Leonardo Bussolin - Academia.edu (original) (raw)
Papers by Leonardo Bussolin
Neonatal Surgery, 2019
Central nervous system (CNS) tumors are the most common solid tumors in childhood. Those tumors a... more Central nervous system (CNS) tumors are the most common solid tumors in childhood. Those tumors are a heterogeneous entity because of their different histologies, behavior, incidence, and therapies that can even be different in different ages of life and, within the childhood, can be different at different stages. A peculiar group are tumors developed before 3 year of age, because of the complex interaction of the disease with the developing brain and because of severe limitation on the treatment with implications both on the side of the surgery and on the medical treatment. Such kind of observation is even more evident if we consider patients younger than 12 months of age. Within this group are included the so-called congenital tumors, considered as the tumors diagnosed in patients younger than 2 months of age, but this definition is commonly extended up to 2 years of age. We will expose a review of the literature and the experience of our Center of Neurosurgery and Neuro-oncology about CNS tumors diagnosed in children younger than 12 months of age, with particular interest in epidemiology and risk factors, clinical presentation, histology, surgical and medical treatment, and outcome. Particular attention is given to neurosurgical difficulties in this age group.
Additional file 1. List of recommendations.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2021
INTRODUCTION There is evidence in the literature for high-fidelity in situ simulation training pr... more INTRODUCTION There is evidence in the literature for high-fidelity in situ simulation training programs being an effective modality for physicians training. This quality initiative focused on implementation of the procedural sedation and analgesia (PSA) in our pediatric emergency department (PED). The primary outcomes of this study were to evaluate the impact of blended in situ simulation training (BST) program on PSA for closed forearm fracture reduction in the PED and to assess its cost-effectiveness. The secondary outcomes were to estimate this change on PSA's clinical efficacy and safety. METHODS Between 2014 and 2018, a single-center, quasi-experimental, uncontrolled before and after study on forearm fracture reduction management was conducted. To assess the impact of our BST-PSA course, both historical control and prospective analyses were performed. Statistical significance was based on Fisher exact test or Pearson χ2 test. RESULTS Eight hundred eighty-five children met inclusion criteria. A significant difference in the number of PSAs performed in the PED, before and after BST, was found (37% vs. 85.3%, P < 0.001). Furthermore, a reduction in the number of hospitalizations for closed fracture reduction was measured (68.2% vs. 31.8%, P < 0.001). The overall cost savings from the BST-enabled increase in PSAs carried out in the PED was €370,714 ($440,838) with a return on investment of 64:1. No significant increase of PSA-related adverse events was found, and no serious adverse events occurred. CONCLUSIONS Findings provide evidence of the benefits of implementing BST to enable PSA use in the PED, with an improved patient flow and significant cost savings from avoiding unnecessary hospitalizations.
Minerva Anestesiologica, 2021
Italian Journal of Pediatrics, 2020
Background In Italy, as in many European countries, Pediatric Emergency Medicine is not formally ... more Background In Italy, as in many European countries, Pediatric Emergency Medicine is not formally recognized as a pediatric subspecialty, hindering nation-wide adoption of standards of care, especially in the field of procedural sedation and analgesia (PSA) in the Emergency Department (ED). For this reason PSA in Italy is mostly neglected or performed very heterogeneously and by different providers, with no reference standard. We aimed to describe the procedures and results of the first multidisciplinary and multi-professional Consensus Conference in Italy on safe and effective pediatric PSA in Italian EDs. Methods The preparation, organization and conduct of the Consensus Conference, held in Florence in 2017, followed the recommended National methodological standards. Professionals from different specialties across the country were invited to participate. Results Overall 86 recommendations covering 8 themes (pre-sedation evaluation, pharmacologic agents, monitoring, equipment and di...
