Pediatric Surgery Patients Research Articles

Effect of thin-split encephalomyosynangiosis on transient neurological events in revascularization surgery for pediatric patients with moyamoya disease.

Transient neurological events (TNEs) are among the most important events after revascularization surgery in pediatric patients with moyamoya disease (MMD). Although hemodynamic changes and crying are representative factors of TNEs, brain compression by encephalomyosynangiosis (EMS) is another important cause of TNEs. Therefore, the authors assumed that making the EMS as thin as possible reduces the frequency of TNEs. However, thin-split EMS can lead to insufficient development of collateral vessels. This study aimed to evaluate the effects of thin-split EMS in combined revascularization surgery on postoperative outcomes in pediatric patients with MMD. The authors retrospectively included 56 consecutive combined revascularization surgeries in the anterior cerebral circulation in pediatric patients with MMD. These surgeries were classified into the former group and thin-split EMS group. The temporal muscle was halved in the former EMS group and split as thinly as possible in the thin-split EMS group. The authors performed between-group comparisons of postoperative stroke events and TNEs during the acute period and the development of collateral flow and stroke events during the chronic period. Former and thin-split EMS procedures were performed in 37 and 19 patients, respectively. TNEs without crying or hemodynamic changes were observed significantly less frequently in the thin-split EMS group than in the former EMS group (0 [0.0%] in the thin-split EMS group vs 9 [24.3%] in the former EMS group, p = 0.021). There were no significant between-group differences in the development of indirect bypass during the chronic period (good: 34 [91.9%] and poor: 3 [8.1%] in the former EMS group vs good: 16 [84.2%] and poor: 3 [15.8%] in the thin-split EMS group; p = 0.397). Additionally, there were no significant between-group differences in the incidence of chronic clinical events, including death or stroke. Thin-split EMS can reduce TNEs that do not accompany crying or hemodynamic changes. Furthermore, the procedure has sufficient prevention effects against stroke events during the chronic postoperative period in pediatric patients with MMD.

TAP block comfort for lower abdominal surgery in pediatric patients

Purpose: The aim of this study was to examine the effect of The transversus abdominis plane (TAP) block after lower abdominal surgery on pain severity and additional analgesic requirement in a pediatric patient group.
 Materials and Methods: In this retrospective study, 46 ASA I children aged 2-18 years undergoing abdominal surgery were divided into two groups. Group T (n: 20) patients who were under the general anesthesia received ultrasound-guided TAP block with 0.5 mL/kg of 0.25% bupivacaine immediately after the operation. Group O (n: 26) patients were administered intravenous (I.V.) 2 µcg/kg opioid (fentanyl) analgesia after recovery from general anesthesia. The patients were taken to the post-anesthesia care unit (PACU) for recovery and initial pain observation. Patients pain was assessed by using the Visual Analogue Scale (VAS) score within the first 24 hours following surgery.
 Results: The incidence of the additional analgesic requirement in the TAP block(%15) group was statistically significantly lower than in the I.V. opioid group(%65). There was a difference between the first analgesic requirement and the discharging time according to TAP block administration, but it was statistically insignificant. The VAS scores at 4 hr and 8 hr in the TAP block group were statistically significantly lower than in the IV opioid group(4.VAS:4.90±1,21 5.90±0.85; 8.VAS:4.05±0.76 3.10±0.85). The VAS scores at postoperative 2 hr were decreased in both groups. However, the decrease in the VAS score at 2 hr was greater in the TAP block group.
 Conclusion: TAP block was superior to IV opioids in reducing additional analgesic requirements in pediatric patients undergoing abdominal surgery. It will contribute further to early discharging a patient as it allows early mobilization.

Correlation Between Sociocultural and Economic Factors in Pediatric Patients' Families and Emergence Delirium.

