Capnodynamic determination of end-expiratory lung volume in a porcine model of hypoxic pulmonary vasoconstriction.

Purpose: The capnodynamic method, End Expiratory Lung Volume CO (EELV-CO), utilizes exhaled carbon dioxide analysis to estimate End-Expiratory Lung Volume (EELV) and has been validated in both normal lungs and lung injury models. Its performance under systemic hypoxia and variations in CO elimination is not examined. This study aims to validate EELV-CO against inert gas wash in/wash out (EELV- SF6, sulfur hexafluoride) in a porcine model of stable hemodynamic conditions followed by hypoxic pulmonary vasoconstriction and inhaled nitric oxide (iNO).

Postoperative Pain Management in children: guidance from the Pain Committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative) Part II.

The ESPA Pain Management Ladder Initiative is a clinical practice advisory based upon expert consensus supported by the current literature to help ensure a basic standard of perioperative pain management for all children. In 2018 the perioperative pain management of six common pediatric surgical procedures was summarised. The current Pain Management Ladder recommendations focus on five more complex pediatric surgical procedures and suggest basic, intermediate, and advanced pain management methods.

Validation of a Novel Method for Noninvasive Mixed Venous Oxygen Saturation Monitoring in Anesthetized Children.

Background: Mixed venous oxygen saturation (SvO 2 ) is a critical variable in the assessment of oxygen supply and demand but is rarely used in children due to the invasive nature of pulmonary artery catheters. The aim of this prospective, observational study was to investigate the accuracy of noninvasively measured SvO 2 acquired by the novel capnodynamic method, based on differential Fick equation (Capno-SvO 2 ), against gold standard CO-oximetry.

Methods: Capno-SvO 2 was compared to SvO 2 measured by pulmonary artery blood gas CO-oximetry in children undergoing cardiac catheter interventions and subjected to moderate hemodynamic challenges.

Exposure to lidocaine in early life does not cause negative long-term behavioural changes in mice.

Background: The local anaesthetic lidocaine is widely used in the neonatal intensive unit to treat seizures in premature babies. However, other antiepileptics administered during early development in various animal models have shown negative long-term behavioural effects. Since no long-term behavioural data so far exist regarding lidocaine exposure at an early age, we decided to perform this extended follow-up study using a sensitive behavioural test.

Validation of an alternative technique for RQ estimation in anesthetized pigs.

Background: Respiratory quotient (RQ) is an important variable when assessing metabolic status in intensive care patients. However, analysis of RQ requires cumbersome technical equipment. The aim of the current study was to examine a simplified blood gas-based method of RQ assessment, using Douglas bag measurement of RQ (Douglas-RQ) as reference in a laboratory porcine model under metabolic steady state.

Capnodynamic end-expiratory lung volume assessment in anesthetized healthy children.

Background: Capnodynamic lung function monitoring generates variables that may be useful for pediatric perioperative ventilation.

Aims: Establish normal values for end-expiratory lung volume CO in healthy children undergoing anesthesia and to compare these values to previously published values obtained with alternative end-expiratory lung volume methods. The secondary aim was to investigate the ability of end-expiratory lung volume CO to react to positive end-expiratory pressure-induced changes in end-expiratory lung volume.

Fascial plane blocks in children-Scientifically supported or not?

Since the introduction of Fascial Plane Blocks in 2007 there has been an enormous interest and application of Fascial Plane Blocks, evidenced by substantially more than 1000 PubMed items. Despite this gigantic number of publications, also including randomized controlled trials and meta-analyses in children, there is still no clear-cut insight into how much of the purported effect is in fact due to the blockade of nerve structures and how much is merely adding the well-known analgesic and anti-inflammatory effects of the plasma levels of local anesthetics that are achieved with these techniques. Furthermore, Fascial Plane Blocks appear useful only if compared to conventional multi-modal analgesia (no block or placebo) and Fascial Plane Blocks lack the potency to provide surgical anesthesia on their own and appear only to be of value when used for minor-moderate surgery.

EEG response to a high volume (1.5 mL/kg) caudal block in infants less than 3 months.

Introduction: The substantial compression of the dural sac and the subsequent cranial shift of cerebrospinal fluid caused by a high-volume caudal block has been shown to significantly but transiently reduce cerebral blood flow. The aim of the present study was to determine whether this reduction in cerebral perfusion is significant enough to alter brain function, as assessed by electroencephalography (EEG).

