General Anesthesia In Children Research Articles

Transition in eye gaze as a predictor of emergence from general anesthesia in children and adults: a prospective observational study

BackgroundIt is useful to monitor eye movements during general anesthesia, but few studies have examined neurological finding of the eyes during emergence from general anesthesia maintained with short-acting opioids and volatile anesthetics.MethodsThirty children aged 1–6 years and 30 adults aged 20–79 years were enrolled. Patients received general anesthesia maintained with sevoflurane and remifentanil. The timing of three physical-behavioral responses—eye-gaze transition (the cycle from conjugate to disconjugate and back to conjugate), resumption of somatic movement (limbs or body), and resumption of respiration—were recorded until spontaneous awakening. The primary outcome measure was the timing of the physical-behavioral responses. Secondary outcome measures were the incidence of eye-gaze transition, and the bispectral index, concentration of end-tidal sevoflurane, and heart rate at the timing of eye-gaze transition.ResultsEye-gaze transition was evident in 29 children (96.7%; 95% confidence interval, 82.8–99.9). After the end of surgery, eye-gaze transition was observed significantly earlier than resumption of somatic movement or respiration (472 [standard deviation 219] s, 723 [235] s, and 754 [232] s, respectively; p < 0.001). In adults, 3 cases (10%; 95% CI, 0.2–26.5) showed eye-gaze transition during emergence from anesthesia. The incidence of eye-gaze transition was significantly lower in adults than in children (p < 0.001).ConclusionIn children, eye-gaze transition was observed significantly earlier than other physical-behavioral responses during emergence from general anesthesia and seemed to reflect emergence from anesthesia. In contrast, observation of eye gaze was not a useful indicator of emergence from anesthesia in adults.

Longitudinal assessment of behaviour in young children undergoing general anaesthesia

BackgroundExposure to general anaesthesia in children might increase the risk of long-term behavioural problems. It is unclear if any behavioural changes in the short term after anaesthesia could be associated with long-term problems. The goal of the current study was to evaluate the short-term trajectory of parent-reported behaviour measured by the Behaviour Assessment System for Children, third edition (BASC-3) amongst children aged 2.5–6 yr who underwent general anaesthesia for elective surgery. MethodsChildren who were undergoing general anaesthesia for surgery were recruited for assessment of behaviour on two occasions: preoperatively (from 1 week to 1 day before anaesthesia), and 3 months postoperatively. To assess longitudinal changes in the parent-reported behaviour measured by BASC-3, linear mixed models were built with visit number included as a categorical variable and subject-specific random intercepts. ResultsSixty-eight children (37 girls [54%]) were enrolled in the study and completed both assessments. At 3 months after anaesthesia, statistically significant improvements (decrease in T scores) in internalising problems (−2.7 [95% confidence interval −4.2 to −1.1]), anxiety (−2.5 [−4.4 to −0.5]), and somatisation (−3.0 [−5.2 to −0.9]) were found. There were no significant differences in scores between visits for other composites or scales. The pattern of results did not depend upon prior anaesthesia exposure. ConclusionsAnaesthesia for elective surgery in young children was associated with a small decrease in internalising problems but no changes in other areas of behavioural problems when assessed at 3 months postoperatively, including in children with prior exposure to anaesthesia.

Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia.

Re-manipulation of paediatric forearm fractures under general anaesthetic may be required following inadequate closed reduction under conscious sedation. Manipulation under general anaesthetic carries significant inherent risks and is preferably avoided. We assessed one institution's experience with paediatric forearm fracture reduction and investigate the incidence of re-manipulation under general anaesthetic of fractures initially managed under conscious sedation without fluoroscopy. All paediatric forearm fractures presenting to the children's emergency department of our national children's hospital between 1 January 2019 and 30 June 2019 were studied. Radius and ulna fractures were categorised according to fracture location (distal third, middle third, proximal third), any associated injury, and any plan to proceed to the operating room that was documented prior to manipulation in the emergency department. Univariate and multivariate statistical analysis was carried out to test for differences between discrete and continuous data and odds ratios were calculated. Three-hundred and nine patients presented during the study period with 267 being eligible for analysis. Fifteen point seven percent (42/267) required fracture manipulation in the operating theatre following initial reduction in the children's emergency department. Independent risk factors associated with significantly higher rates of failed reduction under conscious sedation (p<0.001-0004) were patients who had a delay in presentation to hospital, were older, or had a non-distal fracture site. There are higher rates of re-manipulation under general anaesthetic in children presenting to the emergency department of our national children's hospital with forearm fractures than seen in comparative international studies. Risk factors which predict an inadequate initial reduction and interventions to improve this are discussed.

