Neuroblastoma in Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

Intraoperative Management ◽

Outcome Improvement ◽

Challenging Situation ◽

Abstract Background: Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization and catecholamine-secreting characteristics of the tumor. We undertook a secondary analysis in a previous study to describe patients who underwent neuroblastoma resection.Objective: To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement.Methods: This was a secondary analysis of children who underwent neuroblastoma resection in the initial retrospective study.Results: There were 16 patients with a mean age of 39.3±22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncholaryngospasm and difficult intubation. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure, and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality.Conclusion: In this cohort, 43.8% of the patients had intraoperative and/or postoperative complications in terms of organ dysfunction or sepsis. A total of 81.3% of the patients received intraoperative transfusion. Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation and optimal intraoperative management with validated tools in children could be necessary for a better postoperative outcome in this surgical setting.

Neuroblastoma in Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

10.21203/rs.3.rs-785499/v2 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Anesthetic Management ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Postoperative Outcomes ◽

Goal Directed Therapy ◽

Intraoperative Management ◽

Outcome Improvement ◽

Challenging Situation ◽

Abstract Background: Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization and catecholamine-secreting characteristics of the tumor. We undertook a secondary analysis in a previous study to describe patients who underwent neuroblastoma resection.Objective: To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement.Methods: This was a secondary analysis of children who underwent neuroblastoma resection in the initial retrospective study.Results: There were 16 patients with a mean age of 39.3±22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncholaryngospasm and difficult intubation. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure, and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality.Conclusion: Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation and optimal intraoperative management with validated means in children are necessary for a better postoperative outcome in this surgical setting.

Neuroblastoma in Children: Intraoperative Goal Directed Therapy, Intraoperative And Postoperative Outcomes

10.21203/rs.3.rs-785499/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Anesthetic Management ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Postoperative Outcomes ◽

Study Results ◽

Intraoperative Management ◽

Outcome Improvement ◽

Challenging Situation ◽

Abstract Background Neuroblastoma is the most common tumor in children. Anesthetic management can be challenging due to the localization, catecholamine-secreting characteristic of the tumor. We undertook a secondary analysis in a previously study to describe patients who underwent neuroblastoma resection. Objective To describe intraoperative and postoperative outcomes in patients who underwent neuroblastoma resection and to propose optimal intraoperative management for postoperative outcome improvement. Methods Secondary analysis of children who had neuroblastoma resection in the initial retrospective study. Results There were 16 patients with a mean age of 39.3±22.1 months. Seven (43.8%) patients presented with intraoperative or postoperative complications. One (6.3%) patient had intraoperative broncho-laryngospasm and difficult intubation respectively. Two (12.5%) patients had intraoperative hemorrhagic shock. One patient (6.3%) had postoperative renal failure. Two patients (12.5%) had postoperative respiratory failure and 3 (18.8%) patients had postoperative cardiocirculatory failure. One (6.3%) had postoperative pulmonary sepsis and septicemia respectively. Thirteen (81.3%) patients were intraoperatively transfused. There was no in-hospital mortality. Conclusion Neuroblastoma surgery can be a challenging situation where cardiovascular instability, high blood loss and transfusion requirements can be encountered. Consequently, preoperative preparation, intraoperative optimal management with validated means in children are necessary for a better postoperative outcome in this surgical setting.

Intraoperative Goal-Directed Therapies in Femoral and Pelvic Osteotomies in Children and In-Hospital Postoperative Outcomes

10.21203/rs.3.rs-777279/v2 ◽

2021 ◽

Author(s):

Claudine Kumba ◽

Mathilde Gaume ◽

Arayik Barbarian ◽

Zaga Péjin

Keyword(s):

Point Of Care ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Pelvic Osteotomy ◽

Postoperative Outcomes ◽

Product Management ◽

Transfusion Rate ◽

Management Protocol ◽

Abstract Background: Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary.Objective: We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative and postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management, fluid and hemodynamic therapy with the aim of implementing optimization management protocols for postoperative outcome improvement.Methods: A secondary analysis of patients who underwent femoral and pelvic osteotomy surgery was included in the initial retrospective study.Results: There were eighteen patients with a mean age of 104± 47.1 months. Four (22.2%) patients had intraoperative and/or postoperative complications. One patient (5.6%) had intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure, and one patient (5.6%) had postoperative wound sepsis. Transfusion rate was 50% in nine patients.Conclusion: Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased; thus, this implies the necessity of a global patient blood management protocol with point-of-care tests and fluid- and hemodynamic-guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.

