RSS Anesthesiology
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<channel> <title>((Anesthesiology[Journal]) AND (child[Text Word])) AND ((20250601[Date - Publication] : 3000[Date - Publication]))</title> <link>https://pubmed.ncbi.nlm.nih.gov/rss-feed/?feed_id=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&v=2.18.0.post9+e462414&utm_source=Chrome&utm_campaign=pubmed-2&ff=20251017222831&fc=20251015232334&utm_medium=rss&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh</link> <description>((Anesthesiology[Journal]) AND (child[Text Word])) AND ((20250601[Date - Publication] : 3000[Date - Publication])): Latest results from PubMed</description> <atom:link href="https://pubmed.ncbi.nlm.nih.gov/rss-feed/?feed_id=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&v=2.18.0.post9+e462414&utm_source=Chrome&utm_campaign=pubmed-2&ff=20251017222831&fc=20251015232334&utm_medium=rss&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh" rel="self"/> <docs>http://www.rssboard.org/rss-specification</docs> <generator>PubMed RSS feeds (2.18.0.post9+e462414)</generator> <language>en</language> <lastBuildDate>Sat, 18 Oct 2025 02:28:32 +0000</lastBuildDate> <pubDate>Tue, 09 Sep 2025 06:00:00 -0400</pubDate> <ttl>120</ttl> <item> <title>Effects of Dexmedetomidine-Remifentanil on Neurodevelopment of Children after Inhalation Anesthesia: A Randomized Clinical Trial</title> <link>https://pubmed.ncbi.nlm.nih.gov/40923823/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link> <description>CONCLUSIONS: The addition of dexmedetomidine and remifentanil to sevoflurane anesthesia was not associated with significant differences in neurodevelopmental outcomes at 28 to 30 months compared to sevoflurane alone.</description>
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Anesthesiology. 2025 Oct 1;143(4):827-834. doi: 10.1097/ALN.0000000000005634. Epub 2025 Sep 9.
ABSTRACT
BACKGROUND: Anesthetic exposure in young children raises concerns about neurodevelopmental safety, with preclinical evidence suggesting potential neurotoxicity of volatile anesthetics. This study aimed to assess whether the combination of dexmedetomidine and remifentanil, by reducing sevoflurane exposure, has any differential effect on neurodevelopmental outcomes in young children compared with sevoflurane alone.
METHODS: This study was a prospective, double-blind, randomized clinical trial including children younger than 2 yr undergoing nonstaged, nonrepetitive surgeries. Participants received dexmedetomidine and remifentanil as adjuncts to sevoflurane (DEX-R group) or sevoflurane alone (control group). The study assessed their neurodevelopmental status at 28 to 30 months using the Korean Leiter International Performance Scale and the Child Behavior Checklist, as predefined secondary outcomes. The primary endpoint-full-scale IQ at 5 yr of age-will be reported after completion of long-term follow-up.
RESULTS: Among 400 enrolled participants, 343 completed assessments (169 control, 176 DEX-R). There was no difference in the mean anesthesia duration between the control and DEX-R groups (77.1 min vs. 72.8 min; mean difference [95% CI], 4.4 [-3.8 to 12.6]; P = 0.293). The mean end-tidal sevoflurane concentration was significantly lower in the DEX-R group than in the control group (1.8 vol% vs. 2.6 vol%; mean difference [95% CI], -0.9 [-1.0 to -0.7] vol%; P < 0.001). The mean full-scale IQ score was 102.5 ± 11.5 in the DEX-R group and 103.6 ± 11.5 in the control group (mean difference, -1.1; 95% CI, -3.9 to 1.7; P = 0.442). No significant difference was observed in the Child Behavior Checklist total score between groups.
CONCLUSIONS: The addition of dexmedetomidine and remifentanil to sevoflurane anesthesia was not associated with significant differences in neurodevelopmental outcomes at 28 to 30 months compared to sevoflurane alone.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40923823/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40923823</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005634>10.1097/ALN.0000000000005634</a>
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<guid isPermaLink="false">pubmed:40923823</guid>
<pubDate>Tue, 09 Sep 2025 06:00:00 -0400</pubDate>
<dc:creator>Sang-Hwan Ji</dc:creator>
<dc:creator>Pyoyoon Kang</dc:creator>
<dc:creator>Sung-Ae Cho</dc:creator>
<dc:creator>Jung-Bin Park</dc:creator>
<dc:creator>Young-Eun Jang</dc:creator>
<dc:creator>Eun-Hee Kim</dc:creator>
<dc:creator>Jin-Tae Kim</dc:creator>
<dc:creator>Hee-Soo Kim</dc:creator>
<dc:creator>Hee-Jeong Jung</dc:creator>
<dc:creator>Han-Ah Jung</dc:creator>
<dc:creator>Hyung-Chul Lee</dc:creator>
<dc:creator>Ji-Hyun Lee</dc:creator>
<dc:date>2025-09-09</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Effects of Dexmedetomidine-Remifentanil on Neurodevelopment of Children after Inhalation Anesthesia: A Randomized Clinical Trial</dc:title>
<dc:identifier>pmid:40923823</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005634</dc:identifier>
</item>
<item>
<title>Core Outcome Sets for Pediatric Perioperative Research: An International Stakeholder Engagement Exercise and Consensus Report from the Pediatric Perioperative Outcomes Group</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40742630/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSIONS: The authors identified perioperative core outcome sets for four age-based pediatric populations. Researchers should include these outcomes in their studies whenever appropriate, in addition to the outcomes specific to their research question.</description>
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Anesthesiology. 2025 Nov 1;143(5):1225-1241. doi: 10.1097/ALN.0000000000005693. Epub 2025 Jul 31.
