69 results on '"Franklyn P. Cladis"'
Search Results
2. Evaluating the role for regional analgesia in children with spina bifida: a retrospective observational study comparing the efficacy of regional versus systemic analgesia protocols following major urological surgery
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Robert P, Moore, Nicholas E, Burjek, Megan A, Brockel, Andrew C, Strine, Austin, Acks, Peter J, Boxley, Vidya, Chidambaran, Gino J, Vricella, David I, Chu, Marie, Sankaran-Raval, Rebecca S, Zee, Franklyn P, Cladis, Rajeev, Chaudhry, Vikas N, O'Reilly-Shah, Jennifer J, Ahn, Kyle O, Rove, and Carter J, Sevick
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Analgesia, Epidural ,Analgesics, Opioid ,Pain, Postoperative ,Anesthesiology and Pain Medicine ,Morphine ,Humans ,Multicenter Studies as Topic ,General Medicine ,Child ,Spinal Dysraphism ,Retrospective Studies - Abstract
IntroductionRegional techniques are a key component of multimodal analgesia and help decrease opioid use perioperatively, but some techniques may not be suitable for all patients, such as those with spina bifida. We hypothesized peripheral regional catheters would reduce postoperative opioid use compared with no regional analgesia without increasing pain scores in pediatric patients with spina bifida undergoing major urological surgery.MethodsA retrospective review of a multicenter database established for the study of enhanced recovery after surgery was performed of patients from 2009 to 2021 who underwent bladder augmentation or creation of catheterizable channels. Patients without spina bifida and those receiving epidural analgesia were excluded. Opioids were converted into morphine equivalents and normalized to patient weight.Results158 patients with pediatric spina bifida from 7 centers were included, including 87 with and 71 without regional catheters. There were no differences in baseline patient factors. Anesthesia setup increased from median 40 min (IQR 34–51) for no regional to 64 min (IQR 40–97) for regional catheters (pDiscussionContinuous regional analgesia following major urological surgery in children with spina bifida was associated with a 70% intraoperative and 78% postoperative reduction in opioids without higher pain scores. This approach should be considered for similar surgical interventions in this population.Trial registration numberNCT03245242.
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- 2022
3. Expanded indications of ketamine infusions for pediatric non-surgical pain: a 10 year, single-center experience
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Anne P Pribonic, Scott A Brancolini, Fernando Brea, and Franklyn P Cladis
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Anesthesiology and Pain Medicine ,Neurology (clinical) ,General Medicine - Published
- 2023
4. Transgender patient care: a prospective survey of pediatric anesthesiologist attitudes and knowledge
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Franklyn P. Cladis, Remigio A. Roque, Trevor Adams, Vikas N. O’Reilly-Shah, and Gianni R. Lorello
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medicine.medical_specialty ,business.industry ,Pain medicine ,General Medicine ,Patient care ,Anesthesiology and Pain Medicine ,Anesthesiology ,Family medicine ,Anesthesia ,Transgender ,Perioperative care ,medicine ,Transgender Person ,business ,Prospective survey - Published
- 2021
5. Success With Monobloc Advancement in Mission Surgery
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Anand R. Kumar, Cheryl K. Gooden, Alexander Y. Lin, Franklyn P. Cladis, Jeffrey Weinzweig, Chris Bonfield, and Peter J. Taub
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medicine.medical_specialty ,Maxillary hypoplasia ,Monobloc ,business.industry ,medicine.medical_treatment ,Distraction ,medicine ,Distraction osteogenesis ,Orbit (control theory) ,business ,medicine.disease ,Hypoplasia ,Surgery - Abstract
Syndromic hypoplasia of the orbit and midface results in noticeable dysmorphology. Correction involves advancement of the orbito-facial complex either directly or by distraction osteogenesis. The surgery is challenging no matter where it is performed, however, the challenges are amplified on a surgical mission. Komedyplast Surgical Charity (Chicago, IL) has been performing complex craniofacial procedures, including midfacial advancement at the Monobloc level, for 13 years with safety and success. As such, key points need specific attention to avoid complications in a remote location, where staff and resources may be less than adequately equipped to handle them.
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- 2020
6. Empowering Women as Leaders in Pediatric Anesthesiology: Methodology, Lessons, and Early Outcomes of a National Initiative
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Samuel D Yanofsky, John E. Fiadjoe, Laura K. Berenstain, Anita Honkanen, Jennifer K. Lee, Franklyn P. Cladis, Helen H. Lee, Lawrence I Schwartz, Shobha Malviya, Eugenie Heitmiller, Randall P. Flick, Scott D. Markowitz, Sean Tackett, Nina Deutsch, and Jamie M. Schwartz
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Gender Equity ,Male ,Attitude of Health Personnel ,media_common.quotation_subject ,Sexism ,Coaching ,Physicians, Women ,Mentorship ,Promotion (rank) ,Optimism ,Surveys and Questionnaires ,Medicine ,Humans ,Pediatricians ,Staff Development ,Empowerment ,Goal setting ,media_common ,Response rate (survey) ,Medical education ,business.industry ,Mentors ,COVID-19 ,Anesthesiologists ,Career Mobility ,Leadership ,Anesthesiology and Pain Medicine ,Female ,business ,Career development ,Program Evaluation ,Women, Working - Abstract
Research has shown that women have leadership ability equal to or better than that of their male counterparts, yet proportionally fewer women than men achieve leadership positions and promotion in medicine. The Women's Empowerment and Leadership Initiative (WELI) was founded within the Society for Pediatric Anesthesia (SPA) in 2018 as a multidimensional program to help address the significant career development, leadership, and promotion gender gap between men and women in anesthesiology. Herein, we describe WELI's development and implementation with an early assessment of effectiveness at 2 years. Members received an anonymous, voluntary survey by e-mail to assess whether they believed WELI was beneficial in several broad domains: career development, networking, project implementation and completion, goal setting, mentorship, well-being, and promotion and leadership. The response rate was 60.5% (92 of 152). The majority ranked several aspects of WELI to be very or extremely valuable, including the protege-advisor dyads, workshops, nomination to join WELI, and virtual facilitated networking. For most members, WELI helped to improve optimism about their professional future. Most also reported that WELI somewhat or absolutely contributed to project improvement or completion, finding new collaborators, and obtaining invitations to be visiting speakers. Among those who applied for promotion or leadership positions, 51% found WELI to be somewhat or absolutely valuable to their application process, and 42% found the same in applying for leadership positions. Qualitative analysis of free-text survey responses identified 5 main themes: (1) feelings of empowerment and confidence, (2) acquisition of new skills in mentoring, coaching, career development, and project implementation, (3) clarification and focus on goal setting, (4) creating meaningful connections through networking, and (5) challenges from coronavirus disease 2019 (COVID-19) and the inability to sustain the advisor-protege connection. We conclude that after 2 years, the WELI program has successfully supported career development for the majority of proteges and advisors. Continued assessment of whether WELI can meaningfully contribute to attainment of promotion and leadership positions will require study across a longer period. WELI could serve as a programmatic example to support women's career development in other subspecialties.
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- 2021
7. Cold-stored whole blood platelet function is preserved in injured children with hemorrhagic shock
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Barbara A. Gaines, Franklyn P. Cladis, Richard A. Saladino, Darrell J. Triulzi, Mark H. Yazer, and Christine M. Leeper
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Blood Platelets ,Male ,Resuscitation ,Adolescent ,Shock, Hemorrhagic ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Refrigeration ,Interquartile range ,law ,Humans ,Medicine ,Blood Transfusion ,Platelet ,Child ,Whole blood ,Platelet Count ,business.industry ,030208 emergency & critical care medicine ,Length of Stay ,Intensive care unit ,Platelet transfusion ,Blood Preservation ,Child, Preschool ,Anesthesia ,Cohort ,Wounds and Injuries ,Injury Severity Score ,Female ,Surgery ,business - Abstract
BACKGROUND Recent data demonstrate the safety of uncrossmatched cold-stored whole blood (WB) transfusion in pediatric trauma patients. The hemostatic capabilities of platelets within the cold-stored WB unit have been demonstrated via in vitro studies and animal models. However, platelet function has not been evaluated in pediatric recipients of cold-stored WB transfusions. METHODS Injured children, 2 years or older and 10 kg or greater with hemorrhagic shock received up to 30 mL/kg of cold-stored, low titer (
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- 2019
8. The advancement of pediatric anesthesia pharmacology: David Ryan Cook (scions, serendipity, and six degrees of separation)
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Peter J. Davis, Franklyn P. Cladis, Christine L. Mai, and Myron Yaster
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medicine.medical_specialty ,business.industry ,Serendipity ,education ,History, 20th Century ,Pharmacology ,Hospitals, Pediatric ,History, 21st Century ,Pediatrics ,Perioperative Care ,humanities ,Anesthesiology and Pain Medicine ,Anesthesiology ,Pediatric anesthesiology ,Pediatrics, Perinatology and Child Health ,Perioperative care ,medicine ,Humans ,business ,Pediatric anesthesia - Abstract
Dr David Ryan Cook, Professor Emeritus of Anesthesiology and Pharmacology at the University of Pittsburgh and Chief of Anesthesiology at Children's Hospital of Pittsburgh (1977-1999), is a pioneer in the field of pediatric anesthesiology and pharmacology. Dr Cook contributed significantly to the understanding of pharmacologic differences among infants, children, and adults. His work as a clinician-scientist, educator, and mentor defined the pharmacology of many of the anesthetic agents we continue to use today. He brought science to the art of anesthesia and enhanced the safety of pediatric perioperative care. Based on a 2017 interview with Dr Cook, this article outlines the development of his career and his contributions to the field of anesthesiology and pharmacology.
