Correction to: Efficacy of the Game Ready® cooling device on postoperative analgesia after scoliosis surgery in children.

Unfortunately, one co-author name was incorrectly published in the original publication. The complete correct name of the co-author is given below.

Efficacy of the Game Ready® cooling device on postoperative analgesia after scoliosis surgery in children.

PURPOSE: The aim of this study was to investigate the opioid-sparing effect of a cooling brace after surgical correction of idiopathic surgery in children. METHODS: We compared two consecutive cohorts of patients before and after introducing this technique in our institution. Management of patients was standardized. The primary objective of the study was to investigate the morphine consumption during the first postoperative day. Secondary outcomes were opioid consumption at day 3, pain intensity (at days 1 and 3), the mobilization in the standing position and duration of hospitalization. RESULTS: This study included 23 and 22 patients in the control and the cooling cohorts. Cooling brace was associated with a significant decrease in morphine consumption at day 1 (1.7 [0.9, 3.3] versus 1.2 [0.5, 3.2] mg kg-1, P = 0.02) and day 3 (2.5 [0.5, 6.7] versus 1.2 [0.9, 2.5] mg kg-1, P = 0.003), and a reduction in duration of hospitalization (4 [3, 6] versus 3 [3, 4] days, P = 0.004). However, no difference was found on the pain intensity or the percentage of patient mobilized in the standing position. Number of level fused and intraoperative opioid consumption were also different between the two cohorts. However, multivariate analysis found only the use of the cooling brace as significantly associated with opioid consumption at day 1. CONCLUSION: The use of this cooling brace allows decreasing the opioid use after surgical correction of idiopathic surgery in children. The current results strongly suggest an interest of this technique in the postoperative management of patients. These slides can be retrieved under Electronic Supplementary Material.

Accuracy of the sleep-related breathing disorder scale to diagnose obstructive sleep apnea in children: a meta-analysis.

OBJECTIVES: The main objective of this meta-analysis was to assess the accuracy of the Sleep-Related Breathing Disorder (SRBD) Scale in the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. PATIENTS/METHODS: A literature search of studies comparing SRBD to polysomnography for the diagnosis of OSAS in children was performed. Risks of biases were quantified using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Analyses determined the summary receiver operator characteristic area under the curve (SROC), the pooled sensitivity (Se), the specificity (Sp), and the positive and negative likelihood ratios (LR+ and LR-). Results were graded and are expressed as means [95% confidence interval]. Post-test probabilities were computed for various populations. RESULTS: Eleven studies were included; and two were considered to have high risk of bias. The SROC was 0.73 [CI: 0.63; 0.82]. The combined Se, Sp, LR+ and LR- were: 0.72 [CI: 0.68; 0.77], 0.59 [CI: 0.56; 0.63], 1.74 [CI: 1.32; 2.30], 0.53 [CI: 0.39; 0.71], respectively. Sub-group analyses displayed similar results in comparison to overall results. GRADE evidence for the overall analysis was low to moderate. Finally, pre-test to post-test probabilities were estimated to be: 3.5%-1%, 50%-30% and 75%-30%, for the general population, the obese patients and the patients assigned for surgical treatment of OSAS, respectively. CONCLUSIONS: The current meta-analysis indicates that the SRBD scale has acceptable accuracy in detecting patients with OSAS. It may be useful when evaluating patients with suspected OSAS before surgery. STUDY REGISTRATION: PROSPERO database (CRD42018088216).

Safety Assessment for Thoracoscopic Day Case Surgery in Children with Congenital Pulmonary Malformation.

BACKGROUND: No data exist evaluating the utilization and safety of outpatient thoracoscopy in children. The aim of this study was to investigate the safety of outpatient thoracoscopy and to assess parental opinions on the advantages and disadvantages of a pediatric thoracoscopy outpatient setting. METHODS: A retrospective review of data from patients treated by thoracoscopy for congenital pulmonary malformation between 2013 and 2016 was performed. Study focused on patients who underwent outpatient thoracoscopy. All were placed in a flank position and underwent a three-port (5-mm optical trocar and two 5-mm trocars) thoracoscopy. Insufflation pressure required was 5 mmHg with bilateral lung ventilation. Pain control was provided with multimodal postoperative analgesia and the use of paravertebral block for regional analgesia. No drain was inserted. Outcomes of interest included 30-day overall morbidity, readmission, reoperation, and parental opinions through a phone call questionnaire. RESULTS: A total of 37 thoracoscopies were identified; 11 (30%) with a median age of 5.3 months (4.2-12.3) were performed as an outpatient procedure (10 sequestration, 1 bronchogenic cyst). Median operating time was 51 minutes (34-87). No conversion and no transfusion occurred. No complications occurred (no morbidity, no readmission, and no reoperation). According to parents' view the outpatient setting has no disadvantages. CONCLUSION: This first analysis of a small monocentric dataset demonstrates that pediatric patients can safely undergo thoracoscopy, an outpatient procedure, with a high rate of parental satisfaction.

Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management.