Urologia Journal, 2020
Introduction: Renal trauma is a relevant cause of morbidity in children older than 1 year. Most p... more Introduction: Renal trauma is a relevant cause of morbidity in children older than 1 year. Most patients are currently managed conservatively, even in case of high-grade traumas; nevertheless, harmful complications may occur even in hemodynamically stable patients. We present a case of grade IV blunt renal trauma complicated by post-traumatic pseudoaneurysm. Case description: A 10-year-old girl was referred to our institution for grade IV trauma of the right kidney. During observation she had persistent hematuria that caused anemia. A second contrast-enhanced computed tomography scan revealed a posttraumatic pseudoaneurysm that was successfully treated by angiographic embolization. Conclusions: Although extremely rare after blunt renal trauma, post-traumatic renal pseudoaneurysm may cause severe blood loss and anemia, and angioembolization is therefore indicated. This condition should be suspected and move physicians to investigate further.
Child's Nervous System, 2019
Purpose We hypothesized that children on chronic intrathecal baclofen therapy (ITB) may require l... more Purpose We hypothesized that children on chronic intrathecal baclofen therapy (ITB) may require less analgesics for postoperative pain control and are at higher risk of developing opioid-induced respiratory depression postoperatively. The aims of this study are to review children on chronic intrathecal baclofen therapy receiving opioids after major surgery and to determine the incidence complications in this population. Method We conducted a retrospective cohort study comparing 13 children on ITB, who underwent posterior spinal fusion surgery, to 17 children with spina bifida that received the same surgery. Results On postoperative day 0 (POD 0), four children (40%) had respiratory depression in the baclofen group compared to none in the control group. Desaturation was significantly more frequent in children in the ITB group compared to those of the control group on POD 0; oversedation was recorded in 8 (80%) children in the baclofen group vs. 3 (17.6%) in the control group. Desaturation, respiratory depression, and oversedation were significantly more frequent on POD 0 in children in the baclofen group compared with children in the control group. Conclusions The findings of the current study suggest that children on chronic intrathecal baclofen therapy require lesser amounts of opioids for postoperative pain control and are at a greater risk of developing postoperative respiratory depression and excessive sedation compared to patients without baclofen therapy. Baclofen. Oppioid. Children. Respiratory depression * Flavio Giordano
Anaesthesia and Intensive Care, 2010
The aim of the study was to assess the changes in plasma lignocaine concentrations over time when... more The aim of the study was to assess the changes in plasma lignocaine concentrations over time when the tumescent solution is injected into subcutaneous tissue of children undergoing surgical treatment of burns. Sixteen consecutive children with burns were studied using a prospective study design. After induction of general anesthesia, tumescent lignocaine solution 0.1% with adrenaline in nine patients (adrenaline group) for the treatment of postburn sequelae, or without adrenaline in seven patients (no-adrenaline group) for the treatment of acute burns, was injected into the subcutaneous tissue of burned and donor areas. The maximum dose of lignocaine was 7 mg/kg. Blood samples were collected before the start of the injection as well as at 5, 10, 20, 30, 45, 60, 90 minutes and 2, 4, 8, 12, 24 hours after the infiltration was completed. The course of lignocaine plasma levels was chaotic in the adrenaline group and biphasic during the first hour in the no-adrenaline group. The maximum plasma concentration of lignocaine was 2.09 µg/ml in the adrenaline group and 1.98 µg/ml in the no-adrenaline group. No adverse reactions were noted. Tumescent injection in burned children resulted in lignocaine plasma concentrations that were always lower than the often quoted value of 5 µg/ml, considered to be the toxic plasma threshold in adults. These data lend support to the use of lignocaine using the tumescent technique in burned paediatric patients.
Acta ophthalmologica, Jan 8, 2017
To describe the retinal structure of a group of patients affected by methylmalonic aciduria with ... more To describe the retinal structure of a group of patients affected by methylmalonic aciduria with homocystinuria cblC type, caused by mutations in the MMACHC gene, using spectral domain optical coherence tomography (SD-OCT). Young patients (n = 11, age 0-74 months) with cblC disease, detected by newborn screening or clinically diagnosed within 40 days of life, underwent molecular analysis and complete ophthalmic examination, including fundus photography and SD-OCT. In one case, we also performed fluorescein angiography (FA) and standard electroretinography (ERG). Molecular analysis of the MMACHC gene fully confirmed cblC disease in nine of 11 patients. Two patients harboured only a single heterozygous pathogenic MMACHC mutation and large unbalanced rearrangements were excluded by array-CGH analysis in both. All patients except two showed a bilateral maculopathy. In general, retinal changes were first observed before one year of age and progressed to a well-established maculopathy. Me...