Clinical implementation of plasma cell-free circulating tumor DNA quantification by digital droplet PCR for the monitoring of Ewing sarcoma in children and adolescents.

BackgroundTreatment stratification and response assessment in pediatric sarcomas has relied on imaging studies and surgical/histopathological evidence of vital tumor cells. Such studies and evidence collection processes often involve radiation and/or general anesthesia in children. Cell-free circulating tumor DNA (ctDNA) detection in blood plasma is one available method of so-called liquid biopsies that has been shown to correlate qualitatively and quantitatively with the existence of vital tumor cells in the body. Our clinical observational study focused on the utility and feasibility of ctDNA detection in pediatric Ewing sarcoma (EWS) as a marker of minimal residual disease (MRD).Patients and methodsWe performed whole genome sequencing (WGS) to identify the exact breakpoints in tumors known to carry the EWS-FLI1 fusion gene. Patient-specific fusion breakpoints were tracked in peripheral blood plasma using digital droplet PCR (ddPCR) before, during, and after therapy in six children and young adults with EWS. Presence and levels of fusion breakpoints were correlated with clinical disease courses.ResultsWe show that the detection of ctDNA in the peripheral blood of EWS patients (i) is feasible in the clinical routine and (ii) allows for the longitudinal real-time monitoring of MRD activity in children and young adults. Although changing ctDNA levels correlated well with clinical outcome within patients, between patients, a high variability was observed (inter-individually).ConclusionctDNA detection by ddPCR is a highly sensitive, specific, feasible, and highly accurate method that can be applied in EWS for follow-up assessments as an additional surrogate parameter for clinical MRD monitoring and, potentially, also for treatment stratification in the near future.

Inducibility of atrioventricular nodal reentrant tachycardia and ectopic atrial tachycardia in children under general anesthesia.

In children, invasive electrophysiological studies (EPS) and radiofrequency catheter ablations (RFA) of supraventricular tachycardia (SVT) are often performed under general anesthesia. Atrioventricular nodal reentrant tachycardia (AVNRT) and ectopic atrial tachycardia (EAT) must be inducible during EPS as reliable diagnosis and subsequent therapy are not possible in sinus rhythm. This study aims to assess the problem of noninducible AVNRT and EAT under general anesthesia. Anesthesia protocols of 166 patients undergoing EPS were retrospectively analyzed. 122 AVNRT patients were compared to 22 whose tachycardia was not inducible but probably due to an AVNRT mechanism. Another 16 patients with inducible EAT were compared to 6 whose EAT appeared on surface ECG but not during EPS. Demographic characteristics were similar among all groups. Inducibility did not differ (p=.42) between AVNRT patients with inhalational anesthesia (sevoflurane and/or nitrous oxide) and patients with intravenous anesthesia (propofol with/without remifentanil). The EAT group exhibited lower inducibility under intravenous anesthesia (64%) than under inhalational (88%), however without significance (p=.35). Tachycardia induction succeeds with similar frequency under both inhalational and intravenous general anesthesia in children with AVNRT. In children with EAT, inhalational anesthesia is associated with a trend towards better inducibility.

Comparison of Emergence Agitation Scale Scores and Creatine Kinase Levels After General Anesthesia in Children: A Prospective Cohort Study.