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- 2018
9. Hospitalization Patterns for Inpatient Pediatric Surgery and Procedures in California: The Ground Is Shifting
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Franklyn P. Cladis, Peter J. Davis, and James A. DiNardo
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medicine.medical_specialty ,Inpatients ,business.industry ,MEDLINE ,California ,Hospitalization ,Anesthesiology and Pain Medicine ,Text mining ,Emergency medicine ,Pediatric surgery ,medicine ,Humans ,business ,Child - Published
- 2020
10. A Multimodal Preemptive Analgesic Protocol for Alveolar Bone Graft Surgery: Decreased Pain, Hospital Stay, and Health Care Costs
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Michael R. Bykowski, Wesley N. Sivak, Franklyn P. Cladis, Jesse A. Goldstein, Joseph E. Losee, and Catharine B. Garland
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medicine.medical_specialty ,medicine.medical_treatment ,Analgesic ,Bone grafting ,Alveolar bone graft ,Cohort Studies ,Ilium ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,Child ,030223 otorhinolaryngology ,Bone regeneration ,Retrospective Studies ,Analgesics ,Pain, Postoperative ,Bone Transplantation ,Alveolar Bone Grafting ,business.industry ,Health Care Costs ,030206 dentistry ,Perioperative ,Length of Stay ,humanities ,Surgery ,Otorhinolaryngology ,Oral Surgery ,Alveolar bone grafting ,business ,Hospital stay - Abstract
To evaluate postoperative pain, hospital length of stay (LOS), and associated costs of multiple perioperative analgesic strategies following alveolar bone grafting (ABG).Retrospective comparative cohort study.Tertiary care pediatric hospital.Iliac crest bone graft (ICBG) harvest techniques: "Open Harvest" (n = 22), "Trephine Only" (n = 14), or "Trephine + Pain Pump" (n = 25).The "Open Harvest" group underwent open ICBG harvest with 3-walled osteotomies. For the other 2 treatment groups, a trephine drill was used to harvest iliac crest bone with a ropivacaine infusion pump into the hip donor site ("Trephine + Pain Pump") or without ("Trephine Only"). Patients who underwent ABG with only cadaveric allograft were analyzed as a comparison group ("No Harvest").Outcomes were planned prior to data collection: maximum pain score, hospital LOS, and associated health care costs.Maximum pain scores were significantly higher in the "Open Harvest" group (7.3/10) compared to "Trephine + Pain Pump" (1.8/10; P.0001) and "No Harvest" groups (2.8/10; P.01). Hospital LOS decreased from 2.4 days ("Open Harvest") to 0.5 days (Trephine + Pain Pump"; P.0001). Twelve (48%) patients from "Trephine + Pain Pump" were discharged on the day of surgery. The "Trephine + Pain Pump" saved an estimated $5336 for a unilateral ABG and $7265 for a bilateral ABG compared to "Open Harvest."The combined use of the trephine ICBG technique and ropivacaine infusion catheter effectively decreased pain, shortened hospital stay, and improved cost saving compared to patients who have undergone other methods of ICBG.
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- 2018
11. Pediatric Anesthesiology Fellowship Positions: Is There a Mismatch?
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William B. Waldrop, M. Concetta Lupa, Michael R. Hernandez, Samuel D Yanofsky, Doyle J. Lim, Debnath Chatterjee, Franklyn P. Cladis, and Justin L. Lockman
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Pediatric anesthesiology ,business.industry ,Anesthesiology ,Family medicine ,medicine ,MEDLINE ,Humans ,Internship and Residency ,Fellowships and Scholarships ,business ,Pediatrics - Published
- 2019
12. Personalized pediatric ophthalmology: a case report
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Parth Shah, Lillian K. To, Hannah L. Scanga, Franklyn P. Cladis, Ken K. Nischal, and Alexis L. Franks
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medicine.medical_specialty ,Pediatrics ,business.industry ,Posterior pole ,Opsoclonus ,medicine.disease ,Penetrance ,eye diseases ,Ophthalmology ,Anesthesiology ,Pediatrics, Perinatology and Child Health ,medicine ,Pediatric ophthalmology ,Personalized medicine ,business ,Developmental regression ,Exome sequencing - Abstract
The availability of genetic sequencing has given physicians a new tool for diagnosis and treatment of disease, and “personalized medicine” has become an increasingly common term in general but not in pediatric ophthalmology. We present a case of a toddler who developed ataxia, opsoclonus, myoclonus, and developmental regression following anesthesia for a common otolaryngology procedure. The child was found to have a variant in the MT-ND6 gene (m.14484T>C), most commonly associated with Leber hereditary optic neuropathy, despite a phenotype more closely resembling Leigh syndrome. The incongruence of phenotype and genotype prompted whole exome sequencing, which identified an unexpected intronic missense mutation in RB1 (1960+5G>A), with a 90% penetrance for retinoblastoma. Limited evaluation of the posterior pole in clinic did not identify any lesions, and the risks and benefits of examination under anesthesia were discussed among neurology, ophthalmology, and anesthesiology. We report the outcome of these discussions. The value and risks of personalized medicine are discussed.
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- 2019
13. Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group
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Susan M, Goobie, Franklyn P, Cladis, Chris D, Glover, Henry, Huang, Srijaya K, Reddy, Allison M, Fernandez, David, Zurakowski, Paul A, Stricker, Heike, Gries, and Hubert, Benzon
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Male ,medicine.medical_specialty ,Reconstructive surgery ,Antifibrinolytic ,Databases, Factual ,medicine.drug_class ,Blood Loss, Surgical ,Pediatrics ,Craniosynostosis ,Craniofacial Abnormalities ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Registries ,Cooperative Behavior ,Child ,Adverse effect ,Craniofacial surgery ,business.industry ,Skull ,Infant ,Perioperative ,Plastic Surgery Procedures ,medicine.disease ,Antifibrinolytic Agents ,Surgery ,Anesthesiology and Pain Medicine ,Tranexamic Acid ,Child, Preschool ,Anesthesia ,Aminocaproic Acid ,Pediatrics, Perinatology and Child Health ,Female ,Aminocaproic acid ,business ,030217 neurology & neurosurgery ,Tranexamic acid ,medicine.drug - Abstract
SummaryBackground Antifibrinolytic therapy significantly decreases blood loss and transfusion in pediatric cranial vault reconstructive surgery; however, concern regarding the side effects profile limits clinical use. Aims The aim was to utilize the Pediatric Craniofacial Surgery Perioperative Registry database to identify the safety profile of antifibrinolytic therapy for cranial vault reconstructive surgery by reporting the incidence of adverse events as they relate to exposure to tranexamic acid and aminocaproic acid compared to no exposure to antifibrinolytics. Methods The database was queried for cases of open cranial vault reconstructive surgery. Less invasive procedures such as neuro-endoscopic and spring-mediated cranioplasties were excluded. The outcomes evaluated included any perioperative neurological adverse event including seizures or seizure-like movements and thromboembolic events. Results Thirty-one institutions reported a total of 1638 cases from 2010 to 2015. Total antifibrinolytic administration accounted for 59.5% (tranexamic acid, 36.1% and aminocaproic acid, 23.4%), with 40.5% not receiving any antifibrinolytic. The overall incidence of postoperative seizures or seizure-like movements was 0.6%. No significant difference was detected in the incidence of postoperative seizures between patients receiving tranexamic acid and those receiving aminocaproic acid [the odds ratio for seizures being 0.34 (95% confidence interval: 0.07–1.85) controlling for American Society of Anesthesia (ASA) physical class] nor in patients receiving antifibrinolytics compared to those not administered antifibrinolytics (the odds ratio for seizures being 1.02 (confidence interval 0.29–3.63) controlling for ASA physical class). One complicated patient in the antifibrinolytic group with a femoral venous catheter had a postoperative deep venous thrombosis. Conclusions This is the first report of an incidence of postoperative seizures of 0.6% in pediatric cranial vault reconstructive surgery. There was no significant difference in postoperative seizures or seizure-like events in those patients who received the tranexamic acid or aminocaproic acid vs those that did not. This report provides evidence of the safety profile of antifibrinolytic in children having noncardiac major surgery. Caution should prevail however in using antifibrinolytic in high-risk patients. Antifibrinolytic dosage regimes should be based on pharmacokinetic data avoiding high doses.
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- 2017
14. ERAS protocol for pediatric laparoscopic cholecystectomy promotes safe and early discharge
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Franklyn P. Cladis, Mihaela Visoiu, Marcus M. Malek, Andrew Yeh, Gabriella Butler, Stephen Strotmeyer, and Kelly Austin
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Male ,medicine.medical_specialty ,Adolescent ,Patient Readmission ,Perioperative Care ,Postoperative management ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Clinical Protocols ,030225 pediatrics ,medicine ,Humans ,Pain Management ,Child ,Early discharge ,Laparoscopic cholecystectomy ,Retrospective Studies ,Protocol (science) ,Retrospective review ,business.industry ,General surgery ,Infant, Newborn ,Infant ,General Medicine ,Emergency department ,Length of Stay ,Analgesics, Opioid ,Logistic Models ,Cholecystectomy, Laparoscopic ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Critical Pathways ,Surgery ,Female ,business ,Emergency Service, Hospital ,Hospital stay - Abstract
Elective laparoscopic cholecystectomy (LC) pediatric patients in our institution have historically been admitted for an overnight hospital stay (OHS). The purpose of this study was to implement an ERAS protocol for elective LC in pediatric patients to promote same-day discharge (SDD) while maintaining excellent outcomes.An ERAS protocol for elective LC was implemented encompassing pre-, peri-, and postoperative management. A retrospective review of prospectively collected data from patients before (BI) and after implementation (AI) of the protocol was performed.A total of 250 patients (BI 105, AI 145) were included in the study. The AI group had significantly higher rate of SDD compared to BI (77.2% vs. 1.9%, p 0.01) and significantly decreased opioid use (morphine equivalents mg/kg AI 0.36 vs. BI 0.46, p 0.001). There were also no significant differences in the rate of total 30-day emergency department visits (BI 11.4% vs. AI 9.7%, p = 0.52) or surgery-related 30-day emergency department visits (BI 7.6% vs. AI 8.3%, p = 0.53). Factors that predisposed patients to an OHS after LC included higher ASA, later surgery start times, and longer operative times.The ERAS protocol significantly increased the rate of SDD after elective LC in pediatric patients without an associated increase in emergency department visits or readmissions.III.