The Lancet. Respiratory medicine, May 28, 2017
Little is known about the incidence of severe critical events in children undergoing general anae... more Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered w...
Anesthesia, Intensive Care and Pain in Neonates and Children, 2016
Trauma injury remains to be a major cause of death and severe disability in children from 1 to 14... more Trauma injury remains to be a major cause of death and severe disability in children from 1 to 14 years old.
Pediatric Emergency Care, 2003
Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in ... more Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. Emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma.
Pediatric Anesthesia, 2002
The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suit... more The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suitable for anaesthetized adult patients undergoing either spontaneous or mechanical ventilation. There are few reports on the use of the COPA in children. In this study, the authors assessed the COPA in paediatric patients undergoing minor surgery. The same anaesthesiologist inserted the COPA in 40 consecutive paediatric patients, ASA I and II, aged 1.8-15.3 years. (7.4 +/- 3.9), after induction of anaesthesia with N2O/O2/sevoflurane. COPA size was chosen by measuring the distal tip of the device at the angle of the jaw with the COPA perpendicular to the patient's bed. The proper positioning of the COPA was assessed by observing thoracoabdominal movements, regular capnograph trace, the reservoir bag movements and SpO2 > 94% with a fraction of inspired oxygen of 0.5. Anaesthesia was maintained with 1 MAC halothane, sevoflurane, or isoflurane in N2O/O2 (50%) and the patients were spontaneously breathing. The stability of the COPA following changes in head, neck and body position was tested. We recorded the duration time for COPA insertion, the side-effects of placement of the COPA and during the intraoperative period, the number of attempts, the type of manipulation in order to provide an effective airway and postoperative symptoms, such as the presence of blood on the device, sore throat, neckache, jaw pain and PONV. Successful COPA insertion at the first attempt was 90% and at the second attempt in the remaining 10%. The most frequent airway manipulations were head tilt in 27.5% (obtained by a pillow under shoulders) and chin lift in 5%. No complications both at COPA placement nor during the intraoperative period were observed. On the basis of weight and age, the COPA size was no. 8 in 50%, no. 9 in 30%, no. 10 in 12.5%, and no. 11 in 7.5%. The COPA demonstrated stability after changes in head, neck and body position. Postoperative complications were the presence of blood stains in one case and PONV in six cases (15%). The COPA is an extratracheal airway device suitable in paediatric patients undergoing general anaesthesia with spontaneous ventilation for minor surgery and other painful procedures. This study shows that for paediatric patients: (i) complications seem to be rare; (ii) the COPA allows hands free anaesthesia; (iii) specific indication for the COPA could be obese patients with a small mouth; and (iv) COPA sizing can be easily established by the weight or age of the patients.
Pediatric Anesthesia, 2014
Conclusion: Children receiving multimodal analgesia experience little or no pain after major cran... more Conclusion: Children receiving multimodal analgesia experience little or no pain after major craniotomy. Longer surgical procedures correlate with an increased risk of having postoperative pain.
