Perioperative crisis events refer to unexpected seriously life-threatening when the patient is during or after surgery, and require rapid identification, evaluation, and management by clinical teams to minimize harm. The pediatric anesthesia management during perioperative period is special and challenging for anesthesiologists, requiring professional technical and non-technical skills. The article mainly elaborates on the incidence and risk factors of pediatric anesthesia crisis events during perioperative period and introduces the concept of anesthesia crisis resource management and strategies. The anesthesiologist team needs to adopt a crisis resource management strategy, taking a typical crisis event of malignant hyperthermia as an example, including identification of crisis signs immediately, termination of trigger drugs rapidly, intravenous injection of the special drug dantrolene, physical cooling, and symptomatic support treatment, seeking assistance from other teams actively, recording and feeding back. This study aims to improve the cognitive decision-making ability and teamwork ability of anesthesiologists and their teams, effectively preventing and responding to potential crisis events effectively, and ensuring the safety of pediatric patients during perioperative period.
围手术期危机事件是指在手术期间或手术后发生的、非预料之中的患者生命受到严重威胁的状态，需要临床团队快速识别、评估和管理，最大限度减少对患者的伤害。而围手术期儿科麻醉的管理对于麻醉医师尤其具有特殊性和挑战性，需要麻醉医师具备专业的技术和非技术技能。本文主要阐述围手术期儿科麻醉危机事件的发生率和风险因素，引入麻醉危机资源管理的概念以及处理策略。并以恶性高热典型危机事件为例，介绍了麻醉团队需采取的麻醉危机资源管理策略，包括及时识别危机征兆、迅速终止诱发药物、静注特效药丹曲林钠、物理降温及对症支持治疗、积极寻求其他团队协助、记录和反馈等。以期提高麻醉医师的认知决策能力和团队合作能力，从而有效预防和应对可能发生的潜在危机事件，保障患儿围手术期的安全。.

In China, healthcare has lagged relative to its economic boom during the past 40 years. While the top tier hospitals offer pediatric perioperative care like high-income countries, lower-tier hospitals deliver lesser services of variable quality and safety related to equipment, supplies, clinician education, and availability. The national residency training program and the pediatric anesthesia fellowship program was established in 2013 and 2018 respectively. Increasing clinician workload from patient demand and a lack of consistency in quality and capability between rural and urban areas remain challenging.

