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1. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time.

Author

Stein, Mary, Sarmiento Argüello, Lina, Staffa, Steven, Heunis, Julia, Egbuta, Chinyere, Flynn, Stephen, Khan, Sabina, Sabato, Stefano, Taicher, Brad, Chiao, Franklin, Bosenberg, Adrian, Lee, Angela, Adams, H, von Ungern-Sternberg, Britta, Park, Raymond, Peyton, James, Olomu, Patrick, Hunyady, Agnes, Garcia-Marcinkiewicz, Annery, Fiadjoe, John, and Kovatsis, Pete

Subjects
Complications, Difficult airway, Intubation, Outcomes, Paediatric airway, Video laryngoscopy
Abstract

BACKGROUND: The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications. METHODS: Paediatric patients less than 18 years of age with difficult direct laryngoscopy were enrolled in the Paediatric Difficult Intubation Registry. We define patients with difficult direct laryngoscopy as those in whom (1) an attending or consultant obtained a Cormack Lehane Grade 3 or 4 view on direct laryngoscopy, (2) limited mouth opening makes direct laryngoscopy impossible, (3) direct laryngoscopy failed in the preceding 6 months, and (4) direct laryngoscopy was deferred due to perceived risk of harm or poor chance of success. We used a 5:1 propensity score match to compare an early cohort from the initial Paediatric Difficult Intubation Registry analysis (August 6, 2012-January 31, 2015, 785 patients, 13 centres) and a current cohort from the Registry (March 4, 2017-March 31, 2023, 3925 patients, 43 centres). The primary outcome was first attempt success rate between cohorts. Success was defined as confirmed endotracheal intubation and assessed by the treating clinician. Secondary outcomes were eventual success rate, number of attempts at intubation, number of attempts with direct laryngoscopy, the incidence of persistence with direct laryngoscopy, use of supplemental oxygen, all complications, and severe complications. FINDINGS: First-attempt success rate was higher in the current cohort (42% vs 32%, OR 1.5 95% CI 1.3-1.8, p

Published
2024

2. Patient and Process Outcomes among Pediatric Patients Undergoing Appendectomy during the COVID-19 Pandemic: An International Retrospective Cohort Study

Author

Matava, Clyde T, Tighe, Nathaniel TG, Baertschiger, Reto, Wilder, Robert T, Correll, Lynnie, Staffa, Steven J, Zurakowski, David, Kato, Meredith A, Meier, Petra M, Raman, Vidya, Reddy, Srijaya K, Roque, Remigio A, Peterson, Melissa Brooks, Zhong, John, Edala, Thejovathi, Greer, Timothy J, von Ungern-Sternberg, Britta S, Cravero, Joseph, Simpao, Allan F, Ali, Anita Akbar, Al-Rabbat, Mohamad F, Brzenski, Alyssa B, Casey, William F, Chhabada, Surendrasingh, Collin, Michael, Dhumak, Vipul J, D’Mello, Ajay, Echeverry, Piedad C, Ellison, Pavithra R, Fernandez, Allison M, Fisher, Jake A, Fuller, Clinton L, Glover, Chris D, Guruswamy, Velu, Hesselink, Emily B, Hunyady, Agnes I, Lorinc, Amanda N, King, Michael, Mihaila, Lavinia, Nelson, Jonathon H, Ng, Ann S, Ramjist, Joshua K, Ravula, Nirop R, Beel, Elizabeth Rossmann, Rugnathx, Rahil, Shaw, Robert E, Sheth, Michelle M, Sinha, Tripiti, Sommerfield, Aine, Soneru, Codruta, Templeton, Thomas W, and Williams, RJ

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Pediatric, Patient Safety, Prevention, Good Health and Well Being, Humans, Child, COVID-19, Retrospective Studies, Pandemics, Appendicitis, Appendectomy, COVID-19 Testing, Postoperative Complications, SARS-CoV-2, Length of Stay, PEACOC Collaborators, Anesthesiology, Clinical sciences
Abstract

BackgroundCOVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. The authors hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy.MethodsA retrospective, international, multicenter study was conducted using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients younger than 18 yr old were matched using age, American Society of Anesthesiologists Physical Status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April to May 2020) compared with prepandemic (April to May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis.ResultsA total of 3,351 cases from 28 institutions were available with 1,684 cases in the prepandemic cohort matched to 1,618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 h (interquartile range: 18 to 79) in the pandemic cohort versus 28 h (interquartile range: 18 to 67) in the prepandemic cohort (adjusted coefficient, 1 [95% CI, 0.39 to 1.61]; P < 0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period than in the prepandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, prepandemic 313 (18.6%) versus pandemic 389 (24.1%), an absolute difference of 5.5% (adjusted odds ratio, 1.32 [95% CI, 1.1 to 1.59]; P = 0.003). Preoperative SARS-CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 min (interquartile range: 430 to 1,112) with testing versus 414 min (interquartile range: 231 to 770) without testing, adjusted coefficient, 306 min (95% CI, 241 to 371; P < 0.001), and longer hospital length of stay, 31 h (interquartile range: 20 to 83) with testing versus 24 h (interquartile range: 14 to 68) without testing, adjusted coefficient, 7.0 (95% CI, 2.7 to 11.3; P = 0.002).ConclusionsFor children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.Editor’s perspective

Published
2023

3. Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry

Author

Garcia-Marcinkiewicz, Annery G, Lee, Lisa K, Haydar, Bishr, Fiadjoe, John E, Matava, Clyde T, Kovatsis, Pete G, Peyton, James, Stein, Mary L, Park, Raymond, Taicher, Brad M, Templeton, Thomas W, Collaborative, on behalf of the PeDI, Bruins, Benjamin B, Stricker, Paul, Laverriere, Elizabeth K, Lockman, Justin L, Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo J Daly, Sequera-Ramos, Luis, Teen, Mark S, Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E, Olomu, Patrick N, Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, Nykiel-Bailey, Sydney, Starker, Elizabeth, Szolnoki, Judit, Brooks-Peterson, Melissa, Bhattacharya, Somaletha, Burjek, Nicholas E, Jagannathan, Narasimhan, Lardner, David, Watkins, Scott, Crockett, Christy, Moore, John, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Marin, Piedad Echeverry, Pérez-Pradilla, Carolina, Singh, Neeta, von Ungern-Sternberg, Britta S, Sommerfield, David, Bilen-Rosas, Guelay, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Perez, N Ricardo Riveros, de Graaff, Jurgen C, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lord, Charles, Lee, Angela, Heitmiller, Eugenie, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, and Shaik, Sadiq

Subjects
Rare Diseases, Lung, Assistive Technology, Bioengineering, Infant, Humans, Child, Masks, Intubation, Intratracheal, Retrospective Studies, Respiration, Laryngeal Masks, Airway Management, complications, difficult airway, difficult facemask ventilation, impossible facemask ventilation, paediatrics, supraglottic airway, PeDI Collaborative, Clinical Sciences, Anesthesiology
Abstract

BackgroundDifficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation.MethodsWe queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed.ResultsThe incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening.ConclusionsCertain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.