ABSTRACT
BACKGROUND: Identifying the outcomes that matter in clinical research is important, especially those that matter to patients and their parents/guardians. Consistency in outcome reporting enables meaningful assessments of interventions and facilitates comparison of results across trials. The aim of this study was to develop core outcome sets for pediatric perioperative research.
METHODS: The authors determined core outcome sets through extensive stakeholder engagement, following a stepwise process as recommended by the Core Outcome Measures in Effectiveness Trials (COMET) initiative. They surveyed patients, parents/guardians, and healthcare providers to elicit views on the importance of perioperative outcomes. These results informed a subsequent Delphi process of expert stakeholder representatives. Final core outcome sets were agreed to after virtual face-to-face meetings of the investigators.
RESULTS: A total of 1,178 total subjects were included in the international stakeholder survey: 81 patients ages 8 to 12 yr, 99 patients ages 13 to 17 yr, 587 parents/guardians, and 411 healthcare providers (128 nurses, 147 anesthesiologists, and 136 surgeons). Subjects were recruited in Australia, Canada, China, Colombia, the Netherlands, New Zealand, South Africa, Switzerland, and the United States. Sixty-seven expert stakeholders completed a two-round Delphi, including 7 patient family representatives, 9 surgeons, 7 nurses, and 44 anesthesiologists. Proposed core outcome sets were voted on and unanimously agreed to after the virtual face-to-face meetings for the following populations: neonates, infants, children ages 1 to 12 yr, and adolescents ages 13 to 17 yr. Core outcomes for all populations included cardiovascular or respiratory adverse events, pain, assessment of pain relief, and unplanned medical attention. Quality of recovery was included in all but the neonate population, while return to normal function was also included in the adolescent population.
CONCLUSIONS: The authors identified perioperative core outcome sets for four age-based pediatric populations. Researchers should include these outcomes in their studies whenever appropriate, in addition to the outcomes specific to their research question.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40742630/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40742630</a> | PMC:<a href="https://www.ncbi.nlm.nih.gov/pmc/PMC12513037/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">PMC12513037</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005693>10.1097/ALN.0000000000005693</a>
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<guid isPermaLink="false">pubmed:40742630</guid>
<pubDate>Thu, 31 Jul 2025 06:00:00 -0400</pubDate>
<dc:creator>Paul A Stricker</dc:creator>
<dc:creator>Laszlo Vutskits</dc:creator>
<dc:creator>Jurgen C de Graaff</dc:creator>
<dc:creator>Britta S von Ungern-Sternberg</dc:creator>
<dc:creator>Susan M Goobie</dc:creator>
<dc:creator>Yun-Xia Zuo</dc:creator>
<dc:creator>Tania A Ramos</dc:creator>
<dc:creator>Heidi M Meyer</dc:creator>
<dc:creator>Elsa M Taylor</dc:creator>
<dc:creator>Simon D Whyte</dc:creator>
<dc:creator>Claudia C Malic</dc:creator>
<dc:creator>Piedad C Echeverry</dc:creator>
<dc:creator>Wallis T Muhly</dc:creator>
<dc:creator>De-Ying Xie</dc:creator>
<dc:creator>Suellen M Walker</dc:creator>
<dc:creator>Cyrus Razavi</dc:creator>
<dc:creator>Alexandra M Torborg</dc:creator>
<dc:creator>Joseph P Cravero</dc:creator>
<dc:creator>C Dean Kurth</dc:creator>
<dc:creator>Ellen Rawlinson</dc:creator>
<dc:creator>Lei Yang</dc:creator>
<dc:creator>Ting Xu</dc:creator>
<dc:creator>M Ruth Graham</dc:creator>
<dc:creator>Rob Seal</dc:creator>
<dc:creator>Aine Sommerfield</dc:creator>
<dc:creator>Andrew J Davidson</dc:creator>
<dc:date>2025-07-31</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Core Outcome Sets for Pediatric Perioperative Research: An International Stakeholder Engagement Exercise and Consensus Report from the Pediatric Perioperative Outcomes Group</dc:title>
<dc:identifier>pmid:40742630</dc:identifier>
<dc:identifier>pmc:PMC12513037</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005693</dc:identifier>
</item>
<item>
<title>Adverse Events Associated with Airway Management in Pediatric Anesthesia: A Prospective, Multicenter, Observational Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) Study</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40622860/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSION: s: The Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) study demonstrated adverse event and desaturation incidences and the impact of clinically relevant risk factors during airway-securing procedures in Asian children. This study can help anesthesiologists to identify high-risk children and create a safe airway-securing strategy.</description>
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Anesthesiology. 2025 Oct 1;143(4):835-850. doi: 10.1097/ALN.0000000000005646. Epub 2025 Jul 7.
