المؤلفون: Salaün, Jean‐Philippe, Beaufils, Roxane, Chagnot, Audrey, Alexandre, Cénéric, Petit, Thierry, Hanouz, Jean‐Luc, Orliaguet, Gilles

المصدر: Pediatric Anesthesia ; volume 33, issue 10, page 823-828 ; ISSN 1155-5645 1460-9592

الوصف: Background Maintenance of physiological homeostasis is key in the safe conduct of pediatric anesthesia. Achieving this goal is especially difficult in neonatal surgery. Aims The first aim was to document the absolute number of seven intraoperative parameters monitored during anesthesia in neonates undergoing gastroschisis surgery. The second aims were to determine the frequency of monitoring of each of these intraoperative parameters as well as the proportion of cases in which each parameter was both monitored and maintained within a pre‐defined range. Methods This retrospective observational analysis includes data from 53 gastroschisis surgeries performed at Caen University Hospital (2009–2020). Seven intraoperative parameters were analyzed. First, we assessed if the intraoperative parameters were monitored or not. Second, when monitored, we assessed if these parameters were maintained within a pre‐defined range, based on the current literature and on local agreement. Results The median [first–third Q ], range (min–max) number of intraoperative parameters monitored during the 53 gastroschisis surgeries was 6 [5–6], range (4–7). There were no missing data for the automatically recorded ones such as arterial blood pressure, heart rate, end‐tidal CO 2, and oxygen saturation. Temperature was monitored in 38% of the patients, glycemia in 66%, and natremia in 68% of the cases. Oxygen saturation and heart rate were maintained within the pre‐defined range in 96% and 81% of the cases respectively. The blood pressure (28%) and temperature (30%) were instead the least often maintained within the pre‐defined range. Conclusion Although a median of six out of the seven selected intraoperative parameters were monitored during gastroschisis repair, only two of them (oxygen saturation and heart rate) were maintained within the pre‐defined range more than 80% of the time. It might be of interest to extend physiologic age‐ and procedure‐based approach to the development of specific preoperative anesthetic planning.

الإتاحة: https://doi.org/10.1111/pan.14719Test

المؤلفون: Valent, Arnaud, Nefzi, Imene, Lopez, Vanessa, Mirabile, Cristian, Orliaguet, Gilles

المساهمون: Ramamoorthy, Chandra

المصدر: Pediatric Anesthesia ; volume 31, issue 6, page 644-649 ; ISSN 1155-5645 1460-9592

الوصف: Percutaneous reverse Potts shunt improves right ventricular function in patients with suprasystemic idiopathic pulmonary arterial hypertension. There are no data regarding the anesthesia in this high‐risk procedure. We report our experience of the anesthetic management for the creation of percutaneous reverse Potts shunt in children with suprasystemic idiopathic pulmonary arterial hypertension. This study included 10 patients presenting with symptomatic idiopathic pulmonary arterial hypertension despite undergoing medical treatment. All patients underwent gradual induction of anesthesia to maintain hemodynamic stability (etomidate, n = 8; ketamine, n = 4). Four patients needed extracorporeal life support: 2 were rescued after cardiac arrest and 2 had elective extracorporeal life support due to preprocedural dysfunctional right ventricle and/or small left ventricle volumes with reduced cardiac output. All patients were admitted to the pediatric cardiac intensive care unit (4 [2–5] days). All patients with extracorporeal life support died. None of the six survivors needed pulmonary transplantation. Both ketamine and etomidate support hemodynamics. High‐dose opioid technique has the advantage of blunting noxious stimuli and subsequent increase in pulmonary vascular resistance. We recommend using multimodal monitoring with transesophageal echocardiography. The 100% mortality of extracorporeal life support patients, probably too sick to undergo such procedure, may question its usefulness. Further studies should identify suitable candidates for percutaneous reverse Potts shunt creation.