Published
2023

4. Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI)

Author

Longacre, Mckenna, Park, Raymond S., Staffa, Steven J., Rowland, Matthew J., Meserve, Jonathan, Lord, Charles, Templeton, T. Wesley, Garcia-Marcinkiewicz, Annery G., Peyton, James M., Fiadjoe, John E., Kovatsis, Pete G., Stein, Mary Lyn, Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo J. Daly, Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Battles, Rhae, Bocanegra, Ashley D., Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Khan, Sabina A., Matuszczak, Maria, Hunyady, Agnes, Holmes, Christopher, McCann, Alexander, Sabato, Stefano, Matava, Clyde, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Desai, Sapna, Tennessee, Nashville, Rosander, Sondra, Samba, Sindhu, Schrock, Charles, Nykiel-Bailey, Sydney, Marsh, Jennifer, Brooks Peterson, Melissa, Johnson Lee, Amy Colleen, Bhattacharya, Somaletha, Burjek, Nicholas E., Jagannathan, Narasimhan, Lardner, David, Crockett, Christy, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Echeverry Marin, Piedad, Pérez-Pradilla, Carolina, Singh, Neeta, Taicher, Brad, von Ungern-Sternberg, Britta S., Sommerfield, David, Hauser, Neil, Hesselink, Emily, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, Leite, Fernanda, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lee, Angela, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Anspach, Taylor, Lee, Lisa K., Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Szolnoki, Judit, Mathew, Preethy J., Yaddanapudi, Sandhya, Sen, Indu, Gupta, Aakriti, Handlogten, Kathryn, Sroka, J. Michael, Caldeira Quintao, Vinicius, and Vieira Carlos, Ricardo

Published
2024
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6. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time

Author

Bruins, Benjamin, Stricker, Paul, Laverriere, Elizabeth, Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo Daly, Sequera-Ramos, Luis, Teen, Mark, Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Battles, Rhae, Bocanegra, Ashley, Goldfarb, Tally, Kiss, Edgar, Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Holmes, Christopher, McCann, Alexander, Matava, Clyde, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Desai, Sapna, Rosander, Sondra, Samba, Sindhu, Schrock, Charles, Nykiel-Bailey, Sydney, Marsh, Jennifer, Peterson, Melissa Brooks, Lee, Amy, Bhattacharya, Somaletha, Burjek, Nicholas, Jagannathan, Narasimhan, Lardner, David, Crockett, Christy, Robetson, Sara, Patel, Jasmine, Sharma, Aarti, Templeton, Thomas, Marín, Piedad Echeverry, Pérez-Pradilla, Carolina, Singh, Neeta, Sommerfield, David, Hauser, Neil, Hesselink, Emily, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Meserve, Jonathan, Lord, Charles, Lee, Angela, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Anspach, Taylor, Lee, Lisa K., Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Szolnoki, Judit, Mathew, Preethy, Yaddanapudi, Sandhya, Sen, Indu, Gupta, Aakriti, Handlogten, Kathryn, Sroka, J. Michael, Quintão, Vinícius Caldeira, Carlos, Ricardo Vieira, Leite, Fernanda, Stein, Mary Lyn, Sarmiento Argüello, Lina Andrea, Staffa, Steven J., Heunis, Julia, Egbuta, Chinyere, Flynn, Stephen G., Khan, Sabina A., Sabato, Stefano, Taicher, Brad M., Chiao, Franklin, Bosenberg, Adrian, Lee, Angela C., Adams, H. Daniel, von Ungern-Sternberg, Britta S., Park, Raymond S., Peyton, James M., Olomu, Patrick N., Hunyady, Agnes I., Garcia-Marcinkiewicz, Annery, Fiadjoe, John E., and Kovatsis, Pete G.

Published
2024
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7. A survey of the global impact of COVID‐19 on the practice of pediatric anesthesia: A study from the pediatric anesthesia COVID‐19 Collaborative Group

Author

Soneru, Codruta N, Fernandez, Allison M, Bradford, Victoria, Staffa, Steven J, Raman, Vidya T, Cravero, Joseph, Zurakowski, David, Meier, Petra M, Balakrishnan, Sindu, Bansal, Vipin, Torres, Angela Becerra, Beethe, Amy, Benzon, Hubert A, Bhandari, Angelina, Bocanegra, Ashley, Bould, Dylan, Peterson, Melissa Brooks, Brzenski, Alyssa, Busso, Veronica, Cain, James G, Cassidy, Myles, Cheon, Eric C, Chhabada, Surendrasingh, Correll, Lynnie R, Dalesio, Nicholas M, Davidson, Andrew, Derderian, Courtney, Dhumak, Vipul, Disma, Nicola, D'Mello, Ajay, Echeverry, Piedad, Ellison, Pavithra R, Erb, Thomas, Fajardo, Angelica, Falcon, Ricardo J, Frugoni, Brian, García, Javier, Giraldo, Olga Lucía, Glover, Chris D, Goeller, Jessica, Goobie, Susan M, Gooch, Ingrid, Granados, Lina Maria, Grivoyannis, Anastasia, Guruswamy, Velu, Hesselink, Emily, Hobbs, Jill, Hunyady, Agnes, Jain, Ranu, Jorge‐Reynolds, Lydia, Kato, Meredith A, King, Michael R, Kitzman, Jamie, Koh, Jeffrey, Lester, Andy, Lorinc, Amanda, Lozano, Constanza, Manupipatpong, Katherine, Matava, Clyde, McLuckie, Duncan, Merchant, Kanwal, Levy, Heather Mitzel, Muldowney, Bridget L, Navarro, Julian Andres, Nelson, Jonathon, Patel, Amish, Patel, Roshan, Ravula, Niroop, Reddy, Desigen, Reddy, Srijaya K, McCormick, Megan Rodgers, Roque, Remigio, Rosen, David, Beel, Elizabeth Rossmann, Rothschild, Leelach, Sarmiento, Lina, Shadrina, Anna, Shaw, Robert, Sheth, Michelle, Simpao, Allan F, Singh, Neeta, Smith, Timothy E, Soria, Claire, Szmuk, Peter, Taicher, Brad M, Tan, Gee Mei, Teng, Howard, Edala, Thejovathi, Tighe, Nathaniel, Tom, Simon, Trujillo, Alexander, Vishneski, Susan R, Vivas, Juan Pablo, Von Samek, Adam, von Ungern‐Sternberg, Britta S, Whyte, Simon, and Wilder, Robert T

