The Effects of an Order-Assist Mobile Application on Pediatric Anesthesia Safety: An Observational Study.

Pediatric anesthesia requires the rapid creation, communication, and execution of anesthesia orders, and there is a risk of human error. The authors developed an order-assisted mobile application (app) to reduce human error during pediatric anesthesia preparation. The authors conducted an observational study that compared the effects of the application by comparing anesthesiologists' errors, nurses' errors, nurses leaving the operating room, and delays in surgery, between the Conventional group (n = 101) and the App group (n = 101). The app was associated with reduced human error by anesthesiologists and nurses, and it lowered the frequency and duration of nurses leaving the operating room during anesthesia. In addition, the authors surveyed anesthesia nurses regarding the effectiveness of the app. The nurses confirmed that the app was convenient and reduced human error. This study revealed that the order-assisted mobile app developed by a pediatric anesthesiologist could reduce human errors by anesthesiologists and nurses during pediatric anesthesia preparation.

Pediatric perioperative fluid management.

The purpose of perioperative fluid management in children is to maintain adequate volume status, electrolyte level, and endocrine system homeostasis during the perioperative period. Although hypotonic solutions containing glucose have traditionally been used as pediatric maintenance fluids, recent studies have shown that isotonic balanced crystalloid solutions lower the risk of hyponatremia and metabolic acidosis perioperatively. Isotonic balanced solutions have been found to exhibit safer and more physiologically appropriate characteristics for perioperative fluid maintenance and replacement. Additionally, adding 1-2.5% glucose to the maintenance fluid can help prevent children from developing hypoglycemia as well as lipid mobilization, ketosis, and hyperglycemia. The fasting time should be as short as possible without compromising safety; recent guidelines have recommended that the duration of clear fluid fasting be reduced to 1 h. The ongoing loss of fluid and blood as well as the free water retention induced by antidiuretic hormone secretion are unique characteristics of postoperative fluid management that must be considered. Reducing the infusion rate of the isotonic balanced solution may be necessary to avoid dilutional hyponatremia during the postoperative period. In summary, perioperative fluid management in pediatric patients requires careful attention because of the limited reserve capacity in this population. Isotonic balanced solutions appear to be the safest and most beneficial choice for most pediatric patients, considering their physiology and safety concerns.

Comparison of the UEscope Video Laryngoscope with the Traditional Direct Laryngoscope in Neonates and Infants: A Randomized Clinical Trial.

The role of video laryngoscopy in adults is well established, but its role in children is still inconclusive. Previous studies on the UEscope in pediatric patients with difficult airways showed that it could reduce the time to intubation (TTI) compared to a conventional direct laryngoscope. The main objective of the current study was to investigate if the use of the UEscope could reduce the TTI in neonates and infants. Forty patients under 12 months old were recruited from a single tertiary hospital from March 2020 to September 2021 and were randomly assigned to the direct laryngoscope group (n = 19, neonates = 4, infants = 15) or UEscope group (n = 21, neonates = 6, infants = 15). Although the quality of glottic view was comparable in both groups, the TTI was significantly lower in the UEscope group in both the "intention-to-treat" (-19.34 s, 95% confidence interval = -28.82 to -1.75, p = 0.0144) and "as treated" (-11.24 s, 95% confidence interval: -21.73 to 0, p = 0.0488) analyses. The UEscope may be a better choice for tracheal intubation than conventional direct laryngoscope in neonates and infants.

Awareness and Perspectives among Asian Anesthesiologists on Postoperative Delirium: A Multinational Survey.

Postoperative delirium (POD) is a common perioperative complication. Although POD is preventable in up to 40% of patients, it is frequently overlooked. The objective of the survey is to determine the level of knowledge and clinical practices related to POD among anesthesiologists in different Asian countries. A questionnaire of 22 questions was designed by members of the Asian focus group for the study of POD, and it was sent to anesthesiologists in Singapore, Thailand, and South Korea from 1 April 2019 through 17 September 2019. In total, 531 anesthesiologists (Singapore: 224, Thailand: 124, Korea: 183) responded to the survey. Half the respondents estimated the incidence of POD to be 11-30% and believed that it typically occurs in the first 48 h after surgery. Among eight important postoperative complications, POD was ranked fifth. While 51.4% did not perform any test for POD, only 13.7% monitored the depth of anesthesia in all their patients. However, 83.8% preferred depth of anesthesia monitoring if they underwent surgery themselves. The results suggest that Asian anesthesiologists underestimate the incidence and relevance of POD. Because it increases perioperative mortality and morbidity, there is an urgent need to educate anesthesiologists regarding the recognition, prevention, detection, and management of POD.