Intraoperative Goal-Directed Therapies in Femoral and Pelvic Osteotomies In Children and In-Hospital Postoperative Outcome

10.21203/rs.3.rs-777279/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Point Of Care ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Pelvic Osteotomy ◽

Product Management ◽

Transfusion Rate ◽

Management Protocol ◽

Study Results ◽

Abstract Background Femoral and pelvic osteotomies are potential hemorrhagic interventions where transfusion requirements can be necessary. Objective We undertook a secondary analysis of patients who underwent femoral and pelvic osteotomy in the initial cohort. The objective of this secondary analysis was to describe intraoperative, postoperative outcomes and to describe intraoperative management in these patients in terms of blood product management, fluid and hemodynamic therapy with the aims to implement optimization management protocols for postoperative outcome improvement. Methods Secondary analysis of patients who underwent femoral and pelvic osteotomy surgery included in the initial retrospective study. Results There were eighteen patients with a mean age of 104± 47.1 months. Four (22.2%) patients had intraoperative and or postoperative complications. One patient (5.6%) had intraoperative hemorrhagic shock, two patients (11.1%) had postoperative neurologic failure and one patient (5.6%) had postoperative wound sepsis. Transfusion rate was 50% in nine patients. Conclusion Femoral and pelvic osteotomies are interventions where blood, transfusion and fluid requirements can be increased thus this implies the necessity of global patient blood management protocol with point of care tests, with fluid and hemodynamic guided protocols with validated tools in children for intraoperative and postoperative outcome optimization.

Liver Transplantation in Children and Impact of Intra-operative Goal Directed Therapies on Postoperative Outcome

10.21203/rs.3.rs-744584/v2 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Liver Transplantation ◽

Point Of Care ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Initial Study ◽

Abdominal Sepsis ◽

Postoperative Outcomes ◽

Transfusion Rate ◽

Complication Rates ◽

Abstract Background: Liver transplantation is a hemorrhagic surgery with high postoperative complication rates in terms of organ dysfunction and infections. We conducted a retrospective observational monocentric study that had the objectives of determining predictors of postoperative outcome in children. In the initial cohort, 19 children underwent liver transplantation. A description of the postoperative outcomes of these patients was undertaken.Objective: To describe intraoperative and postoperative outcomes in children undergoing liver transplantation and to propose intraoperative management implementation measures for postoperative outcome improvement.Methods: Secondary analysis of liver transplanted patients included in the initial study.Results: There were 19 patients who underwent liver transplantation with a median age of 31[2-154] months. Five patients had re-operations (26.3%). Fourteen (73.7%) had intraoperative and/or postoperative complications. Five (26.3%) had intraoperative hemorrhagic shock. One (5.3%) had postoperative respiratory failure, one (5.3%) had postoperative multiple organ failure, two (10.5%) had postoperative neurologic failure and five (26.3%) had cardio-circulatory failure. One (5.3%) had postoperative pulmonary sepsis, five (26.3%) had postoperative abdominal sepsis, and six (31.6%) had postoperative septicemia. Intra-operative transfusion rate was 100%. In-hospital mortality rate was 10.5% (two patients).Conclusion: There were multiple postoperative adverse outcome predictors. Optimal intraoperative patient management with transfusion guided by point-of-care viscoelastic devices and goal-directed fluid and hemodynamic therapy with validated parameters and tools in children is a possible pathway to upgrade postoperative evolution in pediatric liver transplantation.