ABSTRACT
BACKGROUND: The incidence of adverse events and desaturation during airway-securing procedures (a sequence from preoxygenation to completion of tracheal intubation or supraglottic airway placement) under general anesthesia in children remains underexplored. Thus, this study investigated the incidence of adverse and desaturation events and associated risk factors.
METHODS: This was a prospective, multicenter, observational study conducted between June 2022 and January 2024 in 10 tertiary care (6 pediatric and 4 university [mixed adult-pediatric]) hospitals in Japan. A standardized data collection system was applied through the recruited institutions to collect 95% or more of cases. The primary and secondary outcomes were adverse events and a 10% or greater drop in oxygen saturation (desaturation) associated with airway-securing procedures.
RESULTS: There were 17,007 airway management procedures in 16,695 children (mean ± SD age, 6.3 ± 4.8 yr). Any adverse events occurred in 346 of 17,007 (2.0%; 95% CI, 1.8 to 2.3) children, including 189 of 17,007 (1.1%; 0.96 to 1.3) respiratory adverse events. Desaturation occurred during 395 of 17,007 (2.3%; 2.1 to 2.6) procedures, with 66 of 308 (21.4%; 17.0 to 26.4) in neonates and 210 of 2,298 (9.1%; 8.0 to 10.4) in infants. Multilevel regression analysis showed younger age (adjusted odds ratio, 0.92; 95% CI, 0.90 to 0.95; P < 0.001), airway management in radiation diagnostic/therapy rooms (5.7, 1.64 to 19.9; P = 0.006), airway sensitivity (1.46, 1.09 to 1.94; P = 0.010), craniocervical surgery (1.41, 1.09 to 1.83; P = 0.009), and presence of one anatomical difficult airway feature (1.74, 1.02 to 2.95; P = 0.042) versus two or more anatomic difficult airway features (2.82, 1.21 to 6.6; P = 0.017) as risk factors of any adverse events. Supraglottic airway device usage at the first attempt (0.42, 0.288 to 0.62; P < 0.001) and muscle relaxant administration (0.62, 0.43 to 0.89; P = 0.009) showed beneficial effects.
CONCLUSION: s: The Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) study demonstrated adverse event and desaturation incidences and the impact of clinically relevant risk factors during airway-securing procedures in Asian children. This study can help anesthesiologists to identify high-risk children and create a safe airway-securing strategy.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40622860/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40622860</a> | PMC:<a href="https://www.ncbi.nlm.nih.gov/pmc/PMC12416892/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">PMC12416892</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005646>10.1097/ALN.0000000000005646</a>
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<guid isPermaLink="false">pubmed:40622860</guid>
<pubDate>Mon, 07 Jul 2025 06:00:00 -0400</pubDate>
<dc:creator>Taiki Kojima</dc:creator>
<dc:creator>Yusuke Yamauchi</dc:creator>
<dc:creator>Fumio Watanabe</dc:creator>
<dc:creator>Shogo Ichiyanagi</dc:creator>
<dc:creator>Yasuma Kobayashi</dc:creator>
<dc:creator>Yu Kaiho</dc:creator>
<dc:creator>Hiroaki Toyama</dc:creator>
<dc:creator>Shugo Kasuya</dc:creator>
<dc:creator>Norifumi Kuratani</dc:creator>
<dc:creator>Yasuyuki Suzuki</dc:creator>
<dc:creator>J-PEDIA study investigators</dc:creator>
<dc:date>2025-07-07</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Adverse Events Associated with Airway Management in Pediatric Anesthesia: A Prospective, Multicenter, Observational Japan Pediatric Difficult Airway in Anesthesia (J-PEDIA) Study</dc:title>
<dc:identifier>pmid:40622860</dc:identifier>
<dc:identifier>pmc:PMC12416892</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005646</dc:identifier>
</item>
<item>
<title>Pediatric Regional Anesthesia: A Practical Guideline for Daily Clinical Practice</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40526440/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>The past two decades have seen remarkable progress in pediatric regional anesthesia. Significant efforts have been made to develop central and peripheral techniques that are both practicable and reliable, with increasing success and very low complication rates driving a growing appreciation for this subspecialty. Regional anesthesia can be used to optimize perioperative pain control, to avoid mechanical ventilation, and to take advantage of favorable immunomodulatory and gastrointestinal side...</description>
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Anesthesiology. 2025 Aug 1;143(2):444-461. doi: 10.1097/ALN.0000000000005554. Epub 2025 Jun 17.