Postoperative delirium is a commonly encountered condition that can arise from multiple factors, and its occurrence varies based on the type of surgery in pediatric patients. This study aimed to investigate the occurrence of delirium during the recovery from anesthesia in children undergoing eye surgery and its association with the sociocultural and economic status of their families. This prospective observational study included children aged 2-12 years who underwent eye surgeries. Demographic data, socioeconomic and educational status of parents, parental separation and cooperation scores, Cravero agitation score, and face, legs, activity, cry, and consolability (FLACC) score (at zero, five, 15, and 30 minutes in the postoperative period) were recorded. Patients who scored 5 on the Cravero agitation scale for at least five minutes were considered to have postoperative delirium. The STROBE checklist was followed for reporting. A total of 104 patients were included in the study, of which 65 were male. The mean age of the patients was 6.5±2.9 years, and 42 patients (40.4%) belonged to the preschool age group. The incidence of delirium was found to be 51.9%. Delirium was found to be associated with postoperative pain (p=0.003), age (p=0.001), preoperative anxiety (not cooperative examination score (p=0.047), poor separation score (p=0.006)), presence of a surgical history (p=0.012), and cataract surgery (p=0.007). No evidence was found to demonstrate a link between sociocultural and economic conditions and the development of delirium. This study identified several factors that influenced the occurrence of delirium, including postoperative pain (FLACC≥4), younger age (<6 years), cataract surgery, presence of surgical history, examination score (score 3, not cooperative), and separation score (scores 3-4, poor).

A multidisciplinary approach to posterior quadrant disconnective epilepsy surgery in pediatric patients

PurposeExtensive lesions of the posterior quadrant are a relevant cause of pediatric drug-resistant epilepsy. Early surgery is the best treatment in these cases, but conventional multilobar resections carry a significant risk in pediatric patients. Despite temporo-parieto-occipital (TPO) disconnection being the preferable technique due to the preservation of motor function, studies reporting long-term longitudinal outcomes are still limited. This study aims to analyze seizures and developmental outcomes after TPO disconnection. MethodsA prospective analysis was carried out on 12 children who underwent TPO disconnection. ResultsTPO disconnection was performed in 12 pediatric patients aged between 14 months and 18 years (median 6.29 years). The average age of seizure onset was 0.97 ± 1.22 years. Causes of TPO included perinatal ischemia in 4 patients and malformation of cortical development (MCD) in 8 patients. The presenting seizure types were focal motor impaired awareness seizures in 7 children and generalized in 5. The affected hemisphere was the right in 9 patients and the left in 3. In half of the patients, the temporal approach was performed through T1, and in the other 50%, it was performed through T2. After neuropsychological examination, 2 children improved, 7 remained stable, 2 patients presented stagnation and 1 declined. Regarding postoperative complications, nonresorptive hydrocephalus and an asymptomatic caudate nucleus infarct were observed. After a median follow-up of 2 years, 9 patients were in Engel’s Class I seizure outcome. ConclusionTPO disconnection is a safe and effective motor-sparing epilepsy surgery for children with refractory seizures located in the posterior quadrant that prevents further cognitive deterioration.

Preliminary Experience With a Continuous Lidocaine Infusion as an Analgesia Adjunct for Acute Pain Management Following Surgery in Pediatric Patients

Preliminary Experience With a Continuous Lidocaine Infusion as an Analgesia Adjunct for Acute Pain Management Following Surgery in Pediatric Patients

Complications of Thyroid Cancer Surgery in Pediatric Patients at a Tertiary Cancer Center.

The incidence of complications and risk factors for hypocalcemia after pediatric thyroid cancer surgery has not been clearly defined in the literature because most reports fail to distinguish between benign and malignant disease. The trend away from total thyroidectomy (TT) to thyroid lobectomy in low-risk disease means there is a need to clearly define the complication profile of malignant disease. After institutional review board (IRB) approval, a retrospective chart review was undertaken at Memorial Sloan Kettering Cancer Center for pediatric patients undergoing surgery for well-differentiated thyroid cancer from 1986 to 2021. Clinicopathologic characteristics and complications were evaluated. Multivariable analysis was performed to identify factors independently associated with postoperative hypocalcemia. The study identified 307 pediatric patients with well-differentiated thyroid carcinoma (median follow-up period, 61 months). Of these patients, 69% underwent TT and 31% received a partial thyroidectomy. Among them, 40% had N0 disease, 28% had N1a disease, and 33% had N1b disease. Postoperatively, no patients experienced a neck hematoma, 1.6% had temporary unilateral vocal cord palsy (VCP), and 0.7% had permanent VCP due to recurrent laryngeal nerve (RLN) invasion. Temporary and permanent hypocalcemia occurred in respectively 32.6 % and 5.2 % of the patients. Multivariable analysis identified central neck dissection (CND) (odds ratio [OR] 3.30; p < 0.001) and N1 disease (OR 2.51; p = 0.036) as independent risk factors for temporary hypocalcemia and N stage (OR 3.64; p = 0.018) as a risk factor for permanent hypocalcemia. Pediatric thyroid cancer surgery results in low complication rates despite nodal metastases. Vocal cord paralysis is rare unless disease is found to be invading the RLN intraoperatively. Both N stage and CND are independent risk factors for hypocalcemia, helping to identify high-risk patients.