BACKGROUND: Delayed extubation and transfer to the intensive care unit (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay, and increase medical expenses; however, whether a child will require delayed extubation or transfer to the ICU after scoliosis orthopedic surgery is not fully understood. In this study, we reviewed the risk factors for delayed extubation and transfer to the ICU after scoliosis orthopedic surgery in children.
METHODS: The electronic medical records of pediatric patients (≤ 18 years) who underwent posterior spinal fusion surgery between January 2018 and November 2021 were reviewed and analyzed. Patient characteristics (age, sex, body mass index, American Society of Anesthesiologists, ASA, grade, preoperative lung function, and congenital heart disease), preoperative Cobb angle, scoliosis type, correction rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allogeneic transfusion, intraoperative hemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg predicted body weight), surgical time, postoperative extubation, and transfer to the ICU were collected. The primary outcomes were delayed extubation and transfer to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and ICU transfer.
RESULTS: A total of 246 children who satisfied the inclusion criteria were enrolled in this study, of whom 23 (9.3%) had delayed extubation and 81 (32.9%) were transferred to the ICU after surgery. High ASA grade (odds ratio [OR] 5.42; 95% confidence interval [CI] 1.49-19.78; p = 0.010), high Cobb angle (OR 1.04; 95% CI 1.02-1.07; p < 0.001), moderate to severe pulmonary dysfunction (OR 10.9; 95% CI 2.00-59.08; p = 0.006) and prolonged surgical time (OR 1.01; 95% CI 1.00-1.03; p = 0.040) were risk factors for delayed extubation. A high Cobb angle (OR 1.02; 95% CI 1.01-1.04; p = 0.004), high intraoperative bleeding volume (OR 1.06; 95% CI 1.03-1.10; p = 0.001), allogeneic transfusion (OR 3.30; 95% CI 1.24-8.83; p = 0.017) and neuromuscular scoliosis (OR 5.38; 95% CI 1.59-18.25; p = 0.007) were risk factors for transfer to the ICU. A high Cobb angle was a risk factor for both delayed extubation and ICU transfer. Age, sex, body mass index, number of vertebral fusion segments, correction rate, and intraoperative tidal volume were not associated with delayed postoperative extubation and ICU transfer.
CONCLUSIONS: The most common risk factor for delayed extubation and ICU transfer in pediatric patients who underwent posterior spinal fusion was a high Cobb angle. Determining risk factors for a poor prognosis may help optimize perioperative respiratory management strategies and planning of postoperative care for children undergoing complicated spinal surgery.
UNASSIGNED: HINTERGRUND: Verzögerte Extubation und Verlegung auf die Intensivstation (ICU) bei Kindern, die sich einer größeren Skolioseoperation unterziehen, können postoperative Komplikationen erhöhen, den Krankenhausaufenthalt verlängern und die medizinischen Kosten steigern. Es ist jedoch nicht vollständig verstanden, ob ein Kind nach einer orthopädischen Skolioseoperation eine verzögerte Extubation oder Verlegung auf die ICU benötigen wird. In dieser Studie haben wir die Risikofaktoren für verzögerte Extubation und Verlegung auf die ICU nach orthopädischer Skolioseoperation bei Kindern überprüft.
UNASSIGNED: Die elektronischen Krankenakten pädiatrischer Patienten (≤ 18 Jahre), die sich zwischen Januar 2018 und November 2021 einer Spondylodese der hinteren Wirbelsäule unterzogen, wurden überprüft und analysiert. Die Patientenmerkmale (Alter, Geschlecht, Body-Mass-Index, ASA-Klassifikation der ASA [Amerikanischen Gesellschaft für Anästhesiologie], präoperative Lungenfunktion und angeborene Herzkrankheiten), präoperativer Cobb-Winkel, Skoliosetyp, Korrekturrate, fusionierte Wirbelsegmente, Pedikelschrauben, chirurgische Osteotomie, intraoperative Blutung, intraoperative allogene Transfusion, intraoperative Hämoglobinveränderungen, intraoperative mittlere arterielle Druckänderungen, intraoperatives Tidalvolumen (ml/kg prognostiziertes Körpergewicht), Operationsdauer, postoperative Extubation und Verlegung auf die Intensivstation wurden erfasst. Die primären Endpunkte waren verzögerte Extubation und Verlegung auf die Intensivstation. Multivariate logistische Regressionsmodelle wurden verwendet, um die Risikofaktoren für verzögerte Extubation und die Verlegung auf die Intensivstation zu ermitteln.
UNASSIGNED: Insgesamt wurden 246 Kinder, die die Einschlusskriterien erfüllten, in diese Studie eingeschlossen, von denen 23 (9,3 %) eine verzögerte Extubation hatten und 81 (32,9 %) nach der Operation auf die Intensivstation verlegt wurden. Ein hoher ASA-Grad (Odds-Ratio [OR] 5,42; 95 % Konfidenzintervall [KI] 1,49–19,78; p = 0,010), ein hoher Cobb-Winkel (OR 1,04; 95 % KI 1,02–1,07; p < 0,001), eine moderate bis schwere Lungenfunktionsstörung (OR 10,9; 95 % KI 2,00–59,08; p = 0,006) und eine verlängerte Operationsdauer (OR 1,01; 95 % KI 1,00–1,03; p = 0,040) waren Risikofaktoren für verzögerte Extubation. Ein hoher Cobb-Winkel (OR 1,02; 95 % KI 1,01–1,04; p = 0,004), ein hohes intraoperatives Blutungsvolumen (OR 1,06; 95 % KI 1,03–1,10; p = 0,001), allogene Transfusion (OR 3,30; 95 % KI 1,24–8,83; p = 0,017) und neuromuskuläre Skoliose (OR 5,38; 95 % KI 1,59–18,25; p = 0,007) waren Risikofaktoren für die Verlegung auf die Intensivstation. Ein hoher Cobb-Winkel war ein Risikofaktor sowohl für die verzögerte Extubation als auch für die Verlegung auf die Intensivstation. Alter, Geschlecht, Body-Mass-Index, Anzahl der fusionierten Wirbelsegmente, Korrekturrate und intraoperatives Tidalvolumen standen nicht im Zusammenhang mit der verzögerten postoperativen Extubation und der Verlegung auf die Intensivstation.
UNASSIGNED: Der häufigste Risikofaktor für eine verzögerte Extubation und die Verlegung auf die Intensivstation bei pädiatrischen Patienten, die sich einer Spondylodese der hinteren Wirbelsäule unterzogen haben, war ein hoher Cobb-Winkel. Die Identifizierung von Risikofaktoren für eine ungünstige Prognose kann dazu beitragen, die perioperative Atemwegsmanagementstrategie zu optimieren und die Planung der postoperativen Versorgung von Kindern mit komplexen Wirbelsäuleneingriffen zu verbessern.