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- 2019
15. Improving the international pediatric peri-operative experience through laughter
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Jacob P Bray and Franklyn P. Cladis
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medicine.medical_specialty ,Laughter ,business.industry ,media_common.quotation_subject ,General surgery ,Perioperative ,Anesthesiology and Pain Medicine ,Pediatrics, Perinatology and Child Health ,Medicine ,Humans ,business ,Child ,Perioperative Period ,media_common - Published
- 2019
16. General anesthesia safety in progressive leukodystrophies: A retrospective study of patients with Krabbe disease and metachromatic leukodystrophy
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Nicholas A. Bascou, Maria C. Marcos, Mercedes C. Roosen-Marcos, Franklyn P. Cladis, Maria L. Escolar, Maria L. Beltran Quintero, and Michele D. Poe
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Male ,Adolescent ,medicine.medical_treatment ,Population ,Hematopoietic stem cell transplantation ,Anesthesia, General ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,030225 pediatrics ,medicine ,Humans ,education ,Child ,Retrospective Studies ,education.field_of_study ,business.industry ,Medical record ,Hematopoietic Stem Cell Transplantation ,Infant ,Retrospective cohort study ,Leukodystrophy, Metachromatic ,medicine.disease ,Leukodystrophy, Globoid Cell ,Metachromatic leukodystrophy ,Transplantation ,Anesthesiology and Pain Medicine ,Anesthesia ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Krabbe disease ,Female ,business ,Complication - Abstract
Background Krabbe disease and metachromatic leukodystrophy are leukodystrophies characterized by neurologic degeneration and early death. Patients often require general anesthesia for diagnostic and therapeutic interventions. Methods A retrospective review of medical records was conducted for patients with Krabbe disease and metachromatic leukodystrophy receiving general anesthesia at a large children's hospital between 2012 and 2017. Patient complications and American Society of Anesthesiologists Physical Status were recorded for all procedures. The Neurodevelopment in Rare Disorders classification system was created to categorize the severity of the patient's disease progression based on clinical markers. Descriptive and inferential statistics were used to compare: (a) complication rate of affected patients vs the general hospital population; (b) the accuracy of the novel Neurodevelopment in Rare Disorders classification system vs American Society of Anesthesiologists Physical Status regarding the assessment of complication risk; (c) complication rate in patients with hematopoietic stem cell transplantation vs those without transplantation; (d) complication rate in immunosuppressed patients vs nonimmunosuppressed patients; and (e) complication rate of the three most commonly performed procedures. Results A total of 96 patients underwent 287 procedures. Of these, 11 cases had complications, yielding a rate of 3.8%. This is significantly higher than the overall complication rate at our institution of 0.246%. Statistical analysis showed better correlation between the Neurodevelopment in Rare Disorders classification system and complication rate than American Society of Anesthesiologists Physical Status and complication rate. The system also showed better accuracy in differentiating low-risk and high-risk patients. No statistically significant difference in complication rate was found for patients with transplantation vs those without transplantation or for immunosuppressed vs nonimmunosuppressed patients. Of the three most common procedures, central catheter placement/removal exhibited the highest complication rate. Conclusions Although the complication rate for patients with Krabbe disease and metachromatic leukodystrophy is higher than the general population, most complications were mild and self-limiting. These results suggest that, in experienced hands, general anesthesia is well tolerated in most children. Findings show that the Neurodevelopment in Rare Disorders classification system is a better indicator for assessing complication risk in patients with Krabbe and metachromatic leukodystrophy than American Society of Anesthesiologists Physical Status.
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- 2019
17. Organ Transplantation
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James Cain, Franklyn P. Cladis, Peter J. Davis, Miriam Anixter, and Steven Lichtenstein
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medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,business.industry ,medicine ,030211 gastroenterology & hepatology ,030230 surgery ,030204 cardiovascular system & hematology ,business ,Organ transplantation ,Surgery - Published
- 2019
18. Pediatric Liver Transplantation
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Franklyn P. Cladis and Jonathon Nelson
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Medicine ,Liver transplantation ,business ,Gastroenterology - Abstract
Liver transplantation has become a standard surgical treatment for pediatric patients with hepatic failure, tumors, and metabolic derangements. Liver transplantation in the pediatric population can be extremely challenging for the anesthesiologist due to multiple perioperative considerations. The first successful liver transplant was performed in a pediatric patient in the 1960s, and since then, there have been significant advances in immunosuppressant medications and preservation solutions which have led to improved survival. Nevertheless, the number of liver transplants continues to be limited by organ availability, although the pediatric donor pool has been increased by living related donors and split livers. The most common pediatric pathology that results in hepatic failure and transplantation is biliary atresia. This chapter covers the perioperative care of a pediatric patient undergoing a liver transplant, from the preoperative preparation to the intraoperative management, and discusses postoperative challenges which may be encountered while in the intensive care unit.
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- 2018
19. Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group
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Franklyn P. Cladis, Daniel Rubens, Galit Ungar-Kastner, Alyssa Brzenski, Surendrasingh Chhabada, Douglas Thompson, Vanessa Pohl, Brad M. Taicher, Jesus Apuya, Meera Gangadharan, Indrani Lakheeram, Jose Luis Martinez, Rochelle Skitt, Vincent Hsieh, Brian Masel, M. Hetmaniuk, Rheana Watts, Wai Sung, B.M. Taicher, Jane Kugler, Laura Ryan, John Hajduk, Shannon Grap, Veronica O. Busso, Chris D. Glover, Karen Wong, Wallis T. Muhly, Kim Poteet-Schwartz, Amanda Gosman, Michelle Kars, Andrew Lee, Jansie Prozesky, Jennifer K Hansen, Olutoyin Olutuye, P.G. Fernandez, Kim-Phuong Nguyen, Petra M. Meier, Bridget L. Muldowney, Hubert A. Benzon, Bobbie Stubbeman, Neil R. Singhal, Thanh Nguyen, S.M. Goobie, Jonathon Nelson, K.V. Isaac, Rachel Dabek, Allison Griffin, Courtney Kowalczyk-Derderian, Davinder J. Singh, John Wieser, Julian Post, Michael Collins, Lillian Zamora, Kristen Labovsky, Eduardo Medellin, Timothy Petersen, Codruta Soneru, Tariq Syed, Srijaya K Reddy, Stefan Budac, Rachel Spitznagel, Ricardo Falconl, Uma Ramesh Parekh, Susan M. Goobie, C.K. Derderian, Paul A. Stricker, Mali Hetmaniuk, Susan R. Staudt, Julie Nicholson, Christopher Abruzzese, John E. Fiadjoe, David Zurakowski, Patrick G. Fernandez, Margaret Owens-Stubblefield, Emad Sorial, Katherine R. Gentry, Peter Szmuk, Charles M. Haberkern, Danielle Claypool, Allison M Fernandez, Karene Ricketts, Heike Gries, Rebecca Hall, Henry Huang, P.A. Stricker, Russell R. Reid, Ranu Jain, Franklin Chiao, Nicholas M. Dalesio, Iskra Ivanova, Lisa Tretault, Heather Mitzel Levy, Amy Beethe, Wendy Binstock, and Pablo Ingelmo
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Male ,medicine.medical_specialty ,Adolescent ,Risk Assessment ,Craniosynostosis ,Craniosynostoses ,Postoperative Complications ,Predictive Value of Tests ,Medicine ,Humans ,Craniofacial ,Child ,Intraoperative Complications ,Craniofacial surgery ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Incidence ,Reproducibility of Results ,Perioperative ,Length of Stay ,Plastic Surgery Procedures ,medicine.disease ,Anesthesiology and Pain Medicine ,Child, Preschool ,Emergency medicine ,Observational study ,Female ,business ,Risk assessment ,Complication ,Algorithms - Abstract
Background The current incidence of major complications in paediatric craniofacial surgery in North America has not been accurately defined. In this report, the Pediatric Craniofacial Collaborative Group evaluates the incidence and determines the independent predictors of major perioperative complications using a multicentre database. Methods The Pediatric Craniofacial Surgery Perioperative Registry was queried for subjects undergoing complex cranial vault reconstruction surgery over a 5-year period. Major perioperative complications were identified through a structured a priori consensus process. Logistic regression was applied to identify predictors of a major perioperative complication with bootstrapping to evaluate discrimination accuracy and provide internal validity of the multivariable model. Results A total of 1814 patients from 33 institutions in the US and Canada were analysed; 15% were reported to have a major perioperative complication. Multivariable predictors included ASA physical status 3 or 4 (P=0.005), craniofacial syndrome (P=0.008), antifibrinolytic administered (P=0.003), blood product transfusion >50 ml kg–1 (P Conclusions The predictive algorithm can be used as a prognostic tool to risk stratify patients and thereby potentially reduce morbidity and mortality. Craniofacial teams can utilise these predictors of complications to identify high-risk patients. Based on this information, further prospective quality improvement initiatives may decrease complications, and reduce morbidity and mortality.