Liver Transplantation in Children and Impact of Intra-operative Goal Directed Therapies on Postoperative Outcome

10.21203/rs.3.rs-744584/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Liver Transplantation ◽

Point Of Care ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Initial Study ◽

Abdominal Sepsis ◽

Postoperative Outcomes ◽

Transfusion Rate ◽

Complication Rates ◽

Abstract Background: Liver transplantation is a hemorrhagic surgery with high postoperative complication rates in terms of organ dysfunction and infections. We conducted a retrospective observational monocentric study that had the objectives of determining predictors of postoperative outcome in children. In the initial cohort, 19 children underwent liver transplantation. A description of the postoperative outcomes of these patients was undertaken.Objective: To describe intraoperative and postoperative outcomes in children undergoing liver transplantation and to propose intraoperative management implementation measures for postoperative outcome improvement.Methods: Secondary analysis of liver transplanted patients included in the initial study.Results: There were 19 patients who underwent liver transplantation with a median age of 31[2-154] months. Five patients had re-operations (26.3%). Fourteen (73.7%) had intraoperative and/or postoperative complications. Five (26.3%) had intraoperative hemorrhagic shock. One (5.3%) had postoperative respiratory failure, one (5.3%) had postoperative multiple organ failure, two (10.5%) had postoperative neurologic failure and five (26.3%) had cardio-circulatory failure. One (5.3%) had postoperative pulmonary sepsis, five (26.3%) had postoperative abdominal sepsis, and six (31.6%) had postoperative septicemia. Intra-operative transfusion rate was 100%. In-hospital mortality rate was 10.5% (two patients).Conclusion:There were multiple postoperative adverse outcome predictors. Optimal intraoperative patient management with transfusion guided by point-of-care viscoelastic devices and goal-directed fluid and hemodynamic therapy with validated parameters and tools in children is a possible pathway to upgrade postoperative evolution in pediatric liver transplantation.

Scoliosis in Children: Impact of Goal Directed Therapies on Intra-operative and Postoperative Outcomes

10.21203/rs.3.rs-765785/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Secondary Analysis ◽

Initial Study ◽

Abdominal Sepsis ◽

Postoperative Outcomes ◽

Scoliosis Surgery ◽

Complication Rates ◽

Wound Sepsis ◽

Intraoperative Complication ◽

Initial Cohort ◽

Abstract Background: Scoliosis is among interventions with high postoperative complication rates due to the characteristics of the surgery, where blood loss, transfusion and fluid requirements can be increased.A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary analysis to describe outcomes in these patients was realized and is presented here.Objective: To describe intraoperative and postoperative outcomes in patients under 18 years old in scoliosis surgery included in the initial study and to propose improvement implementation measures.Methods: Secondary analysis of patients undergoing scoliosis surgery. The study was approved by the Ethics Committee.Results: There were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight patients (24.1%) presented intraoperative and/or postoperative complications. The most common intraoperative complication was hemorrhagic shock in 3 patients (2.6%). The most common postoperative organ failure was neurologic in seven patients (6%), respiratory in 3 patients (2.6%), cardio-circulatory in 2 patients (1.7%) and renal failure in one patient (0.9%).The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in three patients (2.6%), and abdominal sepsis and septicemia in two patients (1.7%).twelve patients (10.3%) had reoperations.Fifty-six patients (48.3%) had intraoperative transfusion.There was no in-hospital mortality.Conclusion: Integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.

Pre-term Infants in Major Abdominal Surgery and Postoperative Outcome

10.21203/rs.3.rs-669064/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Respiratory Failure ◽

Postoperative Complications ◽

Observational Study ◽

Abdominal Surgery ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Surgical Wound ◽

