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Article: The impact of 1.5-T intraoperative magnetic resonance imaging in pediatric tumor surgery: Safety, utility, and challenges.

Becerra, Victoria / Hinojosa, José / Candela, Santiago / Culebras, Diego / Alamar, Mariana / Armero, Georgina / Echaniz, Gastón / Artés, David / Munuera, Josep / Muchart, Jordi

Frontiers in oncology

2023 Volume 12, Page(s) 1021335

Abstract: Objective: In this study, we present our experience with 1.5-T high-field intraoperative magnetic resonance imaging (ioMRI) for different neuro-oncological procedures in a pediatric population, and we discuss the safety, utility, and challenges of this ... ...

Abstract	Objective: In this study, we present our experience with 1.5-T high-field intraoperative magnetic resonance imaging (ioMRI) for different neuro-oncological procedures in a pediatric population, and we discuss the safety, utility, and challenges of this intraoperative imaging technology. Methods: A pediatric consecutive-case series of neuro-oncological surgeries performed between February 2020 and May 2022 was analyzed from a prospective ioMRI registry. Patients were divided into four groups according to the surgical procedure: intracranial tumors (group 1), intraspinal tumors (group 2), stereotactic biopsy for unresectable tumors (group 3), and catheter placement for cystic tumors (group 4). The goal of surgery, the volume of residual tumor, preoperative and discharge neurological status, and postoperative complications related to ioMRI were evaluated. Results: A total of 146 procedures with ioMRI were performed during this period. Of these, 62 were oncology surgeries: 45 in group 1, two in group 2, 10 in group 3, and five in group 4. The mean age of our patients was 8.91 years, with the youngest being 12 months. ioMRI identified residual tumors and prompted further resection in 14% of the cases. The mean time for intraoperative image processing was 54 ± 6 min. There were no intra- or postoperative security incidents related to the use of ioMRI. The reoperation rate in the early postoperative period was 0%. Conclusion: ioMRI in pediatric neuro-oncology surgery is a safe and reliable tool. Its routine use maximized the extent of tumor resection and did not result in increased neurological deficits or complications in our series. The main limitations included the need for strict safety protocols in a highly complex surgical environment as well as the inherent limitations on certain patient positions with available MR-compatible headrests.
Language	English
Publishing date	2023-01-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.1021335
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Article ; Online: Ultrasound-guided maxillary nerve block: an anatomical study using the suprazygomatic approach.

Echaniz, Gaston / Chan, Vincent / Maynes, Jason T / Jozaghi, Yelda / Agur, Anne

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2019 Volume 67, Issue 2, Page(s) 186–193

Abstract: Purpose: Although a maxillary nerve (MN) block reportedly provides satisfactory analgesia for midface surgery and chronic maxillofacial pain syndromes, a safe and reliable MN block technique has not been reported. The goal of this anatomical study was ... ...

Title translation	Bloc du nerf maxillaire échoguidé : une étude anatomique de l’approche supra-zygomatique.
Abstract	Purpose: Although a maxillary nerve (MN) block reportedly provides satisfactory analgesia for midface surgery and chronic maxillofacial pain syndromes, a safe and reliable MN block technique has not been reported. The goal of this anatomical study was to quantify the various angles and depth of the block needle, as well as to evaluate the impact of volume on the extent of injectate spread that might influence anesthetic coverage and block-related complications. Methods: Following an ultrasound-guided suprazygomatic MN block with dye injection, a dissection was performed in the pterygopalatine fossa (PPF) of four lightly embalmed cadaveric specimens. Half of the specimens were injected with 5 mL of dye, and the other half with 1 mL of dye. The needle depth was measured from the ultrasound images and using rubber markers. Following injection, dissection was performed to map the area of dye spread. Results: The median [interquartile range (IQR)] distance from the skin to the PPF was 37 [36-43] mm and 47 [40-50] mm by ultrasound and rubber marker methods, respectively. The median [IQR] needle orientation was 14 [11-32] degrees inferiorly and 15 [10-17] degrees posteriorly. The PPF was consistently dyed in the 5 mL group, but sporadically dyed in the 1 mL group. In the 5 mL group, spread outside of the PPF was seen. Conclusions: We showed that 5 mL of injectate far exceeds the capacity of the PPF, leading to drug spread outside of the PPF. Moreover, we found that 1 mL of injectate largely covered the nerve, suggesting a more efficacious and safer block procedure. This finding will need confirmation in future clinical studies.
MeSH term(s)	Anesthesia, Conduction ; Cadaver ; Humans ; Maxillary Nerve/anatomy & histology ; Maxillary Nerve/diagnostic imaging ; Nerve Block ; Ultrasonography, Interventional
Language	English
Publishing date	2019-09-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-019-01481-x
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Article ; Online: Feasibility of awake craniotomy in the pediatric population.