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- 2018
20. Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group
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Rebecca Hall, Henry Huang, Russell R. Reid, Srijaya K Reddy, Hubert A. Benzon, Rachel Dabek, Michael Collins, Franklin Chiao, Nicholas M. Dalesio, Cornelius B. Groenewald, Karen Wong, Lisa Tetreault, Susan R. Staudt, Olutoyin Olutuye, Kim Poteet-Schwartz, Jordan Cusick, Jose Luis Martinez, Chris D. Glover, Carolyn F. Bannister, Karene Ricketts, Vincent Hsieh, Jane Kugler, Iskra Ivanova, Veronica O. Busso, Wai Sung, Thanh Nguyen, Codruta Soneru, Meera Gangadharan, Adrian T. Bosenberg, Kristen Labovsky, Charles M. Haberkern, Jeffrey L. Koh, Daniel Rubens, Bridget L. Muldowney, Alyssa Brzenski, Peter Szmuk, Lisa Sohn, Tariq Syed, Stefan Budac, Mali Hetmaniuk, Ranu Jain, David Zurakowski, Patrick G. Fernandez, Paul A. Stricker, Pablo Ingelmo, Vanessa Young, Heike Gries, Brad M. Taicher, Rheana Watts, Wendy Binstock, Timothy Petersen, Petra M. Meier, Allison Griffin, Courtney Kowalczyk-Derderian, Rochelle Skitt, Franklyn P. Cladis, Douglas Thompson, Samantha Capehart, Susan M. Goobie, John Hajduk, Kim-Phuong Nguyen, Lillian Zamora, Katherine R. Gentry, Allison M Fernandez, Jennifer K Hansen, John E. Fiadjoe, Razaz H. Mujallid, and Ricardo Falcon
- Subjects
Male ,medicine.medical_specialty ,law.invention ,Craniosynostosis ,Craniofacial Abnormalities ,03 medical and health sciences ,Craniosynostoses ,0302 clinical medicine ,030202 anesthesiology ,law ,medicine ,Humans ,Prospective Studies ,Registries ,Craniofacial ,Prospective cohort study ,Propensity Score ,Craniofacial surgery ,business.industry ,Infant ,Endoscopy ,Perioperative ,Plastic Surgery Procedures ,medicine.disease ,Intensive care unit ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Anesthesia ,Propensity score matching ,Female ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis. We hypothesized that advantages of ESC from single-center studies would be validated based on combined data from a large multicenter registry. METHODS Thirty-one institutions contributed data from June 2012 to September 2015. We analyzed 1382 infants younger than 12 months undergoing open (anterior and/or posterior cranial vault reconstruction, modified-Pi procedure, or strip craniectomy) or endoscopic craniectomy. The primary outcomes included transfusion data, ICU utilization, hospital length of stay, and perioperative complications; secondary outcomes included anesthesia and surgical duration. Comparison of unmatched groups (ESC: N = 311, open repair: N = 1071) and propensity score 2:1 matched groups (ESC: N = 311, open repair: N = 622) were performed by conditional logistic regression analysis. RESULTS Imbalances in baseline age and weight are inherent due to surgical selection criteria for ESC. Quality of propensity score matching in balancing age and weight between ESC and open groups was assessed by quintiles of the propensity scores. Analysis of matched groups confirmed significantly reduced utilization of blood (26% vs 81%, P < .001) and coagulation (3% vs 16%, P < .001) products in the ESC group compared to the open group. Median blood donor exposure (0 vs 1), anesthesia (168 vs 248 minutes) and surgical duration (70 vs 130 minutes), days in ICU (0 vs 2), and hospital length of stay (2 vs 4) were all significantly lower in the ESC group (all P < .001). Median volume of red blood cell administered was significantly lower in ESC (19.6 vs 26.9 mL/kg, P = .035), with a difference of approximately 7 mL/kg less for the ESC (95% confidence interval for the difference, 3-12 mL/kg), whereas the median volume of coagulation products was not significantly different between the 2 groups (21.2 vs 24.6 mL/kg, P = .73). Incidence of complications including hypotension requiring treatment with vasoactive agents (3% vs 4%), venous air embolism (1%), and hypothermia, defined as
- Published
- 2017
21. Preoperative Preparation
- Author
-
Franklyn P. Cladis and Peter J. Davis
- Published
- 2017
22. Preface
- Author
-
Peter J. Davis and Franklyn P. Cladis
- Published
- 2017
23. Acknowledgments
- Author
-
Peter J. Davis and Franklyn P. Cladis
- Published
- 2017
24. Contributors
- Author
-
Ann G. Bailey, Jeffrey R. Balzer, Victor C. Baum, David S. Beebe, Sue R. Beers, Kumar G. Belani, Bruno Bissonette, Brian Blasiole, Adrian T. Bosenberg, Barbara W. Brandom, Claire M. Brett, James G. Cain, Thomas M. Chalifoux, Franklyn P. Cladis, David E. Cohen, Ira T. Cohen, Joseph P. Cravero, Nicholas M. Dalesio, Andrew Davidson, Jessica Davis, Peter J. Davis, Duncan G. de Souza, Nina Deutsch, Laura K. Diaz, James A. DiNardo, Peter F. Ehrlich, Demetrius Ellis, James J. Fehr, Jeffrey M. Feldman, Kathryn Felmet, Jonathan D. Finder, Sean Flack, Randall P. Flick, Michelle A. Fortier, Geoff Frawley, Samir K. Gadepalli, Jeffrey L. Galinkin, Nancy Glass, Salvatore R. Goodwin, George A. Gregory, Lorelei Grunwaldt, Padma Gulur, Nina A. Guzzetta, Dawit T. Haile, Denise M. Hall-Burton, Gregory B. Hammer, Jennifer L. Hamrick, Justin T. Hamrick, Daniel M. Hayward, Eugenie S. Heitmiller, Andrew Herlich, Robert S. Holzman, Vincent C. Hsieh, Elizabeth A. Hunt, James W. Ibinson, Lori T. Justice, Zeev N. Kain, Evan Kharasch, Rahul Koka, Sabine Kost-Byerly, Elliot J. Krane, Barry D. Kussman, Robert Scott Lang, Helen Victoria Lauro, Jennifer K. Lee, Joseph Losee, Igor Luginbuehl, Mohamed Mahmoud, Brian Martin, Keira P. Mason, William J. Mauermann, Lynne G. Maxwell, Francis X. McGowan, Bruce E. Miller, Constance L. Monitto, Philip G. Morgan, Michael L. Moritz, Etsuro K. Motoyama, Michael E. Nemergut, Julie Niezgoda, Shelley Ohliger, Phillip M.T. Pian, David M. Polaner, George D. Politis, Andrew J. Powell, Paul Reynolds, Karene Ricketts, Richard S. Ro, Mark A. Rockoff, Thomas Romanelli, Nancy Bard Samol, Paul J. Samuels, Joseph A. Scattoloni, Jamie McElrath Schwartz, Deborah A. Schwengel, Victor L. Scott, Donald H. Shaffner, Avinash C. Shukla, Allan F. Simpao, Erica L. Sivak, Matthew D. Sjoblom, Kyle Soltys, Sulpicio G. Soriano, Eric T. Stickles, Jennifer M. Thomas, Stevan P. Tofovic, Kha M. Tran, Premal M. Trivedi, Robert D. Valley, Monica S. Vavilala, Lisa Vecchione, Keith M. Vogt, Jeffrey R. Wahl, Kerri M. Wahl, Ari Y. Weintraub, Timothy P. Welch, Robert K. Williams, Eric P. Wittkugel, Susan Woelfel, Myron Yaster, Koichi Yuki, Steven Zgleszewski, Basil J. Zitelli, and Aaron L. Zuckerberg
- Published
- 2017
25. Special Characteristics of Pediatric Anesthesia
- Author
-
Peter J. Davis, Etsuro K. Motoyama, and Franklyn P. Cladis
- Subjects
business.industry ,Anesthesia ,Medicine ,Pediatric anesthesia ,business - Published
- 2017
26. Anesthesia for the Pediatric Trauma Patient
- Author
-
Paul Reynolds, Joseph A. Scattoloni, Samir K. Gadepalli, Peter Ehrlich, Franklyn P. Cladis, and Peter J. Davis
- Published
- 2017
27. Anesthesia for Pediatric Plastic Surgery
- Author
-
Franklyn P. Cladis, Lorelei Grunwaldt, and Joseph Losee
- Published
- 2017
28. Oncologic Disorders
- Author
-
Steven Zgleszewski, Salvatore R. Goodwin, Kevin J. Sullivan, Franklyn P. Cladis, and Peter J. Davis
- Published
- 2017
29. Pierre Robin Sequence
- Author
-
Anand Kumar, Franklyn P. Cladis, Joseph E. Losee, Todd D. Otteson, Matthew D Ford, and Lorelei J. Grunwaldt
- Subjects
medicine.medical_specialty ,Stridor ,Patient Positioning ,Perioperative Care ,Feeding Methods ,Anesthesiology ,medicine ,Humans ,Anesthesia ,Cooperative Behavior ,Patient Care Team ,Pierre Robin Syndrome ,Respiratory distress ,business.industry ,General surgery ,Glossoptosis ,Infant, Newborn ,Infant ,Perioperative ,Plastic Surgery Procedures ,Airway obstruction ,medicine.disease ,Otorhinolaryngologic Surgical Procedures ,Surgery ,Airway Obstruction ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Otorhinolaryngology ,Failure to thrive ,Interdisciplinary Communication ,medicine.symptom ,Respiratory Insufficiency ,business - Abstract
The clinical triad of micrognathia (small mandible), glossoptosis (backward, downward displacement of the tongue), and airway obstruction defines the Pierre Robin sequence (PRS). Airway obstruction and respiratory distress are clinical hallmarks. Patients may present with stridor, retractions, and cyanosis. Severe obstruction results in feeding difficulty, reflux, and failure to thrive. Treatment options depend on the severity of airway obstruction and include prone positioning, nasopharyngeal airways, tongue lip adhesion, mandibular distraction osteogenesis, and tracheostomy. The neonate and infant with PRS require care from multiple specialists including anesthesiology, plastic surgery, otolaryngology, speech pathology, gastroenterology, radiology, and neonatology. The anesthesiologist involved in the care of patients with PRS will interface with a multidisciplinary team in a variety of clinical settings. This perioperative review is a collaborative effort from multiple specialties including anesthesiology, plastic surgery, otolaryngology, and speech pathology. We will discuss the background and clinical presentation of patients with PRS, as well as some of the controversies regarding their care.