IntroductionA simple indicator of muscle damage is creatine kinase (CK). Although CK elevation is informative for malignant hyperthermia, no study has examined the relationship between the anesthetically awake state and CK in children. We aimed to prospectively examine the relationship between the awakening state and CK on the day after surgery in children who have undergone anesthesia with volatile inhalation anesthetics.MethodsThe study included 119 patients aged 0-15 years and scheduled to undergo general anesthesia for cleft lip and palate-related surgery. Emergence agitation (EA) was assessed after completion of general anesthesia using the five-point EA scale, and patients were divided into the following five groups according to the EA score: EA1, EA2, EA3, EA4, and EA5. The primary outcome was ΔCK (comparison of CK values one week prior to surgery to CK values on the day after surgery) in each EA group. The secondary outcome was ΔCK when the EA score was divided into the following two groups: EA ≤2 (EA score of 1 or 2) and EA ≥3 (EA score of 3, 4, or 5).ResultsThe median ΔCK values in the EA1 to EA5 groups were 3 (quartile −19~9), 5 (−32~88), 99.5 (−18~190.5), 121 (29~219.5), and 144 (41~340.5), respectively, indicating a statistically significant difference overall. Statistically significant differences were also observed between the EA1 and EA4 groups and between the EA2 and EA4 groups. The median ΔCK values in the EA ≤2 and EA ≥3 groups were 3 (quartile −27~85) and 108 (23.5~206.7), respectively, indicating a statistically significant difference.ConclusionThe results of this study revealed that a higher EA score at the time of anesthesia awakening is associated with a larger ΔCK, indicating that a high CK level on the day after surgery is highly related to the state of the patient upon awakening.

Comparison of capillary blood glucose level at 1 h after induction of general anesthesia in children receiving intraoperatively either Ringer’s lactate with glucose 1% or Ringer’s lactate alone

Background: Perioperative fluid therapy in children is quite challenging job for anesthesiologists. Variable glycemic control has been reported in the literature regarding the use of balanced electrolyte solution with or without 1–2% glucose supplementation. Aims and Objectives: Hence, this study was planned to determine the capillary blood glucose level (CBG) in the intraoperative period at 1 h after induction of general anesthesia in children (1–6 years of age) receiving either Ringer’s lactate (RL) with glucose 1% or RL alone. Materials and Methods: A total of 60 patients of either gender, aged 1–6 years, of American Society of Anesthesiologists Physical Status Classes 1 and 2 were included for this interventional study. All children received protocolized general anesthesia with strict adherence to standard fasting guidelines. The children received either RL alone (Group A, n=30) or RL plus 1% glucose solution (Group B, n=30) as intraoperative fluid. The pre-operative CBG was recorded. Intraoperative fluid was given at 10 mL/kg/hr. The CBG was checked again at 30 min and 1 h after induction of anesthesia. The glycemic status at 1 h in the intraoperative period was compared (primary outcome) between the two groups. Results: The hemodynamics and intraoperative consumption of fluid were comparable between the groups. The mean CBG values at 30 min and at 1st h were considerably higher in groups receiving RL with 1% glucose compared with those receiving RL alone. However, these differences were not clinically significant. No adverse event was observed. Conclusion: RL alone or RL plus glucose 1% can be used as intraoperative fluid in children (1–6 years of age). None developed clinically significant hypoglycemia or hyperglycemia. However, the optimal amount of glucose which can be safely used in the perioperative period needs to be determined with a larger trial.

The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials.