Alcaraz García-Tejedor, Gabriela / Echániz, Gastón / Strantzas, Samuel / Jalloh, Ibrahim / Rutka, James / Drake, James / Der, Tara

Paediatric anaesthesia

2020 Volume 30, Issue 4, Page(s) 480–489

Abstract: Background: Awake craniotomy with direct cortical stimulation and mapping is the gold standard for resection of lesions near eloquent brain areas, as it can maximize the extent of resection while minimizing the risk of neurological damage. In contrast ... ...

Abstract	Background: Awake craniotomy with direct cortical stimulation and mapping is the gold standard for resection of lesions near eloquent brain areas, as it can maximize the extent of resection while minimizing the risk of neurological damage. In contrast to the adult population, only small series of awake craniotomies have been reported in children. Aims: The aim of our study is to establish the feasibility of awake craniotomy in the pediatric population. Methods: We performed a retrospective observational study of children undergoing a supratentorial awake craniotomy between January 2009 and April 2019 in a pediatric tertiary care center. Our primary outcome was feasibility of awake craniotomy, defined as the ability to complete the procedure without conversion to general anesthesia. Our secondary outcomes were the incidence of serious intraoperative complications and the mapping completion rate. Results: Thirty procedures were performed in 28 children: 12 females and 16 males. The median age was 14 years (range 7-17). The primary diagnosis was tumor (83.3%), epilepsy (13.3%), and arterio-venous malformation (3.3%). The anesthetic techniques were asleep-awake-asleep (96.7%) and conscious sedation (3.3%), all cases supplemented with scalp block and pin-site infiltration. Awake craniotomy was feasible in 29 cases (96.7%), one patient converted to general anesthesia due to agitation. Serious complications occurred in six patients: agitation (6.7%), seizures (3.3%), increased intracranial pressure (3.3%), respiratory depression (3.3%), and bradycardia (3.3%). All complications were quickly resolved and without major consequences. Cortical mapping was completed in 96.6% cases. New neurological deficits occurred in six patients (20%)-moderate in one case and mild in 5-being all absent at 6 months of follow-up. Conclusion: Awake craniotomy with intraoperative mapping can be successfully performed in children. Adequate patient selection and close cooperation between neurosurgeons, anesthesiologists, neuropsychologists, and neurophysiologists is paramount. Further studies are needed to determine the best anesthetic technique in this population group.
MeSH term(s)	Adolescent ; Brain Mapping/methods ; Child ; Craniotomy/methods ; Feasibility Studies ; Female ; Humans ; Intraoperative Complications/prevention & control ; Male ; Monitoring, Intraoperative/methods ; Retrospective Studies ; Wakefulness
Language	English
Publishing date	2020-02-13
Publishing country	France
Document type	Journal Article ; Observational Study
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.13833
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Zs.A 3306: Show issues

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Article ; Online: Monopoly Airplane Lands in Esophagus Leading to Difficult Extraction: A Case Report on Anesthesia and Surgical Considerations.

Matava, Clyde T / Echaniz, Gaston / Parkes, William / Papsin, Blake C / Propst, Evan J / Cushing, Sharon L

A & A case reports

2017 Volume 9, Issue 7, Page(s) 193–196

Abstract: A 2-year-old child presented with an airplane game piece from the board game Monopoly lodged in her esophagus. The airplane's wings, engines, and winglets acted like fish hooks that entered the esophageal mucosa easily but were difficult to extract. ... ...

Abstract	A 2-year-old child presented with an airplane game piece from the board game Monopoly lodged in her esophagus. The airplane's wings, engines, and winglets acted like fish hooks that entered the esophageal mucosa easily but were difficult to extract. Chest radiographs were used to estimate the airplane wingspan dimensions, and a Foley catheter was used to dilate the esophagus to allow foreign body extraction via rigid esophagoscopy with optical forceps. Deliberate deep placement of the endotracheal tube facilitated surgical manipulation. This case report highlights the importance of teamwork, communication, and the involvement of multiple disciplines, each with their unique experience and expertise, to formulate a plan of action for patients during unique surgical emergencies.
Language	English
Publishing date	2017-10-01
Publishing country	United States
Document type	Journal Article
ISSN	2325-7237
ISSN (online)	2325-7237
DOI	10.1213/XAA.0000000000000562
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Article ; Online: Role of Postoperative Antimicrobials in Cleft Palate Surgery: Prospective, Double-Blind, Randomized, Placebo-Controlled Clinical Study in India.

Aznar, María Luisa / Schönmeyr, Bjorn / Echaniz, Gastón / Nebeker, Lismore / Wendby, Lisa / Campbell, Alex

Plastic and reconstructive surgery

2015 Volume 136, Issue 1, Page(s) 59e–66e

Abstract: Background: The purpose of this study was to determine whether administration of postoperative antibiotics affects the incidence of complications after primary cleft palate repair in a developing area.: Methods: This study was a prospective, double- ... ...