- Published
- 2014
30. Perioperative Outcomes and Management in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Study from the Pediatric Craniofacial Collaborative Group
- Author
-
Paul A, Stricker, Susan M, Goobie, Franklyn P, Cladis, Charles M, Haberkern, Petra M, Meier, Srijaya K, Reddy, Thanh T, Nguyen, Lingyu, Cai, Marcia, Polansky, Peter, Szmuk, John, Fiadjoe, Codruta, Soneru, Ricardo, Falcon, Timothy, Petersen, Courtney, Kowalczyk-Derderian, Nicholas, Dalesio, Stefan, Budac, Neels, Groenewald, Daniel, Rubens, Douglas, Thompson, Rheana, Watts, Katherine, Gentry, Iskra, Ivanova, Mali, Hetmaniuk, Vincent, Hsieh, Michael, Collins, Karen, Wong, Wendy, Binstock, Russell, Reid, Kim, Poteet-Schwartz, Heike, Gries, Rebecca, Hall, Jeffrey, Koh, Carolyn, Bannister, Wai, Sung, Ranu, Jain, Allison, Fernandez, Gerald F, Tuite, Ernesto, Ruas, Oleg, Drozhinin, Lisa, Tetreault, Bridget, Muldowney, Karene, Ricketts, Patrick, Fernandez, Lisa, Sohn, John, Hajduk, Brad, Taicher, Jessica, Burkhart, Allison, Wright, Jane, Kugler, Lea, Barajas-DeLoa, Meera, Gangadharan, Veronica, Busso, Kayla, Stallworth, Susan, Staudt, Kristen L, Labovsky, Chris D, Glover, Henry, Huang, Helena, Karlberg-Hippard, Samantha, Capehart, Cynthia, Streckfus, Kim-Phuong T, Nguyen, Peter, Manyang, Jose Luis, Martinez, Jennifer K, Hansen, Heather Mitzel, Levy, Alyssa, Brzenski, Franklin, Chiao, Pablo, Ingelmo, Razaz, Mujallid, Olutoyin A, Olutoye, Tariq, Syed, Hubert, Benzon, and Adrian, Bosenberg
- Subjects
Male ,Reoperation ,Skull ,Infant ,Length of Stay ,Plastic Surgery Procedures ,Perioperative Care ,Craniosynostoses ,Postoperative Complications ,Child, Preschool ,North America ,Practice Guidelines as Topic ,Humans ,Blood Transfusion ,Female ,Registries ,Societies, Medical - Abstract
The Pediatric Craniofacial Collaborative Group established the Pediatric Craniofacial Surgery Perioperative Registry to elucidate practices and outcomes in children with craniosynostosis undergoing complex cranial vault reconstruction and inform quality improvement efforts. The aim of this study is to determine perioperative management, outcomes, and complications in children undergoing complex cranial vault reconstruction across North America and to delineate salient features of current practices.Thirty-one institutions contributed data from June 2012 to September 2015. Data extracted included demographics, perioperative management, length of stay, laboratory results, and blood management techniques employed. Complications and outlier events were described. Outcomes analyzed included total blood donor exposures, intraoperative and perioperative transfusion volumes, and length of stay outcomes.One thousand two hundred twenty-three cases were analyzed: 935 children aged less than or equal to 24 months and 288 children aged more than 24 months. Ninety-five percent of children aged less than or equal to 24 months and 79% of children aged more than 24 months received at least one transfusion. There were no deaths. Notable complications included cardiac arrest, postoperative seizures, unplanned postoperative mechanical ventilation, large-volume transfusion, and unplanned second surgeries. Utilization of blood conservation techniques was highly variable.The authors present a comprehensive description of perioperative management, outcomes, and complications from a large group of North American children undergoing complex cranial vault reconstruction. Transfusion remains the rule for the vast majority of patients. The occurrence of numerous significant complications together with large variability in perioperative management and outcomes suggest targets for improvement.
- Published
- 2016
31. Comprehensive Cleft Care, Volume 1
- Author
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Gretchen Probst, Eric J.W. Liou, Elizabeth J. Leslie, Michael T. Mennuti, Mary Breen, Michael L. Cunningham, Jingtao Li, Linda L. D’Antonio, Nicholas J.V. Hogg, Diane L. Sabo, Jesse A. Goldstein, Donna Cutler-Landsman, Kathleen C.Y. Sie, David K. Chong, Barry L. Ramsey, Alex Campbell, Alexander L. Figueroa, Gregory S. Antonarakis, Robert M. Greene, Lacey Sischo, Richard A. Hopper, Lisa L. Repaske, Jodi E. Gustave, John B. Mulliken, Mohammad Mazaheri, Laura E. Mitchell, Peg C. Nopoulos, Adriane L. Baylis, Michael C. Kao, Kelly N. Evans, Barry H. Grayson, Martin H.S. Huang, Ana M. Mercado, Todd D. Otteson, John Daskalogiannakis, Nancy J. Scherer, Jeffrey L. Marsh, Philip Kuo-Ting Chen, Stephanie E. Watkins, Christopher R. Forrest, Marilyn C. Jones, Peter J. Taub, Thomas Samson, Patricia Daly Chibbaro, Yu-Ray Chen, Dennis R. Warner, Ryan C. Ransom, Robert J. Havlik, Darren M. Smith, Oksana A. Jackson, Faisal Al-Mufarrej, Valerie Pereira, M. Samuel Noordhoff, Dina Ricciardi, Lawrence E. Brecht, Carrie L. Heike, Lyndon M. Hill, Rebecca Gaither, Daniela Damian, Shu-Jin Lee, Robert M. Menard, Kenneth L. Jones, Bernard J. Costello, Donna M. McDonald-McGinn, Ross E. Long, Elaine H. Zackai, Farah Sheikh, Randy Sherman, Brett F. Michelotti, Alexandre Marchac, David L. Jones, Henry K. Kawamoto, Edward P. Buchanan, Hillary L. Broder, Donald R. Mackay, Jamie L. Perry, Earl A. Gage, Lauren DiCairano, Mark Splaingard, Laura A. Monson, Ann W. Kummer, Alison Kaye, Court B. Cutting, William C. Shaw, Cathy R. Henry, Jill A. Helms, Bruce B. Horswell, Gary C. Burget, Richard E. Kirschner, Arun K. Gosain, Seng-Teik Lee, David M. Fisher, Franklyn P. Cladis, Kathleen A. Kapp-Simon, Paula G. Klaiman, Steven T. Lanier, John W. Polley, M. Michele Pisano, Jasmine Y. Rodriguez, Karen W.Y. Wong, Roberto L. Flores, Mary L. Marazita, Scott A. Deacon, Seth M. Weinberg, Mark P. Mooney, Larry H. Hollier, Marilyn A. Cohen, Matthew D. Ford, Peter Randall, Ronald P. Strauss, Christina Tragos, Alvaro A. Figueroa, Joseph Michienzi, Virginia A. Hinton, Anette Lohmander, David P. Kuehn, Scott A. Dailey, Philip J. Lupo, Amy L. Conrad, Lynn Marty Grames, Charles D. Bluestone, Oluwaseun A. Adetayo, Lynn C. Richman, H. Steve Byrd, Donald V. Huebener, Kenneth E. Salyer, Judah S. Garfinkle, Debbie Sell, David E. Kauffman, Sanjay Naran, Stephen B. Baker, Joseph E. Losee, Katherine W.L. Vig, Evan W. Beale, Ramon L. Ruiz, Gunvor Semb, David J. Reisberg, Brian C. Sommerlad, Justine C. Lee, and Susan M. Salkowitz
- Subjects
medicine.medical_specialty ,Plastic surgery ,business.industry ,medicine ,business ,Surgery ,Volume (compression) - Published
- 2016
32. Comprehensive Cleft Care, Volume 2
- Author
-
Mark P. Mooney, Kelly N. Evans, Alison Kaye, David J. Reisberg, Court B. Cutting, Valerie Pereira, M. Samuel Noordhoff, Lawrence E. Brecht, Mark Splaingard, Brian C. Sommerlad, Mary L. Marazita, Lyndon M. Hill, Judah S. Garfinkle, Robert M. Menard, Randy Sherman, Justine C. Lee, Peter Randall, Patricia Daly Chibbaro, Yu-Ray Chen, Darren M. Smith, John Daskalogiannakis, Christina Tragos, Faisal Al-Mufarrej, David L. Jones, Jasmine Y. Rodriguez, Barry H. Grayson, Elaine H. Zackai, Alvaro A. Figueroa, Jeffrey L. Marsh, Jesse A. Goldstein, Virginia A. Hinton, Richard E. Kirschner, Donna Cutler-Landsman, Franklyn P. Cladis, Todd D. Otteson, Robert M. Greene, Joseph Michienzi, Farah Sheikh, Laura A. Monson, Lynn Marty Grames, David K. Chong, Jill A. Helms, Ana M. Mercado, Charles D. Bluestone, Oluwaseun A. Adetayo, Linda L. D’Antonio, Evan W. Beale, Thomas Samson, Donald V. Huebener, Ramon L. Ruiz, Jingtao Li, Bruce B. Horswell, Gary C. Burget, Ross E. Long, Peter J. Taub, Gunvor Semb, M. Michele Pisano, Paula G. Klaiman, Christopher R. Forrest, Henry K. Kawamoto, Roberto L. Flores, Diane L. Sabo, Mohammad Mazaheri, Steven T. Lanier, Scott A. Deacon, Seth M. Weinberg, Larry H. Hollier, Marilyn A. Cohen, Lacey Sischo, Dennis R. Warner, Ryan C. Ransom, John W. Polley, Eric J.W. Liou, John B. Mulliken, Alex Campbell, Gretchen Probst, Nancy J. Scherer, Peg C. Nopoulos, Kenneth L. Jones, Marilyn C. Jones, Laura E. Mitchell, Anette Lohmander, Oksana A. Jackson, Alexander L. Figueroa, Kathleen C.Y. Sie, David P. Kuehn, Bernard J. Costello, Joseph E. Losee, Stephanie E. Watkins, Hillary L. Broder, Cathy R. Henry, Scott A. Dailey, Jodi E. Gustave, Gregory S. Antonarakis, Earl A. Gage, Kathleen A. Kapp-Simon, Ann W. Kummer, Ronald P. Strauss, Philip Kuo-Ting Chen, William C. Shaw, Edward P. Buchanan, Seng-Teik Lee, Philip J. Lupo, Lynn C. Richman, H. Steve Byrd, Matthew D. Ford, Michael C. Kao, Donald R. Mackay, Lauren DiCairano, Donna M. McDonald-McGinn, Jamie L. Perry, Debbie Sell, Arun K. Gosain, Sanjay Naran, Stephen B. Baker, David E. Kauffman, Katherine W.L. Vig, Karen W.Y. Wong, Susan M. Salkowitz, Amy L. Conrad, Kenneth E. Salyer, Michael L. Cunningham, Barry L. Ramsey, Richard A. Hopper, Lisa L. Repaske, Daniela Damian, Shu-Jin Lee, David M. Fisher, Brett F. Michelotti, Alexandre Marchac, Martin H.S. Huang, Robert J. Havlik, Rebecca Gaither, Elizabeth J. Leslie, Nicholas J.V. Hogg, Michael T. Mennuti, Mary Breen, Dina Ricciardi, Carrie L. Heike, and Adriane L. Baylis
- Subjects
medicine.medical_specialty ,Plastic surgery ,business.industry ,Medicine ,business ,Surgery ,Volume (compression) - Published
- 2016
33. Postoperative analgesia via transversus abdominis plane (TAP) catheter for small weight children-our initial experience
- Author
-
Franklyn P. Cladis, Antonio Cassara, Karen Boretsky, Mihaela Visoiu, and Gagandeep Goyal
- Subjects
medicine.medical_specialty ,business.industry ,Local anesthetic ,medicine.drug_class ,Analgesic ,Pain management ,Surgery ,Abdominal wall ,Catheter ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Chart review ,Pediatrics, Perinatology and Child Health ,Medicine ,Transversus abdominis ,business ,Abdominal surgery - Abstract
Summary Pain management in small infants and children is challenging. We report the use of unilateral transversus abdominis plane (TAP) catheters for analgesia following single-sided open lower abdominal surgery when epidural analgesia was undesirable in a series of six low-weight children. Data collection was done via a retrospective chart review. All catheters attempted were successfully placed with resultant low pain scores and the minimal use of rescue analgesic medications. No complications were reported related to these catheters. TAP catheters, although technically challenging, are feasible for the provision of analgesia for surgeries involving the lower abdominal wall in very small patients.
