Anesth. Res., Volume 1, Issue 2 (September 2024) – 4 articles

Background: Infants are at risk of cerebral hypoperfusion from low blood pressure during anesthesia. We conducted a retrospective observational study to determine the patient and perioperative factors associated with low systolic blood pressure (SBP) in healthy infants. Methods: We obtained perioperative data of 266 infants aged 0–6 months who underwent inguinal hernia repair between January 2015 and March 2019 at our institution. SBP was analyzed during two phases: the preparation phase (20 min before procedure start until incision) and the surgical phase (15 to 35 min after procedure start). Low SBP was defined as a value lower than two standard deviations below the 50th percentile for a phase- and weight-specific reference value. Results: Low SBP was observed in 11% (29/265) and 5% (13/259) of patients during the preparation and surgical phases, respectively. Neuromuscular blockade use was associated with normal SBP in both phases (regression coefficient β = 6.15 and p = 0.002, regression coefficient β = 6.52 and p < 0.001, respectively). SBP was more strongly associated with weight than with age (ratio of adjusted standardized regression coefficient = 2.0 in both phases). After controlling for covariates, patients given neuromuscular blockade had significantly fewer low SBP measurements during the preparation phase (regression coefficient β = −1.99 and p < 0.001). Conclusions: With respect to patient factors, in healthy infants under general anesthesia, weight was more strongly associated with SBP than age. A neuromuscular blocking agent administered during anesthesia induction was associated with fewer low SBP measurements in the preparation phase. Full article

Digital mucous cysts (DMCs) are common soft tissue tumors affecting interphalangeal joints. Various treatment options exist, with surgical excision being the standard. Ultrasound-guided cortisone (CC) injection into the distal interphalangeal (DIP) joint has been proposed as a therapeutic alternative. This study aims to assess the technical success and clinical efficacy of US-IPI in terms of swelling resolution and pain control. Fifty-two patients with DMCs underwent CCs DIP joint ultrasound-guided infiltration. Eighty-three percent of patients exhibited a positive response to US-IPI, with a significant reduction in NRS pain scores (p < 0.01). Persistent pain in 17% of patients was effectively managed with marked improvement after a secondary infiltration. Joint swelling was reduced in 68% of patients within 1 month, with complete resolution by 3 to 6 months. No recurrence was reported at the 6-month follow-up. Pain assessment using the Numeric Rating Scale and joint swelling evaluation were conducted at follow-ups of 2 weeks, 1, 3, and 6 months. Statistical analysis was performed to compare pre- and post-procedure NRS pain scores. Here, we show that US-IPI of DMCs is an effective therapeutic option that provides immediate pain relief and long-term aesthetic improvement, resulting in an alternative option to surgical excision. Full article

Background: Pediatric intensive care units (ICUs) face shortages of intensivists, posing challenges in delivering specialized care, especially in underserved regions. While studies on telecritical care in the adult ICU have demonstrated decreased complications and mortality, research on telemedicine in the pediatric ICU setting remains limited. This systematic review evaluates the safety and efficacy of audiovisual telemedicine in pediatric ICUs, assessing patient-centered outcomes when compared to in-person intensivist care. Methods: Two reviewers independently assessed studies from PubMed, MEDLINE (Ovid), Global Health, and EMBASE on the pediatric population in the ICU setting that were provided care by intensivists via telemedicine. Studies without a comparison group of in-person intensivists were excluded. Selected studies were graded using the Newcastle–Ottawa scale and the Levels of Evidence Rating Scale for Therapeutic Studies. Results: Of the 2419 articles identified, 7 met the inclusion criteria. Strong evidence suggested that telemedicine increases access to intensive care. Moderate evidence demonstrated that telemedicine facilitates real-time clinical decision-making, reliable remote clinical assessments, improved ICU process measures (i.e., days on a ventilator, days on antibiotics), and decreased length of stay. Weaker evidence supported that telemedicine decreases complications and mortality. Conclusions: Telemedicine may serve as a promising solution to pediatric ICUs with limited intensivist coverage, particularly in low-resource rural and international settings. Full article

Transforaminal epidural steroid injections are commonly used for the treatment of radicular pain. Some providers opt for an antero-superior approach and others a postero-inferior approach. In this retrospective cohort study, we evaluated MRI evident anatomic differences between the antero-superior and postero-inferior neural foramen at L5-S1 that may be relevant when choosing an approach for injections. A total of 29 L5-S1 neural foramina that were targeted for transforaminal epidural steroid injections were included. Pre-procedure MRIs were assessed for the distribution of the fat within the foramen. Additionally, the presence of foraminal vessels and foraminal stenosis and the presence/absence of anterolisthesis was also observed. Final imaging data were obtained by majority opinion of three or four radiologists. There was a statistically significant difference in the distribution of foraminal fat between the postero-inferior foramen and the antero-superior foramen (p < 0.001), with more fat generally in the postero-inferior foramen. Foraminal vessels were not consistently visualized. There was weak inter-reader reliability for the presence of vessels. In conclusion, this study suggests that there is a difference in the distribution of foraminal epidural fat between the postero-inferior and antero-superior foramen at L5-S1. Through MRI, vessels are inconsistently visualized and cannot be reliably detected on conventional MRI between readers. Full article