ABSTRACT
The past two decades have seen remarkable progress in pediatric regional anesthesia. Significant efforts have been made to develop central and peripheral techniques that are both practicable and reliable, with increasing success and very low complication rates driving a growing appreciation for this subspecialty. Regional anesthesia can be used to optimize perioperative pain control, to avoid mechanical ventilation, and to take advantage of favorable immunomodulatory and gastrointestinal side effects in children. Implementing a broad spectrum of these techniques will require specialized knowledge of anatomic structures, experience to select appropriate techniques for specific surgical procedures, and considerable hand skills to execute these techniques. This review has been written to summarize state-of-the-art information about all relevant aspects of pediatric regional anesthesia and to provide a practical approach to how regional anesthesia in children can be implemented in daily clinical practice.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40526440/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40526440</a> | PMC:<a href="https://www.ncbi.nlm.nih.gov/pmc/PMC12227213/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">PMC12227213</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005554>10.1097/ALN.0000000000005554</a>
]]></content:encoded>
<guid isPermaLink="false">pubmed:40526440</guid>
<pubDate>Tue, 17 Jun 2025 06:00:00 -0400</pubDate>
<dc:creator>Peter Marhofer</dc:creator>
<dc:creator>Markus Zadrazil</dc:creator>
<dc:creator>Philipp L Opfermann</dc:creator>
<dc:date>2025-06-17</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Pediatric Regional Anesthesia: A Practical Guideline for Daily Clinical Practice</dc:title>
<dc:identifier>pmid:40526440</dc:identifier>
<dc:identifier>pmc:PMC12227213</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005554</dc:identifier>
</item>
<item>
<title>Pharmacokinetics and Pharmacodynamics of Remimazolam for Procedural Sedation in Children and Adolescents</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40355106/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSIONS: This study has shown that the pharmacokinetics of remimazolam are likely different between children 6 yr or older and adults (after correcting for size). In addition, the exposure-response relationship shows that to effectively use remimazolam for procedural sedation in children 6 yr or older, the dosing regimen should be modified to allow for higher remimazolam exposures.</description>
<content:encoded><![CDATA[
Anesthesiology. 2025 Aug 1;143(2):368-382. doi: 10.1097/ALN.0000000000005560. Epub 2025 May 12.
ABSTRACT
BACKGROUND: Remimazolam is not approved for use in pediatric patients. The pharmacokinetics of remimazolam have been reported to be similar to those of adult patients after scaling for body size. This article reports on the pharmacokinetics and pharmacodynamics of pediatric patients aged 6 to 18 yr and a subsequent model-based optimization of the used dosing regimen.
METHODS: Thirty-one patients were included in the trial and stratified across four treatment arms: bolus administration, infusion, bolus plus fentanyl, or infusion plus fentanyl. The University of Michigan (Ann Arbor, Michigan) Sedation Scale (UMSS) was used to assess the depth of sedation. Blood samples were drawn to measure the concentrations of remimazolam and its metabolite CNS7054. Population pharmacokinetic pharmacodynamic modeling was performed in NONMEM (GloboMax LLC, USA).
RESULTS: A population pharmacokinetic model was developed for remimazolam and CNS7054. The elimination clearance of remimazolam was 0.70 l · min -1 · 70 kg -1 . A proportional odds model combined with a simplified Minto model described the observed UMSS well. The EC50 of remimazolam for a UMSS score of 3 or greater was 777 ng · ml -1 in the absence of fentanyl, and decreased to 655, 533, and 287 ng/ml for concomitant fentanyl steady state concentrations of 1, 2, or 4 ng · ml -1 , respectively. Simulations confirmed that the studied dosing regimen resulted in 9.2 to 22.0% of patients not reaching a UMSS score of 3 or greater at the end of the induction. Model-based optimization resulted in higher per-kilogram dosages and the removal of the maximum allowable dose. Simulations indicated that the percentage of patients achieving a UMSS score of 3 or greater can be expected to be high (88 to 97%).