Subjects
Clinical Research, Patient Safety, Pediatric, Generic health relevance, Good Health and Well Being, Anesthesia, Anesthesiologists, Anesthesiology, COVID-19, COVID-19 Testing, Child, Humans, Pandemics, Pediatricians, Pediatrics, Personal Protective Equipment, Practice Guidelines as Topic, Practice Patterns, Physicians', SARS-CoV-2, Societies, Medical, Surveys and Questionnaires, United States, hospital economics, pediatric anesthesia, personal protective equipment, preoperative testing, simulation, Pediatric Anesthesia COVID-19 Collaborative, Paediatrics and Reproductive Medicine
Abstract

BackgroundPediatric anesthesiology has been greatly impacted by COVID-19 in the delivery of care to patients and to the individual providers. With this study, we sought to survey pediatric centers and highlight the variations in care related to perioperative medicine during the COVID-19 pandemic, including the availability of protective equipment, the practice of pediatric anesthesia, and economic impact.AimThe aim of the survey was to determine how COVID-19 directly impacted pediatric anesthesia practices during the study period.MethodsA survey concerning four major domains (testing, safety, clinical management/policy, economics) was developed. It was pilot tested for clarity and content by members of the Pediatric Anesthesia COVID-19 Collaborative. The survey was administered by email to all Pediatric Anesthesia COVID-19 Collaborative members on September 1, 2020. Respondents had six weeks to complete the survey and were instructed to answer the questions based on their institution's practice during September 1 - October 13, 2020.ResultsSixty-three institutions (100% response rate) participated in the COVID-19 Pediatric Anesthesia Survey. Forty-one hospitals (65%) were from the United States, and 35% included other countries. N95 masks were available to anesthesia teams at 91% of institutions (n = 57) (95% CI: 80%-96%). COVID-19 testing criteria of anesthesia staff and guidelines to return to work varied by institution. Structured simulation training aimed at improving COVID-19 safety and patient care occurred at 62% of institutions (n = 39). Pediatric anesthesiologists were economically affected by a reduction in their employer benefits and restriction of travel due to employer imposed quarantine regulations.ConclusionOur data indicate that the COVID-19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice. Further investigation into the long-term consequences for the specialty is indicated.

Published
2021

8. Pediatric Airway Management in Coronavirus Disease 2019 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia’s Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society

Author

Matava, Clyde T, Kovatsis, Pete G, Lee, Jennifer K, Castro, Pilar, Denning, Simon, Yu, Julie, Park, Raymond, Lockman, Justin L, Von Ungern-Sternberg, Britta, Sabato, Stefano, Lee, Lisa K, Ayad, Ihab, Mireles, Sam, Lardner, David, Whyte, Simon, Szolnoki, Judit, Jagannathan, Narasimhan, Thompson, Nicole, Stein, Mary Lyn, Dalesio, Nicholas, Greenberg, Robert, McCloskey, John, Peyton, James, Evans, Faye, Haydar, Bishr, Reynolds, Paul, Chiao, Franklin, Taicher, Brad, Templeton, Thomas, Bhalla, Tarun, Raman, Vidya T, Garcia-Marcinkiewicz, Annery, Gálvez, Jorge, Tan, Jonathan, Rehman, Mohamed, Crockett, Christy, Olomu, Patrick, Szmuk, Peter, Glover, Chris, Matuszczak, Maria, Galvez, Ignacio, Hunyady, Agnes, Polaner, David, Gooden, Cheryl, Hsu, Grace, Gumaney, Harshad, Pérez-Pradilla, Caroline, Kiss, Edgar E, Theroux, Mary C, Lau, Jennifer, Asaf, Saeedah, Ingelmo, Pablo, Engelhardt, Thomas, Hervías, Mónica, Greenwood, Eric, Javia, Luv, Disma, Nicola, Yaster, Myron, and Fiadjoe, John E

Subjects
Patient Safety, Lung, Pediatric, Clinical Research, Good Health and Well Being, Adolescent, Airway Management, Anesthesia, Anesthesiology, COVID-19, Child, Child, Preschool, Consensus, Coronavirus Infections, Guidelines as Topic, Humans, Infant, Infant, Newborn, Infection Control, Infectious Disease Transmission, Patient-to-Professional, Intubation, Intratracheal, Pandemics, Pediatrics, Pneumonia, Viral, PeDI-Collaborative, Clinical Sciences, Neurosciences
Abstract

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.

Published
2020

9. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society.

Author

Matava, Clyde T, Kovatsis, Pete G, Lee, Jennifer K, Castro, Pilar, Denning, Simon, Yu, Julie, Park, Raymond, Lockman, Justin L, Von Ungern-Sternberg, Britta, Sabato, Stefano, Lee, Lisa K, Ayad, Ihab, Mireles, Sam, Lardner, David, Whyte, Simon, Szolnoki, Judit, Jagannathan, Narasimhan, Thompson, Nicole, Stein, Mary Lyn, Dalesio, Nicholas, Greenberg, Robert, McCloskey, John, Peyton, James, Evans, Faye, Haydar, Bishr, Reynolds, Paul, Chiao, Franklin, Taicher, Brad, Templeton, Thomas, Bhalla, Tarun, Raman, Vidya T, Garcia-Marcinkiewicz, Annery, Gálvez, Jorge, Tan, Jonathan, Rehman, Mohamed, Crockett, Christy, Olomu, Patrick, Szmuk, Peter, Glover, Chris, Matuszczak, Maria, Galvez, Ignacio, Hunyady, Agnes, Polaner, David, Gooden, Cheryl, Hsu, Grace, Gumaney, Harshad, Pérez-Pradilla, Caroline, Kiss, Edgar E, Theroux, Mary C, Lau, Jennifer, Asaf, Saeedah, Ingelmo, Pablo, Engelhardt, Thomas, Hervías, Mónica, Greenwood, Eric, Javia, Luv, Disma, Nicola, Yaster, Myron, Fiadjoe, John E, and PeDI-Collaborative

Subjects
PeDI-Collaborative, Humans, Pneumonia, Viral, Coronavirus Infections, Anesthesia, Intubation, Intratracheal, Consensus, Anesthesiology, Pediatrics, Infection Control, Adolescent, Child, Child, Preschool, Infant, Infant, Newborn, Guidelines as Topic, Infectious Disease Transmission, Patient-to-Professional, Airway Management, Pandemics, Pneumonia, Viral, Intubation, Intratracheal, Preschool, Newborn, Infectious Disease Transmission, Patient-to-Professional, Clinical Sciences, Neurosciences
Abstract

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.

