Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

2021

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Background Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization, catecholamine-secreting characteristic of the tumor. We undertook a secondary analysis in a previously study to describe patients who underwent neuroblastoma resection. Objective To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement. Methods Secondary analysis of children who had neuroblastoma resection in the initial retrospective study. Results There were 16 patients with a mean age of 39.3±22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncho-laryngospasm and difficult intubation respectively. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia respectively. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality. Conclusion Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation, intraoperative optimal management with validated means in children are necessary for a better postoperative outcome in this surgical setting.

Section: Discussionmentioning

confidence: 99%

Neuroblastoma in Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

2021

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“…Intraoperative goal-directed therapies with validated tools need to be part of patient management in major surgery in children for intraoperative and postoperative optimization (27,28,29,30,31,32).…”

Section: Discussionmentioning

confidence: 99%

Neuroblastoma in Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

2021

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Background: Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization and catecholamine-secreting characteristics of the tumor. We undertook a secondary analysis in a previous study to describe patients who underwent neuroblastoma resection.Objective: To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement.Methods: This was a secondary analysis of children who underwent neuroblastoma resection in the initial retrospective study.Results: There were 16 patients with a mean age of 39.3±22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncholaryngospasm and difficult intubation. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure, and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality.Conclusion: Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation and optimal intraoperative management with validated means in children are necessary for a better postoperative outcome in this surgical setting.

“…Intraoperative and postoperative complications in pediatric surgical settings with regard to age have been described previously (5,6,7,8,9,10). When considering the entire initial cohort of 594 patients, the overall rate of patients with intraoperative and/or postoperative complications was 23.9% (1).…”

Section: Introductionmentioning

confidence: 98%

Exploratory Laparotomy and Intestinal Resection in Children: Intraoperative Goal Directed Therapy and Intraoperative and Postoperative Outcomes

2021

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Background: Reported independent predictors of intraoperative and postoperative complications were age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of the initial retrospective study in patients who underwent exploratory laparotomy and intestinal resection.Objectives: To describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to implement improvement protocols for intraoperative and postoperative optimization.Methods: Secondary analysis of the initial study. The Ethics Committee approved the study.Results: There were 54 patients with a median age of 15.5[0-172] months. Thirty-seven (68.5%) patients underwent intestinal resection, nine (16.7%) underwent exploratory laparotomy, and eight (16.8%) underwent laparotomy for volvulus.Fourteen (25.9%) patients had intraoperative and/or postoperative complications. Two (3.7%) patients had intraoperative hemorrhagic shock. Two (3.7%) patients had postoperative cardio-circulatory failure. Three (5.6%) had postoperative respiratory failure. One (1.8%) patient had postoperative multiple organ failure and neurologic failure. Three (5.6%) patients had postoperative abdominal sepsis. One (1.8%) patient had postoperative multiple organ sepsis and neuromeningeal sepsis. Four (7.4%) patients had postoperative pulmonary sepsis. Two (3.7%) had postoperative septicemia. Six (11.1%) patients had reoperations. Seventeen (31.5%) patients had intraoperative transfusion. The in-hospital mortality rate was 3.7% in two patients.Conclusion: Intraoperative goal-directed therapies need to be developed and included in these surgical settings for intraoperative and postoperative optimization.