CONCLUSIONS: This study has shown that the pharmacokinetics of remimazolam are likely different between children 6 yr or older and adults (after correcting for size). In addition, the exposure-response relationship shows that to effectively use remimazolam for procedural sedation in children 6 yr or older, the dosing regimen should be modified to allow for higher remimazolam exposures.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40355106/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40355106</a> | PMC:<a href="https://www.ncbi.nlm.nih.gov/pmc/PMC12227205/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">PMC12227205</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005560>10.1097/ALN.0000000000005560</a>
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<guid isPermaLink="false">pubmed:40355106</guid>
<pubDate>Mon, 12 May 2025 06:00:00 -0400</pubDate>
<dc:creator>Pieter J Colin</dc:creator>
<dc:creator>Lynn H Bichajian</dc:creator>
<dc:creator>Valentin R Curt</dc:creator>
<dc:creator>Jeroen V Koomen</dc:creator>
<dc:creator>Thomas Stöhr</dc:creator>
<dc:creator>Michel M R F Struys</dc:creator>
<dc:creator>Keira P Mason</dc:creator>
<dc:date>2025-05-12</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Pharmacokinetics and Pharmacodynamics of Remimazolam for Procedural Sedation in Children and Adolescents</dc:title>
<dc:identifier>pmid:40355106</dc:identifier>
<dc:identifier>pmc:PMC12227205</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005560</dc:identifier>
</item>
<item>
<title>Breath Analysis of Propofol and Associated Metabolic Signatures: A Pilot Study Using Secondary Electrospray Ionization-High-resolution Mass Spectrometry</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40258137/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSIONS: This pilot study highlights a robust breath-serum relationship for propofol and reveals surgery-associated shifts in metabolic pathways, including evidence of oxidative stress. These findings underscore the feasibility of exhaled-breath pharmacometabolomics for individualized anesthetic care. Further validation in larger cohorts is warranted to confirm clinical utility and to determine whether real-time breath analysis could ultimately serve as a useful adjunct for guiding...</description>
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Anesthesiology. 2025 Aug 1;143(2):345-356. doi: 10.1097/ALN.0000000000005531. Epub 2025 Apr 21.
ABSTRACT
BACKGROUND: Propofol is a widely used anesthetic for total IV anesthesia. Although it is generally safe, rare but serious complications can occur in vulnerable groups, such as critically ill patients and children. Clinicians often rely on surrogate measures ( e.g. , predicted effect-site concentrations or Bispectral Index), yet more direct indicators of anesthetic exposure and metabolic stress would be valuable. The authors hypothesized that pharmacometabolomics via breath analysis could yield real-time insights into propofol concentrations as well as accompanying metabolic responses to surgery.
METHODS: In this pilot study, 10 pediatric patients (median age, 5.9 yr; interquartile range, 4.3 to 6.6) undergoing propofol anesthesia contributed 47 breath samples (10 preinduction, 37 postinduction) and 37 blood samples. All samples were analyzed by high-resolution mass spectrometry. Linear mixed-effects models examined associations between exhaled compounds and serum propofol concentrations while accounting for repeated measures in individual patients. Volcano plots were used to identify differential changes in metabolites after propofol induction.
RESULTS: Propofol, its metabolites, and endogenous metabolites were readily detected in exhaled breath, demonstrating strong correlations with serum propofol concentrations (partial R ² ≥ 0.65; adjusted P < 0.001). Differential analysis showed significant upregulation of endogenous fatty aldehydes (log 2 [postinduction/preinduction] ≥ 1; adjusted P ≤ 0.05), suggestive of lipid peroxidation and oxidative stress. Exogenous compounds, including benzene and phenols, were also observed, reflecting propofol metabolism in vivo .
CONCLUSIONS: This pilot study highlights a robust breath-serum relationship for propofol and reveals surgery-associated shifts in metabolic pathways, including evidence of oxidative stress. These findings underscore the feasibility of exhaled-breath pharmacometabolomics for individualized anesthetic care. Further validation in larger cohorts is warranted to confirm clinical utility and to determine whether real-time breath analysis could ultimately serve as a useful adjunct for guiding anesthetic management and monitoring perioperative metabolic responses.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40258137/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40258137</a> | PMC:<a href="https://www.ncbi.nlm.nih.gov/pmc/PMC12227210/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">PMC12227210</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005531>10.1097/ALN.0000000000005531</a>
]]></content:encoded>
<guid isPermaLink="false">pubmed:40258137</guid>
<pubDate>Mon, 21 Apr 2025 06:00:00 -0400</pubDate>
<dc:creator>Jiafa Zeng</dc:creator>
<dc:creator>Nikola Stankovic</dc:creator>
<dc:creator>Kapil Dev Singh</dc:creator>
<dc:creator>Regula Steiner</dc:creator>
<dc:creator>Urs Frey</dc:creator>
<dc:creator>Thomas Erb</dc:creator>
<dc:creator>Pablo Sinues</dc:creator>
<dc:date>2025-04-21</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Breath Analysis of Propofol and Associated Metabolic Signatures: A Pilot Study Using Secondary Electrospray Ionization-High-resolution Mass Spectrometry</dc:title>
<dc:identifier>pmid:40258137</dc:identifier>
<dc:identifier>pmc:PMC12227210</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005531</dc:identifier>
</item>
<item>
<title>Development and External Validation of a Novel In-hospital Mortality Model after Pediatric Congenital Heart Surgery: A Multicenter Retrospective Cohort Study</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40237771/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSIONS: The four major traditional models were only moderately effective in predicting in-hospital mortality after congenital heart surgery in the Chinese setting. The novel model founded on the STAT categories in combination with preoperative covariates can serve as a useful and effective tool for predicting the risk of in-hospital mortality after congenital heart surgery in the Chinese setting.</description>
<content:encoded><![CDATA[
Anesthesiology. 2025 Aug 1;143(2):357-367. doi: 10.1097/ALN.0000000000005514. Epub 2025 Apr 16.