- Published
- 2011
34. Perioperative management of children undergoing craniofacial reconstruction surgery: a practice survey
- Author
-
John J. McCloskey, Franklyn P. Cladis, John E. Fiadjoe, Paul A. Stricker, and Lynne G. Maxwell
- Subjects
medicine.medical_specialty ,Modalities ,Perioperative management ,business.industry ,Optimal management ,Reconstruction surgery ,Clinical trial ,Anesthesiology and Pain Medicine ,Blood loss ,Pediatrics, Perinatology and Child Health ,medicine ,Craniofacial ,Intensive care medicine ,business ,Craniofacial surgery - Abstract
Summary Objective/Aims: To assess current practices in the management of children undergoing craniofacial surgery and identify areas of significant practice variability with the intent to direct future research. Background: The perioperative management of infants and children undergoing craniofacial reconstruction surgery can be challenging because of the routine occurrence of significant blood loss with associated morbidity. A variety of techniques have been described to improve the care for these children. It is presently unknown to what extent these practices are currently employed. Methods: A web-based survey was sent to representatives from 102 institutions. One individual per institution was surveyed to prevent larger institutions from being over-represented in the results. Results: Requests to complete the survey were sent to 102 institutions; 48 surveys were completed. The survey was composed of two parts: management of infants undergoing strip craniectomies, and management of children undergoing major craniofacial reconstruction. Conclusions: Significant variability exists in the management of children undergoing these procedures; further study is required to determine the optimal management strategies. Clinical trials assessing the utility of central venous pressure and other hemodynamic monitoring modalities would enable evidence-based decision-making for monitoring in these children. The development of institutional transfusion thresholds should be encouraged, as there exists a body of evidence supporting their efficacy and safety.
- Published
- 2011
35. Postoperative hyponatremia following calvarial vault remodeling in craniosynostosis
- Author
-
Franklyn P. Cladis, Erica Schmitt, Lorelei J. Grunwaldt, Michael L. Moritz, Joseph E. Losee, Sanjay Naran, Michael R. Bykowski, and James J. Cray
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Medical record ,nutritional and metabolic diseases ,medicine.disease ,Surgery ,Craniosynostosis ,Anesthesiology and Pain Medicine ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Medicine ,Tonicity ,Craniofacial ,business ,Complication ,Hyponatremia ,Craniofacial surgery - Abstract
Summary Background: The incidence, severity, and risk factors for the development of hyponatremia in patients undergoing craniosynostosis surgery are not well known. Objective: To determine the incidence and severity of hyponatremia as a complication in surgical correction of craniosynostosis and to identify risk factors for postoperative hyponatremia. Methods: A retrospective medical record review for 2003–2008 of the Cleft and Craniofacial Database was made. Specific data collected included sodium values, age, weight, type of surgery, duration of surgery, administration of DDAVP, composition and volume of pre-operative, intra-operative, postoperative parenteral fluids, volume of blood, colloid, and crystalloid transfused, estimated blood loss (EBL), medications, comorbidities, pre-operative signs of elevated intracranial pressure (ICP), syndromic vs nonsyndromic craniosynostosis, and the complications associated with hyponatremia. Results: A total of 72 records were reviewed. The incidence of postoperative hyponatremia was 30.6%. There was no intra-operative hyponatremia. While hospital stay was not prolonged, ICU stay was significantly longer (1.9 vs 2.9 days, P = 0.001). Elevated ICP was significantly associated with hyponatremia (P
- Published
- 2011
36. Use of Uncrossmatched Cold-Stored Whole Blood in Injured Children With Hemorrhagic Shock
- Author
-
Mark H. Yazer, Barbara A. Gaines, Franklyn P. Cladis, Christine M. Leeper, Richard A. Saladino, and Darrell J. Triulzi
- Subjects
Male ,Resuscitation ,Time Factors ,Blood transfusion ,Adolescent ,medicine.medical_treatment ,Shock, Hemorrhagic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Infusion Procedure ,Blood Component Transfusion ,Research Letter ,medicine ,Humans ,Blood Transfusion ,Child ,Whole blood ,business.industry ,030208 emergency & critical care medicine ,Length of Stay ,Cold Temperature ,Blood Grouping and Crossmatching ,Blood Preservation ,Child, Preschool ,Anesthesia ,Shock (circulatory) ,Pediatrics, Perinatology and Child Health ,Hemorrhagic shock ,Wounds and Injuries ,Female ,medicine.symptom ,Emergency Service, Hospital ,business - Abstract
This study compares the time to transfusion in traumatically injured children receiving uncrossmatched whole blood with time to infusion in a historical cohort that received blood components.
- Published
- 2018
37. Dexmedetomidine as a Rapid Bolus for Treatment and Prophylactic Prevention of Emergence Agitation in Anesthetized Children
- Author
-
Slava V. Martyn, John A. Hauber, Laima P. Bendel, Peter J. Davis, Denise L. McCarthy, Michael C. Young, Jay B. Tuchman, Minh-Chau Evans, Neal F. Campbell, Franklyn P. Cladis, Robert Scott Lang, and Sarah Cunningham
- Subjects
Male ,endocrine system ,Time Factors ,Psychomotor agitation ,medicine.drug_class ,Analgesic ,Anesthesia, General ,Anxiolytic ,Food and drug administration ,Bolus (medicine) ,Double-Blind Method ,polycyclic compounds ,medicine ,Humans ,Hypnotics and Sedatives ,Prospective Studies ,Dexmedetomidine ,Child ,Psychomotor Agitation ,business.industry ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Anesthesia ,Sedative ,Child, Preschool ,Anesthesia Recovery Period ,Female ,Pre-Exposure Prophylaxis ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug ,Pediatric population ,Follow-Up Studies - Abstract
Administration of dexmedetomidine (DEX) in the pediatric population for its sedative, analgesic, and anxiolytic properties has been widely reported, despite there being no label indication approved by the U.S. Food and Drug Administration for pediatric patients. Infusions of DEX, rather than bolus administration, are recommended to attenuate the hemodynamic response caused by the α2-adrenoreceptor agonist. In this prospective, double-blind, randomized study, we examined the effect of rapid IV bolus injection of DEX on emergence agitation and the hemodynamic response in a large sample of children undergoing tonsillectomy with or without adenoidectomy, with or without myringotomy, and/or tympanostomy tube insertion.Four hundred patients, aged 4 to 10 years, undergoing tonsillectomy with or without adenoidectomy, with or without myringotomy, and/or tympanostomy tube insertion, were randomized at a 1:1 ratio into 1 of the 2 treatment groups in a double-blinded fashion. After a standardized anesthetic regimen and approximately 5 minutes before the end of surgery, patients in group DEX were administered a rapid IV bolus of 4 μg·mL DEX at a dose of 0.5 μg·kg, whereas patients in group saline received a rapid IV bolus of equivalent volume saline. Baseline measurements of heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, and blood oxygen saturation were collected immediately before study drug administration and every minute thereafter for 5 minutes. In the postanesthesia care unit, vital signs were measured, emergence agitation (EA) was assessed using the Pediatric Anesthesia Emergence Delirium scale, and postoperative opioid use and complications were recorded.The incidence of EA in group DEX was significantly lower than that in group saline, regardless of whether EA was defined as a Pediatric Anesthesia Emergence Delirium score10 (36% vs 66%, respectively; P0.0001; relative risk [95% confidence interval] = 0.527 [0.421-0.660]; number needed to treat = 3.33) or12 (30% vs 61%, respectively; P0.0001; relative risk [95% confidence interval] = 0.560 [0.458-0.684]; number needed to treat = 3.23). Both groups exhibited similar baseline vital signs before study drug injection (all P ≥ 0.602). After injection, group DEX experienced a significant decrease in heart rate for all time points in comparison with group saline (all P0.0001). A significant, biphasic blood pressure response was observed in group DEX, specifically, a transient increase in systolic blood pressure at 1 minute after injection (P0.0001) and a subsequent decrease below baseline for 3, 4, and 5 minutes (all P0.0001). No patients required treatment for bradycardia, hypertension, or hypotension. A significantly smaller percentage of patients in group DEX received postoperative, supplemental opioid medication compared with group saline (48% vs 73%, respectively; P0.0001). Group DEX appeared to experience fewer adverse events than group saline as well (9% vs 17%, respectively; P = 0.025).Rapid IV bolus administration of DEX in children improved their recovery profile by reducing the incidence of EA. A statistically significant change in hemodynamics was observed, but no patients required any intervention for hemodynamic changes. Furthermore, DEX reduced the incidence of postoperative opioid administration, and a trend of fewer adverse events was observed in group DEX.