BackgroundPropofol and sevoflurane are the most used anesthetics for pediatric surgery. Emergence agitation, postoperative nausea and vomiting and postoperative pain are the primary adverse effect of these general anesthetics. Many clinical studies had compared the safety of propofol and sevoflurane in pediatric surgery, but the results were controversial.ObjectivesTo evaluate the evidence surrounding the safety of propofol versus sevoflurane for general anesthesia in children.MethodsDatabases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Vip Data were searched to collect relevant articles. Trials were strictly selected according to previously defined inclusion and exclusion criteria. RevMan 5.3 software was used for meta-analyses.ResultsTwenty randomized controlled trials recruiting 1,550 children for general anesthesia were included, with overall low-moderate methodological quality. There was evidence that compared with sevoflurane anesthesia, propofol anesthesia significantly decreased the incidence of emergence agitation (OR = 4.99, 95% CI, 3.67–6.80; P < 0.00001), postoperative nausea and vomiting (OR = 1.91, 95% CI, 1.27–2.87; P = 0.002) and postoperative pain (OR = 1.72, 95% CI, 1.11–2.64; P = 0.01) in children. However, patients who received sevoflurane tended to have shorter times to eye opening (MD = −2.58, 95% CI, −2.97– −2.19; P < 0.00001) and times to extubation (MD = −1.42, 95% CI, −1.81– −1.02; P < 0.00001).ConclusionsThis review reveals that the children who received propofol anesthesia had the lower risks of emergence agitation, postoperative nausea and vomiting and postoperative pain when compared with sevoflurane anesthesia. But the children who received sevoflurane recovered slightly faster than those received propofol. Considering the limitations of the included studies, better methodological quality and large controlled trials are expected to further quantify the safety of propofol and sevoflurane for general anesthesia in children.

The Effect of Alfentanil on Emergence Delirium Following General Anesthesia in Children: A Randomized Clinical Trial.

BackgroundEmergence delirium can occur after general anesthesia in children. An intravenous infusion of alfentanil may reduce the incidence or severity of emergence delirium after sevoflurane anesthesia.ObjectiveThe study aimed to investigate the effects of alfentanil intravenous infusion on emergence delirium and other perioperative complications.MethodThis was a single-center, randomized, placebo-controlled, double-blind clinical trial. A total of 172 children undergoing ambulatory dental treatment were randomized into three groups. Alfentanil group Alf2 received 0.2 μg/kg/min of alfentanil for continuous infusion, alfentanil group Alf4 received 0.4 μg/kg/min alfentanil, and the saline group (group Sal) received a continuous infusion of normal saline, with the same volume as the two other groups, as a placebo. The incidence of emergence delirium (assessed by the Paediatric Anaesthesia Emergence Delirium [PAED] scale), hemodynamic parameters, and recovery characteristics were recorded during the recovery period. The Aono scale was also used to assess for emergence delirium. A WeChat applet was designed to facilitate a caregiver teleconsultation and to provide feedback on postoperative nausea and vomiting and any other complications after discharge.ResultsThe incidence of emergence delirium in group Alf2 (22.9%) and group Alf4 (21.1%) was significantly lower than that observed in the Sal group (48.3%). The PAED scores in group Alf2 (6.4 ± 3.5) and group Alf4 (5.8 ± 3.8) were significantly lower than those for group Sal (9.6 ± 5.1) (p < 0.01). Ten children in the Alf4 group needed manual ventilatory assistance to maintain end-tidal carbon dioxide (ETCO2) < 55 mm; children in group Alf2 did not. There was no significant difference between the discharge time of groups Alf2 and Sal (31.2 ± 4.64 vs 30.5 ± 2.82 min; 0.659 [95% confidence interval {CI} −1.052 to 2.369], p = 0.643); the time to discharge of group Alf4 (35.16 ± 3.97 min) was significantly longer than that of groups Alf2 and Sal (p < 0.01). The incidence of nausea and vomiting was similar in the three groups. No other clinically relevant adverse events were observed.ConclusionsIntravenous infusion of 0.2 μg/kg/min and 0.4 μg/kg/min alfentanil decreased the incidence of emergence delirium in the post-anesthesia care unit. The 0.2 μg/kg/min dose of alfentanil resulted in less respiratory depression and discharge delay than the 0.4 μg/kg/min alfentanil dose.Trial registrationChinese Clinical Trial Registry (ChiCTR2100043320)Supplementary InformationThe online version contains supplementary material available at 10.1007/s40272-022-00510-5.