ABSTRACT
BACKGROUND: The applicability of four major traditional in-hospital mortality models in the Chinese setting is unclear due to disease spectrum and population heterogeneity. This study aimed to test the performance of these models in the Chinese setting and to construct and externally validate a novel model.
METHODS: A total of 21,855 consecutive pediatric patients who underwent congenital heart surgery from January 2015 to December 2021 in Shanghai Children's Medical Center were enrolled. For external validation, the study additionally pooled 5,221 consecutive pediatric patients who underwent this surgical treatment from January 2020 to December 2021 in Beijing Fuwai Hospital. The performance of the Aristotle Basis Complexity (ABC) score, Risk Adjustment for Congenital Heart Surgery (RACHS)-1 categories, Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT) score, and STAT categories was tested. Independent predictors were used to develop a model. The area under the receiver operating characteristic curves (AUROCs) and Brier score were used to examine the model performance.
RESULTS: The AUROCs were 0.778 for ABC score, 0.685 for RACHS-1 categories, 0.808 for STAT score, and 0.784 for STAT categories. When preoperative covariates were added to the four models, the AUROCs improved: ABC score (AUROC = 0.860), RACHS-1 categories (AUROC = 0.844), STAT score (AUROC = 0.856), and STAT categories (AUROC = 0.864). The best-performing model incorporated six variables, including age, height, oxygen support, previous cardiac operation, emergency surgery, and STAT categories. The AUROCs and Brier score were 0.864 and 0.00977 in the development cohort and 0.860 and 0.00654 in the external validation cohort.
CONCLUSIONS: The four major traditional models were only moderately effective in predicting in-hospital mortality after congenital heart surgery in the Chinese setting. The novel model founded on the STAT categories in combination with preoperative covariates can serve as a useful and effective tool for predicting the risk of in-hospital mortality after congenital heart surgery in the Chinese setting.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40237771/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40237771</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005514>10.1097/ALN.0000000000005514</a>
]]></content:encoded>
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<pubDate>Wed, 16 Apr 2025 06:00:00 -0400</pubDate>
<dc:creator>Chaoyang Tong</dc:creator>
<dc:creator>Qihang Li</dc:creator>
<dc:creator>Xinwei Du</dc:creator>
<dc:creator>Mengqin Shan</dc:creator>
<dc:creator>Yuxin Zhang</dc:creator>
<dc:creator>Haixi Wu</dc:creator>
<dc:creator>Ziyun Shen</dc:creator>
<dc:creator>Zhuoming Xu</dc:creator>
<dc:creator>Xiaodong Ge</dc:creator>
<dc:creator>Shuang Cai</dc:creator>
<dc:creator>Xin Fu</dc:creator>
<dc:creator>Kan Zhang</dc:creator>
<dc:creator>Haibo Zhang</dc:creator>
<dc:creator>Shoujun Li</dc:creator>
<dc:creator>Changhong Miao</dc:creator>
<dc:creator>Jijian Zheng</dc:creator>
<dc:date>2025-04-16</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Development and External Validation of a Novel In-hospital Mortality Model after Pediatric Congenital Heart Surgery: A Multicenter Retrospective Cohort Study</dc:title>
<dc:identifier>pmid:40237771</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005514</dc:identifier>
</item>
<item>
<title>Thrombin Generation in Pediatric Cardiac Surgery Patients: A Prospective Single-center Cohort Study</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40227961/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSIONS: In children undergoing cardiac surgery, thrombin generation assay revealed significant and persistent decline in endogenous thrombin potential after cardiopulmonary bypass, despite hemostatic interventions. This reduced thrombin potential correlated with a higher volume of transfusions. Additionally, greater intraoperative heparin requirements could be linked to a more pronounced decline in thrombin generation.</description>
<content:encoded><![CDATA[
Anesthesiology. 2025 Jul 1;143(1):84-97. doi: 10.1097/ALN.0000000000005502. Epub 2025 Apr 14.
ABSTRACT
BACKGROUND: The objective of this study was to describe thrombin generation in children undergoing cardiac surgery with cardiopulmonary bypass. Change in the endogenous thrombin potential (ETP) across three measurements before and after cardiopulmonary bypass (after protamine and at chest closure) was the primary outcome. Secondary analyses explored an association between thrombin generation and transfusion requirements and predictors of the thrombin generation decline.
METHODS: Blood samples of children (median age, 6.3 months; 68.5% weighed less than 10 kg) were collected intraoperatively three times: before administration of heparin (baseline), shortly after protamine, and at sternal closure. Platelet-poor plasma obtained after centrifugation of these samples was frozen at -80ºC. Thrombin generation and anti-Xa assays were performed in series on batches of thawed samples to evaluate thrombin generation parameters and functional activity of unfractionated heparin, which could have affected thrombin generation assay results.
