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Central arterial lines are indispensable in pediatric cardiac surgery, ensuring real-time hemodynamic monitoring, arterial blood sampling, and effective perioperative management. While the femoral artery has traditionally been the preferred access point, growing clinical concern over its associated complications has driven interest in alternative sites — most notably, the axillary artery. A recent single-center, retrospective study by Zaleski et al. (2025), published in Anesthesia & Analgesia, provides the most comprehensive dataset to date on this topic. Analyzing 1,263 arterial line placements at Boston Children’s Hospital over a decade, the study compares axillary and femoral approaches regarding safety, complication rates, and procedural trends. The results are eye-opening—and may be practice-changing Why central arterial access matters in pediatric cardiac surgery In the delicate landscape of pediatric cardiac surgery, central arterial lines serve as vital conduits for: Continuous blood pressure monitoring Arterial blood gas sampling Hemodynamic assessment Timely detection of intraoperative events However, the choice of arterial access site can profoundly influence the risk of complications, particularly in neonates, infants, and children with comorbidities such as genetic syndromes or prematurity. Study design Setting: Boston Children’s Hospital Duration: July 2012 – June 2022 Patients: 1,135 pediatric cardiac surgery patients Lines Analyzed: 1,263 (195 axillary, 1,068 femoral) Primary Outcome: Complication rate (vascular compromise, pulse loss, thrombus, infection) Secondary Outcomes: Risk factors for complications, line placement trends Key findings Complication rates Why arterial site choice matters: Anatomical and physiological considerations Axillary artery: Robust collateral circulation via the subclavian and scapular arteries Less prone to ischemia, even in the event of temporary obstruction Avoids the groin, reducing infection risk in diapered or immobile patients Femoral artery: High risk of thrombotic events, especially in small vessels of neonates Limited collateral circulation increases the potential for ischemic damage Proximity to the groin increases infection risk in some pediatric patients Independent […]
May 23, 2025
Postoperative delirium (POD) is a frequent and serious complication in older adults undergoing surgery, marked by acute cognitive disturbances. In recent years, electroencephalography (EEG) has emerged as a promising non-invasive tool to identify patients at risk of POD. A new systematic review by Bruzzone et al. (2025) offers a comprehensive examination of EEG’s role across the perioperative continuum; before, during, and after surgery. Understanding postoperative delirium What is POD? POD is a transient neuropsychiatric condition with fluctuating attention and cognitive impairments. It typically arises within 1 to 3 days after surgery. Incidence in older adults ranges between 11% and 51%. Why is POD important? Associated with longer hospital stays, increased mortality, and lasting cognitive decline. Risk is higher in patients with preexisting cognitive vulnerabilities or neurodegenerative disorders. The role of EEG in POD What is EEG? EEG measures brain electrical activity using scalp electrodes. Frequency bands include delta (1–3 Hz), theta (4–7 Hz), alpha (8–13 Hz), and beta (13–20 Hz). EEG slowing, particularly increased delta and theta activity, is associated with delirium. Why use EEG for POD? Offers real-time insight into brain function. Can potentially identify at-risk individuals before symptoms develop. Key findings from the systematic review Study overview Total studies reviewed: 55 Participants: 13,046 POD incidence: 21% (n = 2,706) Preoperative EEG 16 studies investigated preoperative EEG. Most used power spectral analysis; results were inconsistent. Common findings in patients who developed POD: Lower spectral edge frequency (SEF) Reduced gamma band power Changes in alpha connectivity Several studies found no significant EEG changes before surgery. Intraoperative EEG 38 studies examined intraoperative EEG data. Most used BIS (bispectral index) or SedLine monitors. Main EEG indicators associated with POD: Increased burst suppression (BS) duration Lower alpha power during anesthesia Absence of spindle activity during emergence Burst suppression and POD Seen […]
May 22, 2025
The study conducted by Carley et al., published in Regional Anesthesia & Pain Medicine (2025), offers the first comprehensive evaluation of mepivacaine dosing for spinal anesthesia in pediatric orthopedic surgery. This retrospective review of over 3,200 cases represents a significant step forward in tailoring anesthetic approaches to the unique physiological needs of children and adolescents. Spinal anesthesia is an established technique in adult practice and increasingly in pediatric care. However, until now, no guidelines existed for using mepivacaine—a widely used intermediate-acting local anesthetic—for pediatric spinal anesthesia, especially in patients aged 5–18 years. This study fills that knowledge gap with age- and weight-specific dosing insights that can refine anesthetic care in ambulatory pediatric settings. Why Mepivacaine? Traditionally, bupivacaine has been the go-to agent for pediatric spinal anesthesia due to its long duration and established safety profile in infants. Yet, its prolonged effect can be a limitation in ambulatory surgery, especially for older children and adolescents. Key advantages of mepivacaine: Intermediate duration of action: Reduces the risk of delayed ambulation and urinary retention. Faster recovery: Facilitates earlier discharge, improving throughput in surgical centers. Safer discharge profile: Offers sufficient duration for most pediatric orthopedic procedures without prolonged sedation or motor blockade. Despite these benefits and decades of safe adult use, mepivacaine has been underutilized in pediatrics due to a lack of dosing guidance. Carley et al.’s study directly addresses this gap. Study overview Study design: Retrospective chart review. Setting: Hospital for Special Surgery (HSS), New York City. Study period: January 2016 – May 2022. Population: Pediatric patients (ages 5–18) undergoing lower extremity orthopedic surgery. Total cases analyzed: 3,267 single-shot spinal anesthetics using 1.5% preservative-free mepivacaine. Inclusion criteria: Use of single-agent spinal mepivacaine (1.5%) without adjuncts. Documented patient demographics and surgical details. Lower extremity orthopedic procedures only. Age-based dosing patterns: What the data show […]
May 20, 2025
