Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2022
ReviewPerioperative Pain Disparity in Children: A Call for Action.
Racial and ethnic disparities in both healthcare management and delivery have been extensively documented in medical literature. For example, patients from non-White minority backgrounds in the United States have been found to experience worse clinical outcomes after surgery, to receive fewer surgical procedures, and to experience worse perioperative pain management compared with patients from non-minority backgrounds. ⋯ Specifically, there is a need for randomized control trials and health services research studying pediatric perioperative pain disparities. A multidisciplinary systems-based approach would help translate findings from scientific research to clinical practice and is a crucial step to ensuring all children of diverse backgrounds receive optimal perioperative care.
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Paediatric anaesthesia · Dec 2022
Review Meta AnalysisVirtual Reality in Pediatrics, Effects on Pain and Anxiety: A Systematic Review and Meta-Analysis Update.
Medical procedures are often accompanied by pain and anxiety in pediatric patients. A relatively new technique to reduce pediatric pain and anxiety is virtual reality. Virtual reality is both applied as a distraction tool and as an exposure tool to prepare patients for medical procedures. Research into the application of virtual reality in medical settings is rapidly evolving. This meta-analysis is an update of the meta-analysis of Eijlers et al. investigating the effectiveness of virtual reality as an intervention tool on pain and anxiety in pediatric patients undergoing medical procedures. ⋯ The current updated systematic review and meta-analysis indicates that virtual reality is a useful tool to reduce pain and anxiety in pediatric patients undergoing a range of medical procedures as it significantly decreases pain and anxiety outcomes when compared to care as usual.
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Paediatric anaesthesia · Dec 2022
A magnetic resonance imaging study of the sciatic nerve variation in the pediatric gluteal region: implications for the posterior approach of the sciatic nerve blockade.
In pediatric patients, the sciatic nerve is one of the most commonly blocked peripheral nerves during orthopedic procedures of the lower limb. Ultrasound guidance is the current standard for a successful localization of the sciatic nerve in the gluteal region. Relevant anatomical landmarks are also used to determine the nerve location when ultrasound is not available or inadequate. However, reports have demonstrated paucity of information regarding the sciatic nerve location and variation in the hip throughout pediatric development. This imaging study aimed to document and analyze the relative morphometric relationship of the sciatic nerve in the pediatric gluteal region throughout development. ⋯ Despite the small sample size of younger age group, this study is the first to document the morphometric changes of the sciatic nerve in the gluteal region across pediatric development and may be useful for providing confirmatory guidelines for nerve location when ultrasound is not accessible or cannot be utilized for practice.
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Paediatric anaesthesia · Dec 2022
Levobupivacaine plasma concentrations following repeat caudal anesthetics.
A single caudal anesthetic at the start of lower abdominal surgery is unlikely to provide prolonged analgesia. A second caudal at the end of the procedure extends the analgesia duration but total plasma concentrations may be associated with toxicity. Our aim was to measure total plasma levobupivacaine concentrations after repeat caudal anesthesia in infants and to generate a pharmacokinetic model for prediction of plasma concentrations after repeat caudal anesthesia in neonates, infants and children. ⋯ Repeat caudal levobupivacaine 2.5 mg kg-1 at 3 h after an initial 2.5 mg kg-1 dose does not exceed the concentration associated with systemic local anesthetic toxicity. In 2.5% of simulated neonates (weight 3.8 kg, PMA 40 weeks), repeat caudal anesthesia demonstrates broaching of the lower concentration limit associated with toxicity at both 3 and 4 h after initial caudal.
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Paediatric anaesthesia · Dec 2022
Multicenter StudySafety of Antifibrinolytics in 6583 Pediatric Patients Having Craniosynostosis Surgery: A Decade of Data Reported from the Multicenter Pediatric Craniofacial Collaborative Group.
Antifibrinolytics such as tranexamic acid and epsilon-aminocaproic acid are effective at reducing blood loss and transfusion in pediatric patients having craniofacial surgery. The Pediatric Craniofacial Collaborative Group has previously reported low rates of seizures and thromboembolic events (equal to no antifibrinolytic given) in open craniofacial surgery. ⋯ This multicenter international experience of pediatric craniofacial surgery reports no increase in seizures or thromboembolic events in those that received antifibrinolytics (tranexamic acid and epsilon-aminocaproic acid) versus those that did not. This report provides further evidence of antifibrinolytic safety. We recommend following pharmacokinetic-based dosing guidelines for administration.