Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (<scp>WAKKA</scp>)

Becke, Karin; Eich, Christoph; Höhne, Claudia; Jöhr, Martin; Machotta, Andreas; Schreiber, Markus; Sümpelmann, Robert

doi:10.1111/pan.13383

Cited by 21 publications

(27 citation statements)

References 111 publications

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“…30 Finally, evidence on anaesthesia-associated neurotoxicity is conflicting and the current notion is that procedures should not be avoided or delayed if the indication is robust. 31…”

Section: Discussionmentioning

confidence: 99%

Casting in infantile idiopathic scoliosis as a temporising measure: A systematic review and meta-analysis

2020

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Objective: Treatment of infantile idiopathic scoliosis remains vague. Because implantation of temporary telescopic devices carries a high risk of complications, interest in the older technique of serial casting is growing as a temporising measure before invasive procedures. The goal of this review was to meta-analyse studies examining the effect and safety of casting in infantile idiopathic scoliosis. Methods: Two reviewers independently searched for relevant studies in PubMed and Embase databases through November 2018. The studies included were limited to infantile idiopathic scoliosis patients who underwent casting, had a mean Cobb angle of 20 or more and written in English. The methodological quality of the chosen studies was assessed. The primary outcome was the difference in Cobb angle means from before and after casting. The secondary outcome was adverse events of casting. Heterogeneity was explored and a funnel plot was drawn. Results: Of the 366 studies screened, 10 studies were included in the meta-analysis (243 subjects) and all were non-randomised. The casting was consistently associated with a reduction in the mean Cobb angle. The pooled mean difference was 24.85° (95% confidence interval: 19.25 to 30.46, p < 0.001). A number of reversible adverse events were reported, most commonly skin irritation and transient pulmonary symptoms. Heterogeneity between studies was high. In the meta-regression analysis, the starting Cobb angle did not influence Cobb angle change, but there was an inverse correlation between the mean difference in Cobb angle and mean age. Conclusion: Casting seems to be effective and safe in decreasing Cobb angle even in high curve magnitudes. In older patients, casting showed less Cobb angle correction.

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“…30 Finally, evidence on anaesthesia-associated neurotoxicity is conflicting and the current notion is that procedures should not be avoided or delayed if the indication is robust. 31…”

Section: Discussionmentioning

confidence: 99%

Casting in infantile idiopathic scoliosis as a temporising measure: A systematic review and meta-analysis

2020

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“…Perioperative normothermia is an important quality metric in pediatric anesthesia [ 1 , 2 ]. Despite significant efforts [ 3 ], perioperative hypothermia is still common in children and has to be considered a severe complication leading to acidosis, coagulopathy, or apnea [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Nemeth¹,

Lovric²,

Asendorf³

et al. 2020

J Clin Monit Comput

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In pediatric anesthesia, deviations from normothermia can lead to many complications, with infants and young children at the highest risk. A measurement method for core temperature must be clinically accurate, precise and should be minimally invasive. Zero-heat-flux (ZHF) temperature measurements have been evaluated in several studies in adults. We assessed the agreement between the 3M Bair Hugger™ temperature measurement sensor (TZHF) and esophageal temperature (TEso) in children up to and including 6 years undergoing surgery with general anesthesia. Data were recorded in 5 min-intervals. We investigated the accuracy of the ZHF sensor overall and in subgroups of different age, ASA classification, and temperature ranges by Bland–Altman comparisons of differences with multiple measurements. Change over time was assessed by a linear mixed model regression. Data were collected in 100 children with a median (1st–3rd quartile) age of 1.7 (1–3.9) years resulting in 1254 data pairs. Compared to TEso (range from 35.3 to 39.3 °C; median 37.2 °C), TZHF resulted in a mean bias of +0.26 °C (95% confidence interval +0.22 to +0.29 °C; 95% limits of agreement −0.11 to +0.62 °C). Lin’s concordance correlation coefficient was 0.89. There was no significant or relevant change of temperature over time (0.006 °C per hour measurement interval, p = 0.199) and no relevant differences in the subgroups. Due to the mean bias of +0.26 °C in TZHF, the risk of hypothermia may be underestimated, while the risk of hyperthermia may be overestimated. Nevertheless, because of its high precision, we consider ZHF valuable for intraoperative temperature monitoring in children and infants.

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“…Sie sollten nur bei Verdacht auf oder bei Kenntnis von relevanten Organerkrankungen, zur Erfassung von Nebenwirkungen einer Pharmakotherapie oder vor größeren Operationen mit potenziell erhöhtem Blutverlust erfolgen (s. Abschn. Präoperative Anämie; [15,16]).…”

Section: Präoperative Labordiagnostikunclassified

Präoperative Vorbereitung in der Kinderanästhesie

Becke‐Jakob

Eich

Röher

2020

Monatsschr Kinderheilkd

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Tab. 1 Risikofaktoren für perioperative Komplikationen. (Nach Becke [3]) Patientenbezogen Alter <1 Jahr, im Speziellen <1 Monat Ehemalige Frühgeborene Schwerwiegende Komorbiditäten Kinder mit hyperreagiblem Atemweg Kinder mit Herzerkrankungen und/oder pulmonaler Hypertension Eingriffsbezogen Atemwegsnahe Eingriffe (Hals-, Nasen-, Ohren-, Augen-, Zahn-, Mundund Kieferoperationen) Abdominal-, Thorax-oder Kardiochirurgie Notfalleingriffe Anlage eines zentralen Venenkatheters Anästhesie-/ Teambezogen Individuelle und institutionelle Kompetenz

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Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA)

Cited by 21 publications

References 111 publications

Casting in infantile idiopathic scoliosis as a temporising measure: A systematic review and meta-analysis

Casting in infantile idiopathic scoliosis as a temporising measure: A systematic review and meta-analysis

Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26 °C: an observational study in 100 infants and young children

Präoperative Vorbereitung in der Kinderanästhesie

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