The results suggest that sonographic assessment of the gastric antrum provides useful information regarding gastric content (empty versus nonempty) and volume (ml·kg(-1) ) in pediatric patients. Results suggest that the three-point grading system may be a valuable tool to assess gastric 'fullness' based on a qualitative exam of the antrum.

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.

CAN J ANESTH 55: 1 www.cja-jca.org Januar y, 2008Purpose: To determine whether a functional difference exists between the size 2 laryngeal mask airway (LMA)-Classic™ (CLMA) and LMA-Proseal™ (PLMA) in anesthetized children who have received neuromuscular blockade. Airway leak during intermittent positive pressure ventilation (IPPV) and adequacy of fibreoptic laryngeal view were the primary study outcomes. Methods:A randomized, controlled, single-blinded study of 51 ASA I or II children weighing 10-20 kg was undertaken. The anesthetic technique was standardized. Following insertion of the LMA and cuff inflation to 60 cm H 2 O, we measured oropharyngeal leak pressure and gastric insufflation and leak fraction during IPPV, and evaluated the adequacy of fibreoptic view.Results: Oropharyngeal leak pressure measured by neck auscultation was higher for the PLMA compared to the CLMA (23.7 vs 16.5 cm H 2 O, P = 0.009) but, when measured by the inspiratory hold maneuver was not significantly different (24.8 vs 20.3 cm H 2 O, respectively, P = 0.217). Leak fraction values were similar for the CLMA and the PLMA (21.2%. vs 13.3%, respectively, P = 0.473). A satisfactory view of the larynx was obtained more frequently in the PLMA group (21/25 vs 10/25, P = 0.003). Gastric insufflation during leak determination was more common with the CLMA (12/26 vs 2/25 CLMA vs PLMA, respectively, P = 0.006). Conclusion:In children undergoing IPPV with neuromuscular blockade, the size 2 PLMA is associated with a higher leak pressure by auscultation and less gastric insufflation compared to the CLMA. Leak pressures assessed by manometric stability are similar with these two devices. The improved fibreoptic view of the larynx through the PLMA may be advantageous for bronchoscopy. CLMA (23,7 vs 16,5 cm H 2 O, P = 0,009) ; toutefois, lorsque celle-ci a été mesurée par manoeuvre de retenue respiratoire, il n'y a pas eu de différence significative (24,8 vs 20,3 cm H 2 O, respectivement, P = 0,217). Les valeurs de fraction de fuite étaient semblables avec le CLMA et le PLMA (21,2 % vs 13,3 %, respectivement, P = 0,473). Une vision satisfaisante du larynx a été plus fréquemment obtenue dans le groupe PLMA (21/25 vs 10/25, P = 0,003). L'insufflation gastrique pendant la détermination de la fuite a été plus fréquemment observée dans le groupe CLMA (12/26 vs 2/25 CLMA vs PLMA, respectivement, P = 0,006).

Purpose The purpose of this evidence-based clinical update is to identify the best evidence when selecting a long-acting local anesthetic agent for single-shot pediatric caudal anesthesia in children.

The results of this study suggest that monitoring S100B levels in the late postoperative period may still have a role in detecting neurological injury after cardiac surgery in children. Consistent with previous observations, S100B is high preoperatively in neonates and early postbypass in all patients.

The first prototype of the laryngeal mask airway (LMA TM ) was used clinically in the summer of 1981 at Ashford, Kent, UK, by Dr. Archie Brain. Dr. Brain followed in the worthy footsteps of Clover, O'Dwyer, Shipway, Leech, and others in developing a supraglottic airway to facilitate the delivery of anesthetic gases via a reliable supraglottic airway. 1 The LMA TM was released in the UK in 1988 and in the USA in 1992. Since the original range of pediatric LMAs TM was soon found to be inadequate to address all children's sizes, half-sizes (1.5 and 2.5) were developed. As with adult practice, the LMA TM and other supraglottic airways have radically changed pediatric anesthesia practice and have become a key component of airway management in children, both in the operating room and in remote anesthesia locations. These devices have increasingly been advocated for emergency airway control in the field, in the emergency department, and in the delivery suite. So what have we learned about pediatric supraglottic airways over the past two decades and where does the future lie with respect to these devices?Much of the published research in this area relates to the LMA Classic TM . From the clinical anesthesiologist's perspective, the following questions relating to the LMA Classic TM are important: When should it be used (patient and procedure related factors), how should it be used, and when should an alternative device be used?Indications for the use of the LMA Classic TM are extensive, and it is often the airway of choice in routine general anesthesia for minor procedures in children. In a prospective study of 1,400 children who had LMA TM -based anesthesia conducted by supervised trainees, the device was found to be highly effective for a broad range of surgical procedures, and there was no instance where the LMA TM had to be replaced with an endotracheal tube (ETT). 2 Initial misgivings about the use of the LMA TM for head and neck procedures were shown to be largely unfounded. For example, the LMA TM was shown to be safe and effective when used for ophthalmological surgery and adenotonsillectomy in children 3,4 ; however, these situations require a surgeon with some insight that the trachea is not intubated.Pediatric anesthesia is increasingly being delivered in areas outside the operating room where the LMA TM has been proven to be particularly valuable. For instance, the LMA TM has been used for radiotherapy, 5 magnetic resonance imaging, 6 fibreoptic bronchoscopy, 7 and upper gastrointestinal endoscopy. 8 Its relative stability combined with the ease of respiratory monitoring and the relative lack of airway complications are distinct advantages in these remote locations.One clinical scenario of particular interest is the difficult pediatric airway. Here the LMA TM has proven to be invaluable both as a rescue airway device in the child with a difficult airway and as a conduit for fibreoptic bronchoscopy and endotracheal intubation. 7 Consequently, the LMA TM has a role in both anticipated and unanticipated difficu...

For fit healthy children undergoing outpatient surgery, parental presence in the PACU decreases negative behavior change at 2 weeks postoperatively but makes no difference in crying in the PACU. Future studies of behavior change postoperatively should consider parental presence in the PACU a factor and determine whether the effect persists with other interventions.

IntroductionTrauma is the leading cause of death among children aged 1–18. Studies indicate that better control of bleeding could potentially prevent 10–20% of trauma-related deaths. The antifibrinolytic agent tranexamic acid (TxA) has shown promise in haemorrhage control in adult trauma patients. However, information on the potential benefits of TxA in children remains sparse. This review proposes to evaluate the current uses, benefits and adverse effects of TxA in the bleeding paediatric trauma population.Methods and analysisA structured search of bibliographic databases (eg, MEDLINE, EMBASE, PubMed, CINAHL, Cochrane CENTRAL) has been undertaken to retrieve randomised controlled trials and cohort studies that describe the use of TxA in paediatric trauma patients. To ensure that all relevant data were captured, the search did not contain any restrictions on language or publication time. After deduplication, citations will be screened independently by 2 authors, and selected for inclusion based on prespecified criteria. Data extraction and risk of bias assessment will be performed independently and in duplicate. Meta-analytic methods will be employed wherever appropriate.Ethics and disseminationThis study will not involve primary data collection, and formal ethical approval will therefore not be required. The findings of this study will be disseminated through a peer-reviewed publication and at relevant conference meetings.Trial registration numberCRD42016038023.