الإتاحة: https://doi.org/10.1111/pan.14169Test

المؤلفون: WEBER, TONI, SALVI, NADÈGE, ORLIAGUET, GILLES, WOLF, ANDREW

المصدر: Pediatric Anesthesia ; volume 19, issue s1, page 46-54 ; ISSN 1155-5645 1460-9592

الإتاحة: https://doi.org/10.1111/j.1460-9592.2009.02998.xTest

المؤلفون: Marsac, Lucile, Michelet, Daphné, Sola, Chrystelle, Didier‐Vidal, Anne, Combet, Sylvie, Blanc, Frederic, Orliaguet, Gilles, Aubineau, Jean‐Vincent, Julien‐Marsollier, Florence, Brasher, Christopher, Dahmani, Souhayl

المصدر: Pediatric Transplantation ; volume 23, issue 6 ; ISSN 1397-3142 1399-3046

الوصف: Background Renal transplantation is the best available therapeutic option for end‐stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. Material and Methods The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). Results Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. Conclusions The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.

الإتاحة: https://doi.org/10.1111/petr.13509Test

المؤلفون: Vergnaud, Estelle, Vidal, Charles, Montmayeur Verchere, Juliette, Taright, Hanna, Meyer, Philippe G., Carli, Pierre A., Orliaguet, Gilles A.

المساهمون: Anderson, Brian

المصدر: Pediatric Anesthesia ; volume 25, issue 2, page 160-166 ; ISSN 1155-5645 1460-9592

الوصف: Summary Background Thoracic bioreactance is a noninvasive and continuous method of cardiac output ( CO ) measurement that is being developed in adult patients. Very little information is available on thoracic bioreactance use in children. Objective The aim of the study was to evaluate the ability of a bioreactance device ( NICOM ® ; Cheetah Medical, Tel Aviv, Israel) to estimate CO and to track changes in CO induced by volume expansion (VE) in children. Methods Cardiac output values obtained using the NICOM ® device ( CO NICOM ) and measured by trans‐thoracic echocardiography ( CO TTE ) were compared in pediatric neurosurgical patients during the postoperative period. Results Seventy‐three pairs of measurements of CO obtained in 30 children were available for analysis. The bias (lower and upper limits of agreement) between CO NICOM and CO TTE was −0.11 (−1.4 to 1.2) l·min −1 . The percentage error (PE) was 55%. The precision of the NICOM ® device was 45%. A significant correlation was observed between the CO values obtained using the two methods ( r = 0.89, <0.001). The concordance percentage between changes in CO TTE and CO N icom induced by VE was 84% following exclusion of patients with changes in CO <15% ( n = 5). Conclusions The PE observed is too large, and the limits of agreement too wide, to enable us to comment on the equivalence of the two techniques of CO measurements. However, the NICOM ® device performs well in tracking changes in CO following VE.

الإتاحة: https://doi.org/10.1111/pan.12412Test

المؤلفون: Orliaguet, Gilles A., Gall, Olivier, Egan, Michael, Salvi, Nadège, Bernard, Remy, Treluyer, Jean‐Marc, Carli, Pierre A.

المساهمون: Polaner, David

المصدر: Pediatric Anesthesia ; volume 24, issue 6, page 641-642 ; ISSN 1155-5645 1460-9592

الإتاحة: https://doi.org/10.1111/pan.12407Test

المؤلفون: Bourdaud, Nathalie, Devys, Jean‐Michel, Bientz, Jocelyne, Lejus, Corinne, Hebrard, Anne, Tirel, Olivier, Lecoutre, Damien, Sabourdin, Nada, Nivoche, Yves, Baujard, Catherine, Orliaguet, Gilles A.

المساهمون: Lerman, Jerrold, Public Health Service Award from the Programme Hospitalier de Recherche Clinique national 2007 (PHRC national 2007). Direction G�n�rale de lOffre de Soins, Minist�re charge de la Sant�. Paris, France.

