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Lung ultrasound assessment of atelectasis following different anesthesia induction techniques in pediatric patients: a propensity score-matched, observational study
Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rate...
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Published in: | Journal of Anesthesia, Analgesia and Critical Care (Online) Analgesia and Critical Care (Online), 2024-10, Vol.4 (1), p.69-9, Article 69 |
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description | Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS).
This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis.
Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p |
doi_str_mv | 10.1186/s44158-024-00206-x |
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This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis.
Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21-8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis.
Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates.
ClinicalTrials.gov identifier: NCT06069414.</description><identifier>ISSN: 2731-3786</identifier><identifier>EISSN: 2731-3786</identifier><identifier>DOI: 10.1186/s44158-024-00206-x</identifier><identifier>PMID: 39369249</identifier><language>eng</language><publisher>England: Springer Nature B.V</publisher><subject>Airway management ; Atelectasis ; Fentanyl ; General anesthesia ; Inhalatory induction ; Intravenous induction ; Intubation ; Lung ultrasound ; Medical personnel ; Observational studies ; Patients ; Pediatric anesthesia ; Pediatrics ; Surgery ; Ultrasonic imaging</subject><ispartof>Journal of Anesthesia, Analgesia and Critical Care (Online), 2024-10, Vol.4 (1), p.69-9, Article 69</ispartof><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c448t-789be896e0ab8299418c54f2532e78c2eb201e8d3cf973a63d4beb5ac56ca7ba3</cites><orcidid>0000-0002-1160-1456</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/3113187455/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3113187455?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25728,27898,27899,36986,36987,44563,53763,53765,75093</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39369249$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Camporesi, Anna</creatorcontrib><creatorcontrib>Roveri, Giulia</creatorcontrib><creatorcontrib>Vetrugno, Luigi</creatorcontrib><creatorcontrib>Buonsenso, Danilo</creatorcontrib><creatorcontrib>De Giorgis, Valentina</creatorcontrib><creatorcontrib>Costanzo, Sara</creatorcontrib><creatorcontrib>Pierucci, Ugo Maria</creatorcontrib><creatorcontrib>Pelizzo, Gloria</creatorcontrib><title>Lung ultrasound assessment of atelectasis following different anesthesia induction techniques in pediatric patients: a propensity score-matched, observational study</title><title>Journal of Anesthesia, Analgesia and Critical Care (Online)</title><addtitle>J Anesth Analg Crit Care</addtitle><description>Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS).
This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis.
Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21-8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis.
Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates.
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Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS).
This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis.
Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21-8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis.
Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates.
ClinicalTrials.gov identifier: NCT06069414.</abstract><cop>England</cop><pub>Springer Nature B.V</pub><pmid>39369249</pmid><doi>10.1186/s44158-024-00206-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1160-1456</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Airway management Atelectasis Fentanyl General anesthesia Inhalatory induction Intravenous induction Intubation Lung ultrasound Medical personnel Observational studies Patients Pediatric anesthesia Pediatrics Surgery Ultrasonic imaging |
title | Lung ultrasound assessment of atelectasis following different anesthesia induction techniques in pediatric patients: a propensity score-matched, observational study |
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