Effects of high-flow nasal oxygen combined with early extubation on the incidence of respiratory adverse events during emergence from general anesthesia in children undergoing adenoid-tonsillectomy

Objective: To investigate the effects of high-flow nasal oxygen (HFNO) combined with early extubation on the incidence of respiratory adverse events (RAE) during emergence from general anesthesia in children undergoing adenoid-tonsillectomy. Methods: From December 2021 to January 2022, 40 pediatric patients [21 males, 19 females, with a median age of 4 (4, 5) years] undergoing tonsillectomy and/or adenoidectomy in Eye & ENT Hospital of Fudan University were randomly divided into two groups: HFNO-assisted early extubation group (Group H, n=20) and conventional extubation group (Group C, n=20) by using a random number table. After entering the post-anesthesia care unit (PACU), the patients in group H received humidified and heated oxygen (flow rate: 25 L/min) through a nasal cannula until their consciousness regained. After patient's spontaneous breathing resumed for 10 min, the oral endotracheal tube was removed. Patients in group C did not receive HFNO. The oral endotracheal tube was removed after the patient's spontaneous breathing resumed for at least 10 min with signs of tube intolerance, or 20 min without signs of tube intolerance. During the PACU stay, the incidence of RAE, the incidence of cough, the application rate of intensive care strategy, the time to extubation, the duration of PACU stay, and vital signs at spontaneous breathing resuming and extubation in each group were recorded. Results: In Group H, the total incidence of RAE [30% (6/20) vs 65% (13/20), P=0.027], the incidence of cough [10% (2/10) vs 45% (9/20), P=0.031] and the application rate of intensive care strategy [20% (4/20) vs 55% (11/20), P=0.048] during PACU stay was significantly lower, compared with those of Group C. Likewise, the time to extubation was significantly shorter [(33.4±4.5) min vs (42.7±5.3) min, P<0.001]. However, there was no statistically significant difference in the duration of PACU stay, the vital signs at the time of spontaneous breathing resuming and extubation between the two groups (P>0.05), except that the end-tidal carbon dioxide partial pressure (PETCO2) at the time of extubation in group H was significantly higher than group C [(52.9±9.4) mmHg vs (48.9±3.1) mmHg (1 mmHg=0.133 kPa), P<0.001]. Conclusion: HFNO combined with early extubation can significantly reduce the incidence of RAE in children undergoing adenoid-tonsillectomy during the emergence from general anesthesia.

SWK-03. Neuroimaging in CNS tumours: To GA , or not to GA, that is the question.

Children with a Central Nervous System (CNS) tumour have frequent magnetic resonance imaging (MRI) scans during their disease trajectory. Younger children routinely have these performed under general anaesthetic (GA) with an associated risk and inconvenience. Our project over a two-year period was to introduce a structured programme to any child over the age of five years old to achieve an MRI scan without the need for a GA. Thirty-six patients took part. The motivation behind this project was to enhance the hospital experience for patients and their families, lessen time spent in hospital and minimise risk. In addition, there was an added incentive of cost saving and increased availability of GA scans for other specialities within the hospital setting. During the COVID pandemic, it has also resulted in a reduction of our patients requiring COVID swabs, and isolation and in turn a reduction in aerosol generating procedures. As part of the structured programme, each child had an initial assessment with the nurse specialist followed by a minimum of one play preparation session with the play specialist. Children were required to demonstrate they could follow simple instructions, engage in social stories and role-play with hospital equipment and specialised resources. During these sessions, the children visited the MRI department where they practiced lying flat on the MRI bed as it moved into the scanner. Over the two-year period, of the total number of MRI scans performed, the amount of MRI scans requiring a GA reduced from 41% to 31%. The quality of the MRI scans was scrutinised and shown not to be significantly affected. In summary, by introducing a structured programme, it is possible to significantly reduce the need for GA in children requiring CNS imaging as part of their tumour journey.

Monitoring of analgesia level during general anesthesia in children.