Perioperative blood loss reduction using a sterile exsanguination tourniquet for orthopedic femoral-related surgeries in children: a randomized controlled study

ObjectivesThe sterile exsanguination tourniquet (SET) could be an alternative for providing bloodless surgeries in orthopedic femoral-related surgeries in pediatric patients where the standard pneumatic tourniquet would not be feasible. This randomized-controlled study aimed to evaluate the efficacy of SET in decreasing total perioperative blood loss and blood transfusion.MethodsWe conducted an unplanned interim analysis of data from a randomized-controlled trial. At the time of the analysis, 31 pediatric patients had been randomly assigned to undergo surgery with the SET application (the SET group, 15 patients) and without the SET application (the control group, 16 patients). An intention-to-treat analysis was performed to evaluate the total perioperative blood loss, postoperative blood transfusion, estimated intraoperative blood loss, total drainage volume, postoperative hemoglobin level, and operative time according to the significance level adjusted for multiplicity (p < 0.029).ResultsThere was a borderline statistically significant lower body weight-adjusted TBL in the SET group (SET = 14.1 (7.7, 16.9) ml/kg vs. control 18.3 (14.8, 37.2) ml/kg, p-value = 0.027). The body weight-adjusted transfusion volume was statistically significantly greater in the control group (SET = 0.0 (0.0, 0.0) ml/kg vs. control = 2.1 (0.0, 9.7) ml/kg, p = 0.017). Body weight-adjusted estimated intraoperative blood loss was significantly lower in the SET group (SET = 0.8 (0.2, 3.5) ml/kg vs. control = 5.6 (3.4, 21.5) ml/kg, p < 0.001). In addition, the operative time was lower in the SET group with borderline statistical significance (SET = 105 (85.0, 125.0) vs. control = 130 (101.3, 167.5), p = 0.039).ConclusionUtilization of a sterile exsanguination tourniquet (SET) significantly reduced an estimated intraoperative blood loss while preventing the need for blood transfusion after pediatric orthopedic femoral-related surgeries.Trial registration TCTR20220412003.

The Safety and Effectiveness of an In-Depth Esmarch Tourniquet Technique in Achieving Target Pressures for Pediatric Upper Extremity Surgery

Purpose: This study aimed to determine the appropriate number of turns required for an Esmarch tourniquet, using commonly sized Esmarch bandages, to achieve a pressure target of at least 150 mm Hg during pediatric upper extremity surgery. Methods: Twenty participants who underwent upper extremity surgery were included in the study. Two surgeons used 2- and 3-inch-sized Esmarch bandages to apply an Esmarch tourniquet to each participant’s arm. The pressure and number of turns were recorded from the second to fifth turns. The pressure was measured using a pressure sensor device. Results: At the third turn of both the 2- and 3-inch-sized Esmarch bandages, a 150 mm Hg pressure was achieved in all participants. Intra-observer reliability resulted was “good”; however, inter-observer revealed “poor” reliability. Conclusions: The Esmarch tourniquet is an effective and safe method for creating a bloodless operative field for upper extremity surgery in pediatric patients. The results of this present study suggested the application of three turns of the 2- and 3-inch-sized Esmarch bandages.

