Sylvain Tosetti

Background. The operating theatre, anaesthesia induction and separation from parents create fear and anxiety in children. Anxiety leads to adverse behavioral changes appearing and sometimes persisting during the postoperative period. Our aim was to compare the effects of midazolam (0.3 mg kg⁻¹: MDZ) for premedication with age-appropriate tablet game apps (TAB) on children anxiety during and after ambulatory surgery. Methods. A randomized controlled trial was conducted from May 16th, 2013 to March 25th, 2014 at the Children Hospital of Lyon. The primary outcome of this study was the change in m-YPAS score at the time of anaesthetic mask induction. Anxiety was also assessed in the waiting surgical area, at the time of separation with parents and when back in the ambulatory surgery ward. Results. One hundred and eighteen patients aged four-11 yr were recruited, 60 in the TAB Group and 58 in the MDZ Group. Main endpoint was missing for three patients from the MDZ Group. At the time of mask induction, there was no significant difference between MDZ and TAB Group for the m-YPAS score (40.5 (18.6) vs 41.8 (20.7), P = 0.99). There was no significant correlation between m-YPAS score and its evolution over the four period of time between subjects. Conclusions. We were not able to show whether TAB is superior to MDZ to blunt anxiety in children undergoing ambulatory surgery. TAB is a non-pharmacological tool which has the capacity in reducing perioperative stress without any sedative effect in this population. Clinical trial registration. NCT 02192710

Summary: Background: Several clinical and surgical factors can influence the occurrence of allogeneic blood transfusion (ABT) during oncologic neurosurgery.Objectives: To identify the potential predictive factors of ABT during craniotomy for the removal of brain tumors in children and the potential impact of intraoperative ABT on early postoperative outcome.Methods: A retrospective study was performed in all pediatric patients younger than 18 years who underwent craniotomy for brain tumor removal from December 2009 to December 2012 in our institution. Pre‐, intra‐, and postoperative data were collected from medical and stored electronic anesthesia records. The predictors of intraoperative ABT were determined using multivariate logistic regression.Results: A total of 110 patients were included. Twenty‐seven patients (25%) received intraoperative ABT with a volume of 16 ± 8 ml·kg⁻¹. On multivariate analysis, an age 270 min, and a preoperative hemoglobin −1 were independently associated with the need for intraoperative ABT. We did not show any significant difference concerning postoperative early outcome and length of stay between the transfused and non‐transfused patients except for the duration of postoperative mechanical ventilation that was significantly higher in the transfused group (P = 0.04).Conclusion: In children, craniotomy for brain tumor removal is at risk of intraoperative ABT. An age 270 min, and a preoperative hemoglobin −1 are the main factors associated with intraoperative ABT during this surgery.

Locoregional anesthesia is an important aspect of perioperative analgesia. It decreases requirements for anesthetic agents and opioids, decreases the surgical stress response, and provides postoperative analgesia. Nonetheless, pediatric patients, especially infants, demonstrate specificities towards regional anesthesia techniques, as an increased sensitivity to local anesthetics (LA) and a higher ease of LA spread especially when using blocks that rely on the volume of LA and its spread as those used for abdominal wall analgesia or caudal. Thus, we present a case of transient abdominal wall deformity following caudal anesthesia in an infant.