Does anesthesia duration or number of cases per patient predict safety events?

Background: The need for dental rehabilitation under general anesthesia is increasing, with varying needs between patients. Mortality has been found to be a rare event in these patients; however other perioperative events can and do occur. Previous studies have established increased incidence of perioperative events with younger, sicker children, and longer anesthetics, however, no studies to date have evaluated if the incidence of perioperative events is more closely associated with one long anesthetic or multiple anesthetics per patient.

COVID-19 pre-procedural testing strategy and early outcomes at a large tertiary care children's hospital.

Purpose: With the emergence of the coronavirus disease-2019 (COVID-19) pandemic, institutions were tasked with developing individualized pre-procedural testing strategies that allowed for re-initiation of elective procedures within national and state guidelines. This report describes the experience of a single US children's hospital (Children's Wisconsin, CW) in developing a universal pre-procedural COVID-19 testing protocol and reports early outcomes.

Methods: The CW pre-procedural COVID-19 response began with the creation of a multi-disciplinary taskforce that sought to develop a strategy for universal pre-procedural COVID-19 testing which (1) maximized patient safety, (2) prevented in-hospital viral transmission, (3) conserved resources, and (4) allowed for resumption of procedural care within institutional capacity.

Staged biliary reconstruction after liver transplantation: A novel surgical strategy for high acuity pediatric transplant recipients.

Introduction: Biliary complications after pediatric orthotopic liver transplantation remain causes of significant patient morbidity. Staged operative approach in complex hepatobiliary surgery has improved postoperative outcomes but has not been evaluated in pediatric orthotopic liver transplantation. We sought to analyze the outcomes of staged biliary reconstruction after orthotopic liver transplantation in high acuity patients.

Anesthetic Management of an Infant With Postnatally Diagnosed Tracheal Agenesis Undergoing Tracheal Reconstruction: A Case Report.

A term infant born cyanotic failed multiple intubation attempts and tracheostomy placement. After esophageal intubation resulted in the ability to ventilate, he was presumed to have tracheal agenesis and distal bronchoesophageal fistula. He was transferred to our institution where he was diagnosed with Floyd Type II tracheal agenesis.

Side-to-Side Tracheobronchoplasty to Reconstruct Complex Congenital Tracheobronchial Stenosis.

Background: Long segment tracheobronchial stenosis is a rare congenital anomaly that can also occur in combination with abnormal bronchial arborization. Long segment tracheal reconstruction in the setting of a supernumerary bridging bronchus has been reported; however, these repairs can be particularly complex. We present our experience using the bridging bronchus to augment long segment tracheal stenosis with a side-to-side tracheobronchoplasty.

Use of Modified Statlock™ Device for Securing an Endotracheal Tube in Facial Burn-Like Conditions.

The Statlock(™) is an IV stabilization device developed by Bard Access Systems, Inc. We describe the use of a modified Statlock with tracheostomy ties to provide a secure anchor for an endotracheal tube in a child with toxic epidermal necrolysis. We review the benefits and drawbacks of previously described devices in patients with similar conditions (burns, epidermolysis bullosa, Stevens Johnson syndrome).

Droperidol transiently prolongs the QT interval in children undergoing single ventricle palliation.

Historically, droperidol was commonly used for postoperative sedation of critically ill children. A FDA black box warning regarding its arrhythmogenic potential greatly reduced its use. We hypothesized that administration of neuroleptic dose droperidol during volatile anesthesia would transiently prolong the corrected QT interval (QTc) in patients undergoing single ventricle palliation.

Anterior tracheal suspension for tracheobronchomalacia in infants and children.

Background: Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS).

Increased recombinant activated factor VII use and need for surgical reexploration following a switch from aprotinin to epsilon-aminocaproic acid in infant cardiac surgery.

Study Objective: To evaluate whether conversion from aprotinin to epsilon-aminocaproic acid (EACA) during infant cardiac surgery was associated with increased perioperative bleeding.

Design: Structured retrospective chart review.

Setting: University-affiliated large congenital cardiac surgery program.

Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests.

Background: Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric in-hospital cardiac arrests. This concept has recently been questioned, although the effect of CPR duration on outcomes has not recently been described. Our objective was to determine the relationship between CPR duration and outcomes after pediatric in-hospital cardiac arrests.

Case report: giant cardiac malignancy in a nine-year-old female.

Purpose: To describe the management of a giant cardiac malignancy initially diagnosed as an anterior mediastinal mass.

