmed SJ, Resu NR, Farooqui D, Oleti TP Tags: Paediatr Anaesth Source Type: research

Caring for the Caregiver Following an Adverse Event.
Abstract In this article, we review the potential for adverse impacts on the clinician following a medical error or poor clinical outcome. Second victim syndrome, its symptoms, risk factors, natural history and possible outcomes are described. We also discuss the important role of organizational leadership and culture and highlight possible programmatic interventions designed to support clinicians following an adverse event. PMID: 33185306 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - November 13, 2020 Category: Anesthesiology Authors: Tanabe K, Janosy N, Vogeli J, Brainard A, Whitney G Tags: Paediatr Anaesth Source Type: research

Symptomatology and racial disparities amongst children undergoing universal preoperative COVID-19 screening at three US children's hospitals: Early pandemic through resurgence.
Abstract The coronavirus disease 2019 (COVID-19) pandemic has seen>48 million confirmed cases worldwide as ofNovember 6, 2020.The infection rate amongst children was initially reported to be low, with children constituting only 2% of recorded cases. However, this reflected testing for COVID-19 only when symptomatic or with known close contact with an infected person(1). The purpose of this reportis to describe the characteristics of pediatric patients undergoing universal testing for COVID-19 during routine preoperativescreening at threetertiarychildren's hospitals across the United States. PMID: 33185923 ...
Source: Paediatric Anaesthesia - November 13, 2020 Category: Anesthesiology Authors: Adler AC, Shah AS, Blumberg TJ, Fazal FZ, Chandrakantan A, Ellingsen K, Nathanson BH, Lin EE Tags: Paediatr Anaesth Source Type: research

The Impact of Parental Health Mindset on Postoperative Recovery in Children.
Abstract BACKGROUND: Mindset, or one's beliefs about the ability to change one's outcomes, has been studied in the educational domain but not in surgical settings. The purpose of this study was to examine the role of parental health mindset on children's recovery. METHODS: Participants were part of a larger National Institutes of Health-funded trial that included 1470 children undergoing outpatient tonsillectomy and adenoidectomy. We used measures of parental coping style (Monitor Blunter Style Scale; MBSS) and medication attitudes (Medication Attitudes Questionnaire; MAQ) to validate the Health Beliefs Scale...
Source: Paediatric Anaesthesia - November 13, 2020 Category: Anesthesiology Authors: Kain A, Mueller C, Golianu BJ, Jenkins BN, Fortier MA Tags: Paediatr Anaesth Source Type: research

The effects of xenon on sevoflurane anesthesia-induced acidosis and brain cell apoptosis in immature rats.
Abstract Anesthesia-induced neurodegeneration (AIN) occurs in newborn large animal modelswhere physiological homeostasis is maintained. However, most immature rodent models of AINreport mortality ratesand hypercarbia alone, mimicking that produced by anesthesia, increases neuro-apoptosis1 .Thepotential influence of physiological derangement is one reason why rodent models of AIN are notidealfor predicting clinical effect.However, they remain necessary for theinitial pre-clinical investigation of toxicity or treatment. PMID: 33187024 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - November 13, 2020 Category: Anesthesiology Authors: Gill H, Pickering AE Tags: Paediatr Anaesth Source Type: research

The Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference Methodology.
This article describes the methodology used for the Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference. This is a novel Consensus Conference of national experts in Pediatric Craniofacial Surgery and Anesthesia, who will follow standards set by the Institute of Medicine and using the Research and Development/University of California, Los Angeles appropriateness method, modeled after the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Topics related to pediatric craniofacial anesthesia for open cranial vault surgery were divided into twelve subgroups with a systematic review of the li...
Source: Paediatric Anaesthesia - November 11, 2020 Category: Anesthesiology Authors: Derderian CK, Derderian CA, Fernandez A, Glover CD, Goobie S, Hansen JK, King M, Kugler J, Lang SS, Meier-Haran P, Nelson O, Reddy SK, Reid R, Ricketts K, Rottgers SA, Singh D, Szmuk P, Taicher BM, Taylor J, Stricker PA Tags: Paediatr Anaesth Source Type: research