Monitoring of intraoperative nociception has made substantial progress in adult anesthesia during the last 10 years. Several monitors have been validated and their use has been associated with intraoperative or postoperative benefits in the adult population. In pediatric anesthesia, less data are available. However, several recent publications have assessed the performance of nociception monitors in children, and investigated their potential benefits in this context. This review will describe the main validated intraoperative nociception monitors, summarize adult findings and describe the available pediatric data. Six intraoperative nociception indices were included in this review. Among them, four have shown promising results in children: Surgical Pleth Index (GE-Healthcare, Helsinki, Finland), Analgesia-Nociception Index (Mdoloris Medical Systems, Loos, France), Newborn-Infant Parasympathetic Evaluation (Mdoloris Medical Systems), and Pupillometry (IDMED, Marseille, France). The relevance of Skin Conductance (MedStorm innovations, AS, Oslo, Norway) under general anesthesia could not be established. Finally, the Nociception Level (Medasense, Ramat Gan, Israel) still requires to be investigated in children. To date, four monitors may provide a relevant assessment of intraoperative nociception in children. However, the potential clinical benefits associated with their use to guide analgesia remain to be demonstrated.

Evaluation of the Cause of Dental Treatment in Children under General Anesthesia from the Perspective of Pediatric Dentists and Postgraduate Students and Parents of Children under General Anesthesia at the Dentistry School of Tehran University of Medical Science.

Nowadays, dental treatment under general anesthesia is accepted as a treatment method in children in which other common methods do not allow to achieve acceptable results. The benefits of general anesthesia in pediatric dental treatment are that the treatment is completed in one session, the person is relieved of pain, and most importantly, the child does not need to cooperate. However, it is important to determine the exact dental reasons for children under general anesthesia. In this study, the cause of dental treatment under general anesthesia in children was examined from the perspective of specialists, assistants, and parents of children under general anesthesia. In this descriptive-analytical cross-sectional study, participants were selected from among the parents of children under general anesthesia for dental treatment and pediatric dentists and assistants in a purposeful manner. After the items were prepared by the professors, the prepared checklist was read to the people. After completing the checklist, the data were entered into SPSS software version 20 and analyzed using descriptive statistics such as frequency determination, mean, and statistical rests. According to the consensus of parents and experts, the main reasons for general anesthesia for children to perform their dental operations were: young age, lack of cooperation during previous dental treatment, a large number of dental treatments, systemic disease of the child, unwillingness of parents to perform behavioral control procedures, higher quality work under anesthesia, mental and physical behavioral problems, and reduced number of treatment sessions. Therefore, reasons such as young age, lack of cooperation, and a large number of dentist's work are among the most important factors that lead to the decision to perform general anesthesia in children. In light of this decision, the consequences and disadvantages/advantages of this method are important and therefore more research should be done on this issue.

Sevoflurane-Induced Neurotoxicity in the Developing Hippocampus via HIPK2/AKT/mTOR Signaling.

Sevoflurane (Sev) is a widely used inhalational anesthetic for general anesthesia in children. Previous studies have confirmed that multiple exposures to inhaled anesthetic can induce long-term neurotoxicity in newborn mice. However, the underlying mechanisms remain elusive. In this study, we investigated the role of homeodomain interacting protein kinase 2 (HIPK2), a stress activating kinase involved in neural survival and synaptic plasticity, and its underlying mechanism in sevoflurane-induced neurotoxicity. Empirical study showed that neuronal apoptosis was elevated after exposure to sevoflurane. Meanwhile, up-regulation of HIPK2 and AKT/mTOR signaling was observed in primary hippocampal neurons and hippocampus in mice upon anesthetic exposure. A64, antagonist of HIPK2, could significantly reduce increased apoptosis and activation of AKT/mTOR induced by sevoflurane. AKT antagonist MK2206 partially alleviated neuronal apoptosis without affecting the expression of HIPK2. Experimental results demonstrated a crucial role of HIPK2/AKT/mTOR signaling in neurotoxicity of sevoflurane. Thus, HIPK2/AKT/mTOR signaling can serve as a potential target for the protection of inhalation anesthesia-induced cytotoxicity in the future.