The prevalence and risk factors of coagulopathy in pediatric patients undergoing surgery for epilepsy.

Hematological consequences of novel antiseizure medications (ASMs) or combined therapies are rarely reported, especially in pediatric patients undergoing surgery for epilepsy. This study aimed to assess the prevalence and risk factors of coagulation dysfunction in this population and evaluate their relationship with intra- and postoperative bleeding. Three hundred ninety children who underwent surgery for epilepsy and 104 children without epilepsy who underwent nonepilepsy surgery at the authors' center were included in the study. The authors retrospectively collected and analyzed the following clinical data: sex, age, weight, course of epilepsy, antiseizure therapy, first laboratory data after admission, and transfusion-related data. ASMs were responsible for the higher incidence of coagulation dysfunction in pediatric epilepsy surgery patients. Low body weight (OR 0.95, 95% CI 0.92-0.98) and valproic acid (VPA) therapy (OR 5.13, 95% CI 3.25-8.22) were the most relevant factors leading to coagulation dysfunction. The most common hematological side effects of VPA were thrombocytopenia and hypofibrinogenemia, whereas low body weight was only associated with hypofibrinogenemia. Both VPA and low body weight increased the need for intra- or postoperative transfusion (p < 0.001). Pediatric epilepsy surgery patients often take multiple ASMs, resulting in an increased incidence of coagulopathy. VPA levels and low body weight were found to be the main influential factors associated with an increased risk of coagulation dysfunction. Platelet and fibrinogen levels were the main indices that were affected. Both VPA and low body weight were relevant to additional surgery-related transfusion, necessitating the need for increased awareness of preoperative coagulopathy before pediatric epilepsy surgery. Clinical trial registration no.: NCT05675254 (ClinicalTrials.gov).

Comparison of Post-Operative Pain Score Between Open Appendectomy and Laparoscopic Appendectomy on Acute Appendicitis Patient in Siloam Hospital Lippo Village

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Appendicitis is inflammation of vermiform appendix which can be caused by luminal obstruction. Appendicitis is one of the most common causes of emergency abdominal surgery, with 11 cases per 10.000 person per year. Until today, open appendectomy is still the gold standard for appendicitis treatment although laparoscopic appendectomy has significantly lower post-operative pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study uses cross-sectional study design with post-open appendectomy and laparoscopic appendectomy patients in Siloam Hospital Lippo Village as the sample population. The Visual Analogue Scale (VAS) is taken from patient’s medical record and processed using Mann-U-Whitney test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; From 70 acute appendicitis patients, 36 underwent open appendectomy and 34 underwent laparoscopic appendectomy. The result showed the median score of VAS 1 day post open appendectomy surgery (median = 3, min/max = 2/6 [95% CI = 2,55 – 3,14]) is higher than post laparoscopic appendectomy (median = 2,25, min/max = 0/4, [95% CI = 1,97 – 2,59]), with adjusted p value against age and surgery duration is 0,024. In pediatric patients, median score of VAS 1 day post open appendectomy surgery is the same with laparoscopic appendectomy (median = 3, p value = 0,863). Multivariate analysis showed that surgery duration affects VAS 1 day post appendectomy surgery in pediatric patients (p value = 0,042).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study shows that the median score of VAS 1 day post open appendectomy surgery is higher than laparoscopic appendectomy. This result is statistically significant. However, in pediatric patients the median score of VAS 1 day post open appendectomy surgery and laparoscopic appendectomy is the same. VAS 1 day post appendectomy surgery in pediatric patients is affected by surgery duration.&lt;/p&gt;&lt;/div&gt;