Workplace wellbeing in pediatric anaesthesia: How to design and implement a bespoke evidence-based framework in your department.
This article outlines how an anaesthesia department can design and implement a framework for wellbeing, regardless of resources and financial constraints. The "Long lives, Healthy Workplaces toolkit" is a framework which has been specifically developed by mental health experts for anaesthetists, and does not require departments to pay for external experts.1 Departments can design a long-term model of evidence-based mental health strategies to meet their unique needs using five steps outlined in the toolkit and detailed in this article. The framework uses cycles of assessment and review to create an adaptable appr...
Source: Paediatric Anaesthesia - November 11, 2020 Category: Anesthesiology Authors: Shrivastava PP, McDonald JM Tags: Paediatr Anaesth Source Type: research

Development and Initial Validation of Self-Report Measures of General Gealth, Pre-Operative Anxiety, and Post-Operative Pain in Young Children Using Computer-Administered Animation.
Abstract BACKGROUND: For young children, existing measures of children's health-related quality of life (HRQOL) must be parent reported or interviewer administered for those who cannot read or complete measures independently. Parents' and childrens' reports about the child's health have been shown to disagree. AIMS: 1) To test the reliability and validity of an animated, computer administered Child Health Rating Inventories (CHRIS2.0) among children ages 4-12 undergoing surgery; and 2) to develop and test two CHRIS measures of pre-operative anxiety and post-operative pain management. METHODS: We conducte...
Source: Paediatric Anaesthesia - November 10, 2020 Category: Anesthesiology Authors: Kaplan SH, Fortier MA, Shaughnessy M, Maurer E, Vivero-Montemayor M, Gago Masague S, Hayes D, Stern HS, Dai M, Kain ZN Tags: Paediatr Anaesth Source Type: research

Challenging the Status Quo of Scientific Presentations.
Abstract Scientific presentations, usually given with slide presentation software such as PowerPointTM , are the most common method for disseminating knowledge to students and peers. Unfortunately, many are boring, text-heavy, bullet point-riddled data dumps, with animations or cartoons that obscure or distract rather than clarify the message. These presentations, which we have all sat through and/or delivered, are often so dull that they are referred to as "death by PowerPoint™." In this paper, the authors intend to impart basic techniques for organizing and communicating information in the most e...
Source: Paediatric Anaesthesia - November 5, 2020 Category: Anesthesiology Authors: Chatterjee D, Yaster M, Lockman JL, Glass NL, Schreiner MS, L J, Sinskey, Fiadjoe JE Tags: Paediatr Anaesth Source Type: research

Well-being Curriculum for Anesthesiology Residents: Development, Processes, and Preliminary Outcomes.
Abstract Physician burnout and healthcare worker stress are well covered topics in both the medical and lay press. Burnout in physicians can start as early as medical school. Well-being initiatives, programming, and access to support for all medical professionals are of paramount importance. In 2014 the Accreditation Council for Graduate Medical Education (ACGME) Milestones for Resident/Fellow Education in Anesthesiology added Professionalism as a milestone. A subcategory of Professionalism includes: A responsibility to maintain personal, emotional, physical, and mental health.This subcategory charges all residenc...
Source: Paediatric Anaesthesia - November 3, 2020 Category: Anesthesiology Authors: Janosy NR, Brainard A, Vogeli J, Beacham A Tags: Paediatr Anaesth Source Type: research

Perioperative anaphylaxis in children: a report from the Wake-Up Safe collaborative.
CONCLUSION: The estimated incidence of anaphylaxis and inciting agents among the pediatric population in this study were consistent with the most recent published studies outside of the United States, however new findings included need for cardiopulmonary resuscitation in 11% of cases, and estimated fatality of 1.6%. The management of perioperative anaphylaxis could be improved for some cases as epinephrine was not administered, or its administration was delayed. Fewer than half of reported cases had additional investigation to formally identify the responsible agent. PMID: 33141983 [PubMed - as supplied by publisher]...
Source: Paediatric Anaesthesia - November 3, 2020 Category: Anesthesiology Authors: Wakimoto M, Miller R, Kim SS, Uffman JC, Nafiu OO, Tobias JD, Beltran RJ Tags: Paediatr Anaesth Source Type: research

Epidural Catheter Placement in Children with Baclofen Pumps.
DISCUSSION: In this case series, not only was epidural placement feasible but there were no observed complications. This work highlights the importance of a multidisciplinary approach to complex regional anesthetic techniques, as well as the importance of basic competency in spine fluoroscopy for regional anesthesiologists. PMID: 33135307 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - November 1, 2020 Category: Anesthesiology Authors: Eklund SE, Samineni AV, Koka A, Riley BL, Brusseau RR, Shore BJ, Miller PE, Stone SS, Berde CB, Alrayashi W Tags: Paediatr Anaesth Source Type: research