Pediatric Anesthesia, 2010
Within the last 3 years, there have been published several case reports and series regarding the ... more Within the last 3 years, there have been published several case reports and series regarding the successful application of new intubating devices in the pediatric setting of difficult airway management. Common for these devices are that they all give excellent views of the glottic opening. The Storz Videolaryngoscope, the Glidescope and the TruView are attractive devices in difficult airways as they occupy less space in the mouth, when compared to the Airtraq. However, despite this advantage it may still be technically difficult to direct the endotracheal tube into vision and pass it through the glottic opening. To improve the chance of successful intubation, it is necessary to use a malleable intubation stylet placed in the endotracheal tube during insertion. This technique is however not without risks in the form of iatrogenic airway injury, and accidental perforation of the palatopharyngeal arch has been reported with the use of the Glidescope (2). The Airtraq has the potential advantage, compared to the videolaryngoscopes, of having the endotracheal tube mounted in a guide channel on the side of the device thereby avoiding the potential adverse events associated with tube advancement when using other devices. The trade off however is that the Airtraq is more bulky and therefore more difficult to use it in children with limited mouth opening and narrow airway anatomy as in Pierre Robin children. Despite the good view of glottis obtained with the Airtraq, it needs to be remembered that this is no guarantee for successful intubation (as illustrated in the two cases presented here). In our practice, we have used the Airtraq successfully on several occasions in adults and older children with difficult airways as well as in infants with normal airways. However, when there is limited space in the oral cavity, the Airtraq may not be the best choice and the use of a videolaryngoscope or a fiberscope probably should be the preferred method of choice. R O L F J . H O L M-K N U D S E N* J O N A T H A N W H I T E† *Department of Anaesthesia 4231 †Department of Intensive Care 4131 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (email: rhk@rh.dk) References
The Journal of Trauma: Injury, Infection, and Critical Care, 2011
Trauma is the leading cause of death and disability in Italy among patients aged between 1 year a... more Trauma is the leading cause of death and disability in Italy among patients aged between 1 year and 19 years. To transform its fragmented regional pediatric trauma system to a more organized and efficient spoke and hub model, Tuscany has developed a partnership with physicians from the United States to facilitate the process and to implement a series of strategic system changes to create the first pediatric trauma center in Italy. After establishing a multidisciplinary and institutional task force, a rigorous needs assessment was conducted to evaluate resources and develop a strategic timeline with specific project goals. Once an intensive educational program was completed, a series of system changes were made in Tuscany to create a full-service pediatric trauma center. Once accomplished, regional changes were enacted to divert the most severely injured children to the new center. In &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3 years, a full-service pediatric trauma center was developed and ingratiated into the adult trauma system. All these changes were achieved through relentless administrative support, creation of a strong sense of urgency, and empowerment of innovators and early adopters to effect change. Through a comprehensive process including early extensive system analysis leading to educational interventions and organizational changes, the Anna Meyer Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Hospital has developed the first Italian pediatric trauma center.
Journal of Pediatric Urology, 2008
To monitor the effects of regular bladder washout regime and use of acetylcysteine in te preventi... more To monitor the effects of regular bladder washout regime and use of acetylcysteine in te prevention of stones and frequency of symptomatic urine infections in children post bladder augmentation.
Neonatal Surgery, 2019
Central nervous system (CNS) tumors are the most common solid tumors in childhood. Those tumors a... more Central nervous system (CNS) tumors are the most common solid tumors in childhood. Those tumors are a heterogeneous entity because of their different histologies, behavior, incidence, and therapies that can even be different in different ages of life and, within the childhood, can be different at different stages. A peculiar group are tumors developed before 3 year of age, because of the complex interaction of the disease with the developing brain and because of severe limitation on the treatment with implications both on the side of the surgery and on the medical treatment. Such kind of observation is even more evident if we consider patients younger than 12 months of age. Within this group are included the so-called congenital tumors, considered as the tumors diagnosed in patients younger than 2 months of age, but this definition is commonly extended up to 2 years of age. We will expose a review of the literature and the experience of our Center of Neurosurgery and Neuro-oncology about CNS tumors diagnosed in children younger than 12 months of age, with particular interest in epidemiology and risk factors, clinical presentation, histology, surgical and medical treatment, and outcome. Particular attention is given to neurosurgical difficulties in this age group.
Additional file 1. List of recommendations.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2021
INTRODUCTION There is evidence in the literature for high-fidelity in situ simulation training pr... more INTRODUCTION There is evidence in the literature for high-fidelity in situ simulation training programs being an effective modality for physicians training. This quality initiative focused on implementation of the procedural sedation and analgesia (PSA) in our pediatric emergency department (PED). The primary outcomes of this study were to evaluate the impact of blended in situ simulation training (BST) program on PSA for closed forearm fracture reduction in the PED and to assess its cost-effectiveness. The secondary outcomes were to estimate this change on PSA's clinical efficacy and safety. METHODS Between 2014 and 2018, a single-center, quasi-experimental, uncontrolled before and after study on forearm fracture reduction management was conducted. To assess the impact of our BST-PSA course, both historical control and prospective analyses were performed. Statistical significance was based on Fisher exact test or Pearson χ2 test. RESULTS Eight hundred eighty-five children met inclusion criteria. A significant difference in the number of PSAs performed in the PED, before and after BST, was found (37% vs. 85.3%, P < 0.001). Furthermore, a reduction in the number of hospitalizations for closed fracture reduction was measured (68.2% vs. 31.8%, P < 0.001). The overall cost savings from the BST-enabled increase in PSAs carried out in the PED was €370,714 ($440,838) with a return on investment of 64:1. No significant increase of PSA-related adverse events was found, and no serious adverse events occurred. CONCLUSIONS Findings provide evidence of the benefits of implementing BST to enable PSA use in the PED, with an improved patient flow and significant cost savings from avoiding unnecessary hospitalizations.