Minimally invasive surgery during abdominal, thoracic and urological procedures has become the standard management of many surgical interventions in adults. Recent development of smaller devices has allowed the management of many paediatric surgeries using these minimally invasive techniques. However, the lack of knowledge of (a) adequate management of haemodynamic and respiratory alterations occurring during those procedures and (b) postoperative advantages of these techniques over open surgeries, still impairs their development. The current review aimed to clarify mechanisms of those haemodynamic and respiratory alterations, propose easy rules in order to overcome them and shed the light on potential postoperative advantages of minimally invasive surgery in paediatrics.

Fast track pediatric thoracic surgery: Toward day-case surgery?

PURPOSE: Thoracoscopic lung resection for congenital pulmonary airway malformation (CPAM) is a safe technique for children. Our purpose was to evaluate the feasibility of a fast-track protocol in such cases. METHODS: From September 2007 to May 2016, 101 patients underwent a thoracoscopic pulmonary resection of which 83 for CPAM (lobectomy, wedge resection or sequestrectomy). We retrospectively reviewed the characteristics of surgical procedure, postoperative management and complications through three time periods (September 2007-December 2009: n=14, January 2010-March 2013: n=30, April 2013-May 2016: n=39) corresponding to management protocols modifications introducing fast-track pathways. RESULTS: Through the 3 time periods, median postoperative hospital stay decreases (4, 3, 2days successively, P=0.02). In the third time period, 4 patients underwent surgery in day-case surgery. The overall and surgical complication rates, mainly related to air leakage, remain stable through the 3 time periods (14%, P=0.41 and 10%, P=0.52 respectively). Among the 13 patients without postoperative pleural drainage, one required secondary drainage after a partial resection of an emphysema. CONCLUSION: Fast-track protocol for children undergoing uncomplicated thoracic surgery for CPAM seems feasible without extra morbidity. Selected patient undergoing thoracoscopic resection of the lung may benefit from the absence of pleural drainage and can be operated on in day-case surgery. LEVEL OF EVIDENCE: Level III.

Muscle relaxation for tracheal intubation during paediatric anaesthesia: A meta-analysis and trial sequential analysis.

BACKGROUND: Muscle relaxation for tracheal intubation during paediatric anaesthesia remains a subject of debate. OBJECTIVE: The aim of the current meta-analysis was to investigate the effect of muscle relaxants (MR) compared with opioids on intubation conditions in children. DESIGN: Meta-analysis of randomised controlled studies. DATA SOURCES: Exhaustive literature analysis. ELIGIBILITY CRITERIA: Clinical trials, with no high-risk bias, that examined the effect of MR in comparison with opioids on intubation conditions (excellent: primary outcome, acceptable: secondary outcome) in children were included. RESULTS: Excellent intubation conditions were not significantly different in their occurrence between children receiving MR or opioids, risk ratio [95% Confidence Interval]  = 1.17 [0.96, 1.43], I = 36%, number of studies = 5, number of patients = 226. However, trial sequential analysis indicated the lack of power of this result and the need for more trials to provide certainty for this outcome (81 patients needed in future trials). Acceptable intubation conditions were more frequent when administering MR, risk ratio = 1.25 [1.06, 1.47], I = 70%, number of studies = 6, number of patients = 362. This effect was confirmed using the trial sequential analysis. Grading of Recommendations Assessment, Development and Evaluation analysis found a low and moderate quality of evidences for excellent and acceptable intubation conditions, respectively. CONCLUSION: The current meta-analysis shows that the use of MR during tracheal intubation might improve the quality of intubation conditions. Further studies, including at least 81 children, are required to confirm this and determine the impact of MR on complications related to intubation.

Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies.

INTRODUCTION: Dexmedetomidine (Dex) has sedative, analgesic, and anesthetic-sparing effects. This meta-analysis examines demonstrated intraoperative and postoperative effects of intraoperative Dex administration during pediatric surgery. METHODS: A search for randomized placebo-controlled trials was conducted to identify clinical trials examining intraoperative Dex use in children, infants, and neonates. Primary outcome was postoperative opioid consumption; secondary outcomes were: postoperative pain intensity and postoperative nausea and vomiting (PONV). RESULTS: Fourteen randomized controlled trials performed during painful procedures were analyzed. Intraoperative Dex administration was associated with significantly reduced postoperative opioid consumption in the postanesthesia care unit [PACU; risk ratio (RR) = 0.31 (0.17, 0.59), I (2) = 76%, p < 0.0001 and cumulative z score using trial sequential analysis], decreased pain intensity in PACU [standardized mean difference (SMD) = -1.18 (-1.88, -0.48), I (2) = 91%, p < 0.0001] but had no effect upon PONV incidence [RR = 0.67 (0.41, 1.08), I (2) = 0%, p = 0.48]. Subgroup analyses found administering Dex during adenotonsillectomy and using a bolus <0.5 µg/kg (irrespective to the use of a continuous administration) without effects on studies outcomes. Heterogeneity was high among results and a high suspicion of publication bias was present for all analyzed outcomes. CONCLUSIONS: This meta-analysis shows that intraoperative Dex administration in children reduces postoperative opioids consumption and postoperative pain in PACU. According to our results, optimal bolus dose was found to be ≥0.5 µg/kg. Future studies have to explore this particular point and the postoperative analgesic effects of Dex during longer periods.