Needle decompression of the abdomen in a premature infant with abdominal compartment syndrome and cardiopulmonary arrest: a case report.
Abstract A premature infant with abdominal compartment syndrome underwent cardiopulmonary arrest before receiving decompressive laparotomy and the effect of cardiopulmonary resuscitation was poor. The abdomen was punctured with an 18 gauge needle, alleviating the distention and resulting in successful cardiopulmonary resuscitation. PMID: 33128258 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 30, 2020 Category: Anesthesiology Authors: Yang L, Di Y, Wu Y, Li Y, Liao R, Zuo Y Tags: Paediatr Anaesth Source Type: research

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children.
CONCLUSIONS: For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus. PMID: 33128267 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 30, 2020 Category: Anesthesiology Authors: Moser B, Kemper M, Dullenkopf A, Dave MH, Buehler PK, Weiss M Tags: Paediatr Anaesth Source Type: research

The "Difficult Learner" in Anesthesiology: Challenges, Pitfalls, and Recommendations.
The "Difficult Learner" in Anesthesiology: Challenges, Pitfalls, and Recommendations. Paediatr Anaesth. 2020 Oct 30;: Authors: Margolis RD, Ku CM Abstract Struggling learners often require interventions that are time consuming and emotionally exhausting for both the trainee and faculty. Numerous barriers, including lack of resources, faculty development, and fear of legal retribution can impede medical educators from developing and implementing robust remediation plans. Despite the large volume of literature citing professionalism education and the "hidden curriculum" as problem ar...
Source: Paediatric Anaesthesia - October 30, 2020 Category: Anesthesiology Authors: Margolis RD, Ku CM Tags: Paediatr Anaesth Source Type: research

Association of NPO Duration with Glycemia in Non-Diabetic Adolescents Undergoing Anesthesia for Non-Cardiac Surgery.
Abstract Children and adolescents are required to fast prior to undergoing anesthesia to minimize the risk of pulmonary aspiration of gastric contents. Pre-operative fasting times vary, with longer fasts (8 hours) for solid foods and shorter fasts for clear liquids (1-2hours). Pediatric patients are more sensitive than adults to pre-operative fasting secondary to smaller glycogen stores and resultant propensity to ketoacidosis.1 Prolonged pre-operative fasting is associated with suboptimal perioperative outcomes including insulin resistance, hypotension upon induction, patient thirst and malaise, and postoperative...
Source: Paediatric Anaesthesia - October 29, 2020 Category: Anesthesiology Authors: Vanderhoek SM, Wolf RM Tags: Paediatr Anaesth Source Type: research

Anesthetic management of achild with Marinesco Sjogren syndrome for cataract surgery.
We report the anesthetic management of a child diagnosed with Marinesco Sjogren syndrome (MSS) scheduled for bilateral lens aspiration.MSS is an autosomal recessive multisystem disorder clinically characterized by cerebellar ataxia, cataract, myopathy,global developmental delay, and variable intellect first described by Marinesco et al in 1931.1-3 The neuro-radiologic hallmarks include cerebellar hypoplasia and a small posterior fossa.1 Sixty percent of patients have been found to have SIL1 gene mutation linked to chromosome 5q31. PMID: 33124089 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 29, 2020 Category: Anesthesiology Authors: Gupta M, Dass C, Garg H, Chhabra A Tags: Paediatr Anaesth Source Type: research

Not a "first world problem" - care of the Anesthetist in East and Southern Africa.
Not a "first world problem" - care of the Anesthetist in East and Southern Africa. Paediatr Anaesth. 2020 Oct 29;: Authors: Workneh RS, Tuyishime E, Mumbwe M, Igaga EN, Bould MD Abstract Burnout and related concepts such as resilience, wellness and taking care of healthcare professionals have become increasingly prevalent in the medical literature. Most of the work in this area comes from high-income countries, with the remainder from upper-middle income countries, and very little from lower-middle income or low-income countries. Sub-Saharan Africa is particularly poorly represented in this ...
Source: Paediatric Anaesthesia - October 29, 2020 Category: Anesthesiology Authors: Workneh RS, Tuyishime E, Mumbwe M, Igaga EN, Bould MD Tags: Paediatr Anaesth Source Type: research