- Published
- 2015
38. Development of Volunteer International Craniofacial Surgery Missions: The Komedyplast Protocol
- Author
-
Franklyn P. Cladis, Anand Kumar, Joseph E. Losee, Stephen B. Baker, Red Starks, Wieslawa De Pawlikowski, Alexander Y. Lin, John A. Duncan, Andres Wiegering Cecchi, Jeffrey Weinzweig, Cheryl K. Gooden, Peter J. Taub, and Robert M. Menard
- Subjects
Protocol (science) ,Volunteers ,business.industry ,education ,Dentistry ,Medical Missions ,General Medicine ,Safe delivery ,medicine.disease ,Craniofacial Abnormalities ,Otorhinolaryngology ,medicine ,Humans ,Organizational Objectives ,Surgery ,Medical emergency ,Craniofacial ,business ,Developing Countries ,health care economics and organizations ,Craniofacial surgery - Abstract
Volunteer surgical missions to provide cleft care to patients in developing countries has been done successfully for a number of years. Similar missions that provide craniofacial surgery introduce a dramatic step up in complexity. While articles have addressed protocols for the safe delivery of cleft care around the world, little has been written on volunteer craniofacial surgical missions. Komedyplast was established in March 2001 as a 501c(3) nonprofit organization to provide craniofacial surgical care to underserved populations and educate local surgeons in craniofacial principles. During 9 annual missions, the organization has provided surgical care to more than 150 patients with various complex, congenital, craniofacial conditions. The article addresses important safeguards that have been implemented to maximize safety and minimize risk.
- Published
- 2015
39. The Spinal Countdown
- Author
-
Franklyn P. Cladis and Audra M. Webber
- Subjects
Bupivacaine ,Bradycardia ,Sympathetic nervous system ,business.industry ,medicine.medical_treatment ,Neuraxial blockade ,Spinal anesthesia ,Atropine ,medicine.anatomical_structure ,Sympathectomy ,Anesthesia ,medicine ,medicine.symptom ,Propofol ,business ,medicine.drug - Abstract
This case discusses primary and secondary pharmacodynamic interactions between general anesthesia and spinal anesthesia resulting in hypotension and bradycardia.
- Published
- 2015
40. The Use of Ultra-Short-Acting Opioids in Paediatric Anaesthesia
- Author
-
Franklyn P. Cladis and Peter J. Davis
- Subjects
Vomiting ,medicine.drug_class ,Nausea ,Analgesic ,Remifentanil ,Blood Pressure ,Anesthesia, General ,Pharmacology ,Piperidines ,Pharmacokinetics ,Heart Rate ,Seizures ,medicine ,Humans ,Pharmacology (medical) ,Child ,Adverse effect ,business.industry ,Analgesics, Opioid ,Opioid ,Sedative ,Anesthesia ,medicine.symptom ,Respiratory Insufficiency ,business ,Anesthetics, Intravenous ,medicine.drug - Abstract
Remifentanil is a synthetic opioid that was developed in the early 1990s and introduced into clinical use in 1996. It is a methyl ester and is metabolised by nonspecific tissue and plasma esterases. Consequently, it is a drug that undergoes rapid elimination and has a reported terminal elimination half-life of between 10 and 35 minutes. Because there is no drug accumulation, the context-sensitive half-time remains constant; thus the pharmacokinetics of the drug do not change regardless of the duration of infusion. The organ-independent elimination of remifentanil, coupled with the fact that its clearance is greater in infants and neonates compared with older age groups, make its pharmacokinetic profile different from any other opioid. In addition, its unique metabolism confers predictability in its clinical use. Like other opioid mu receptor agonists, remifentanil provides dose-dependent analgesia, while the adverse effects of this drug, e.g. respiratory depression, are also thought to be dose related. The incidence of nausea and vomiting appear similar to other opioids. Its rapid and consistent metabolism regardless of duration of infusion has made remifentanil an attractive analgesic/anaesthetic option for paediatric care providers.
- Published
- 2005
41. Abstract PR241
- Author
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Paul A. Stricker, C. D. Glover, Susan M. Goobie, Henry Huang, and Franklyn P. Cladis
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Medicine ,business ,medicine.disease ,Surgery ,Craniosynostosis - Published
- 2016
42. Intraoperative High-Dose Epinephrine Infiltration in Cleft Palate Repair
- Author
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Lisa Vecchione, Joseph E. Losee, Franklyn P. Cladis, Christopher R. Kinsella, Shao Jiang, Matthew D Ford, Darren M. Smith, Gary E. DeCesare, Nelson Castillo, and Sanjay Naran
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,Adolescent ,Epinephrine ,medicine.drug_class ,medicine.medical_treatment ,Hemodynamics ,Electrocardiography ,medicine ,Humans ,Child ,Intraoperative Complications ,Retrospective Studies ,Dose-Response Relationship, Drug ,Local anesthetic ,business.industry ,Infant ,General Medicine ,United States ,Surgery ,Cleft Palate ,Blood pressure ,Palatoplasty ,Otorhinolaryngology ,Vasoconstriction ,Child, Preschool ,Anesthesia ,Anesthetic ,Female ,medicine.symptom ,business ,Anesthesia, Local ,medicine.drug - Abstract
OBJECTIVE Local infiltration of epinephrine before surgical procedures is a well-accepted technique to promote vasoconstriction. Typically, the dose of epinephrine is limited by the co-administration of local anesthetic as well as the risk for arrhythmogenesis and hemodynamic changes. In addition, some controversy exists regarding the acceptable dose of epinephrine given to children. This retrospective review examines the use and safety of "high-dose" epinephrine in palatoplasty at our cleft-craniofacial center. DESIGN A retrospective review of epinephrine use in primary palatoplasty at a tertiary children's hospital from 2003 to 2007 was performed. Operative and anesthetic records were reviewed for hypertension (systolic blood pressure, >120 or diastolic blood pressure, >70) and tachycardia (>190 beats per min) as defined by the American Heart Association guidelines, as well as dysrhythmias, intraoperative complications, and postoperative complications. RESULTS A total of 102 patients who underwent consecutive primary palatoplasties performed by a single surgeon were identified. After the induction of anesthesia and before incision, the patients received an initial epinephrine infiltration (without local anesthetic) up to a maximum 10 μg/kg. The average total dose of epinephrine administered during palatoplasty was 12.8 μg/kg (range, 3.2-75.0 μg/kg). Doses up to a maximum of 10 μg/kg were administered as needed at 30-minute intervals. No instances of clinically unstable tachycardia or hypertension occurred. A total of 21.6% of the patients (22/102) experienced an instance of hypertension, and only 13.7% of these (14/102) were related to epinephrine administration. One (1%) postoperative fistula was identified. CONCLUSIONS Locally infiltrated high-dose epinephrine during palatoplasty can be safely used as a means of vasoconstriction. Doses reaching a maximum of 10 μg/kg, administered as needed at 30-minute intervals, do not seem to be a significant risk for hemodynamic instability, intraoperative complications, or postoperative complications.
- Published
- 2014
43. Children who are shot: A 30-year experience
- Author
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William M. Stahl, Joy D. Howell, David Friedman, Rao R. Ivatury, Maureen S. Durkin, Barbara Barlow, Danielle Laraque, Carla DiScala, and Franklyn P. Cladis
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Male ,medicine.medical_specialty ,Adolescent ,Student Dropouts ,Population ,Poison control ,Community Networks ,Suicide prevention ,Occupational safety and health ,Life Change Events ,Case fatality rate ,Injury prevention ,medicine ,Humans ,Family ,Registries ,Child ,education ,education.field_of_study ,Illicit Drugs ,business.industry ,Incidence ,Infant ,General Medicine ,medicine.disease ,United States ,humanities ,Death ,Brain Injuries ,Case-Control Studies ,Child, Preschool ,Population Surveillance ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Drug and Narcotic Control ,Female ,New York City ,Wounds, Gunshot ,Surgery ,Crime ,Medical emergency ,Gunshot wound ,business ,Pediatric trauma - Abstract
Three data sets describe the pattern of gunshot injuries to children from 1960 to 1993: The Harlem Hospital pediatric trauma registry (HHPTR), the northern Manhattan injury surveillance system (NMISS) a population-based study, and the National Pediatric Trauma Registry (NPTR). A small case-control study compares the characteristics of injured children with a control group. Before 1970 gunshot injuries to Harlem children were rare. In 1971 an initial rise in pediatric gunshot admissions occurred, and by 1988 pediatric gunshot injuries at Harlem Hospital had peaked at 33. Population-based data through NMISS showed that the gunshot rate for Central Harlem children 10 to 16 years of age rose from 64.6 per 100,000 in 1986 to 267.6 per 100,000 in 1987, a 400% increase. The case fatality for children admitted to Harlem Hospital (1960 to 1993) was 3%, usually because of brain injury, but the majority of deaths occurred before hospitalization. During the same period, felony drug arrests in Harlem increased by 163%. The neighboring South Bronx experienced the same increase in gunshot wound admissions and felony arrests from 1986 to 1993. The NPTR showed a similar injury pattern for other communities in the United States. In a case-control analysis, Harlem adolescents who had sustained gunshot wounds were more likely to have dropped out of school, to have lived in a household without a biological parent, to have experienced parental death, and to have known of a relative or friend who had been shot than community adolescents treated for other medical or surgical problems. Since 1990, the Harlem Injury Prevention Program formed a coalition of school and community organizations joined by the District Attorney's Office in collaboration with the Tactical Narcotic Team (to eliminate drug selling from the schools and playgrounds), to provide safe, supervised activities for children. Data from 1990 to 1992 show a moderate decline in the incidence of gunshot wounds to children. Gun control legislation in conjunction with the community violence prevention activities are needed to curb the epidemic of gunshot injuries.