Wound Sepsis ◽

Term Infants ◽

Initial Cohort

Abstract Background: A monocentric observational study was undertaken in pediatric surgical patients in neurosurgery, abdominal and orthopedic surgery to determine predictors of postoperative outcome. In this cohort of 594 patients with a mean age of 90.86±71.80 months there were 25 pre-terms aged less than 37 weeks. A description of postoperative outcome was undertaken in these pre-term infants. Objective: The objective of this study was to describe the characteristics in pre-term patients in this initial cohort. Methods: Secondary analysis of pre-term patients included in the initial retrospective observational study. The Ethics Committee approved the study. Results: 25 pre-terms aged <37 weeks were included with a mean weight of 2.43±0.75 kg in major neonatal abdominal surgery. 9 patient presented postoperative complications among which 1 had an intra-operative cardiac arrest, 4 had postoperative respiratory failure, 2 had pulmonary sepsis, 1 had surgical wound sepsis, 1 had septicemia and 1 had multi-organ sepsis. Conclusion: In this cohort of 25 critically ill pre-terms in major neonatal abdominal surgery, the most common postoperative complications concerned the respiratory system which included respiratory failure and pulmonary sepsis. There was no in-hospital mortality.

Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

10.21203/rs.3.rs-638904/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Postoperative Complications ◽

Observational Study ◽

Organ Failure ◽

Preterm Infants ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Preterm Children ◽

Surgery Patient ◽

Neurosurgical Patients ◽

One Year

Abstract Background and Objective : An observational study conducted earlier to determine predictors of postoperative outcome in non-cardiac surgical pediatric patients showed that factors which influenced postoperative evolution were multiple. These included American Society of Anesthesiologists (ASA) score, transfusion, age, emergency surgery, and surgery. The objective was to describe in details outcomes in non-preterm children under one year old included in the initial study. Methods : Secondary analysis of the initial retrospective observational study in 594 patients with a mean age of 90.86±71.80 months. The Ethics Committee approved the study under the registration number 2017-CK-5-R1. Results : There were 97 non-preterm children included with a mean age of 4.4±3.5 months. Mean weight was 5.1±2.7 kilograms. There were 48 abdominal surgical patients (49.5%), 48 neurosurgical patients (49.5%) and 1 orthopedic surgery patient (1%). 30 patients had intra-operative and or postoperative complications (organ failure or sepsis) (30.9%). The most common intra-operative complication was hemorrhagic shock (5.2%); the most affected system in the postoperative period was the respiratory system in terms of organ failure and pulmonary sepsis with an overall rate of 12.4%; the most common postoperative infection was septicemia (7.2%). The rate of postoperative renal failure was 1%. There were 5 in-hospital deaths (5.2%). Conclusion : In this cohort of 97 non-preterm infants under one year old, the rate of patients with intra-operative and or postoperative complications was 30.9%. It is time to reconsider integrating goal directed therapies in intra-operative patient management to improve postoperative outcome.

Patient Blood Management in Craniosynostosis Surgery

10.21203/rs.3.rs-774234/v1 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Retrospective Study ◽

Hemorrhagic Shock ◽

Point Of Care ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Ethics Committee ◽

Patient Blood Management ◽

Blood Management ◽

Outcome Improvement ◽

Point Of Care Tests

Abstract Background: Craniosynostosis surgery is one of the most hemorrhagic interventions, where transfusion rates vary from 20 to 100% depending on the study.Objective: To describe intraoperative and postoperative outcomes in a secondary analysis of children who underwent craniosynostosis surgery included in the initial retrospective study with the aim of proposing intraoperative implementation optimization protocols for postoperative outcome improvement.Methods: Secondary analysis. The study was approved by the Ethics Committee.Results: There were 69 children with a median age of 10 [0-207] months.Eight (11.6%) patients had intraoperative and/or postoperative complications. One patient (1.5%) had intraoperative hemorrhagic shock, and two patients (2.9%) had intraoperative broncholaryngospasm. One patient (1.5%) had postoperative anaphylaxis. One patient (1.5%) had postoperative hemorrhagic shock. One patient (1.5%) had postoperative respiratory failure. Two patients (2.9%) had postoperative neurologic failure. One patient (1.5%) had neuro-meningeal sepsis. One patient (1.5%) had a re-operation. There was no in-hospital mortality.Fourty-eight patients (69.6%) had intraoperative transfusions.Conclusion: Transfusion protocols guided with point-of-care tests should be included in patient blood management programs in craniosynostosis surgery.