Impact of aerosol box use on orotracheal intubation times in children.
Abstract Anesthesiologists are at particularly high risk of contagion for SARS CoV-2(1). The use of a transparent plastic box has been proposed to reduce the risk duringtracheal intubation(TI)(2). However, its safety hasve not been evaluated in children.Our hypothesis was that the aerosol box (AB) prolongs the tracheal intubation time (TIT). PMID: 33119187 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 29, 2020 Category: Anesthesiology Authors: Trujillo A, Arango F Tags: Paediatr Anaesth Source Type: research

Challenges and Opportunities Facing Pediatric Anesthesia Providers in Low and Middle Income Countries (LMICs): India.
Abstract India is a vast, populous country with a huge variability in the standards of healthcare. While the cities have state of the art hospitals with trained doctors, rural areas where most of the population lives, have a severe shortage of resources. Children form nearly 40% of India's population, and there is a great demand for pediatric surgical and anesthesia services. Specialty training in pediatric anesthesia however, is still in its infancy, with the majority of children being administered anesthesia by general anesthesiologists. This review discusses the reasons behind India's ailing healthcare system a...
Source: Paediatric Anaesthesia - October 29, 2020 Category: Anesthesiology Authors: Dave N, Varghese E, Jacob R Tags: Paediatr Anaesth Source Type: research

Anesthesia in the Modern World of Apps and Technology: Implications and Impact on Wellness.
a C Abstract Recent decades have seen an unprecedented leap in digital innovation, with far-reaching implications in healthcare. Anesthesiologists have historically championed the adoption of new technologies. However, the rapid evolution of these technologies has outpaced attempts at studying their potential impact on healthcare providers' well-being. This document introduces several categories of workplace technologies commonly encountered by the anesthesiologist. We examine examples of novel technology and the impact of these digital interventions on the anesthesiologist's well-being. We also review popular per...
Source: Paediatric Anaesthesia - October 29, 2020 Category: Anesthesiology Authors: Lo C, Yu J, Görges M, Matava C Tags: Paediatr Anaesth Source Type: research

Inhaled Sedation with Sevoflurane in Critically Ill Children During Extracorporeal Membrane Oxygenation.
The objective is to assess the effectiveness and safety of sevoflurane during ECMO in two pediatric patients. Sedation was successfully achieved in both patients and patients' contribution to breathing was possible even with deep sedation. There were not any side effects during sevoflurane treatment or after withdrawal. PMID: 33112440 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 28, 2020 Category: Anesthesiology Authors: Butragueño Laiseca L, Murciano M, López-Herce J, Mencía S Tags: Paediatr Anaesth Source Type: research

Prevalence of SARS-CoV-2 Infections in a Pediatric Orthopedic Hospital.
Abstract Montreal has the highest incidence of coronavirusdisease (SARS-CoV-2) in Canadarepresenting about one quarter of all reported cases nationwide (1).At the start of the pandemic, March 2020,the Shriners Hospital for Children, Canada,implemented a set of measures to minimize the risk of infection, such as screening each person entering the hospital, mandatory temperature checks at the entrance, wearing face masks within the building and reducing the number of clinic visits. The aim of this project was to assess whether the institution remained free of SARS-CoV-2 infections after these countermeasures were im...
Source: Paediatric Anaesthesia - October 27, 2020 Category: Anesthesiology Authors: Bardai G, Ouellet J, Engelhardt T, Bertolizio G, Wu Z, Rauch F Tags: Paediatr Anaesth Source Type: research

It's the Culture! - how systemic and societal constructs impact well-being.
Abstract Pediatric anesthesiologists practice within a culture, a system, and a society. In this article, we provide an overview of the influence these have on the well-being or the unwellness of pediatric anesthesiologists. The scope of these issues is broad and far reaching; thus, our goal has been to highlight those areas which would be likely to have the largest impact on well-being if addressed fully by society, institutions, and leaders in our field. We discuss the burnout-promoting aspects of medical education and training. We survey occupational factors, such as the high-stakes pediatric anesthesia environ...
Source: Paediatric Anaesthesia - October 27, 2020 Category: Anesthesiology Authors: Vinson AE, Bachiller PR Tags: Paediatr Anaesth Source Type: research