المصدر: Pediatric Anesthesia ; volume 24, issue 9, page 945-952 ; ISSN 1155-5645 1460-9592

الوصف: Summary Background Few data are available in the literature on risk factors for postoperative vomiting ( POV ) in children. Objective The aim of the study was to establish independent risk factors for POV and to construct a pediatric specific risk score to predict POV in children. Methods Characteristics of 2392 children operated under general anesthesia were recorded. The dataset was randomly split into an evaluation set ( n = 1761), analyzed with a multivariate analysis including logistic regression and backward stepwise procedure, and a validation set ( n = 450), used to confirm the accuracy of prediction using the area under the receiver operating characteristic curve ( ROC AUC ), to optimize sensitivity and specificity. Results The overall incidence of POV was 24.1%. Five independent risk factors were identified: stratified age (>3 and <6 or >13 years: adjusted OR 2.46 [95% CI 1.75–3.45]; ≥6 and ≤13 years: a OR 3.09 [95% CI 2.23–4.29]), duration of anesthesia (a OR 1.44 [95% IC 1.06–1.96]), surgery at risk (a OR 2.13 [95% IC 1.49–3.06]), predisposition to POV (a OR 1.81 [95% CI 1.43–2.31]), and multiple opioids doses (a OR 2.76 [95% CI 2.06–3.70], P < 0.001). A simplified score was created, ranging from 0 to 6 points. Respective incidences of POV were 5%, 6%, 13%, 21%, 36%, 48%, and 52% when the risk score ranged from 0 to 6. The model yielded a ROC AUC of 0.73 [95% CI 0.67–0.78] when applied to the validation dataset. Conclusions Independent risk factors for POV were identified and used to create a new score to predict which children are at high risk of POV .

الإتاحة: https://doi.org/10.1111/pan.12428Test

المؤلفون: Bernard, Remy, Salvi, Nadège, Gall, Olivier, Egan, Michael, Treluyer, Jean‐Marc, Carli, Pierre A., Orliaguet, Gilles A.

المساهمون: Lonnqvist, Per‐Arne

المصدر: Pediatric Anesthesia ; volume 24, issue 3, page 303-308 ; ISSN 1155-5645 1460-9592

الوصف: Summary Background Little information is available on the titration of morphine postoperatively in children. This observational study describes the technique in terms of the bolus dose, the number of boluses required, the time to establish analgesia, and side effects noted. Methods Morphine was administered if pain score ( VAS or FLACC ) was >30. Patients weighing less than 45 kg received a 50 μg·kg −1 bolus of morphine with subsequent boluses of 25 μg kg −1 as required. Patients weighing over 45 kg received boluses of 2 mg. Pain and Ramsay scores were recorded up to 90 min after the end of the titration and any side effect or complication was noted. Data are presented as the median [interquartile Q1–Q3 range]. Results Overall, 103 children were studied. The median age was 4.2 years [0.8–12.2 years]. The median weight was 15.5 kg [8.2–35.0 kg]. The protocol was effective for pain control with a significant decrease in pain scores over time. The median pain score ( VAS or FLACC ) was 70 [50–80] prior to the initial bolus and 0 [0–10] 90 min after the last bolus. Median Ramsay score was 1 [1–2] before the initial bolus administration and 4 [2–4] at 90 min. The median total dose of morphine was 100 [70–140] μg·kg −1 , and the median number of boluses was 3 [2‐5]. Side effects were observed in 17% of cases. No serious complications were observed. Conclusions Our study of morphine titration for children shows that our protocol was effective for pain control with a significant decrease in pain scores over time. No serious complications were encountered. More studies on larger cohorts of patients are needed to confirm the efficacy and safety of this protocol.