Minerva Anestesiologica, 2021
Italian Journal of Pediatrics, 2020
Background In Italy, as in many European countries, Pediatric Emergency Medicine is not formally ... more Background In Italy, as in many European countries, Pediatric Emergency Medicine is not formally recognized as a pediatric subspecialty, hindering nation-wide adoption of standards of care, especially in the field of procedural sedation and analgesia (PSA) in the Emergency Department (ED). For this reason PSA in Italy is mostly neglected or performed very heterogeneously and by different providers, with no reference standard. We aimed to describe the procedures and results of the first multidisciplinary and multi-professional Consensus Conference in Italy on safe and effective pediatric PSA in Italian EDs. Methods The preparation, organization and conduct of the Consensus Conference, held in Florence in 2017, followed the recommended National methodological standards. Professionals from different specialties across the country were invited to participate. Results Overall 86 recommendations covering 8 themes (pre-sedation evaluation, pharmacologic agents, monitoring, equipment and di...
Urologia Journal, 2020
Introduction: Renal trauma is a relevant cause of morbidity in children older than 1 year. Most p... more Introduction: Renal trauma is a relevant cause of morbidity in children older than 1 year. Most patients are currently managed conservatively, even in case of high-grade traumas; nevertheless, harmful complications may occur even in hemodynamically stable patients. We present a case of grade IV blunt renal trauma complicated by post-traumatic pseudoaneurysm. Case description: A 10-year-old girl was referred to our institution for grade IV trauma of the right kidney. During observation she had persistent hematuria that caused anemia. A second contrast-enhanced computed tomography scan revealed a posttraumatic pseudoaneurysm that was successfully treated by angiographic embolization. Conclusions: Although extremely rare after blunt renal trauma, post-traumatic renal pseudoaneurysm may cause severe blood loss and anemia, and angioembolization is therefore indicated. This condition should be suspected and move physicians to investigate further.
Child's Nervous System, 2019
Purpose We hypothesized that children on chronic intrathecal baclofen therapy (ITB) may require l... more Purpose We hypothesized that children on chronic intrathecal baclofen therapy (ITB) may require less analgesics for postoperative pain control and are at higher risk of developing opioid-induced respiratory depression postoperatively. The aims of this study are to review children on chronic intrathecal baclofen therapy receiving opioids after major surgery and to determine the incidence complications in this population. Method We conducted a retrospective cohort study comparing 13 children on ITB, who underwent posterior spinal fusion surgery, to 17 children with spina bifida that received the same surgery. Results On postoperative day 0 (POD 0), four children (40%) had respiratory depression in the baclofen group compared to none in the control group. Desaturation was significantly more frequent in children in the ITB group compared to those of the control group on POD 0; oversedation was recorded in 8 (80%) children in the baclofen group vs. 3 (17.6%) in the control group. Desaturation, respiratory depression, and oversedation were significantly more frequent on POD 0 in children in the baclofen group compared with children in the control group. Conclusions The findings of the current study suggest that children on chronic intrathecal baclofen therapy require lesser amounts of opioids for postoperative pain control and are at a greater risk of developing postoperative respiratory depression and excessive sedation compared to patients without baclofen therapy. Baclofen. Oppioid. Children. Respiratory depression * Flavio Giordano
Anaesthesia and Intensive Care, 2010
The aim of the study was to assess the changes in plasma lignocaine concentrations over time when... more The aim of the study was to assess the changes in plasma lignocaine concentrations over time when the tumescent solution is injected into subcutaneous tissue of children undergoing surgical treatment of burns. Sixteen consecutive children with burns were studied using a prospective study design. After induction of general anesthesia, tumescent lignocaine solution 0.1% with adrenaline in nine patients (adrenaline group) for the treatment of postburn sequelae, or without adrenaline in seven patients (no-adrenaline group) for the treatment of acute burns, was injected into the subcutaneous tissue of burned and donor areas. The maximum dose of lignocaine was 7 mg/kg. Blood samples were collected before the start of the injection as well as at 5, 10, 20, 30, 45, 60, 90 minutes and 2, 4, 8, 12, 24 hours after the infiltration was completed. The course of lignocaine plasma levels was chaotic in the adrenaline group and biphasic during the first hour in the no-adrenaline group. The maximum plasma concentration of lignocaine was 2.09 µg/ml in the adrenaline group and 1.98 µg/ml in the no-adrenaline group. No adverse reactions were noted. Tumescent injection in burned children resulted in lignocaine plasma concentrations that were always lower than the often quoted value of 5 µg/ml, considered to be the toxic plasma threshold in adults. These data lend support to the use of lignocaine using the tumescent technique in burned paediatric patients.