Rett Syndrome (RTT) is a rare, severe, and progressive developmental disorder with intellectual disability. Anesthesia in RTT patients presents a range of challenges. We report a child with RTT who received dental treatment under muscle relaxant-free general anesthesia in our ambulatory center.
A 15-year-old girl with RTT was admitted to our dental clinic with multiple dental caries and residual roots. Dental treatment was scheduled under ambulatory general anesthesia. After anesthesia induction, a nasal tube was initiated under the guidance of a fiberoptic bronchoscope. Multimodal analgesia, body temperature monitoring, and postoperative nausea and vomiting prevention were applied. No muscle relaxants were used throughout the process. The endotracheal tube was successfully removed after the operation and the patient was discharged home the same day.
An individualized anesthesia strategy enabled a quick and safe recovery for this RTT patient after dental treatment under muscle relaxant-free general anesthesia.

Erector spinae plane block is a promising strategy for pain management in some settings. However, the effectiveness of erector spinae plane block versus caudal block in pediatric inguinal hernia repair has yet to be formally investigated.
One hundred and two patients aged 2-5 years undergoing unilateral open inguinal hernia repair randomly received unilateral erector spinae plane block (0.2% ropivacaine 0.5 mL kg-1), caudal block (0.2% ropivacaine 1 mL kg-1), or no block. The primary outcome was time to the first rescue analgesia, defined as the interval from the end of surgery to the Face, Legs, Activity, Cry, and Consolability scale greater than three. Secondary outcomes included the number of patients requiring rescue analgesia, the area under the curve of pain scores over time, satisfaction of guardians, and adverse events.
The median time to the first rescue analgesia was longer in the erector spinae plane block group than in the caudal block group [10.0 h (interquartile range, 6.6-24.0 h) vs. 5.0 h (interquartile range, 2.9-7.3 h); p < .001]. The Cox regression model demonstrated that the risk of postoperative rescue analgesia requirement was 0.38 in children receiving erector spinae plane block compared with caudal block (95% confidence interval 0.23-0.64; p < .001). Additionally, the area under the curve of the pain scores over time was lower in the erector spinae plane block group than in the caudal block group (44.3 [36.6-50.7] vs. 59.0 [47.1-64.5]; p < .001).
Erector spinae plane block provided superior postoperative analgesia compared to caudal block in children undergoing inguinal hernia repair.Trial registration: Chinese Clinical Trial Registry; ChiCTR2100048303.
Erector spinae plane block (ESPB) is beneficial for postoperative analgesia in children undergoing inguinal hernia repair.Ultrasound-guided ESPB provided superior analgesia efficacy to caudal block in the pediatric population.ESPB is an attractive strategy for pain management after lower abdominal surgical procedures.

暂无摘要。

Objective: To investigate the anesthesia outcomes of ketamine and propofol in pediatric anesthesia and analyze associated prognostic factors. Methods: A retrospective study was conducted on 160 children who underwent anesthesia and operation in Children\'s Hospital of Nanjing Medical University from 2020 to 2022. The anesthesia outcomes was analyzed by comparing the blood oxygen saturation (SpO2), heart rate (HR), mean arterial pressure (MAP) at before (T1), during (T2) and after (T3) operations, recovery time after anesthesia, post-anesthesia care unit (PACU) stay, adverse reactions, as well as the Steward and FLACC scores between the control and research groups. Univariate analysis and logistic regression analysis were used to identify the prognostic factors in pediatric anesthesia. Results: The changes in SpO2, HR, and MAP were different between the two groups at different time points (P < 0.05). There were significant differences in anesthesia recovery time, PACU stay, Steward and FLACC scores, and incidence of adverse reactions between the two groups (P < 0.05). Logistic regression analysis revealed that operation time ≥ 49.5 minutes (P = 0.001, OR = 3.828, 95% CI: 1.715-8.544) and single use of ketamine for anesthesia (P = 0.048, OR = 2.257, 95% CI: 1.006-5.063) were independent risk factors for postoperative delirium. Conclusion: Combining propofol with ketamine for pediatric anesthesia yields superior clinical outcome compared to using ketamine alone. This combined approach can effectively maintain stable circulation during operation, lead to shorter anesthesia recovery time, ensure high recovery quality, reduce postoperative pain, adverse reaction rate, and risk of post-anesthesia delirium in children, thereby improving the prognosis.

