Anesthesia

Anesth Analg. 2025 May 1;140(5):e62. doi: 10.1213/ANE.0000000000007458.

NO ABSTRACT

PMID:40228203 | DOI:10.1213/ANE.0000000000007458

Anesth Analg. 2025 May 1;140(5):e62. doi: 10.1213/ANE.0000000000007445.

NO ABSTRACT

PMID:40228202 | DOI:10.1213/ANE.0000000000007445

Anesth Analg. 2025 May 1;140(5):1239-1241. doi: 10.1213/ANE.0000000000007294.

NO ABSTRACT

PMID:40228201 | DOI:10.1213/ANE.0000000000007294

Anesth Analg. 2025 May 1;140(5):1037-1039. doi: 10.1213/ANE.0000000000007254.

NO ABSTRACT

PMID:40228200 | DOI:10.1213/ANE.0000000000007254

Anesth Analg. 2025 May 1;140(5):1028. doi: 10.1213/ANE.0000000000007497.

NO ABSTRACT

PMID:40228199 | DOI:10.1213/ANE.0000000000007497

Anesth Analg. 2025 May 1;140(5):1015. doi: 10.1213/ANE.0000000000007496.

NO ABSTRACT

PMID:40228198 | DOI:10.1213/ANE.0000000000007496

Anesthesiology. 2025 Apr 14. doi: 10.1097/ALN.0000000000005499. Online ahead of print.

ABSTRACT

BACKGROUND: Anesthesiologists manage life-threatening, critical events in a fast-paced, high-distraction atmosphere, with little time to deliberate about treatment options. The Society for Pediatric Anesthesia developed the Pedi Crisis 2.0 Mobile Application to assist in managing critical pediatric perioperative events. We hypothesized that the application could be used as a formal educational assessment tool in pediatric anesthesiology fellowship training and developed a one-hour classroom examination designed to assess the impact of the application on fellows' knowledge of the management of pediatric critical events. We sought to evaluate whether the just-in-time knowledge provided by the application leads to improved testing outcomes compared with baseline knowledge alone.

METHODS: Pediatric anesthesia fellows participated in a one-hour session with ten pediatric critical event scenarios (stems). Each scenario presented a case with open-ended questions on standard management. Participants were randomized to answer half of the stems using the application (APP) and half of the stems not using the application (NO APP). Instead, they utilized knowledge from routine practice, memory recall, and alternative electronic resources. Two blinded reviewers graded answers, and the average percent of correct answers was calculated.

RESULTS: Fifty-one pediatric anesthesiology fellows from four institutions enrolled in the study. Six fellows were improperly randomized and excluded. The total percent correct scores for stems 1/3/5/7/9 and 2/4/6/8/10 were significantly higher for the APP condition (78.7% vs 45.4%, 59% vs 40%, p<0.0001). The percent correct answers for individual stems varied; the APP condition scores were always statistically higher than the NO APP condition (p < 0.05).

CONCLUSIONS: Pediatric anesthesiology fellows were significantly more successful at describing the management of pediatric critical events when using the Pedi Crisis 2.0 application compared to not using the application. Thus, we believe that cognitive aids, such as Pedi Crisis 2.0, should be an integral component of pediatric anesthesia fellowship training curricula.

PMID:40227963 | DOI:10.1097/ALN.0000000000005499

Anesthesiology. 2025 Apr 14. doi: 10.1097/ALN.0000000000005502. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this study was to describe thrombin generation in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Change in the endogenous thrombin potential (ETP) across three measurements before and after CPB (after protamine and at chest closure) was the primary outcome. Secondary analyses explored an association between thrombin generation and transfusion requirements and predictors of the thrombin generation decline.

METHODS: Blood samples of children (median age 6.3 months; 68.5% weighed <10 kg) were collected intraoperatively three times: before administration of heparin (baseline), shortly after protamine and at sternal closure. Platelet poor plasma obtained after centrifugation of these samples was frozen at -80ºC. Thrombin generation and anti-Xa assays were performed in series on batches of thawed samples to evaluate thrombin generation parameters and functional activity of unfractionated heparin which could have affected thrombin generation assay results.

RESULTS: Between August 2022 and May 2024, 162 plasma samples from 54 patients were collected and analyzed. Compared with baseline, mean ETP decreased by 1911 nM (95% CI 1655 to 2168) after administration of protamine, and by 1865 nM (95% CI 1609 to 2122) at sternal closure, P<0.001. Similar changes were observed in secondary thrombin generation parameters. Median unfractionated heparin activity was <0.1 U/ml at all three time points. Secondary analyses showed strong negative correlation between ETP after protamine and volume of transfusion after bypass (ρ =-0.52, P<0.001). Among five examined factors, only total heparin dose was independently associated with ETP decline, with higher dose being predictive of greater ETP decline (P=0.002).

