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Anesth Analg ; 130(2): 452-461, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30676349


BACKGROUND: Many of the common equations used for body surface area determination were either introduced before the widespread prevalence of childhood obesity, contained very few children in their sample, or have not been assessed in overweight/obese children. Therefore, we compared 6 body surface area formulae to determine their performance across body mass index categories using cross-sectional anthropometric data of children who underwent elective cardiac procedures. METHODS: We selected 6 formulae from the literature that included data from pediatric subjects in their derivation. We then substituted measured height and weight into each equation to compute body surface area data for the study subjects. The average values of the 6 formulae were calculated for each patient and used as reference for comparison. Comparisons between each formula and the reference standard were made with the 1-way ANOVA, Pearson correlation coefficient (measure of precision), the Lin concordance correlation coefficient (measure of bias and precision), and the Bland-Altman limit-of-agreement. All comparisons were made across age, sex, and body mass index categories. RESULTS: Among the 1000 (mostly Caucasian: 76.1%) subjects, 16.7% were overweight, while 14.1% were obese and 51.2% were girls. All calculated body surface area data showed a strong positive correlation with each other and the derived reference body surface area values (0.99-1.00; P < .001). Calculated body surface area values for all the formulae were significantly higher in overweight and obese children across every age group. CONCLUSIONS: Obesity status is a critical factor in the determination of body surface area values in children undergoing elective cardiac procedures. We caution that indexed hemodynamic and other therapeutic interventions may be inappropriate if limitations of body surface area formulae and the effect of obesity are not taken into consideration when caring for overweight and obese children. Body surface area studies utilizing accurate contemporary techniques that include sufficient number of overweight and obese children of various races are urgently needed.

Índice de Massa Corporal , Superfície Corporal , Procedimentos Cirúrgicos Cardíacos/métodos , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/cirurgia , Adolescente , Antropometria/métodos , Procedimentos Cirúrgicos Cardíacos/normas , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Sobrepeso/diagnóstico , Sobrepeso/cirurgia
J Natl Med Assoc ; 111(5): 481-489, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31003832


BACKGROUND: Recent data among pediatric otolaryngology patients showed unexplained higher rates of serious perioperative respiratory adverse events (PRAE) in black children compared to their white peers. We evaluated whether preoperative respiratory comorbidity (PRC) burden contributes to racial disparity in serious PRAE in children undergoing non-otolaryngologic procedures. METHODS: Rates of serious PRAE (laryngospasm and/or bronchospasm) were compared across racial groups in a retrospective cohort of black and white children (N = 18538; black 10%) who underwent various elective, non-otolaryngologic procedures between 2007 and 2014 at a US tertiary Children's hospital. Self-reported race was the primary exposure while age, gender, recent upper respiratory tract infection, use of endotracheal intubation, PRC burden and an interaction term between PRC and race were covariates. RESULTS: Serious PRAE occurred in 9.6% of black children and 6.6% of white children. Although there was no significant difference in age between the groups, being black (odds ratio (OR) 1.70; 95% confidence interval (CI) 1.11-2.62) was independently associated with serious PRAE. Similarly, baseline PRC was independently linked (p < 0.001) with serious PRAE. Notably, there was no significant (p = 0.454) interactions between race and PRC and serious PRAE in our subjects. CONCLUSION: Race and PRC are important considerations in the risk of serious PRAE and black children are especially at risk compared to their white peers. Children, with PRC (particularly those with SDB and asthma) are also at risk suggesting that due consideration should be given to these factors in the perioperative care of children undergoing elective surgical procedures. Mechanisms underlying these associations deserve further evaluation.

Anesth Analg ; 127(3): e47, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29683830