Published
2020

10. Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry

Author

Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Daly Guris, Rodrigo J., Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, Nykiel-Bailey, Sydney, Starker, Elizabeth, Szolnoki, Judit, Brooks-Peterson, Melissa, Bhattacharya, Somaletha, Burjek, Nicholas E., Jagannathan, Narasimhan, Lardner, David, Watkins, Scott, Crockett, Christy, Moore, John, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Echeverry Marin, Piedad, Pérez-Pradilla, Carolina, Singh, Neeta, von Ungern-Sternberg, Britta S., Sommerfield, David, Bilen-Rosas, Guelay, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, de Graaff, Jurgen C., Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lord, Charles (Ted), Lee, Angela, Heitmiller, Eugenie, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Garcia-Marcinkiewicz, Annery G., Lee, Lisa K., Haydar, Bishr, Fiadjoe, John E., Matava, Clyde T., Kovatsis, Pete G., Peyton, James, Stein, Mary L., Park, Raymond, Taicher, Brad M., and Templeton, Thomas W.

Published
2023
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11. Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI)

Author

Longacre, Mckenna, Park, Raymond S., Staffa, Steven J., Rowland, Matthew J., Meserve, Jonathan, Lord, Charles, Templeton, T. Wesley, Garcia-Marcinkiewicz, Annery G., Peyton, James M., Fiadjoe, John E., Kovatsis, Pete G., Stein, Mary Lyn, Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo J. Daly, Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Battles, Rhae, Bocanegra, Ashley D., Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Khan, Sabina A., Matuszczak, Maria, Hunyady, Agnes, Holmes, Christopher, McCann, Alexander, Sabato, Stefano, Matava, Clyde, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Desai, Sapna, Tennessee, Nashville, Rosander, Sondra, Samba, Sindhu, Schrock, Charles, Nykiel-Bailey, Sydney, Marsh, Jennifer, Brooks Peterson, Melissa, Johnson Lee, Amy Colleen, Bhattacharya, Somaletha, Burjek, Nicholas E., Jagannathan, Narasimhan, Lardner, David, Crockett, Christy, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Echeverry Marin, Piedad, Pérez-Pradilla, Carolina, Singh, Neeta, Taicher, Brad, von Ungern-Sternberg, Britta S., Sommerfield, David, Hauser, Neil, Hesselink, Emily, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, Leite, Fernanda, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lee, Angela, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Anspach, Taylor, Lee, Lisa K., Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Szolnoki, Judit, Mathew, Preethy J., Yaddanapudi, Sandhya, Sen, Indu, Gupta, Aakriti, Handlogten, Kathryn, Sroka, J. Michael, Caldeira Quintao, Vinicius, and Vieira Carlos, Ricardo

Published
2025
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12. A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Author

Sommerfield, David, Holmes, Chris, Ravula, Niroop, Jette, Christine, Mireles, Sam, Matava, Clyde, Whyte, Simon, Vega, Eduardo, Yang, Lei, Echeverry-Marin, Piedad, Perez-Pradilla, Carolina, Starker, Elizabeth, Zieg, Jennifer, Szolnoki, Judit, Lee, Angela, Heitmiller, Eugenie, Rehman, Mohamed, Zamora, Lillian, Fernandez, Allison, Meserve, Jonathan, Bhattacharya, Solmaletha, Reynolds, Paul, Lewis, Ian, Haydar, Bishr, Therrian, Megan, Sarmiento, Linare, Richtsfeld, Martina, Belani, Kumar, Robertson, Sara, Sathyamoorthy, Kumar, Schrock, Charles, de Graaff, Jurgen, Soneru, Codruta, Singh, Neeta, Taicher, Brad, Castro, Pilar, Riveros Perez, N.R., Stricker, Paul, Lockman, Justin L., Galvez, Jorge, Isserman, Rebecca, Struyk, Brian, Ward, Christopher, Hsu, Grace, Nishisaki, Akira, Kodavatiganti, Ramesh, Ramos, Luis S., Scheu, Eric, Bruins, Benjamin, Goldfarb, Tally, Szmuk, Peter, Jain, Ranu, Matuszczak, Maria, Polaner, David, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Rosas, Guelay B., Lee, Lisa K., Iyah, Ihab, Dalesio, Nicholas, Greenberg, Rob, Peyton, James, Park, Raymond, Staffa, Steven J., Sabato, Stefano, Templeton, Thomas W., Stein, Mary Lyn, Garcia-Marcinkiewicz, Annery G., Kiss, Edgar, Fiadjoe, John Edem, von Ungern-Sternberg, Britta, Chiao, Franklin, Olomu, Patrick, Zurakowski, David, and Kovatsis, Pete G.

Published
2021
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13. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial

Author

Ladner, David, Burjek, Nicholas, Jagannathan, Narasimhan, Hadjuk, John, Asaf, Saeedah, Glover, Chris, Stein, Mary L, Kodavatiganti, Ramesh, Bruins, B B, Struyk, Brian, Sequera-Ramos, Luis, Ward, Christopher, Laverriere, Elizabeth, Gurnaney, Harshad, Scheu, Eric, Farrell, Heather, Stricker, Paul, Castro, Pilar, Lee, Angela, Valairucha, Songyos, Szolnoki, Judit, Zieg, Jennifer, Chiao, Franklin B, Taicher, Brad M, De Graaff, Jurgen C, Dalesio, Nicholas M, Greenberg, Robert S, Lucero, Angela R, Zamora, Lillian, Fernandez, Allison, Mohamed, Nada, Sabato, Stefano C, Holmes, Christopher D, Bhattacharya, Somaletha T, Meserve, Jonathan, Reynolds, Paul I, Haydar, Bishr, Weber, Monica, Therrian, Megan, Richtsfeld, Martina, Teen, Mark S, Garcia-Marcinkiewicz, Annery G, Kovatsis, Pete G, Hunyady, Agnes I, Olomu, Patrick N, Zhang, Bingqing, Sathyamoorthy, Madhankumar, Gonzalez, Adolfo, Kanmanthreddy, Siri, Gálvez, Jorge A, Franz, Amber M, Peyton, James, Park, Raymond, Kiss, Edgar E, Sommerfield, David, Griffis, Heather, Nishisaki, Akira, von Ungern-Sternberg, Britta S, Nadkarni, Vinay M, McGowan, Francis X, Jr, and Fiadjoe, John E

Published
2020
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14. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time