A comparison of laryngeal mask airway I-gel and Supreme during general anesthesia for lower abdominal surgery in children

Background: Both laryngeal mask airway I-gel and Supreme have been available for clinical use, but there was no comparison between two devices. This study was designed to compare the efficacy and complications of the laryngeal mask airway I-gel and Supreme in children undergoing general anesthesia for lower abdominal surgery. Methods: One hundred and twenty children were randomly assigned to either the I-gel or the Supreme group (60 children in each group). All patients of the two groups received the same protocol of general anesthesia. Evaluation criteria included successful mask insertion rate, ease of insertion, insertion time, and number of adjustments needed during anesthesia maintenace and postoperative complications. Results: There were no differences in the demographic data between the two groups. The success rate of insertion in the first attempt of the I-gel group was 94.8% and the Supreme group (98.3%) (p&gt;0.05). According to ease of placement, grade 1 (very easy) ratios of Supreme, and I-gel were 40% and 3.3%, respectively (p&lt;0.01). The insertion time of the I-gel was longer than that of Supreme (p &lt; 0.05). The rate of airway manipulations during anesthesia maintenance of Supreme, and I-gel group were 5% and 11.7%, respectively (p &gt; 0.05). The most common complication was cough, with the rate of 17% in I-gel group and 5% in Supreme group (p&lt;0.05). There were no differences in other complications between both groups. Conclusions: Both I-gel and Supreme provided a satisfactory airway during general anesthesia in children. Insertion of Supreme was significantly easier and more rapid than insertion of I-gel, and the incidence of cough after surgery was significantly lower with Supreme than I-gel. Key words: Laryngeal mask airway, I-gel, Supreme, children

Assessment of Pediatric First Permanent Molar Management under General Anesthesia at the King Abdulaziz Medical City, Jeddah, Saudi Arabia

Background: The use of general anesthesia (GA) among children has seen an increase globally. Both tooth extraction and restoration treatments on children were done under GA, but there are consequences in using GA in children, which also include changes in the treatment plan. First permanent molar (FPM) treatment under GA is a very strategic treatment, but there is a notable lack of studies that assess in detail this type of treatment, especially its frequency of administration under GA. This study determines the treatment frequency and the type of FPM treatment in children under GA at the King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia.&#x0D; Methods: Our study is a cross-sectional study that reviewed the cases of dental rehabilitation in children between the ages of 5 and 14 years old from 2015 to 2018. These children had erupted first permanent molars and were treated under GA.&#x0D; Results: This study included 394 children, with 1330 FPMs treated under general anesthesia for (27%) preventive, (56%) restorative, and (17%) extraction treatments. The frequency of FPM treatments administered were color restoration (49%), fissure sealant application (37%), SSC (8.9%), and amalgam filling (4.5%). Low pulpal treatment was reported which was mostly involved indirect pulp capping. Most of the final restorations that were done covered only one surface, followed by the two-surface restorations, and then by SSC. &#x0D; Conclusions: The pediatric dentists’ decision for FPMs treatment under general anesthesia at KAMC was following AAPD guideline and its frequency was mostly restorative followed by preventive, and the least treatment was extraction treatments. The type of FPMs treatment administered on children was significantly influenced by their ages, gender, and health conditions. The type of tooth restoration and pulp therapy treatments were significantly dependent on children’s age. KAMC pediatric dentist efforts should be directed to initiate more preventive programs and effective dental home care utilization at PHC centers.

Gamma Knife Radiosurgery With Mask Fixation Under General Anesthesia for Pediatric Patients.

