PMID- 36475241
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221207
IS  - 2516-5410 (Electronic)
IS  - 2096-6938 (Print)
IS  - 2516-5410 (Linking)
VI  - 4
IP  - 4
DP  - 2021
TI  - Association of anesthetic and surgical risk factors with outcomes of initial 
      diagnostic biopsies in a current cohort of children with anterior mediastinal 
      masses.
PG  - e000303
LID - 10.1136/wjps-2021-000303 [doi]
LID - e000303
AB  - BACKGROUND: Diagnostic biopsies of pediatric anterior mediastinal masses (AMMs) 
      are high-risk procedures in which general anesthesia (GA) is traditionally 
      avoided. However, awareness of historically recognized risk factors and 
      corresponding perioperative management have improved over time and may now no 
      longer strictly preclude the use of GA. Therefore, in this study, we examined the 
      association of anesthetic and surgical risk factors and modalities with resulting 
      procedural and survival outcomes in a current patient cohort. METHODS: We 
      retrospectively reviewed charts of 35 children with AMMs who underwent initial 
      diagnostic biopsies between January 2001 and August 2019, and determined tracheal 
      compression and deviation from archival CT scans and procedural and disease 
      outcomes. RESULTS: Twenty-three (65%) patients underwent GA while 12 (35%) 
      received sedation. Among patients with available CT measurements, 13 of 25 (52%) 
      had >50% anteroposterior tracheal diameter reduction. Patients with >50% 
      anteroposterior tracheal compression received sedation more frequently (p=0.047) 
      and were positioned upright (p=0.015) compared with patients with </=50% 
      compression, although 4 of 13 and 9 of 12, respectively, still received GA. 
      Intraoperative adverse events (AEs) occurred in four (11.4%) patients: three 
      received GA, and all were positioned supine or lateral. AEs were not associated 
      with radiographic airway risk factors but were significantly associated with 
      morphine and sevoflurane use (p<0.001) and with thoracoscopic biopsies (p=0.035). 
      There were no on-table mortalities, but four delayed deaths occurred (three 
      related to disease and one from late procedural complications). CONCLUSIONS: In a 
      current cohort of pediatric AMM biopsies, patients with >50% anteroposterior 
      tracheal compression were more frequently managed with a conservative 
      perioperative management strategy, though not completely excluding GA. The 
      corresponding reduction in frequency of procedural AEs in this traditionally 
      high-risk group suggests that increased awareness of procedural risk factors and 
      appropriate risk-guided perioperative management choices may obviate the 
      procedural mortality historically associated with pediatric AMM biopsies.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Halepota, Huma Faiz
AU  - Halepota HF
AD  - Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
AD  - Department of Paediatric General Surgery, The Indus Hospital, Karachi, Sindh, 
      Pakistan.
FAU - Tan, Josephine S K
AU  - Tan JSK
AD  - Department of Paediatric Anesthesia, KK Women's and Children's Hospital, 
      Singapore.
FAU - Reddy, Satish K
AU  - Reddy SK
AD  - Department of Paediatric Anesthesia, KK Women's and Children's Hospital, 
      Singapore.
FAU - Tang, Phua Hwee
AU  - Tang PH
AD  - Department of Diagnostic and Interventional Imaging, KK Women's and Children's 
      Hospital, Singapore.
FAU - Ong, Lin Yin
AU  - Ong LY
AD  - Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
FAU - Lee, York Tien
AU  - Lee YT
AD  - Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
FAU - Chan, Mei Yoke
AU  - Chan MY
AD  - Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's 
      and Children's Hospital, Singapore.
FAU - Soh, Shui Yen
AU  - Soh SY
AD  - Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's 
      and Children's Hospital, Singapore.
FAU - Chang, Kenneth T E
AU  - Chang KTE
AD  - Department of Pathology and Laboratory Medicine, KK Women's and Children's 
      Hospital, Singapore.
FAU - Ng, Agnes S B
AU  - Ng ASB
AD  - Department of Paediatric Anesthesia, KK Women's and Children's Hospital, 
      Singapore.
FAU - Loh, Amos Hong Pheng
AU  - Loh AHP
AUID- ORCID: 0000-0001-8333-1486
AD  - Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore.
LA  - eng
PT  - Journal Article
DEP - 20211027
PL  - England
TA  - World J Pediatr Surg
JT  - World journal of pediatric surgery
JID - 101761337
PMC - PMC9717380
OTO - NOTNLM
OT  - anesthetics
OT  - diagnostic imaging
OT  - medical oncology
OT  - pediatrics
OT  - thoracic surgery
COIS- Competing interests: None declared.
EDAT- 2021/10/27 00:00
MHDA- 2021/10/27 00:01
PMCR- 2021/10/27
CRDT- 2022/12/07 02:15
PHST- 2021/05/02 00:00 [received]
PHST- 2021/10/06 00:00 [accepted]
PHST- 2022/12/07 02:15 [entrez]
PHST- 2021/10/27 00:00 [pubmed]
PHST- 2021/10/27 00:01 [medline]
PHST- 2021/10/27 00:00 [pmc-release]
AID - wjps-2021-000303 [pii]
AID - 10.1136/wjps-2021-000303 [doi]
PST - epublish
SO  - World J Pediatr Surg. 2021 Oct 27;4(4):e000303. doi: 10.1136/wjps-2021-000303. 
      eCollection 2021.