Acta ophthalmologica, Jan 8, 2017
To describe the retinal structure of a group of patients affected by methylmalonic aciduria with ... more To describe the retinal structure of a group of patients affected by methylmalonic aciduria with homocystinuria cblC type, caused by mutations in the MMACHC gene, using spectral domain optical coherence tomography (SD-OCT). Young patients (n = 11, age 0-74 months) with cblC disease, detected by newborn screening or clinically diagnosed within 40 days of life, underwent molecular analysis and complete ophthalmic examination, including fundus photography and SD-OCT. In one case, we also performed fluorescein angiography (FA) and standard electroretinography (ERG). Molecular analysis of the MMACHC gene fully confirmed cblC disease in nine of 11 patients. Two patients harboured only a single heterozygous pathogenic MMACHC mutation and large unbalanced rearrangements were excluded by array-CGH analysis in both. All patients except two showed a bilateral maculopathy. In general, retinal changes were first observed before one year of age and progressed to a well-established maculopathy. Me...
The Lancet. Respiratory medicine, May 28, 2017
Little is known about the incidence of severe critical events in children undergoing general anae... more Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered w...
Anesthesia, Intensive Care and Pain in Neonates and Children, 2016
Trauma injury remains to be a major cause of death and severe disability in children from 1 to 14... more Trauma injury remains to be a major cause of death and severe disability in children from 1 to 14 years old.
Pediatric Emergency Care, 2003
Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in ... more Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. Emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma.
Pediatric Anesthesia, 2002
The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suit... more The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suitable for anaesthetized adult patients undergoing either spontaneous or mechanical ventilation. There are few reports on the use of the COPA in children. In this study, the authors assessed the COPA in paediatric patients undergoing minor surgery. The same anaesthesiologist inserted the COPA in 40 consecutive paediatric patients, ASA I and II, aged 1.8-15.3 years. (7.4 +/- 3.9), after induction of anaesthesia with N2O/O2/sevoflurane. COPA size was chosen by measuring the distal tip of the device at the angle of the jaw with the COPA perpendicular to the patient's bed. The proper positioning of the COPA was assessed by observing thoracoabdominal movements, regular capnograph trace, the reservoir bag movements and SpO2 > 94% with a fraction of inspired oxygen of 0.5. Anaesthesia was maintained with 1 MAC halothane, sevoflurane, or isoflurane in N2O/O2 (50%) and the patients were spontaneously breathing. The stability of the COPA following changes in head, neck and body position was tested. We recorded the duration time for COPA insertion, the side-effects of placement of the COPA and during the intraoperative period, the number of attempts, the type of manipulation in order to provide an effective airway and postoperative symptoms, such as the presence of blood on the device, sore throat, neckache, jaw pain and PONV. Successful COPA insertion at the first attempt was 90% and at the second attempt in the remaining 10%. The most frequent airway manipulations were head tilt in 27.5% (obtained by a pillow under shoulders) and chin lift in 5%. No complications both at COPA placement nor during the intraoperative period were observed. On the basis of weight and age, the COPA size was no. 8 in 50%, no. 9 in 30%, no. 10 in 12.5%, and no. 11 in 7.5%. The COPA demonstrated stability after changes in head, neck and body position. Postoperative complications were the presence of blood stains in one case and PONV in six cases (15%). The COPA is an extratracheal airway device suitable in paediatric patients undergoing general anaesthesia with spontaneous ventilation for minor surgery and other painful procedures. This study shows that for paediatric patients: (i) complications seem to be rare; (ii) the COPA allows hands free anaesthesia; (iii) specific indication for the COPA could be obese patients with a small mouth; and (iv) COPA sizing can be easily established by the weight or age of the patients.
