Judging causal associations in observational research on caudal anesthesia and hypospadias repair

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140029/1/pan13260_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/140029/2/pan13260.pd

Harm attributable to research distraction? Challenging conclusions on caudal epinephrine

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109642/1/pan12563.pd

Caudal clonidine and apnea risk

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110530/1/pan12605.pd

Urethrocutaneous fistula following hypospadias repair: regional anesthesia and other factors

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115999/1/pan12719.pd

Difficult or Impossible Facemask Ventilation in Children With Difficult Tracheal Intubation: A Retrospective Analysis of the PeDI Registry

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

Dexmedetomidine and remifentanil as sole anesthetics in infants: Questionable hypnosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/166343/1/pan14073.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/166343/2/pan14073_am.pd

ESPA pain management ladder: Caudal clonidine and cost/benefit considerations

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148218/1/pan13575.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148218/2/pan13575_am.pd

Anesthetic impacts on pulmonary function: Implications for cystic fibrosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172955/1/pan14462.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172955/2/pan14462_am.pd

Complications associated with removal of airway devices under deep anesthesia in children: an analysis of the Wake Up Safe database

Abstract Background Previous studies examining removal of endotracheal tubes and supraglottic devices under deep anesthesia were underpowered to identify rare complications. This study sought to report all adverse events associated with this practice found in a large national database of pediatric anesthesia adverse events. Methods An extract of an adverse events database created by the Wake Up Safe database, a multi-institutional pediatric anesthesia quality improvement initiative, was performed for this study. It was screened to identify anesthetics with variables indicating removal of airway devices under deep anesthesia. Three anesthesiologists screened the data to identify events where this practice possibly contributed to the event. Event data was extracted and collated. Results One hundred two events met screening criteria and 66 met inclusion criteria. Two cardiac etiology events were identified, one of which resulted in the patient’s demise. The remaining 97% of events were respiratory in nature (64 events), including airway obstruction, laryngospasm, bronchospasm and aspiration. Some respiratory events consisted of multiple distinct events in series. Nineteen respiratory events resulted in cardiac arrest (29.7%) of which 15 (78.9%) were deemed preventable by local anesthesiologists performing independent review. Respiratory events resulted in intensive care unit admission (37.5%), prolonged intubation and temporary neurologic injury but no permanent harm. Provider and patient factors were root causes in most events. Upon investigation, areas for improvement identified included improving patient selection, ensuring monitoring, availability of intravenous access, and access to emergency drugs and equipment until emergence. Conclusions Serious adverse events have been associated with this practice, but no respiratory events were associated with long-term harm.http://deepblue.lib.umich.edu/bitstream/2027.42/173426/1/12871_2022_Article_1767.pd