Are pediatric patients with PHACE association at high risk for anesthetic complications?
Abstract PHACE association (posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta, and eye abnormalities) is a rare X-linked neurocutaneous association that occurs more frequently in females.1-5 Cerebrovascular anomalies are most common among PHACE association patients (57%), followed by cardiovascular (43%), eye (16%), ventral developmental defects (21%), and endocrine abnormalities (6%).5 To date, there are a few case reports of the anesthetic management of children with PHACE .1,3 The purpose of this retrospective case series is to report the perioperative complications in chi...
Source: Paediatric Anaesthesia - October 20, 2020 Category: Anesthesiology Authors: Escarza BS, Cruz-Beltran S, Lessans G, Austin TM, Lam HV Tags: Paediatr Anaesth Source Type: research

Outcomes from Wake Up Safe, the Pediatric Anesthesia Quality Improvement Initiative.
CONCLUSIONS: The majority of anesthesia-related serious adverse events reported to the Wake Up Safe database are preventable. Medication events are the most common anesthesia-related adverse events. Innovations aimed at decreasing medication events may be the most impactful. PMID: 33078514 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 20, 2020 Category: Anesthesiology Authors: Haché M, Sun LS, Gadi G, Busse J, Lee AC, Lorinc A, Rampersad S Tags: Paediatr Anaesth Source Type: research

Coaching for the Pediatric Anesthesiologist: Becoming our Best Selves.
Abstract Anesthesiologists must balance demanding clinical workloads with career development goals. Leadership, conflict management, and other skills can improve medical outcomes, reduce stress at work, and increase career satisfaction. However, Medicine in general, and Anesthesiology in particular have not traditionally emphasized physician growth in these areas. Coaching utilizes concepts from psychology, adult learning, and adult development theory to support an individual in personal and professional growth through inquiry, reflection and shared discovery. This manuscript reviews the history and evidence basis...
Source: Paediatric Anaesthesia - October 18, 2020 Category: Anesthesiology Authors: Schwartz JM, Wittkugel E, Markowitz S, Lee JK, Deutsch N Tags: Paediatr Anaesth Source Type: research

Regional Anesthesia in Neonates and Infants Outside the Immediate Perioperative Period: a Systematic Review of Studies with Efficacy and Safety Considerations.
Abstract This review examines the quality and quantity of literature regarding methods that measure efficacy in the context of reported safety of regional anesthesia techniques in preterm and term infants less than 1 year of age. Because the role of anesthesiologists continues to expand outside the operating room, we focused on all relevant settings with assessments that extend beyond 24 hours from the intraoperative period. All study designs were included from a search of MEDLINE, Embase, CINAHL, Scopus, and Cochrane databases from 1946 to the end of 2019. A total of 31 studies were included (n = 1038 participant...
Source: Paediatric Anaesthesia - October 18, 2020 Category: Anesthesiology Authors: Relland LM, Neel ML, Gehred A, Maitre NL Tags: Paediatr Anaesth Source Type: research

De-mystifying the 'Mixifusor'.
Abstract Total intravenous anesthesia (TIVA) using a mixture of propofol and remifentanil in the same syringe has become an accepted technique in Pediatric Anesthesia. A survey by a group of respected UK anesthetists demonstrated a low incidence of serious complications, related to the pharmacology and dose of the drugs. However, a current guideline for the safe use of TIVA recommends against this practice. Pharmaceutical concerns include the physical stability of the emulsion when remifentanil is mixed with propofol; changes in drug concentration over time; non-uniform mixing of propofol and remifentanil; the ris...
Source: Paediatric Anaesthesia - October 13, 2020 Category: Anesthesiology Authors: Absalom AR, Rigby-Jones AE, Rushton AR, Sneyd JR Tags: Paediatr Anaesth Source Type: research

Successful Navigation of Late Career Transitions.
Abstract The purpose of this educational review is to describe the challenges that may face the anesthesiologist near the end of their career, and to propose strategies that will enable the individual to continue to be a productive and valued member of their Department, both clinically and by other contributions. PMID: 33048390 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 13, 2020 Category: Anesthesiology Authors: Cox RG Tags: Paediatr Anaesth Source Type: research

