Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2025
Case Series of Anesthetic Management of Gene Therapy in Children With Aromatic L-Amino Acid Decarboxylase Deficiency.
Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare life-threatening inborn error of neurotransmitter biosynthesis. It is characterized by deficient biosynthesis of neurotransmitters dopamine and serotonin, leading to catecholamines deficiency and sympathetic deprivation, while the parasympathetic system remains functional. Since 2012, gene therapy has led to clinical improvements in symptoms and motor function with a severe phenotype. General anesthesia of children with AADC deficiency is challenging. ⋯ Using an anesthetic plan based on atropine, ketamine, sevoflurane, and a titrated infusion of norepinephrine, prolonged anesthesia appeared to be safe and reproductible in this population.
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Paediatric anaesthesia · Jan 2025
Evaluation of the Pediatric Regional Anesthesia Time-Out Checklist: A Simulation Study.
The Society for Pediatric Anesthesia Quality and Safety Committee developed the Pediatric Regional Anesthesia Time-Out Checklist, consisting of 14 safety items intended to be reviewed by an anesthesia team prior to a regional anesthetic. Primarily, we hypothesized that use of this Checklist would increase the number of safety items performed compared with no checklist, evaluating the usefulness of this tool. Secondarily, we hypothesized that, after checklist training, subjects would show better clinical judgment by electing to perform a regional anesthetic in scenarios in which no programmed error existed and electing to not perform a regional anesthetic in scenarios in which a programmed error did exist. ⋯ Pediatric Regional Anesthesia Time-Out Checklist training led to an increased number of safety items performed prior to a simulated anesthetic.
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Paediatric anaesthesia · Jan 2025
Supervision of Pediatric Anesthesia After-Hours: A Survey of Pediatric Anesthetists in Australia and New Zealand.
After-hours pediatric anesthesia may pose increased risks, with a heightened potential for sudden cardio-respiratory decline. While mortality rates are low in Australia and New Zealand, critical events and morbidity occur more frequently and present ongoing challenges. However, little is known about how trainees are supervised during these high-risk periods. ⋯ Pediatric anesthetists in Australia and New Zealand recognize major risk factors but tend to supervise more remotely after-hours. Further research is needed to evaluate the effects of these supervision practices on outcomes.
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Paediatric anaesthesia · Jan 2025
The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial.
In children, monitoring depth of anesthesia is challenging because of the still developing brain. Electroencephalographic density spectral array monitoring provides age- and anesthetic drug-specific electroencephalographic patterns, making it suitable for use in children. Yet, not much is known about the benefits of using density spectral array on post-operative recovery in children. ⋯ This randomized controlled trial provides initial evidence of an added value of density spectral array monitoring in terms of the speed of recovery and allows sevoflurane to be dosed 22% lower during maintenance than with a more traditional approach using a minimal alveolar concentration of 0.9.