Effect of intraoperative Hartmann's versus hypotonic solution administration on FLACC pain scale scores in children: A prospective randomized controlled trial.

BACKGROUND: In healthy children, an isotonic solution containing no glucose or a small amount of glucose (1-2%) has been recommended as an intraoperative maintenance fluid due to the potential risk of hyponatremia associated with hypotonic solutions. However, a hypotonic solution with glucose is still widely used as a maintenance fluid for pediatric anesthesia. We speculated that the hypotonic solution may worsen postoperative discomfort and irritability in pediatric patients due to hyponatremia. PATIENTS AND METHODS: In the current study, we compared the post-operative Face, Legs, Activity, Cry, Consolability(FLACC) scale scores of pediatric patients aged 3-10 years who received either a 1:2 dextrose solution or Hartmann's solution during Nuss Bar removal. RESULTS: The FLACC scale score in the post-anesthesia care unit was higher in the 1:2 dextrose solution group(HYPO) (n = 20) than in the Hartmann's solution group(ISO) (n = 20) (6.30 vs 4.70, p = 0.044, mean difference and 95% Confidence Interval(CI) was 1.6 (0.04 to 3.16)). We also compared opioid consumption at the post-anesthesia care unit. Total dose of fentanyl per body weight in the post-anesthesia care unit was also higher in the HYPO (0.59 vs 0.37 mcg/kg, p = 0.042, mean difference and 95% CI was 0.22 mcg/kg (0.030 to 0.402)). CONCLUSIONS: Intraoperative use of the hypotonic solution in children causes increased FLACC scale scores, leading to higher opioid consumption in post-anesthesia care unit.

Comparison between Post-Operative Analgesic Efficacy of Low-Concentration High-Volume and High-Concentration Low-Volume Combinations of Ropivacaine for Transverse Abdominis Plane Block in Pediatric Open Inguinal Hernia Repair.

Transverse abdominis plane (TAP) block can provide post-operative analgesia in children undergoing open inguinal hernia repair. However, the optimal anesthetic dose, and concentration for TAP block in the pediatric population, is not well defined. This study compared the post-operative analgesic effect of TAP block between low-concentration, with high-volume (LCHV) and high-concentration, with low-volume (HCLV) combinations of local anesthetic. Forty-four patients who underwent open inguinal hernia repair were randomly assigned to two groups. The patients in the LCHV group received 0.67 mL/kg of 0.15% ropivacaine. Whereas, those in the HCLV group received 0.4 mL/kg of 0.25% ropivacaine. Both groups received the same amount of ropivacaine (1 mg/kg). The primary outcome measure was the face, leg, activity, cry, consolability (FLACC) scale score at post-anesthetic care unit (PACU; T1). FLACC scale score at T1 was significantly lower in the HCLV group (2.91 versus 1.43; mean difference, -1.49; 95% confidence interval, -0.0245 to -2.936; p = 0.0464). FLACC scale scores one hour and six hours after the surgery were not different between the two groups. This study reports better post-operative analgesic effects after unilateral open inguinal hernia repair with 1 mg/kg of 0.25% ropivacaine than 1 mg/kg of 0.15% ropivacaine at PACU.

Preventative effect of ketamine on post-surgical hyperalgesia induced at a body part remote from the surgical site.

BACKGROUND: It is known that pain hypersensitivity can be induced at a body part remote from a surgical site (tertiary hyperalgesia), leading to patient discomfort. Nevertheless, no reported study to date has investigated methods to attenuate such tertiary hyperalgesia. Ketamine is known to modulate hyperalgesia induced by central sensitization. Thus, we investigated whether intraoperative administration of ketamine could decrease post-surgical tertiary hyperalgesia in patients undergoing a laparoscopic hysterectomy. METHODS: In total 46 patients were studied. Ketamine (1 mg/kg IV and 0.5 mg/kg/h or the same volume of 0.9% saline) was administered during surgery in the ketamine and control groups, respectively. The mechanical pain threshold was measured on the patients' dominant palm before and 24 hours after the surgery to evaluate hyperalgesia. RESULTS: The change in mechanical pain threshold over time (preoperative and postoperative) differed between the groups, with a lower postoperative threshold in the control group (118.6±170.5 vs. 419.2±233; P=0.015). The postoperative visual analogue scale score at rest was lower in the ketamine group (22±16 vs. 13±9; P=0.02). Visual analogue scale scores during deep breathing, consumption of analgesia and antiemetics, and the incidence of dizziness did not differ significantly between the groups (P>0.05). CONCLUSIONS: These results suggest that the intraoperative administration of ketamine may decrease post-surgical hyperalgesia developing at a region remote from the surgical site.