暂无摘要。

UNASSIGNED: Emergence delirium is an early postoperative behavior change in pediatric patients, posing risks to patient safety and leading to prolonged hospital stays and increased medical costs. As a result, the research on emergence delirium has grown substantially. This study aims to identify the most influential literature, trends, and topics in emergence delirium research, as well as to quantify the fundamental data of academic publications on this topic.
UNASSIGNED: We searched for articles on emergence delirium in the Science Citation Index Expanded databases, covering the period from 2002 to 2022. Bibliographic information, including countries, institutions, journals, authorships, references, and keywords, was collected for further analysis.
UNASSIGNED: A total of 739 articles on emergence delirium published between 2002 and 2022 were collected. China emerged as the most prolific publisher in this field, accounting for over 30% of all articles (226 publications), followed by the United States (n = 143) and South Korea (n = 92). The top three productive journals were Pediatric anesthesia (n=78, IF=2.129), Anesthesia and Analgesia (n=28, IF=6.627), and BMC Anesthesiology (n=28, IF=2.583). Yonsei University was the most active institution, with 22 publications related to emergence delirium. Among authors, Kin, Hee-Soo (n = 9) published the most articles in this field, followed by Yao, Yusheng (n = 7), Lee, Ji-Hyun (n = 7). The prominent topics in emergence delirium research during the past two decades were \"children\", \"emergence delirium\" and \"propofol\".
UNASSIGNED: Through bibliometric analysis, this study provides a comprehensive overview of the trends and developments in the field of emergence delirium over the past two decades. The results demonstrate a significant growth in emergence delirium research worldwide, with China leading in the number of publications. Despite the wealth of literature on strategies for preventing and managing emergence delirium in clinical settings, further basic research is needed to elucidate the underlying mechanisms of emergence delirium.

OBJECTIVE: To compare the safety profiles between propofol and sevoflurane in pediatric anesthesia and to investigate risk factors for postoperative adverse reactions.
METHODS: The data of 194 children who received surgical treatment in Peking Union Medical College Hospital between January 2019 and May 2022 were analyzed retrospectively. According to the different anesthetic drugs the children received, they were divided into a control group (conventional anesthesia with sevoflurane, n=94) and an observation group (anesthesia with both propofol and sevoflurane, n=100). The two groups were compared in terms of anesthetic effect, heart rate, blood oxygen saturation, Ramsay sedation scale (RSS) score during the recovery of anesthesia, and anesthesia safety. Further, the children were grouped based on RSS score to identify the risk factors for agitation during the recovery of anesthesia via logistics regression.
RESULTS: The onset time of anesthesia, spontaneous breathing recovery time, extubation time, eye opening time and awake time in the observation group were all significantly shorter than those in the control group (P<0.05). At T1 (during anesthesia induction), T2 (after tracheal intubation) and T3 (after extubation), the observation group showed relatively stable heart rate and blood oxygen saturation than the control group (P<0.05). At the time of awakening, extubation and 30 minutes after extubation, the observation group exhibited significantly lower RSS score than the control group (P<0.05). The observation group also showed a significantly lower incidence of nausea, vomiting and agitation than the control group (P<0.05). Additionally, age ≤6 years old and anesthesia scheme were independent risks for agitation in children during the recovery of anesthesia. The occurrence group had significantly higher risk scores than the non-occurrence group (P<0.05). According to receiver operating characteristic curve-based analysis, the area under the curve of risk score in predicting agitation during the recovery of anesthesia was 0.733.
CONCLUSIONS: Anesthesia with both propofol and sevoflurane is effective in children undergoing surgical treatment, because the combination can substantially reduce the agitation of children during the recovery of anesthesia and has high anesthesia safety. Propofol combined with sevoflurane is a protective factor against agitation in children during the recovery of anesthesia.