Author

Stein, Mary Lyn, primary, Sarmiento Argüello, Lina Andrea, additional, Staffa, Steven J., additional, Heunis, Julia, additional, Egbuta, Chinyere, additional, Flynn, Stephen G., additional, Khan, Sabina A., additional, Sabato, Stefano, additional, Taicher, Brad M., additional, Chiao, Franklin, additional, Bosenberg, Adrian, additional, Lee, Angela C., additional, Adams, H. Daniel, additional, von Ungern-Sternberg, Britta S., additional, Park, Raymond S., additional, Peyton, James M., additional, Olomu, Patrick N., additional, Hunyady, Agnes I., additional, Garcia-Marcinkiewicz, Annery, additional, Fiadjoe, John E., additional, Kovatsis, Pete G., additional, Bruins, Benjamin, additional, Stricker, Paul, additional, Laverriere, Elizabeth, additional, Lockman, Justin L., additional, Struyk, Brian, additional, Ward, Christopher, additional, Nishisaki, Akira, additional, Kodavatiganti, Ramesh, additional, Guris, Rodrigo Daly, additional, Sequera-Ramos, Luis, additional, Teen, Mark, additional, Oke, Ayodele, additional, Hsu, Grace, additional, Lingappan, Arul, additional, Battles, Rhae, additional, Bocanegra, Ashley, additional, Goldfarb, Tally, additional, Kiss, Edgar, additional, Szmuk, Peter, additional, Mireles, Sam, additional, Murray, Andrea, additional, Whyte, Simon, additional, Jain, Ranu, additional, Matuszczak, Maria, additional, Holmes, Christopher, additional, McCann, Alexander, additional, Matava, Clyde, additional, Dalesio, Nicholas, additional, Greenberg, Robert, additional, Lucero, Angela, additional, Desai, Sapna, additional, Rosander, Sondra, additional, Samba, Sindhu, additional, Schrock, Charles, additional, Nykiel-Bailey, Sydney, additional, Marsh, Jennifer, additional, Peterson, Melissa Brooks, additional, Lee, Amy, additional, Bhattacharya, Somaletha, additional, Burjek, Nicholas, additional, Jagannathan, Narasimhan, additional, Lardner, David, additional, Crockett, Christy, additional, Robetson, Sara, additional, Patel, Jasmine, additional, Sharma, Aarti, additional, Templeton, Thomas, additional, Marín, Piedad Echeverry, additional, Pérez-Pradilla, Carolina, additional, Singh, Neeta, additional, Sommerfield, David, additional, Hauser, Neil, additional, Hesselink, Emily, additional, Lewkowitz-Shpuntoff, Hilana, additional, Castro, Pilar, additional, Riveros Perez, N. Ricardo, additional, Vega, Eduardo, additional, González, Alejandro, additional, Ostermann, Paola, additional, Rubin, Kasia, additional, Meserve, Jonathan, additional, Lord, Charles, additional, Lee, Angela, additional, Valairucha, Songyos, additional, Dalal, Priti, additional, Tran, Thanh, additional, Anspach, Taylor, additional, Lee, Lisa K., additional, Ayad, Ihab, additional, Rehman, Mohamed, additional, Fernandez, Allison, additional, Zamora, Lillian, additional, Ravula, Niroop, additional, Shaik, Sadiq, additional, Szolnoki, Judit, additional, Mathew, Preethy, additional, Yaddanapudi, Sandhya, additional, Sen, Indu, additional, Gupta, Aakriti, additional, Handlogten, Kathryn, additional, Sroka, J. Michael, additional, Quintão, Vinícius Caldeira, additional, Carlos, Ricardo Vieira, additional, and Leite, Fernanda, additional

Published
2024
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15. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Author

Davidson, Andrew J, Frawley, Geoff, Hardy, Pollyanna, Arnup, Sarah, Grobler, Anneke, Lee, Katherine, Hunt, Rod W, Stargatt, Robyn, Sheppard, Suzette J, Ormond, Gillian D, Hartmann, Penelope L, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, von Ungern-Sternberg, Britta, Wilton, Niall C, Knottenbelt, Graham, Withington, Davinia, Furue, Koto, Gagnon, Hélène, Disma, Nicola, Mameli, Leila, Giribaldi, Gaia, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, de Graaff, Jurgen C, van der Werff, Desiree BM, van Gool, Jose TDG, van Loon, Kim, Kalkman, Cor J, van Baar, Anneloes L, Absalom, Anthony R, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Bell, Graham, Dorris, Liam, Morton, Neil S, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, McCann, Mary Ellen, Berde, Charles, Soriano, Sulpicio, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Mueller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffrey, Kravitz, Brian, Farrow-Gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, Williams, Robert, Hunt, Rodney W, Bellinger, David C, von Ungern Sternberg, Britta S, Wilton, Niall, Polaner, David M, and Morton, Neil

Published
2019
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17. Difficult intubation in syndromic versus nonsyndromic forms of micrognathia in children.

Author

Hunyady, Agnes I., Sergeeva, Vera, Kovatsis, Pete G., Evans, Kelly N., Staffa, Steven J., Zurakowski, David, Fiadjoe, John E., Jimenez, Nathalia, von Ungern‐Sternberg, Britta S, Sommerfield, David, Hauser, Neil, Taicher, Brad M, Dalesio, Nicholas M, Matuszczak, Maria, Garcia‐Marcinkiewicz, Annery G., Bruins, Benjamin B., Kodavatiganti, Ramesh, Hsu, Grace, Ward, Christopher, and Struyk, Brian

Subjects
*TRACHEA intubation, *MICROGNATHIA, *INTUBATION, *PROPENSITY score matching, *CRANIOFACIAL abnormalities
Abstract

Background: We investigated how syndromic versus nonsyndromic forms of micrognathia impacted difficult intubation outcomes in children. Primary outcome was the first‐attempt success rate of tracheal intubation, secondary outcomes were number of intubation attempts and complications. We hypothesized that syndromic micrognathia would be associated with lower first‐attempt success rate. Methods: In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012–03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings. Results: Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First‐attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p =.478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p =.959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: −0.7, 0.7; p =.999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: −0.5, 0.5; p =.999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p =.07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p =.185). Conclusions: Presence of syndrome was not associated with lower first‐attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Difficult or impossible facemask ventilation in children with difficult tracheal intubation:a retrospective analysis of the PeDI registry

Author

Garcia-Marcinkiewicz, Annery G., Lee, Lisa K., Haydar, Bishr, Fiadjoe, John E., Matava, Clyde T., Kovatsis, Pete G., Peyton, James, Stein, Mary L., Park, Raymond, Taicher, Brad M., Templeton, Thomas W., Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Daly Guris, Rodrigo J., Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, de Graaff, Jurgen C., Garcia-Marcinkiewicz, Annery G., Lee, Lisa K., Haydar, Bishr, Fiadjoe, John E., Matava, Clyde T., Kovatsis, Pete G., Peyton, James, Stein, Mary L., Park, Raymond, Taicher, Brad M., Templeton, Thomas W., Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Daly Guris, Rodrigo J., Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, and de Graaff, Jurgen C.