Trends in Paediatric Traumatic Major Haemorrhage from a Major Trauma Centre.
Abstract Injury requiring management of major haemorrhage in paediatric trauma (called 'code red' at our institution) can result in critically injured children with high injury severity scores (ISS) and mortality. The rise in penetrating trauma in younger adolescents has led to an increase in major haemorrhage activations in injured children at this trauma centre. Criteria used to define a paediatric code red, at our institution, is non-compressible haemorrhage, obvious signs of bleeding, clinical signs of shock and/or cardiac arrest at scene. PMID: 33049082 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 13, 2020 Category: Anesthesiology Authors: Lewis H, O'Neill B, Edmonds N Tags: Paediatr Anaesth Source Type: research

The COVID-19 era and pediatric procedural sedation: a consecutive case series with an emphasis on preparation, precautions and risk reduction.
rbi E Abstract The COVID-19 pandemic challenged health care systems to balance high standards of care with patients' needs and health care workers' safety.1 Pediatric sedation poses multiple potential contagion risks: aerosol generating procedures such as bag-valve mask ventilation and oro-pharyngeal suctioning2 , close proximity of the sedationist to the patient's airway, the need for airway manipulation or insertion of airway devices and the risk of patient vomiting and coughing. Although COVID risk mitigation to providers is achieved for elective procedures that allow for pre-sedation COVID-19 testing, it is im...
Source: Paediatric Anaesthesia - October 9, 2020 Category: Anesthesiology Authors: Nisticò D, Saccari A, Comar M, Conti R, Penco A, Peri F, Conversano E, Barbi E Tags: Paediatr Anaesth Source Type: research

Sj ögren-Larsson Syndrome: Anesthetic Considerations and Practical Recommendations.
CONCLUSIONS: We found that anesthesia can be safely administered in patients with Sjögren-Larsson syndrome. Providers should be aware of anesthetic management issues in Sjögren-Larsson syndrome including challenges placing and securing lines and monitors secondary to the ichthyosis. PMID: 33037729 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 9, 2020 Category: Anesthesiology Authors: Franzen MH, LeRiger MM, Kugler JA, Pellegrino KP, Rizzo WB Tags: Paediatr Anaesth Source Type: research

Mindfulness and GAIN: The Solution To Burnout in Medicine?
This article will briefly review the problem of burnout, including drivers and costs, and then focus on meditation and mindfulness practices that we may embrace in order to become more resilient. PMID: 33034156 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 9, 2020 Category: Anesthesiology Authors: Hammer GB Tags: Paediatr Anaesth Source Type: research

Too Noisy to Sleep Safely? - An Observational Study of Noise Levels and Distractions During Critical Phases of Pediatric Anesthesia.
CONCLUSIONS: We documented noise levels well above recommended levels during all phases of pediatric anesthesia. We highlighted factors with potential to contribute to noise and distraction but found no statistically significant correlation with noise levels. PMID: 33035361 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 9, 2020 Category: Anesthesiology Authors: Monaghan M, Abdelaal Ahmed Mahmoud M Alkhatip A, Holmes C Tags: Paediatr Anaesth Source Type: research

The Relationship between Parental Factors, Child Symptom Profile and Persistent Postoperative Pain Interference and Analgesic Use in Children.
DISCUSSION: These findings suggest that the relationship between parent factors and long-term postoperative pain outcomes may be dependent on the child's symptom profile at baseline. Since there may be bidirectional relationships between parent and child factors, interventions to mitigate long-term pain should address child symptoms as well as parental factors. PMID: 33010105 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - October 2, 2020 Category: Anesthesiology Authors: Correa L, Foxen-Craft E, Malviya S, Ramirez M, Li Y, James C, Voepel-Lewis T Tags: Paediatr Anaesth Source Type: research

Pediatric neuroanesthesia in developing countries: Challenges and solutions.
PMID: 32997858 [PubMed - in process] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 30, 2020 Category: Anesthesiology Authors: Bawa C, Sarna R Tags: Paediatr Anaesth Source Type: research

The American Academy of Pediatrics; its structure; mission and the importance of getting involved and supporting individual subsections.
PMID: 32997859 [PubMed - in process] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 30, 2020 Category: Anesthesiology Authors: Adler AC, Chandrakantan A, Agarwal R Tags: Paediatr Anaesth Source Type: research

COVID-19 and congenital heart disease: Cardiopulmonary interactions for the worse!
PMID: 32997860 [PubMed - in process] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 30, 2020 Category: Anesthesiology Authors: Magoon R Tags: Paediatr Anaesth Source Type: research