Gamma knife radiosurgery (GKS) is performed on children by frame fixation of the skull under general anesthesia. With the introduction of the Gamma Knife Icon, treatment by fixing with a thermoplastic mask has become possible. In this study, we performed GKS by mask fixation under general anesthesia, measured the accuracy, and examined whether an accuracy equivalent to that of frame fixation could be guaranteed.We included three children who underwent mask fixation under general anesthesia between September and November 2020. After the induction of general anesthesia, a patient marker was attached to the nose, and the movement of the marker before mask fixation was measured using a real-time high-definition motion management (HDMM) system. The movement of the patient marker from the start to the end of treatment after mask fixation was monitored and measured.After the induction of general anesthesia, the movement of the patient marker was ≤0.3 mm in two cases and ≥1.0 mm in one case without mask fixation. When the mask was fixed, it was ≤0.2 mm in all three cases. It was confirmed that the marker could move even under general anesthesia without mask fixation, and it could be suppressed to a minimum after mask fixation.With the mask fixation method devised in this study, GKS under general anesthesia for children seems to be a safe and highly accurate method.

PH and specific gravity of corrosive agents as indicators in caustic injuries.

Video endoscopy, which remains the diagnostic gold standard after ingestion of a corrosive substance, is performed under general anesthesia in children, requires advanced technology, and is costly. Simple and accessible methods are therefore needed to determine the need for endoscopy. The aim of this study was to evaluate the role of the pH and specific gravity of ingested substance in determining endoscopy indications after corrosive ingestion. This prospective study included pediatric patients who presented after ingesting a corrosive substance from June 2018 to June 2019. Relationships between the extent of damage detected by endoscopy and the patient's age, physical examination findings, and the pH and specific gravity of the causative substance were evaluated. The degree of damage detected on endoscopy was significantly milder for corrosive substances with a pH between 2 and 12 (P = 0.003). In addition, pH values between 2 and 12 were significantly more common among patients without physical examination findings (P = 0.029). Specific gravity less than 1,005 was associated with mild injury detected by video-endoscopy (P = 0.011). Patients in whom severe injury was detected by endoscopy had marked findings on physical examination (P < 0.001). There was no significant relationship between physical examination findings and the specific gravity of the substance involved (P = 0.087). The results of this study suggest that conservative treatment options can be used without performing endoscopy in patients who have no physical examination finding after corrosive ingestion and where the pH of the substances is between 2 and 12 and the specific gravity of the substances is less than 1,005.

Minimal invasive management of complete renoureteral duplication with upper pole megaureter in children

Renal malformations represent a large part of the pathology referred to the pediatric surgeon. Most of them are diagnosed during pregnancy. We present one case of complete ureteral duplex with upper pole obstructive megaureter managed in a private hospital using minimally invasive methods for both diagnosis and treatment due to good teamwork. We do not want to demonstrate that other investigations are not leading to the same diagnose, we want to highlight an alternative to the classic approach. We hope that our experience is a starting point for further research and that in future radiation and general anesthesia in children will be avoided as much as possible for renal investigations.

Longitudinal assessment of cognitive function in young children undergoing general anaesthesia

BackgroundExposure to general anaesthesia in children may be related to deficits in certain areas of cognition. It is unclear if these deficits could be measured in the immediate postoperative period in young children. The goal of the current study was to evaluate the trajectory of cognitive function in the domains of processing speed, working memory, and fine motor skills amongst children aged 2.5–6 yr who underwent general anaesthesia for elective surgery. MethodsChildren who were scheduled to receive general anaesthesia for surgery were recruited for assessment of cognitive function at three times: preoperatively, 1–2 weeks postoperatively, and 3 months postoperatively. Assessments included processing speed, working memory, and fine motor skills. To assess longitudinal changes in the cognitive outcomes, linear mixed models were built with visit number included as a categorical variable and subject-specific random intercepts. ResultsSixty-one children (33 girls [54%]) enrolled in the study. Twenty-three children (38%) had received general anaesthesia previously. Significant improvements in picture memory, cancellation, and the processing speed composite were found at Visit 2. The improvement in cancellation and processing speed composite remained significant at Visit 3. Statistically significant improvement in Mullen fine motor score was noticed at Visit 3 compared with Visit 1. The pattern of results did not depend upon prior anaesthesia exposure. ConclusionsGeneral anaesthesia for elective surgery in young children was not associated with declines in working memory, processing speed, and fine motor skills in the first 3 months postoperatively, including in children with prior exposure to anaesthesia.