Abstract

Background: Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation. Methods: We queried a multicentre registry for children who experienced “difficult” or “impossible” facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed. Results: The incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with “difficult” mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening. Conclusions: Certain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.

Published
2023

21. Hyperammonemia is associated with reduced objective anesthetic requirements in children: A retrospective case–control study.

Author

O'Reilly‐Shah, Vikas N., Van Cleve, Wil, Walters, Andrew, Hunyady, Agnes I., Morgan, Philip G., Li, Li, and Polaner, David M.

Subjects
CHILD patients, HYPERAMMONEMIA, ANESTHETICS, CASE-control method
Abstract

A retrospective case-control study published in the journal Pediatric Anesthesia examined the impact of hyperammonemia, or elevated blood ammonia levels, on anesthetic requirements in children. The study analyzed processed electroencephalogram (EEG) data as a measure of anesthetic depth in hyperammonemic pediatric patients compared to healthy controls. The results showed that children with hyperammonemia exhibited greater anesthetic depth at lower anesthetic concentrations compared to age-matched controls without hyperammonemia. The study suggests that the presence of hyperammonemia is associated with enhanced sensitivity to anesthetics in pediatric patients. However, further research is needed to confirm these findings and understand the underlying mechanisms. [Extracted from the article]

Published
2024
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22. Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry

Author

Burjek, Nicholas E., Nishisaki, Akira, Fiadjoe, John E., Adams, H. Daniel, Peeples, Kenneth N., Raman, Vidya T., Olomu, Patrick N., Kovatsis, Pete G., Jagannathan, Narasimhan, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Hopkins, Paul, Glover, Chris, Olutoye, Olutoyin, Szmuk, Peter, McCloskey, John, Dalesio, Nicholas, Koka, Rahul, Greenberg, Robert, Watkins, Scott, Patel, Vikram, Reynolds, Paul, Matuszczak, Maria, Jain, Ranu, Khalil, Samia, Polaner, David, Zieg, Jennifer, Szolnoki, Judit, Sathyamoorthy, Kumar, Taicher, Brad, Riveros Perez, N. Ricardo, Bhattacharya, Solmaletha, Bhalla, Tarun, Stricker, Paul, Lockman, Justin, Galvez, Jorge, Rehman, Mohamed, Von Ungern-Sternberg, Britta, Sommerfield, David, Soneru, Codruta, Chiao, Franklin, Richtsfeld, Martina, Belani, Kumar, Sarmiento, Lina, Mireles, Sam, Bilen Rosas, Guelay, Park, Raymond, and Peyton, James

Published
2017
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25. A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Author

Peyton, James, primary, Park, Raymond, additional, Staffa, Steven J., additional, Sabato, Stefano, additional, Templeton, Thomas W., additional, Stein, Mary Lyn, additional, Garcia-Marcinkiewicz, Annery G., additional, Kiss, Edgar, additional, Fiadjoe, John Edem, additional, von Ungern-Sternberg, Britta, additional, Chiao, Franklin, additional, Olomu, Patrick, additional, Zurakowski, David, additional, Kovatsis, Pete G., additional, Sommerfield, David, additional, Holmes, Chris, additional, Ravula, Niroop, additional, Jette, Christine, additional, Mireles, Sam, additional, Matava, Clyde, additional, Whyte, Simon, additional, Vega, Eduardo, additional, Yang, Lei, additional, Echeverry-Marin, Piedad, additional, Perez-Pradilla, Carolina, additional, Starker, Elizabeth, additional, Zieg, Jennifer, additional, Szolnoki, Judit, additional, Lee, Angela, additional, Heitmiller, Eugenie, additional, Rehman, Mohamed, additional, Zamora, Lillian, additional, Fernandez, Allison, additional, Meserve, Jonathan, additional, Bhattacharya, Solmaletha, additional, Reynolds, Paul, additional, Lewis, Ian, additional, Haydar, Bishr, additional, Therrian, Megan, additional, Sarmiento, Linare, additional, Richtsfeld, Martina, additional, Belani, Kumar, additional, Robertson, Sara, additional, Sathyamoorthy, Kumar, additional, Schrock, Charles, additional, de Graaff, Jurgen, additional, Soneru, Codruta, additional, Singh, Neeta, additional, Taicher, Brad, additional, Castro, Pilar, additional, Riveros Perez, N.R., additional, Stricker, Paul, additional, Lockman, Justin L., additional, Galvez, Jorge, additional, Isserman, Rebecca, additional, Struyk, Brian, additional, Ward, Christopher, additional, Hsu, Grace, additional, Nishisaki, Akira, additional, Kodavatiganti, Ramesh, additional, Ramos, Luis S., additional, Scheu, Eric, additional, Bruins, Benjamin, additional, Goldfarb, Tally, additional, Szmuk, Peter, additional, Jain, Ranu, additional, Matuszczak, Maria, additional, Polaner, David, additional, Hunyady, Agnes, additional, Bosenberg, Adrian, additional, Tham, See, additional, Low, Daniel, additional, Rosas, Guelay B., additional, Lee, Lisa K., additional, Iyah, Ihab, additional, Dalesio, Nicholas, additional, and Greenberg, Rob, additional

Published
2021
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27. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial

Author

Garcia-Marcinkiewicz, Annery G, primary, Kovatsis, Pete G, additional, Hunyady, Agnes I, additional, Olomu, Patrick N, additional, Zhang, Bingqing, additional, Sathyamoorthy, Madhankumar, additional, Gonzalez, Adolfo, additional, Kanmanthreddy, Siri, additional, Gálvez, Jorge A, additional, Franz, Amber M, additional, Peyton, James, additional, Park, Raymond, additional, Kiss, Edgar E, additional, Sommerfield, David, additional, Griffis, Heather, additional, Nishisaki, Akira, additional, von Ungern-Sternberg, Britta S, additional, Nadkarni, Vinay M, additional, McGowan, Francis X, additional, Fiadjoe, John E, additional, Ladner, David, additional, Burjek, Nicholas, additional, Jagannathan, Narasimhan, additional, Hadjuk, John, additional, Asaf, Saeedah, additional, Glover, Chris, additional, Stein, Mary L, additional, Kodavatiganti, Ramesh, additional, Bruins, B B, additional, Struyk, Brian, additional, Sequera-Ramos, Luis, additional, Ward, Christopher, additional, Laverriere, Elizabeth, additional, Gurnaney, Harshad, additional, Scheu, Eric, additional, Farrell, Heather, additional, Stricker, Paul, additional, Castro, Pilar, additional, Lee, Angela, additional, Valairucha, Songyos, additional, Szolnoki, Judit, additional, Zieg, Jennifer, additional, Chiao, Franklin B, additional, Taicher, Brad M, additional, De Graaff, Jurgen C, additional, Dalesio, Nicholas M, additional, Greenberg, Robert S, additional, Lucero, Angela R, additional, Zamora, Lillian, additional, Fernandez, Allison, additional, Mohamed, Nada, additional, Sabato, Stefano C, additional, Holmes, Christopher D, additional, Bhattacharya, Somaletha T, additional, Meserve, Jonathan, additional, Reynolds, Paul I, additional, Haydar, Bishr, additional, Weber, Monica, additional, Therrian, Megan, additional, Richtsfeld, Martina, additional, and Teen, Mark S, additional