Serum Angiopoetin-2 Levels in Pediatric Patients After Fontan Operation

Angiopoietin-2 is associated with chronic inflammation and angiogenesis, but its activity after Fontan operation in pediatric patients remains uncertain. We compared serum angiopoietin-2 levels in pediatric patients after Fontan operation versus those with congenital heart disease as a control group. A total of 185 patients (median age 7 [3 to 12] years, 106 males) were included, consisting of 140 in the Fontan group and 45 in the control group. Serum angiopoietin-2 levels were significantly higher in the Fontan group (7,670 vs 2,351pg/ml, p<0.001). In the Fontan group, a serum angiopoietin-2 level ≥3.9 of common logarithm was an independent risk factor for death or Fontan-related adverse events with an adjusted hazard ratio of 6.25 (95% confidence interval 1.64 to 23.9, p=0.007). In preoperative variables, desaturation was independently associated with increased serum angiopoietin-2 levels after Fontan operation (p=0.047). In conclusion, serum angiopoietin-2 levels were elevated in the pediatric phase after Fontan operation. In Fontan patients, a higher serum angiopoietin-2 level was an independent risk factor for death or Fontan-related adverse events. The clinical implication of measuring and monitoring serum angiopoietin-2 levels in this cohort requires further investigation.

Postoperative benefit of abdominal interventions in children performed by laparoscopic sugery compared with conventinal surgery

Objective: To compare the postoperative benefits of abdominal interventions in children performed by laparoscopic and open surgery. Method: This is an integrative Literature Review carried out in the LILACS and MEDLINE databases in the Virtual Health Library using the descriptors laparoscopy, “open surgery” and children, associated with the Boolean operator AND and obtaining 30 articles. Results: The sample consisted of 18 articles that met the inclusion and exclusion criteria, in which there was a predominance of articles that evaluated the postoperative result and the effectiveness of laparoscopic surgery, most of which were published in the year 2021. Discussion: The study covers the pre- and intraoperative characteristics of children in the decision of the surgical method, in addition to the construction of the results of the laparoscopic method and its comparison with the conventional approach, regarding the postoperative period of abdominal surgeries in pediatric patients. Conclusion: It was evidenced that the laparoscopic method presents a better visualization of the procedure, less postoperative complications, shorter hospitalization time, less pain and better aesthetic result.

Anesthetic management of a pediatric patient with Freeman-Sheldon syndrome undergoing atrial septal defect closure: a case report

BackgroundFreeman-Sheldon syndrome (FSS) is a rare disorder characterized by specific deformities of the extremities and face. There have been no reports of open-heart surgery in pediatric patients with FSS.Case presentationWe present the case of an 8-year-old girl with FSS who underwent atrial septal defect closure. Tracheal intubation was uncomplicated, although the patient had microstomia. Inhalational anesthetics and dopamine antagonists were avoided intraoperatively and perioperatively. We chose dexmedetomidine as an adjuvant for postoperative pain management contributing to adequate analgesia and early extubation without causing respiratory depression.ConclusionsAnesthetic management of FSS requires consideration for airway management and prevention of malignant hyperthermia and respiratory complications. We successfully managed the case avoiding the use of malignant hyperthermia-triggering drugs.

Medicate or operate: epilepsy surgery could save lives.

Drug-resistant epilepsy is a complex neurological disorder with a significant impact on the lives of affected children and their families. A child is diagnosed with drug-resistant epilepsy if seizure control is not achieved despite receiving the maximally optimised doses of two appropriately chosen antiepileptic medications. 1 Kwan P Arzimanoglou A Berg AT et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010; 51: 1069-1077 Crossref PubMed Scopus (2851) Google Scholar Mortality risk is seven times higher in children with epilepsy than in the general population. 2 Callenbach PM Westendorp RG Geerts AT et al. Mortality risk in children with epilepsy: the Dutch study of epilepsy in childhood. Pediatrics. 2001; 107: 1259-1263 Crossref PubMed Scopus (98) Google Scholar One contributor to the mortality associated with drug-resistant epilepsy is sudden unexpected death in epilepsy (SUDEP); ie, unexpected death with no obvious cause. 3 Nashef L So EL Ryvlin P Tomson T Unifying the definitions of sudden unexpected death in epilepsy. Epilepsia. 2012; 53: 227-233 Crossref PubMed Scopus (397) Google Scholar One in 833 children with drug-resistant epilepsy is estimated to die from SUDEP every year. 4 Ryvlin P Rheims S Lhatoo SD Risks and predictive biomarkers of SUDEP. Curr Opin Neurol. 2019; 32: 205-212 Crossref PubMed Scopus (0) Google Scholar The most common risk factors for SUDEP are high seizure frequency, early age of seizure onset, and multiple antiseizure drugs. 5 Abdel-Mannan O Taylor H Donner EJ Sutcliffe AG A systematic review of sudden unexpected death in epilepsy (SUDEP) in childhood. Epilepsy Behav. 2019; 90: 99-106 Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar Other causes of death include status epilepticus, injury related to seizures, and suicide. Comparison of long-term survival with continued medical therapy, vagus nerve stimulation, and cranial epilepsy surgery in paediatric patients with drug-resistant epilepsy in the USA: an observational cohort studyPaediatric patients with drug-resistant epilepsy who underwent cranial epilepsy surgery or VNS had a higher survival rate than those who received only medical treatment. These findings highlight the importance of a multidisciplinary comprehensive team approach to the treatment of epilepsy, which includes tailored evaluation and deployment of medical and surgical treatment options for patients with this challenging disease. Full-Text PDF