- Published
- 1995
44. Smith's Anesthesia for Infants and Children : Expert Consult Premium
- Author
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Peter J. Davis, Franklyn P. Cladis, Etsuro K. Motoyama, Peter J. Davis, Franklyn P. Cladis, and Etsuro K. Motoyama
- Subjects
- Children, Infants, Pediatric anesthesia, Anesthesia
- Abstract
Smith's Anesthesia for Infants and Children, 8th Edition, edited by Drs. Peter J. Davis, Franklyn P. Cladis, and Etsuro K. Motoyama, delivers all the state-of-the-art guidance you need to provide optimal perioperative care for any type of pediatric surgery. Now in full color throughout, it also features online access to an image and video library, including ultrasound-guided pediatric regional blocks, review-style questions, plus the complete fully-searchable text at expertconsult.com. Get expert guidance from leading experts covering both basic science and clinical practice for every aspect of pediatric anesthesia. Incorporate the latest clinical guidelines and innovations in your practice. Find key facts fast with quick-reference appendices: drug dosages, growth curves, normal values for pulmonary function tests, and a listing of common and uncommon syndromes. Access the complete contents and illustrations online at expertconsult.com - fully searchable! Watch online video demonstrations of ultrasound-guided and conventional pediatric regional blocks, airway management, cardiac anesthesia, single-lung ventilation, neonatal surgery, and fetal surgery. Gain new insight into today's hottest topics, including sleep-disordered breathing, cuffed endotracheal tubes, premedication, emergence agitation, postoperative vomiting, and new airway devices. Stay current with new chapters on ICU management, conjoined twins, and basic neonatal physiology, plus new coverage of pharmacology and monitoring techniques. Get outstanding visual guidance with full-color illustrations throughout the book.
- Published
- 2011
45. Safety of preoperative erythropoietin in surgical calvarial remodeling: an 8-year retrospective review and analysis
- Author
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Ian F. Pollack, James P. Bradley, Franklyn P. Cladis, James J. Cray, Lorelei J. Grunwaldt, Hurig V. Katchikian, Joseph E. Losee, Gregory F. Cooper, Jeffrey A. Fearon, Sanjay Naran, and Brett F Michelotti
- Subjects
Male ,medicine.medical_specialty ,Deep vein ,Blood Loss, Surgical ,Sagittal Sinus Thrombosis ,Postoperative Complications ,Preoperative Care ,Medicine ,Humans ,Orthopedic Procedures ,Erythropoietin ,Retrospective Studies ,business.industry ,Skull ,Infant ,Retrospective cohort study ,Thrombosis ,Perioperative ,medicine.disease ,Pulmonary embolism ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Synostosis ,Hematinics ,Female ,business ,Complication ,medicine.drug - Abstract
Background Calvarial remodeling is typically associated with significant blood loss. Although preoperative erythropoiesis-stimulating agents have proven to significantly decrease the need for blood transfusions, recent data in adults have raised concerns that elevating hemoglobin levels greater than 12.5 g/dl may increase the risk of thrombotic events. This study was designed to assess the risks of erythropoietin in the pediatric population. Methods Records were retrospectively reviewed from 2000 to 2008 at three major metropolitan children's hospitals of all children undergoing calvarial remodeling after receiving preoperative erythropoietin. Demographic and perioperative outcome data were reviewed, including transfusion reactions, pressure ulcer secondary to prolonged positioning, pneumonia, infection, deep vein thrombosis, cerebrovascular accident, pulmonary embolism, sagittal sinus thrombosis, pure red cell aplasia, and myocardial infarction. Results A total of 369 patients met the inclusion criteria (mean age, 0.86±1.1 years). On average, three preoperative doses of erythropoietin were administered (600 U/kg). Iron was also supplemented. No complications associated with dosing were noted, there were no thrombotic events identified, and no other major complications were seen (i.e., death or blindness). Thirty-one patients (8.40 percent) experienced one or more postoperative complications. There was no significant correlation between hemoglobin levels greater than 12.5 g/dl and the occurrence of any noted complication. Conclusions With zero thrombotic postoperative complications, the authors estimate the risk of a thrombotic event in the pediatric population to be less than 0.81 percent (95 percent confidence). These data suggest that preoperative administration of erythropoietin in children undergoing calvarial remodeling does not appear to increase the incidence of thrombotic events or other significant complications. Clinical question/level of evidence Therapeutic, IV.
- Published
- 2012
46. Postoperative analgesia via transversus abdominis plane (TAP) catheter for small weight children-our initial experience
- Author
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Mihaela, Visoiu, Karen R, Boretsky, Gagandeep, Goyal, Franklyn P, Cladis, and Antonio, Cassara
- Subjects
Male ,Pain, Postoperative ,Catheters ,Morphine ,Abdominal Wall ,Body Weight ,Infant ,Nerve Block ,Amides ,Catheterization ,Analgesics, Opioid ,Anesthesia, Conduction ,Humans ,Pain Management ,Female ,Ropivacaine ,Anesthetics, Local ,Retrospective Studies - Abstract
Pain management in small infants and children is challenging. We report the use of unilateral transversus abdominis plane (TAP) catheters for analgesia following single-sided open lower abdominal surgery when epidural analgesia was undesirable in a series of six low-weight children. Data collection was done via a retrospective chart review. All catheters attempted were successfully placed with resultant low pain scores and the minimal use of rescue analgesic medications. No complications were reported related to these catheters. TAP catheters, although technically challenging, are feasible for the provision of analgesia for surgeries involving the lower abdominal wall in very small patients.
- Published
- 2012
47. Perioperative management of children undergoing craniofacial reconstruction surgery: a practice survey
- Author
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Paul A, Stricker, Franklyn P, Cladis, John E, Fiadjoe, John J, McCloskey, and Lynne G, Maxwell
- Subjects
Central Venous Pressure ,Operative Blood Salvage ,Blood Loss, Surgical ,Blood Component Transfusion ,Endoscopy ,Plastic Surgery Procedures ,Antifibrinolytic Agents ,Perioperative Care ,Craniofacial Abnormalities ,Blood Transfusion, Autologous ,Health Care Surveys ,Monitoring, Intraoperative ,Embolism, Air ,Humans ,Child ,Erythropoietin ,Craniotomy - Abstract
To assess current practices in the management of children undergoing craniofacial surgery and identify areas of significant practice variability with the intent to direct future research. The perioperative management of infants and children undergoing craniofacial reconstruction surgery can be challenging because of the routine occurrence of significant blood loss with associated morbidity. A variety of techniques have been described to improve the care for these children. It is presently unknown to what extent these practices are currently employed. A web-based survey was sent to representatives from 102 institutions. One individual per institution was surveyed to prevent larger institutions from being over-represented in the results. Requests to complete the survey were sent to 102 institutions; 48 surveys were completed. The survey was composed of two parts: management of infants undergoing strip craniectomies, and management of children undergoing major craniofacial reconstruction. Significant variability exists in the management of children undergoing these procedures; further study is required to determine the optimal management strategies. Clinical trials assessing the utility of central venous pressure and other hemodynamic monitoring modalities would enable evidence-based decision-making for monitoring in these children. The development of institutional transfusion thresholds should be encouraged, as there exists a body of evidence supporting their efficacy and safety.
- Published
- 2011
48. Contributors
- Author
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Ann G. Bailey, Vipin Bansal, David Barinholtz, Victor C. Baum, David S. Beebe, Kumar G. Belani, Richard Berkowitz, Bruno Bissonnette, Adrian Bosenberg, Barbara W. Brandom, Claire Brett, Robert B. Bryskin, Patrick Callahan, Franklyn P. Cladis, David E. Cohen, Ira Todd Cohen, Andrew Davidson, Jessica Davis, Peter J. Davis, Duncan de Souza, Nina Deutsch, James A. DiNardo, Peter Ehrlich, Demetrius Ellis, Jeffrey M. Feldman, Kathryn Felmet, John E. Fiadjoe, Jonathan D. Finder, Randall P. Flick, Michelle Fortier, Salvatore R. Goodwin, George A. Gregory, Lorelei Grunwaldt, Dawit T. Haile, Steven Hall, Gregory Hammer, Michael W. Hauser, Eugenie S. Heitmiller, Andrew Herlich, Robert S. Holzman, Elizabeth A. Hunt, Nathalia Jimenez, Lori T. Justice, Zeev N. Kain, Evan Kharasch, Sabine Kost-Byerly, Elliot J. Krane, Barry D. Kussman, Ira S. Landsman, Ronald S. Litman, Joseph Losee, Igor Luginbuehl, Anne M. Lynn, Thomas J. Mancuso, Brian P. Martin, Keira Mason, William J. Mauermann, Lynne G. Maxwell, George M. McDaniel, Francis X. McGowan, Constance L. Monitto, Philip G. Morgan, Etsuro K. Motoyama, Julie Niezgoda, David M. Polaner, Paul Reynolds, Mark A. Rockoff, Thomas Romanelli, Allison Kinder Ross, Joseph A. Scattoloni, Jamie McElrath Schwartz, Robert J. Sclabassi, Victor L. Scott, Donald H. Shaffner, Avinash C. Shukla, Robert M. Smith, Kyle Soltys, Sulpicio G. Soriano, Brian P. Struyk, Kevin J. Sullivan, Jennifer Thomas, Stevan P. Tofovic, Kha Tran, Donald C. Tyler, Robert D. Valley, Monica S. Vavilala, Lisa Vecchione, Kerri M. Wahl, Jay A. Werkhaven, Susan Woelfel, Myron Yaster, Aaron L. Zuckerberg, Cuneyt M. Alper, Lawrence M. Borland, James G. Cain, William A. Devine, Joseph E. Dohar, Christopher M. Grande, Timothy D. Kane, Lizabeth M. Lanford, George V. Mazariegos, Douglas A. Potoka, Kenneth P. Rothfield, and Robert F. Yellon
- Published
- 2011
49. Index of Syndromes and Their Pediatric Anesthetic Implications
- Author
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Franklyn P. Cladis
- Subjects
Index (economics) ,medicine.anatomical_structure ,business.industry ,Anesthesia ,Anesthetic ,Medicine ,business ,Appendix ,medicine.drug - Published
- 2011
50. Anesthesia for the Pediatric Trauma Patient
- Author
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Franklyn P. Cladis, Joseph A. Scattoloni, Peter F. Ehrlich, Paul I. Reynolds, and Peter J. Davis
- Subjects
business.industry ,Anesthesia ,Medicine ,business ,medicine.disease ,Pediatric trauma - Published
- 2011
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