In this issue October 2020.
PMID: 32997861 [PubMed - in process] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 30, 2020 Category: Anesthesiology Authors: Davidson A Tags: Paediatr Anaesth Source Type: research

Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia - a prospective observational study.
CONCLUSION: This study showed that the gastric emptying time of children after intake up to 5 mL kg-1 clear fluids was less than 1 hour in a clinical setting. These results support the more liberal fasting regimen favoring a 1 hour fasting time and suggest 5 mL kg-1 as an upper limit for clear fluids (e.g. water, sugared water or tea or diluted fruit juice) from 2 hours to 1 hour before induction of anesthesia in children. PMID: 32997821 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 29, 2020 Category: Anesthesiology Authors: Beck CE, Chandrakumar T, Sümpelmann R, Nickel K, Keil O, Heiderich S, Boethig D, Witt L, Dennhardt N Tags: Paediatr Anaesth Source Type: research

Assessment of different techniques for the administration of inhaled salbutamol in children breathing spontaneously via tracheal tubes, supraglottic airway devices and tracheostomies.
CONCLUSION: Via tracheal tube and non-valved spacer, the following doses should be delivered after single actuation of a 100 µg labelled-claim salbutamol dose: ~2 µg kg-1 per actuation to a 3 kg neonate, ~1 µg kg-1 per actuation to a 16 kg child, and ~0.5 µg kg-1 per actuation for a 50-75 kg child. The least effective methods were the syringe, and the uni- and bidirectional adaptor methods, which require replacement by the direct method if a spacer is unavailable. PMID: 32997848 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 29, 2020 Category: Anesthesiology Authors: Anderson N, Schultz A, Ditcham W, von Ungern-Sternberg BS Tags: Paediatr Anaesth Source Type: research

Routine Chest X-Ray Following Ultrasound-Guided Internal Jugular Veins Catheterization in Critically Ill Children: A Prospective Observational Study.
CONCLUSIONS: In this critically ill pediatric cohort, all central venous catheters inserted under ultrasound guidance, could have been used with safety prior to acquiring chest x-ray. Overall chest x-ray impacted patient management in only 1% of cases. Our results do not support delaying urgent central venous catheter use pending chest x-ray completion in critically ill children. PMID: 32997852 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 29, 2020 Category: Anesthesiology Authors: Weissbach A, Gendler Y, Lakovsky Y, Kadmon G, Nahum E, Kaplan E Tags: Paediatr Anaesth Source Type: research

Evaluation of the Relationship Between Airway Measurements with Ultrasonography and Laryngoscopy in Newborns and Infants.
CONCLUSIONS: The risk of a difficult laryngoscopy increases in children under the age of one. The preoperative airway assessment tools and Body Mass Index (BMI) had acceptable negative predictive values. We believe that all measurements could be used as markers for difficult laryngoscopy in newborns and infants. PMID: 32981070 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 26, 2020 Category: Anesthesiology Authors: Sever F, Özmert S Tags: Paediatr Anaesth Source Type: research

Efficacy of caudal versus intravenous administration of α2 adrenoceptor agonists to prolong analgesia in pediatric caudal block: A systematic review and meta-analysis.
CONCLUSION: Caudal α2 adrenoceptor agonists as adjuncts to local anesthetic during pediatric caudal block are more effective than intravenous injection. However, the results were affected by small sample size and significant heterogeneity. PMID: 32978991 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 25, 2020 Category: Anesthesiology Authors: Xing M, Liang X, Li L, Liao L, Liang S, Jiang S, Li J, Zhang C, Zou W Tags: Paediatr Anaesth Source Type: research

Management of accidental lumbar epidural catheter breakage in a 5-months-old infant.
rdo S Abstract Epidural anesthesia is a widely-used technique for anesthesia and analgesia in infants and children.1 Epidurals, as well as other regional blocks, are a useful component of a multimodal approach to anesthesia and analgesia, in order to reduce the risk of opioid-related side effects such as postoperative apnoea, especially in preterms.2 Epidural catheter breakage is a very rare but alarming complication, the correct management of which is uncertain. PMID: 32974908 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - September 23, 2020 Category: Anesthesiology Authors: Smedile F, Giordano G, Pariante R, Padua M, Bagolan P, Longo D, Sgrò S, Picardo S Tags: Paediatr Anaesth Source Type: research