Development of Protocol for Ventriculoperitoneal Shunt Surgery in Paediatric Patients to Reduce Shunt Infection

Background: Ventriculoperitoneal shunt (VPS) is the most common treatment modality for hydrocephalus. However, VPS infection is acommon and serious complication with high rates of mortality and morbidity and there is some emerging evidence suggesting that adherence to a strict protocol may be important in reducing the rate of shunt infection. Objectives: To develop a protocol for initial ventriculoperitoneal shunt surgery and assess the efficacy of this protocol in reducing ventriculoperitoneal shunt infection rate. Materials and Methods: This study was a comparative study was carried out in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from December 2021 to March 2023. Total 100 patients were included in this study. Patients &lt; 18 years of age undergoing initial ventriculoperitoneal shunt surgery for hydrocephalus due to various etiologies in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Data collection sheet was used to collect the necessary information. Voluntary written informed consent was taken from the patients and/or the legal guardian/responsible family members after completely explaining to them the procedure and the purpose of the study. Using simple random sampling by lottery method, the patients were divided into a study group and a control group. Patients in the study group underwent ventriculoperitoneal shunt surgery as per the proposed surgery protocol and strict adherence to the protocol by the operating surgeon was ensured. Patients in the control group underwent ventriculoperitoneal shunt surgery as per the current standard practice. Post-operative care of the patient was carried out as per the standard practice in both the groups. Follow-up of the patients were done on an outpatient department basis at 1 month and at 3 months postoperatively, where they were examined thoroughly for signs and symptoms of shunt infection. Patients not showing up at the outpatient department were ...