الإتاحة: https://doi.org/10.1111/pan.12286Test

المؤلفون: Jouffroy, Romain, Baugnon, Thomas, Carli, Pierre, Orliaguet, Gilles

المصدر: Pediatric Anesthesia ; volume 21, issue 4, page 385-393 ; ISSN 1155-5645 1460-9592

الوصف: Summary Background: There are so far no existing consensus guidelines regarding red blood cell transfusion during pediatric surgery, and there is a little information regarding red blood cell transfusion policy among pediatric anesthesiologists. Objectives: To determine the transfusion threshold and the volumes of packed red blood cell (PRBC) transfusion among French‐speaking pediatric anesthesiologists. Materials and methods: A questionnaire of case scenarios was sent to active members of the French Language Society of Pediatrics Anesthesiologists (ADARPEF). Results: Of the 324 active members of the ADARPEF, 175 (54%) completed the questionnaire. The threshold for blood transfusion varied from 6 to 12 g·dl −1 depending on the scenario. The hemoglobin threshold for blood transfusion and the volume of blood transfused vary among ADARPEF physicians, for the same class of patients. The median [95% CI] hemoglobin threshold for starting blood transfusion was 7.9 [6.9–8.9], 7.3 [6.4–8.2], and 8.1 [7.0–9.2] g·dl −1 in the pre‐, intra‐, and postoperative phase, respectively. The median [95% CI] PRBC volume transfused was 11.7 [6.6–16.8] ml·kg −1 , and the median hemoglobin target was 11.3 [9.8–12.8] g·dl −1 . Physicians ranked age (79%), clinical tolerance of anemia (99%), underlying medical conditions (95%), hemodynamic instability (89%), hemostasis disorder (86%), and sepsis (79%) as the most significant factors affecting their transfusion decisions. Most pediatric anesthesiologists (89%) measure the hemoglobin level before PRBC transfusion. Conclusions: This survey identifies significant differences in transfusion practice patterns among pediatric anesthesiologists with a median transfusion threshold of 7.6 [6.6–8.6] g·dl −1 and a median PRBC volume transfusion of 11.7 [16.8–6.6] ml·kg −1 .

الإتاحة: https://doi.org/10.1111/j.1460-9592.2011.03531.xTest

المؤلفون: Greff, Bruno, Faivre, Judith, Carli, Pierre A., Niaudet, Patrick, Orliaguet, Gilles A.

المصدر: Pediatric Anesthesia ; volume 22, issue 3, page 244-249 ; ISSN 1155-5645 1460-9592

الوصف: Summary Background: There are few data regarding perioperative adverse events in children with nephrotic syndrome. Objectives: The aim of this study was to describe the nature and frequency of perioperative adverse events in children with nephrotic syndrome. Materials and Methods: This is a retrospective study from a large university pediatric hospital. All procedures under general anesthesia in children with nephrotic syndrome between January 1995 and May 2007 were included, with the exception of renal transplantation. Data were collected on demographics, etiology of nephrotic syndrome and related treatments, surgical procedures and anesthetic techniques, and pre‐ and postoperative treatments. Adverse events occurring during the intraoperative period and up to the fifth postoperative day were recorded. Results: Data on eight patients who underwent 24 surgical or interventional procedures under general anesthesia over the study period were reviewed. Three patients had steroid‐resistant nephrotic syndrome and five patients had congenital or infantile nephrotic syndrome. Five patients had progressed to end‐stage renal failure requiring dialysis. General anesthesia was performed for: nephrectomy ( n = 9), central venous catheter insertion ( n = 8), peritoneal dialysis catheter insertion ( n = 5), and emergency surgery in two cases (acute intestinal intussusception and hemodialysis catheter insertion). Three patients were receiving aspirin and one anticoagulant therapy. No postoperative thrombosis or infections, bleeding, peripheral edema or ascites, and increase in kalemia were noted. There was no significant postoperative increase in median serum creatinine level. Conclusions: Surgical procedures were seldom associated with the occurrence of perioperative adverse events. However, larger studies are needed to confirm these results.

الإتاحة: https://doi.org/10.1111/j.1460-9592.2011.03750.xTest