Published
2020
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30. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Author

Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, Williams, Robert, Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, and Williams, Robert

Abstract

Background In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes. Methods In this international, assessor-masked, equivalence, randomised, controlled trial conducted at 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand, we recruited infants of less than 60 weeks' postmenstrual age who were born at more than 26 weeks' gestation and were undergoing inguinal herniorrhaphy, without previous exposure to general anaesthesia or risk factors for neurological injury. Patients were randomly assigned (1:1) by use of a web-based randomisation service to receive either awake-regional anaesthetic or sevoflurane-based general anaesthetic. Anaesthetists were aware of group allocation, but individuals administering the neurodevelopmental assessments were not. Parents were informed of their infants group allocation upon request, but were told to mask this information from assessors. The primary outcome measure was full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III), at 5 years of age. The primary analysis was done on a per-protocol basis, adjusted for gestational age at birth and country, with multiple imputation used to account for missing data. An intention-to-treat analysis was also done. A difference in means of 5 points was predefined as the clinical equivalence margin. This completed trial is registered with ANZCTR, number ACTRN12606000441516, and ClinicalTrials.gov, number NCT00756600. Findings Between F

Published
2019

31. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Author

Leerstoel Baar, Development and Treatment of Psychosocial Problems, Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, Williams, Robert, Leerstoel Baar, Development and Treatment of Psychosocial Problems, Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, and Williams, Robert

Published
2019

33. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Author

McCann, Mary Ellen, primary, de Graaff, Jurgen C, additional, Dorris, Liam, additional, Disma, Nicola, additional, Withington, Davinia, additional, Bell, Graham, additional, Grobler, Anneke, additional, Stargatt, Robyn, additional, Hunt, Rodney W, additional, Sheppard, Suzette J, additional, Marmor, Jacki, additional, Giribaldi, Gaia, additional, Bellinger, David C, additional, Hartmann, Penelope L, additional, Hardy, Pollyanna, additional, Frawley, Geoff, additional, Izzo, Francesca, additional, von Ungern Sternberg, Britta S, additional, Lynn, Anne, additional, Wilton, Niall, additional, Mueller, Martin, additional, Polaner, David M, additional, Absalom, Anthony R, additional, Szmuk, Peter, additional, Morton, Neil, additional, Berde, Charles, additional, Soriano, Sulpicio, additional, Davidson, Andrew J, additional, Arnup, Sarah, additional, Lee, Katherine, additional, Hunt, Rod W, additional, Ormond, Gillian D, additional, Takagi, Michael J, additional, Taylor, Kaitlyn, additional, Malarbi, Stephanie, additional, Doyle, Melissa, additional, Ragg, Philip, additional, Costi, David, additional, von Ungern-Sternberg, Britta, additional, Wilton, Niall C, additional, Knottenbelt, Graham, additional, Furue, Koto, additional, Gagnon, Hélène, additional, Mameli, Leila, additional, Pini Prato, Alessio, additional, Mattioli, Girolamo, additional, Wolfler, Andrea, additional, Bova, Stefania M, additional, Krachmalnicoff, Arianna, additional, Guuva, Claudia, additional, van der Werff, Desiree BM, additional, van Gool, Jose TDG, additional, van Loon, Kim, additional, Kalkman, Cor J, additional, van Baar, Anneloes L, additional, Hoekstra, Frouckje M, additional, Volkers, Martin, additional, Oostra, Martine, additional, Morton, Neil S, additional, Pownall, Jaycee, additional, Waldman, Jack, additional, Hind, Ruth, additional, Symonds, Joseph D, additional, Bagshaw, Oliver, additional, McCann, Mary Ellen, additional, Sethna, Navil, additional, Kovatsis, Pete, additional, Cravero, Joseph, additional, Bellinger, David, additional, Ivanova, Iskra, additional, Hunyady, Agnes, additional, Verma, Shilpa, additional, Polaner, David, additional, Thomas, Joss, additional, Haret, Denisa, additional, Steiner, Jeffrey, additional, Kravitz, Brian, additional, Farrow-Gillespie, Alan, additional, Suresh, Santhanam, additional, Hays, Stephen, additional, Taenzer, Andreas, additional, Maxwell, Lynne, additional, and Williams, Robert, additional

Published
2019
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35. Hemokinin-1 plays a potent pronociceptive role in acute and chronic models in mice

Author

Borbely, Eva, primary, Hajna, Zsofia, additional, Scheich, Balint, additional, Hunyady, Agnes, additional, Bekefi, Katinka, additional, Gubanyi, Timea, additional, Berger, Alexandra, additional, Paige, Christopher J, additional, McDougall, Jason, additional, Quinn, John, additional, Szolcsanyi, Janos, additional, Pinter, Erika, additional, and Helyes, Zsuzsanna, additional

Published
2017
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36. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

Author

Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, and Tibboel, Dick

Subjects
Male, Internationality, Spinal, Apnea, Research Support, U.S. Gov't, P.H.S, Child Development, Postoperative Complications, Research Support, N.I.H., Extramural, Risk Factors, Journal Article, Humans, Comparative Study, Anesthesia, Wakefulness, General, Anesthesia, General, Anesthesia, Spinal, Female, Follow-Up Studies, Infant, Infant, Newborn, Treatment Outcome, Anesthesiology and Pain Medicine, Research Support, Non-U.S. Gov't, Newborn, Multicenter Study, Randomized Controlled Trial
Abstract

Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods: Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Results: Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. Conclusions: RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

Published
2015

37. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

Author

Frawley, Geoff, Bell, Graham, Disma, NICOLA MASSIMO, Withington, Davinia E., De Graaff, Jurgen C., Morton, Neil S., Mccann, Mary Ellen, Arnup, Sarah J., Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J., Hardy, Pollyanna, Hunt, Rodney W., Stargatt, Robyn, Ormond, Gillian, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern Sternberg, Britta S., Wilton, Niall, Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Tuo, Pietro, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Izzo, Francesca, Salvo, Ida, Sonzogni, Valter, Locatelli, Bruno Guido, Khotcholava, Magda, Van Gool, Jose T. D. G., Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H. M., Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, Carlin, John, Leslie, Kate, De Lima, Jonathan, Field, David, Gebski, Val, Tibboel, Dick, Szmuk, Peter, Steiner, Jeffery, and Kravitz, Brian

Subjects
Male, Hernia, Internationality, Spinal, Apnea, Hernia, Inguinal, Anesthesia, Conduction, Anesthesia, General, Anesthesia, Spinal, Child Development, Cohort Studies, Female, Humans, Infant, Infant, Newborn, Predictive Value of Tests, Prospective Studies, Single-Blind Method, Treatment Failure, Treatment Outcome, Anesthesiology and Pain Medicine, Conduction, Article, Anesthesia, General, Newborn, Inguinal
Abstract

Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure.This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic.RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46).The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.