#5623 PERITONEAL DIALYSIS AND POSTOPERATIVE OUTCOMES IN CHILDREN AFTER CARDIAC SURGERY: A SINGLE-CENTER COHORT STUDY

Abstract Background and Aims Acute kidney injury (AKI) is a frequent complication in neonates and infants after congenital heart disease surgery, with great impact on morbidity and mortality. Peritoneal dialysis (PD) is the renal replacement therapy of choice, as it allows continuous gentle ultrafiltration with minimal impact on hemodynamic status. However, there is no standardized prescription. The present study aimed to describe our experience of using PD in the management of AKI after cardiac surgery in pediatric patients and the postoperative outcomes. Method Single-center cross-sectional study including 21 children undergoing cardiac surgery between 2017 and 2022, in a congenital heart disease reference center. Demographic and clinical data were collected from the electronic records. Results Of the 21 patients treated with PD, 11 were female. Mean age was 32 ± 45 days and median weight was 3.4 kg (IQR 0.5). All pregnancies had been full-term with a mean birth weight of 3.2 ± 0.3 kg. No congenital urinary tract anomalies had been previously documented. Previous history of AKI was present in 2 patients. Transposition of the great arteries was the most common surgical indication (52%). RACHS-1 score was ≥4 in 12 patients and median PRISM-IV score was 6.5% (IQR 6). Cardiopulmonary bypass was performed in 19 patients with a mean time of 181 ± 72 minutes and a mean aortic clamping time of 94 ± 29 minutes. All patients required inotropic support after cardiac surgery with ≥2 drugs, for 197 ± 136 hours. Median time with mechanical ventilation support was 126 hours (IQR 288) and median length of stay at the intensive care unit (ICU) was 9 days (IQR 15.3).The indications for PD initiation were anuria (66.7%), oliguria (23.8%) and fluid overload (9.5%). Median time between cardiac surgery and AKI diagnosis was 2.5 hours (IQR 8.8) and between AKI diagnosis and PD initiation was 1.8 hours (IQR 4.3). Median duration under dialysis was 2 days (IQR 3.5). Exchange volume of dialysate varied between 6 and 15 mL/kg at the beginning of PD. In 11 patients, this volume was progressively increased to a maximum of 60 mL/kg (minimum: 30 mL; maximum: 120 mL). Continuous veno-venous hemodiafiltration was required in 3 patients, mainly due to mechanical catheter dysfunction. Complications related to PD occurred in 5 patients: 1 patient developed peritonitis, 1 patient had mechanical catheter dysfunction and 3 patients had peri-catheter leak. Complete recovery of renal function was achieved in 14 patients. Longer time on PD was associated with lower weight before surgery (p = 0.04), longer time on mechanical ventilation and inotropic support (p &amp;lt; 0.001), and longer stay at the ICU (p &amp;lt; 0.001). Time on inotropic support could predict time on PD using a multiple regression model (adjusted R2 = 59%, p = 0.003), adjusted to cardiopulmonary bypass time, time on mechanical ventilation support and weight before surgery (adjusted ß = 0.7, p = 0.005). Eight patients died during hospitalization, due to multiorgan failure (38%), cardiogenic shock (38%), disseminated intravascular coagulation (13%) and septic shock (13%). Longer cardiopulmonary bypass time was associated with in-hospital mortality (149 ± 53 vs 235 ± 46, p = 0.004). Both the time between AKI diagnosis and PD initiation and the time on PD were not associated with in-hospital mortality. Conclusion Our study suggests that PD is a safe and effective dialysis modality in the management of post-cardiac surgery AKI in pediatric population. Early identification of high-risk infants is important to implement preventive measures.

Outcomes of resective surgery in pediatric patients with drug-resistant epilepsy: A single-center study from the Eastern Mediterranean Region.

Epilepsy surgery is widely accepted as an effective therapeutic option for carefully selected patients with drug-resistant epilepsy (DRE). There is limited data on the outcome of epilepsy surgery, especially in pediatric patients from the Eastern Mediterranean region. Hence, we performed a retrospective study examining the outcomes of resective surgery in 53 pediatric patients with focal DRE. Patients with focal DRE who had undergone epilepsy surgery were included in the present study. All patients underwent a comprehensive presurgical evaluation. Postoperative seizure outcomes were classified using the Engel Epilepsy Surgery Outcome Scale. After surgery, 33 patients (62.2%) were Class I according to the Engel classification of surgical outcomes; eight patients (15.0%) were Class II, 11 (20.7%) were Class III, and one (1.8%) was Class IV. The relationships of presurgical, surgical, and postsurgical clinical variables to seizure outcomes were compared. Older age at seizure onset, older age at the time of surgery, the presence of focal to bilateral tonic-clonic seizures, seizure duration over 2 minutes, unsuccessful treatment with three or fewer antiseizure medications, lesions confined to one lobe (as demonstrated via magnetic resonance imaging [MRI]), surgical site in the temporal lobe, and histopathology including developmental tumors were significantly linked to an Engel Class I outcome. A univariate analysis of excellent surgical outcomes showed that lateralized semiology, localized interictal and ictal electroencephalogram (EEG) discharges, lateralized single-photon emission computed tomography and positron emission tomography findings, and temporal lobe resections were significantly related to excellent seizure outcomes. The results of our study are encouraging and similar to those found in other centers around the world. Epilepsy surgery remains an underutilized treatment for children with DRE and should be offered early.