Clinical Features: A nine-year-old female with right facial swelling and chronic cough was diagnosed with a large right mediastinal mass. Intermittent ventricular and supraventricular arrhythmias were noted on admission electrocardiograms.

Antithrombin replacement during extracorporeal membrane oxygenation.

Heparin remains the predominant anticoagulant during extracorporeal membrane oxygenation (ECMO). Heparin acts by potentiating the anticoagulant effect of antithrombin (ATIII). Acquired ATIII deficiency, common in pediatric patients requiring ECMO, may result in ineffective anticoagulation with heparin.

Perioperative opiate requirements in children with previous opiate infusion.

Background: Critically ill children often require continuous opiate infusions. Tolerance may develop requiring a weaning strategy to prevent withdrawal symptoms. These children may also require subsequent surgical procedures.

The effect of caudal vs intravenous morphine on early extubation and postoperative analgesic requirements for stage 2 and 3 single-ventricle palliation: a double blind randomized trial.

Background: High-dose single-shot caudal morphine has been postulated to facilitate early extubation and to lower initial analgesic requirements after staged single-ventricle (SV) palliation.

Methods: With Institutional Review Board approval and written informed parental consent, 64 SV children aged 75-1667 days were randomized to pre-incisional caudal morphine-bupivacaine (100 μg·kg(-1) morphine (concentration 0.1%), mixed with 0.

Probability of survival based on etiology of cardiopulmonary arrest in pediatric patients.

Objective: To aggregate data across institutions to identify, characterize, and differentiate potential survivors from nonsurvivors based on etiology of event.

Aim: To evaluate the association of the cardiopulmonary resuscitation (CPR) duration and probability of survival (Ps), stratified by etiology of arrest.

Background: In-hospital cardiac arrests occur in 2-6% of pediatric patients with poor survival rates resulting in significant expenditures of time and resources.

Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial.

Background: Gabapentin has opioid-sparing effects in adult surgical patients, but no reported studies have involved children and adolescents. In a double-blind, randomized, controlled trial, we examined whether gabapentin decreases postoperative opioid consumption for pediatric spinal fusion patients with idiopathic scoliosis.

Methods: Patients, aged 9 to 18 years, received preoperative gabapentin (15 mg/kg, treatment) or placebo.

Effect of volume resuscitation on regional perfusion in dehydrated pediatric patients as measured by two-site near-infrared spectroscopy.

Objective: The aim of this study was to measure the change of cerebral and somatic regional oxygen saturation (rSO2) using near-infrared spectroscopic (NIRS) monitoring during volume resuscitation of dehydrated children.

Methods: This prospective, observational study enrolled 17 moderately dehydrated children presenting to the emergency department in a tertiary care pediatric hospital. Pulse oximetry and 2-site rSO2 using forehead and flank NIRS probes were monitored continuously during intravenous rehydration.

Near infrared spectroscopy monitoring during pediatric aortic coarctation repair.

Background: Near infrared spectroscopy (NIRS) measures regional tissue oxygenation continuously and noninvasively and may allow assessment of changes in regional perfusion in real time.

Methods: We used NIRS monitoring to track real-time changes in regional oxygenation (rSO2) above and below the aortic cross-clamp in patients undergoing aortic coarctation repair and routinely stored these data in an operative electronic data base. This allowed us to analyze the changes in rSO2 during aortic coarctation repair for three pediatric age groups (neonates, infants <1 year, and children >1 year).

A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients.

Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication.

Droperidol for perioperative sedation causes a transient prolongation of the QTc time in children under volatile anesthesia.

Background: Droperidol is useful for postoperative sedation in infants and children after cardiac surgery because it provides sedation and akinesia with minimal respiratory depression. However, droperidol has been associated with QT prolongation and ventricular arrhythmias. We investigated, if neuroleptanalgesic doses of droperidol led to QT prolongation and cardiac arrhythmias in children undergoing cardiac surgery.

Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients.

Objective: To demonstrate the efficacy of a 10-day, single daily dose, enteral methadone weaning protocol for the prevention of opioid withdrawal symptoms in pediatric patients after prolonged fentanyl exposure.

Design: Prospective, observational study.

Setting: Twenty-four-bed medical-surgical intensive care unit within a 222-bed pediatric teaching hospital.

Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model.

Objective: Guidelines for risk reduction during procedural sedation from the American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) rely on expert opinion and consensus. In this article, we tested the hypothesis that application of an AAP/ASA-structured model would reduce the risk of sedation-related adverse events.

Methods: Prospectively coded sedation records were abstracted by a hospital quality improvement specialist with practical and administrative experience in pediatric sedation.