Pediatric Anesthesia, 2014
Conclusion: Children receiving multimodal analgesia experience little or no pain after major cran... more Conclusion: Children receiving multimodal analgesia experience little or no pain after major craniotomy. Longer surgical procedures correlate with an increased risk of having postoperative pain.
Pediatric Anesthesia, 2010
Within the last 3 years, there have been published several case reports and series regarding the ... more Within the last 3 years, there have been published several case reports and series regarding the successful application of new intubating devices in the pediatric setting of difficult airway management. Common for these devices are that they all give excellent views of the glottic opening. The Storz Videolaryngoscope, the Glidescope and the TruView are attractive devices in difficult airways as they occupy less space in the mouth, when compared to the Airtraq. However, despite this advantage it may still be technically difficult to direct the endotracheal tube into vision and pass it through the glottic opening. To improve the chance of successful intubation, it is necessary to use a malleable intubation stylet placed in the endotracheal tube during insertion. This technique is however not without risks in the form of iatrogenic airway injury, and accidental perforation of the palatopharyngeal arch has been reported with the use of the Glidescope (2). The Airtraq has the potential advantage, compared to the videolaryngoscopes, of having the endotracheal tube mounted in a guide channel on the side of the device thereby avoiding the potential adverse events associated with tube advancement when using other devices. The trade off however is that the Airtraq is more bulky and therefore more difficult to use it in children with limited mouth opening and narrow airway anatomy as in Pierre Robin children. Despite the good view of glottis obtained with the Airtraq, it needs to be remembered that this is no guarantee for successful intubation (as illustrated in the two cases presented here). In our practice, we have used the Airtraq successfully on several occasions in adults and older children with difficult airways as well as in infants with normal airways. However, when there is limited space in the oral cavity, the Airtraq may not be the best choice and the use of a videolaryngoscope or a fiberscope probably should be the preferred method of choice. R O L F J . H O L M-K N U D S E N* J O N A T H A N W H I T E† *Department of Anaesthesia 4231 †Department of Intensive Care 4131 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (email: rhk@rh.dk) References
The Journal of Trauma: Injury, Infection, and Critical Care, 2011
Trauma is the leading cause of death and disability in Italy among patients aged between 1 year a... more Trauma is the leading cause of death and disability in Italy among patients aged between 1 year and 19 years. To transform its fragmented regional pediatric trauma system to a more organized and efficient spoke and hub model, Tuscany has developed a partnership with physicians from the United States to facilitate the process and to implement a series of strategic system changes to create the first pediatric trauma center in Italy. After establishing a multidisciplinary and institutional task force, a rigorous needs assessment was conducted to evaluate resources and develop a strategic timeline with specific project goals. Once an intensive educational program was completed, a series of system changes were made in Tuscany to create a full-service pediatric trauma center. Once accomplished, regional changes were enacted to divert the most severely injured children to the new center. In &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3 years, a full-service pediatric trauma center was developed and ingratiated into the adult trauma system. All these changes were achieved through relentless administrative support, creation of a strong sense of urgency, and empowerment of innovators and early adopters to effect change. Through a comprehensive process including early extensive system analysis leading to educational interventions and organizational changes, the Anna Meyer Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Hospital has developed the first Italian pediatric trauma center.
Journal of Pediatric Urology, 2008
To monitor the effects of regular bladder washout regime and use of acetylcysteine in te preventi... more To monitor the effects of regular bladder washout regime and use of acetylcysteine in te prevention of stones and frequency of symptomatic urine infections in children post bladder augmentation.