Application of the concept of fast-track surgery in pediatric ophthalmic surgery

To explore the effects of the fast-track surgery (FTS) approach during the perioperative period of ophthalmic surgery in pediatric patients. A bidirectional cohort design was applied in this study. The traditional nursing mode was followed in relation to 40 pediatric patients admitted for ophthalmic surgery in March 2018 (control group), whereas the FTS mode was followed with regard to 40 pediatric patients admitted for ophthalmic surgery in April 2018 (observation group). The effects of the FTS mode were determined by comparing the postoperative pain score, restlessness score, and the incidence of postoperative nausea and vomiting between the two groups. The pain and restlessness scores of the patients at 4hours after surgery in the observation group were significantly decreased compared with those in the control group (P<0.01). The incidence of postoperative nausea and vomiting in the observation group was also slightly lower than that in the control group (P>0.05). A perioperative FTS-based nursing mode can effectively alleviate the postoperative pain and restlessness of pediatric patients without increasing their stress response.

Comparative study between sugammedex and neostigmine as a reversal agent of rocuronium for pediatric patients 2-12 years old going for surgery under general anaesthesia

Aim. The neuromuscular blocker has long been used during surgical procedures. The neuromuscular blockade produced by rocuronium can be reversed with sugammadex and neostigmine as reversal agents. This systematic review aims to determine the impact of sugammadex and neostigmine comparison as a reversal agent of rocuronium for pediatric patients 2-12 years old going for surgery under general anesthesia. Materials and Methods. This review examined recent studies assessing the impact of sugammadex and neostigmine comparison as a reversal agent of rocuronium for pediatric patients 2-12 years old going for surgery under general anesthesia. Data were searched from Google Scholar, PubMed, Hindawi, Anesthesiology, MEDLINE, and CENTRAL using keywords’ General Anesthesia,’ ‘Reversal Agent,’ ‘Rocuronium for Pediatric Patients,’ ‘Neuromuscular Blockers,’ ‘Sugammadex and Neostigmine,’ ‘Role of Analgesics.’ The review followed PRISMA guidelines. Results. The initial search for publications comparing sugammadex and neostigmine as a reversal agent of rocuronium for pediatric patients yielded 9000 papers, from which 600 were selected. The reviews’ articles were further analyzed to ensure they were pertinent to the Comparative Impact of Reversal Agents (Sugammadex And Neostigmine) of Rocuronium for Pediatric Patients. Around 319 references were examined for their potential applicability to the medical field of anesthesia. A total of 15 articles were included, with preference given to those published from 2014 to 2023 during the last ten years. Conclusion. The particular relaxant-binding medication promptly and successfully alleviates rocuronium-induced neuromuscular blockade in pediatric surgery patients. Considering the study’s outcomes, it can be concluded that sugammadex may restore any level of steroidal muscle relaxant-induced neuromuscular block faster than neostigmine.

Immediate Extubation in the Operating Room Following Pediatric Liver Transplantation: A Retrospective Cohort Study

Although immediate extubation in the operating room following pediatric liver transplantation can be safe and beneficial for select patients, many surgeons and anesthesiologists are still cautious. The study aimed to evaluate the safety and efficiency of immediate extubation in the operating room following pediatric liver transplantation. Sixty-four pediatric liver transplant recipients were included in this retrospective study. Patients were divided into 2 groups: immediate extubation (IE) (those who were extubated in the operating room) and delayed extubation (DE) (those who were extubated in the intensive care unit). Preoperative, intraoperative, and postoperative variables were recorded. Although a total of 19 (29.7%) patients were extubated in the pediatric intensive care unit (group DE), 45 (70.3%) were extubated in the operating room at the end of surgery (group IE). The use of fresh frozen plasma and platelets was statistically higher in group DE (P=.017 and P=.002, respectively). Duration of anesthesia and length of stay in the pediatric intensive care unit was statistically longer in group DE (P=.020 and P=.0001, respectively). Three (15.8%) patients required reintubation in group DE and 2 (4.4%) in group IE. Hospital stay was statistically longer in group DE (P=.012). The current study demonstrated that immediate extubation in the operating room after surgery for pediatric patients who have undergone liver transplantation was safe. The duration of anesthesia and the intraoperative use of blood products such as platelet and fresh frozen plasma can effectively decide immediate extubation.