RESULTS: Between August 2022 and May 2024, 162 plasma samples from 54 patients were collected and analyzed. Compared with baseline, mean ETP decreased by 1,911 nM (95% CI, 1,655 to 2,168) after administration of protamine and by 1,865 nM (95% CI, 1,609 to 2,122) at sternal closure ( P < 0.001). Similar changes were observed in secondary thrombin generation parameters. Median unfractionated heparin activity was less than 0.1 U/ml at all three time points. Secondary analyses showed a strong negative correlation between ETP after protamine and volume of transfusion after bypass (Ï = -0.52, P < 0.001). Among five examined factors, only total heparin dose was independently associated with ETP decline, with a higher dose being predictive of greater ETP decline ( P = 0.002).
CONCLUSIONS: In children undergoing cardiac surgery, thrombin generation assay revealed significant and persistent decline in endogenous thrombin potential after cardiopulmonary bypass, despite hemostatic interventions. This reduced thrombin potential correlated with a higher volume of transfusions. Additionally, greater intraoperative heparin requirements could be linked to a more pronounced decline in thrombin generation.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40227961/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40227961</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005502>10.1097/ALN.0000000000005502</a>
]]></content:encoded>
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<pubDate>Mon, 14 Apr 2025 06:00:00 -0400</pubDate>
<dc:creator>Elena Ashikhmina Swan</dc:creator>
<dc:creator>Brian D Lahr</dc:creator>
<dc:creator>Ahmad H Al-Huniti</dc:creator>
<dc:date>2025-04-14</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Thrombin Generation in Pediatric Cardiac Surgery Patients: A Prospective Single-center Cohort Study</dc:title>
<dc:identifier>pmid:40227961</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005502</dc:identifier>
</item>
<item>
<title>Development of the Pediatric Scale for Quality of Recovery (PedSQoR)</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40227959/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSIONS: The Pediatric Scale for Quality of Recovery scale is a 20-item questionnaire designed to provide a holistic representation of a child's physical, emotional, and psychologic recovery after surgery and anesthesia. It was developed and validated with consumer involvement and a strong patient-centered focus. Once further validation has been established, it is expected to become a standardized endpoint in pediatric perioperative trials and quality improvement projects.</description>
<content:encoded><![CDATA[
Anesthesiology. 2025 Aug 1;143(2):275-286. doi: 10.1097/ALN.0000000000005503. Epub 2025 Apr 14.
ABSTRACT
BACKGROUND: Measuring the quality of a patient's recovery is vital, and reliable patient-centered outcome metrics are needed for clinical investigations and quality improvement. Currently, assessment tools to measure quality of recovery in pediatric patients are lacking. This study aimed to develop a scale to assess the quality of recovery construct in pediatric patients.
METHODS: Using a mixed-methods investigative model, item generation was achieved using two complementary approaches. First, a comprehensive review of the literature identified tools and questions that assessed the endpoints relevant to recovery in children. Questions were categorized and then assessed by an expert Delphi panel who determined the most significant domains and items to be included. Concurrently, semistructured interviews were conducted with patients and their families to identify themes related to recovery that were important to patients and families. The resulting pilot questionnaire was administered to patients and their families presenting for elective surgery in the United States and Australia.
RESULTS: The literature search identified 41 instruments, comprising 216 questions relevant to recovery. After the initial Delphi round, the item list was reduced to 91 questions, and then to 50 questions after the second round. The themes identified in the semistructured interviews aligned with domains considered important by a panel of experts. A 50-item questionnaire was administered to 1,162 children at multiple timepoints after surgery. Item reduction and factor analysis resulted in the 20-item Pediatric Scale for Quality of Recovery that assesses the domains relevant to physical and psychologic recovery.