CONCLUSIONS: In children undergoing cardiac surgery, we noted a significant and persistent decline in endogenous thrombin potential following cardiopulmonary bypass, despite hemostatic interventions. This reduced thrombin potential correlated with higher volume of transfusions. Additionally, greater intraoperative heparin requirements could be linked to a more pronounced decline in thrombin generation.

PMID:40227961 | DOI:10.1097/ALN.0000000000005502

Anesthesiology. 2025 Apr 14. doi: 10.1097/ALN.0000000000005505. Online ahead of print.

ABSTRACT

BACKGROUND: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are leading causes of transfusion-related morbidity and mortality. Soluble factors in red blood cell (RBC) supernatant may increase risk for these complications. We hypothesized that point-of-care allogeneic RBC washing may be an effective intervention to mitigate elevations in soluble factors as well as physiologic responses associated with transfusion-associated respiratory complications in the setting of cardiac surgery.

METHODS: This is a two-center, non-blinded, randomized clinical trial evaluating point-of-care washed versus standard-issue allogeneic RBC transfusions administered during or on the day of cardiac surgery. The primary analysis was performed via modified intention-to-treat. The primary outcomes assessed were changes in intermediate markers of lung injury as well as cardiopulmonary physiologic responses to RBC transfusion. Secondary outcomes included the duration of intensive care unit and hospital stay, durations of mechanical ventilation and oxygen supplementation, presence of TRALI or TACO, and mortality.

RESULTS: Among 154 analyzed patients (81 washed, 73 standard issue), median age was 66 years and 77 (50.0%) were women. The median (IQR) number of allogeneic RBC units transfused on the day of surgery was 3.0 (2.0 - 5.0) in the washed RBC group and 3.0 (2.0 - 4.0) in the standard issue group (p = 0.13). No between-group differences were identified in any of the assessed recipient lung injury biomarkers (all p-values > adjusted alpha). Durations of intensive care unit stay (median [interquartile range]; 3.0 [2.0-5.0] versus 3.0 [2.0-4.0] days; p = 0.117) and hospital length of stay (12.0 [9.0-17.0] versus 12.0 [9.0-17.0] days; p = 0.801) were similar, as were the number of ventilator-free days at day 28 (27.0 [27.0-27.0] versus 27.0 [26.0-27.0]; p = 0.699) and oxygen free days at day 28 (24.0 [19.0-26.0] versus 24.0 [22.0-26.0]; p = 0.400) . No significant differences were noted in mortality rate nor in incidence rates for TRALI, TACO, and acute kidney injury.

CONCLUSIONS: Among patients undergoing cardiovascular surgery with high risk of RBC transfusion, point-of-care washing of allogeneic RBC transfusions did not mitigate changes in intermediate markers of lung injury or cardiopulmonary physiologic responses to RBC transfusion and was not associated with improved clinical outcomes.

PMID:40227960 | DOI:10.1097/ALN.0000000000005505

Anesthesiology. 2025 Apr 14. doi: 10.1097/ALN.0000000000005503. Online ahead of print.

ABSTRACT

BACKGROUND: Measuring the quality of a patient's recovery is vital, and reliable patient-centered outcome metrics are needed for clinical investigations and quality improvement. Currently, assessment tools to measure quality of recovery in pediatric patients are lacking. This study aimed to develop a scale to assess the quality of recovery (QoR) construct in pediatric patients.

METHODS: Using a mixed-methods investigative model, item generation was achieved using two complementary approaches. First, a comprehensive review of the literature identified tools and questions that assessed the endpoints relevant to recovery in children. Questions were categorized and then assessed by an expert Delphi panel who determined the most significant domains and items to be included. Concurrently, semi-structured interviews were conducted with patients and their families to identify themes related to recovery that were important to patients and families. The resulting pilot questionnaire was administered to patients and their families presenting for elective surgery in the US and Australia.

RESULTS: The literature search identified 41 instruments, comprising 216 questions relevant to recovery. After the initial Delphi round, the item list was reduced to 91 questions, and then to 50 questions after the second round. The themes identified in the semi-structured interviews aligned with domains considered important by a panel of experts. A 50-item questionnaire was administered to 1162 children, at multiple time points post-surgery. Item reduction and factor analysis resulted in the 20-item Pediatric Scale for Quality of Recovery (PedSQoR) that assesses the domains relevant to physical and psychological recovery.

CONCLUSIONS: The PedSQoR scale is a 20-item questionnaire designed to provide a holistic representation of a child's physical, emotional, and psychological recovery after surgery and anesthesia. It was developed and validated with consumer involvement and a strong patient-centered focus. Once further validation has been established, it is expected to become a standardized endpoint in pediatric perioperative trials and quality improvement projects.

PMID:40227959 | DOI:10.1097/ALN.0000000000005503