Methods: Following ethics approval and parental informed consent, 11 infants (0-3 months) scheduled to undergo inguinal hernia repair were included in the study.

Spinal anaesthesia in children: A narrative review.

Spinal anaesthesia is an established and frequently used anaesthetic technique in adults. However, this versatile regional anaesthetic technique is less frequently used in paediatric anaesthesia even though it can be used for minor (e.g.

Standardized blood volume changes monitored by capnodynamic hemodynamic variables: An experimental comparative study in pigs.

Background: The capnodynamic method, based on Volumetric capnography and differential Fick mathematics, assess cardiac output in mechanically ventilated subjects. Capnodynamic and established hemodynamic monitoring parameters' capability to depict alterations in blood volume were investigated in a model of standardized hemorrhage, followed by crystalloid and blood transfusion.

Methods: Ten anesthetized piglets were subjected to controlled hemorrhage (450 mL), followed by isovolemic crystalloid bolus and blood re-transfusion.

Capnodynamics - noninvasive cardiac output and mixed venous oxygen saturation monitoring in children.

Hemodynamic monitoring in children is challenging for many reasons. Technical limitations in combination with insufficient validation against reference methods, makes reliable monitoring systems difficult to establish. Since recent studies have highlighted perioperative cardiovascular stability as an important factor for patient outcome in pediatrics, the need for accurate hemodynamic monitoring methods in children is obvious.

Perioperative water and electrolyte balance and water homeostasis regulation in children with acute surgery.

Background: Hospital-acquired hyponatremia remains a feared event in patients receiving hypotonic fluid therapy. Our objectives were to assess post-operative plasma-sodium concentration and to provide a physiological explanation for plasma-sodium levels over time in children with acute appendicitis.

Methods: Thirteen normonatremic (plasma-sodium ≥135 mmol/L) children (8 males), median age 12.

How to report drug concentrations or classic pharmacokinetics in regional anesthesia and pain medicine: what information needs to be provided?

When reporting individual drug concentrations or proper pharmacokinetic data, it is important to adequately report the circumstances associated with sampling, storing, analysis methodology and pharmacokinetic modelling. If this is not done in sufficient detail it will be impossible to properly evaluate the validity of the results. The present text represents a suggested approach on what to report when you are contemplating to submit a manuscript to regional anesthesia and pain medicine, this to achieve relevant standards in this context.

Intranasal dexmedetomidine sedation for paediatric MRI by radiology personnel: A retrospective observational study.

Background: MRI often requires sedation or anaesthesia to ensure good image quality in paediatric patients. Access to paediatric anaesthesia services is, however, a limiting factor for effective paediatric MRI service, and alternative sedation methods are, therefore, warranted.

Objective: To investigate the efficacy and safety of an intranasal dexmedetomidine sedation program for paediatric MRI, without immediate presence of anaesthesia personnel.

Severe Covid-19 and acute pulmonary hypertension: 24-month follow-up regarding mortality and relationship to initial echocardiographic findings and biomarkers.

Introduction: Critically ill Covid-19 patients are likely to develop the sequence of acute pulmonary hypertension (aPH), right ventricular strain, and eventually right ventricular failure due to currently known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. Furthermore, an in-hospital trans-thoracic echocardiography (TTE) diagnosis of aPH is associated with a substantially increased risk of early mortality. The aim of this retrospective observational follow-up study was to explore the mortality during the 1-24-month period following the TTE diagnosis of aPH in the intensive care unit (ICU).

Local Anesthetic Cardiac Toxicity Is Mediated by Cardiomyocyte Calcium Dynamics.

Background: Long-lasting local anesthetic use for perioperative pain control is limited by possible cardiotoxicity (e.g., arrhythmias and contractile depression), potentially leading to cardiac arrest.

The Retro Superior Costotransverse Ligament Space as a New Target for Ultrasound-Guided Intertransverse Process Block: A Report of 2 Cases.

An intertransverse process block (ITPB) is a paraspinal thoracic nerve block technique, where the local anesthetic (LA) is injected into the thoracic intertransverse tissue complex posterior to the superior costotransverse ligament (SCTL). Although an ITPB can be ultrasound-guided, it is performed using surrogate bony landmarks without even identifying the SCTL. This report describes a transverse ultrasound imaging technique to identify the retro-SCTL space and perform an ITPB with a retro-SCTL space injection, in 2 patients undergoing video-assisted thoracoscopic surgery.