Published
2015

38. Enrollment challenges in multicenter, international studies: The example of the GAS trial.

Author

Gentry, Katherine R., Arnup, Sarah J., Disma, Nicola, Dorris, Liam, Graaff, Jurgen C., Hunyady, Agnes, Morton, Neil S., Withington, Davinia E., McCann, Mary Ellen, Davidson, Andrew J., and Lynn, Anne M.

Abstract

Summary: Introduction: Randomized trials are important for generating high‐quality evidence, but are perceived as difficult to perform in the pediatric population. Thus far there has been poor characterization of the barriers to conducting trials involving children, and the variation in these barriers between countries remains undescribed. The General Anesthesia compared to Spinal anesthesia (GAS) trial, conducted in seven countries between 2007 and 2013, provides an opportunity to explore these issues. Methods: We undertook a descriptive analysis to evaluate the reasons for variation in enrollment between countries in the GAS trial, looking specifically at the number of potential subjects screened, and the subsequent application of four exclusion criteria that were applied in a hierarchical order. Results: A total of 4023 patients were screened by 28 centers in seven countries. Australia and the USA screened the most subjects, accounting for 84% of all potential trial participants. The percentage of subjects eliminated from the screened pool by each exclusion criterion varied between countries. Exclusion due to a predefined condition (H1) eliminated only 5% of potential subjects in Italy and the UK, but 37% in Canada. Exclusions due to a contraindication or a physician's refusal most impacted enrollment in Australia and the USA. The patient being "too large for spinal anesthesia" was the most commonly cited by anesthetists who refused to enroll a patient (64% of anesthetist refusals). The majority of surgeon refusals came from the USA, where surgeons preferred the patient to receive a general anesthetic. The percentage of approached parents refusing to consent ranged from a low of 3% in Italy to a high of 70% in the USA and Netherlands. The most frequently cited reason for parent refusal in all countries was a preference for general anesthesia (median: 43%, range: 32%‐67%). However, a sizeable proportion of parents in all countries had a contrasting preference for spinal anesthesia (median: 25%, range: 13%‐31%), and 23% of U.S. parents expressed concern about randomization. Conclusion: The GAS trial highlights enrollment challenges that can occur when conducting multicenter, international, pediatric studies. Investigators planning future trials should be aware of potential differences in screening processes across countries, and that exclusions by anesthetists and surgeons may vary in reason, in frequency, and by country. Furthermore, investigators should be aware that the U.S. centers encountered particularly high surgeon and parental refusal rates and that U.S. parents were uniquely concerned about randomization. Planning trials that address these difficulties should increase the likelihood of successfully recruiting subjects in pediatric trials. [ABSTRACT FROM AUTHOR]

Published
2019
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39. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

Author

Medische staf Anesthesiologie, Circulatory Health, Brain, Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, Tibboel, Dick, Medische staf Anesthesiologie, Circulatory Health, Brain, Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, and Tibboel, Dick

Published
2015

40. Contributors

Author

Abecassis, Isaac Josh, Agbeko, Rachel S., Adelson, P. David, Alder, Matthew N., Al Ibrahim, Omar, Almodovar, Melvin C., Aminoff, Alexandra R., Amlie-LeFond, Catherine, Angus, Derek C., Arvedson, Joan C., Aspesberro, Francois, Baatz, John E., Baden, Harris P., Badugu, Srinivasarao, Bakar, Adnan M., Banker, Katherine, Bass, John L., Bayir, Hülya, Beaulieu, Pierre, Becker, Lance B., Bell, Michael J., Bender, M.A., Benton, Wade W., Berg, Robert A., Biagas, Katherine V., Bishop, Naomi B., Blatt, Julie, Blowey, Douglas L., Blumer, Jeffrey L., Bonow, Robert H., Brandom, Barbara W., Brilli, Richard J., Brogan, Thomas V., Bronicki, Ronald A., Browd, Samuel R., Bunchman, Timothy E., Burns, Jeffrey P., Caglar, Derya, Campbell, Sally, Carcillo, Joseph A., Carrillo-Lopez, Hector, Cashen, Katherine, Cassara, Antonio, Charpie, John R., Chavez, Adrian, Chun, Robert H., Clark, Jonna Derbenwick, Clark, Robert S.B., Clement, Katherine C., Conlon, Thomas, Conway, Edward E., Jr., Coopersmith, Craig M., Corey, Seth J., Cox, Peter N., Curley, Martha A.Q., Czosnyka, Marek, Dalton, Heidi J., Damian, Mihaela, Davis, Peter J., de Prost, Nicolas, Deutschman, Clifford S., Dezfulian, Cameron, Diekema, Douglas S., Doctor, Allan, Doherty, Meaghan, Dorfman, Molly V., Downes, John J., Dreyfuss, Didier, Duncan, Christine, Dupree, Phylicia D., Eigen, Howard, El-Hassan, Nahed, Eriksson, Carl O., Felmet, Kate, Fineman, Jeffrey R., Fink, Ericka L., Fish, Frank A., Fitzgerald, Tamara N., Flynn, Joseph T., Pérez Fontán, J. 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Published
2017
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46. Fever following an Epidural Blood Patch in a Child

Author

I. Hunyady, Agnes, T. M. Anderson, Corrie, D. Kuratani, John, and Kundu, Anjana

Abstract

There is increasing evidence that children suffer from the consequences of spontaneous or iatrogenic intracranial hypotension. Pediatric epidural blood patch is gaining popularity because of its ability to alter cerebrospinal fluid dynamics and to alleviate headaches attributed to low cerebrospinal fluid pressure. There is, however, still not enough data to document the safety profile of an epidural blood patch. Here we describe a case of a fever in a child temporally related to the administration of an epidural blood patch. This case depicts the dilemmas in making the diagnosis and instituting treatment for complications of this procedure in the pediatric population.

Published
2012
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