CONCLUSIONS: The Pediatric Scale for Quality of Recovery scale is a 20-item questionnaire designed to provide a holistic representation of a child's physical, emotional, and psychologic recovery after surgery and anesthesia. It was developed and validated with consumer involvement and a strong patient-centered focus. Once further validation has been established, it is expected to become a standardized endpoint in pediatric perioperative trials and quality improvement projects.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40227959/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40227959</a> | PMC:<a href="https://www.ncbi.nlm.nih.gov/pmc/PMC12227209/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">PMC12227209</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005503>10.1097/ALN.0000000000005503</a>
]]></content:encoded>
<guid isPermaLink="false">pubmed:40227959</guid>
<pubDate>Mon, 14 Apr 2025 06:00:00 -0400</pubDate>
<dc:creator>Cameron Graydon</dc:creator>
<dc:creator>Paul A Stricker</dc:creator>
<dc:creator>Stephen Kelleher</dc:creator>
<dc:creator>Joseph Cravero</dc:creator>
<dc:creator>Nazmul Karim</dc:creator>
<dc:creator>Wallis T Muhly</dc:creator>
<dc:creator>Paul Lee-Archer</dc:creator>
<dc:date>2025-04-14</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Development of the Pediatric Scale for Quality of Recovery (PedSQoR)</dc:title>
<dc:identifier>pmid:40227959</dc:identifier>
<dc:identifier>pmc:PMC12227209</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005503</dc:identifier>
</item>
<item>
<title>Oxygen Supplementation in Pediatric Sedation: Prospective, Multicenter, Randomized Controlled Trial</title>
<link>https://pubmed.ncbi.nlm.nih.gov/40215365/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414</link>
<description>CONCLUSIONS: Routine oxygen supplementation prevents hypoxemia during pediatric moderate and deep sedation. Low-flow oxygen can be a reasonable choice as it effectively reduces hypoxemia while being more cost-effective and widely accessible than high-flow oxygen.</description>
<content:encoded><![CDATA[
Anesthesiology. 2025 Jul 1;143(1):132-141. doi: 10.1097/ALN.0000000000005500. Epub 2025 Apr 11.
ABSTRACT
BACKGROUND: Children undergoing moderate to deep sedation for diagnostic and therapeutic procedures are susceptible to hypoxemia because of their anatomical and physiologic features. However, optimal oxygen administration methods are unclear. This study aimed to evaluate the efficacy of oxygen supplementation during sedation using either low-flow or high-flow nasal cannula.
METHODS: This prospective, multicenter randomized controlled trial included children (younger than 18 yr) undergoing moderate to deep sedation. The participants were randomly assigned to three groups as follows: (1) control (no oxygen), (2) low-flow (2 to 6 l/min oxygen via nasal cannula), and (3) high-flow (oxygen administration via high-flow nasal cannula with a flow rate of 2 l/kg and 50% fraction of inspired oxygen). The primary outcome was hypoxemia incidence (saturation of peripheral oxygen, oxygen saturation measured by pulse oximetry 95% or less for more than 5 s). Secondary outcomes included oxygen saturation measured by pulse oximetry less than 90%, rescue interventions, and sedation-related complications. Between-group differences were compared using a logistic regression model.
RESULTS: A total of 253 participants were randomized, with 250 completing the study. Hypoxemia occurred in 27.6% of participants in the control group, 7.2% in the low-flow group, and 1.2% in the high-flow group ( P < 0.001). The odds of hypoxemia in the low-flow and high-flow groups were lower than that in the control group (odds ratio [OR], 0.184; 95% CI, 0.067 to 0.503; P = 0.001 for low-flow; OR, 0.026; 95% CI, 0.003 to 0.207; P < 0.001 for high-flow). However, hypoxemia incidence of the high-flow group was not statistically lower than the low-flow group (OR, 0.143; 95% CI, 0.017 to 1.245; P = 0.078). Rescue interventions were conducted more frequently in the control group (52.9%) than in the low-flow (10.8%) and high-flow (3.6%) groups ( P < 0.001). Sedation-related complications such as desaturation and apnea were lower in the low-flow and high-flow groups than in the control group ( P < 0.001).
CONCLUSIONS: Routine oxygen supplementation prevents hypoxemia during pediatric moderate and deep sedation. Low-flow oxygen can be a reasonable choice as it effectively reduces hypoxemia while being more cost-effective and widely accessible than high-flow oxygen.
PMID:<a href="https://pubmed.ncbi.nlm.nih.gov/40215365/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">40215365</a> | PMC:<a href="https://www.ncbi.nlm.nih.gov/pmc/PMC12147724/?utm_source=Chrome&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1RYYbE7j9SU2Be0iGnhBL4ELVftm0WYo7D2KOUjoOrE19aDUOh&fc=20251015232334&ff=20251017222831&v=2.18.0.post9+e462414">PMC12147724</a> | DOI:<a href=https://doi.org/10.1097/ALN.0000000000005500>10.1097/ALN.0000000000005500</a>
]]></content:encoded>
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<pubDate>Fri, 11 Apr 2025 06:00:00 -0400</pubDate>
<dc:creator>Ji-Hyun Lee</dc:creator>
<dc:creator>Hyun Jung Ko</dc:creator>
<dc:creator>Jung-Bin Park</dc:creator>
<dc:creator>Sang-Hwan Ji</dc:creator>
<dc:creator>Jin-Tae Kim</dc:creator>
<dc:date>2025-04-11</dc:date>
<dc:source>Anesthesiology</dc:source>
<dc:title>Oxygen Supplementation in Pediatric Sedation: Prospective, Multicenter, Randomized Controlled Trial</dc:title>
<dc:identifier>pmid:40215365</dc:identifier>
<dc:identifier>pmc:PMC12147724</dc:identifier>
<dc:identifier>doi:10.1097/ALN.0000000000005500</dc:identifier>
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