Abstract	Background: The purpose of this study was to determine whether administration of postoperative antibiotics affects the incidence of complications after primary cleft palate repair in a developing area. Methods: This study was a prospective, double-blind, randomized, placebo-controlled trial composed of 518 consecutive patients who underwent primary cleft palate repair at a single institution. Patients were aged 1 to 43 years at the time of surgery (median, 9 years). The patients were divided randomly into two groups. One group received a 5-day regimen of oral amoxicillin (50 mg/kg/day) postoperatively and the other group received placebo medication. Both groups received a single dose of cefuroxime (30 mg/kg) before incision. Patients and providers were blinded to the randomization. Patients were followed postoperatively for early complications (infection and wound breakdown) and for late complications (palatal fistulas). Results: The incidence of early complications was 13.8 percent among the patients in the placebo group and 8.7 percent among the patients in the antibiotic group (p = 0.175). Fistulas were noted in 17.1 percent in the placebo group and in 10.7 percent in the antibiotic group (p = 0.085). Logistic regression analysis identified visiting surgeons as the only covariate related to early complications (OR, 3.71; p < 0.001). However, the use of placebo (OR, 2.09; p = 0.037), female sex (OR, 2.04; p = 0.047), and Veau III and IV (OR, 3.31; p = 0.004) were observed as factors associated with the incidence of fistulas. Conclusion: The authors' results indicate that postoperative antibiotic prophylaxis can reduce the incidence of fistulas after primary cleft palate repair in a developing area.
MeSH term(s)	Adolescent ; Adult ; Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Child ; Child, Preschool ; Cleft Palate/surgery ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Incidence ; India ; Infant ; Logistic Models ; Male ; Postoperative Care/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Prospective Studies ; Risk Factors ; Treatment Outcome ; Young Adult
Chemical Substances	Anti-Bacterial Agents ; Amoxicillin (804826J2HU)
Language	English
Publishing date	2015-06-22
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000001324
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Uk I Zs.142: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 293: Show issues

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Article ; Online: Incidence and timing of hypotension after transcervical carotid artery stenting: correlation with postoperative complications.

Cirbian, Jesús / Echaniz, Gastón / Gené, Anna / Silva, Lorena / Fernández-Valenzuela, Valentín / de Nadal, Miriam

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2014 Volume 84, Issue 6, Page(s) 1013–1018

Abstract: Objectives: To assess the incidence and timing of hypotension after carotid artery stenting (CAS) and its correlation with postoperative complications.: Background: CAS-associated postoperative hypotension has been linked to surgical morbidity and ... ...

Abstract	Objectives: To assess the incidence and timing of hypotension after carotid artery stenting (CAS) and its correlation with postoperative complications. Background: CAS-associated postoperative hypotension has been linked to surgical morbidity and mortality, especially to stroke and cardiac complications. Methods: Ninety-seven consecutive patients undergoing transcervical CAS were monitored for at least 12 hr after operation. Hypotension was defined as systolic blood pressure < 90 mm Hg. Patients were divided into three groups: normal blood pressure and early (≤6 hr) and late (>6 hr) hypotension. Complications were recorded. Results: Hypotension occurred in 34% of the patients (early hypotension in 63% of them). Hypotension was recorded in 21.6% of patients during surgery and in 21.6%, 15.5%, and 1.0% at 6, 12, and 24 hr postoperatively. Bradycardia occurred in 26.8% during operation and in 25.8%, 13.4%, and 10.3% at 6, 12, and 24 hr after surgery. Intraoperative bradycardia (P = 0.01) and hypotension (P = 0.02) were predictors of postoperative hypotension. The overall rate of complications was 5% without differences between the study groups. The mean length of stay was 3, 3.6, and 2.8 days in the normotensive, early hypotension, and late hypotension groups, respectively. Conclusions: Most postoperative hypotension episodes occurred within the first 6 hr, and more than one-third between the 6 and 12 hr post-procedure. All patients with late hypotension were asymptomatic. There was no difference in complications between the study groups. In patients undergoing ambulatory CAS, hemodynamic monitoring in the postoperative period is particularly important during the first 12 hr.
MeSH term(s)	Aged ; Aged, 80 and over ; Angioplasty, Balloon/adverse effects ; Angioplasty, Balloon/instrumentation ; Blood Pressure ; Blood Pressure Determination ; Bradycardia/epidemiology ; Bradycardia/physiopathology ; Carotid Stenosis/diagnosis ; Carotid Stenosis/physiopathology ; Carotid Stenosis/therapy ; Female ; Heart Rate ; Humans ; Hypotension/diagnosis ; Hypotension/epidemiology ; Hypotension/physiopathology ; Incidence ; Length of Stay ; Male ; Middle Aged ; Postoperative Care/methods ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Spain/epidemiology ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2014-11-15
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1459995-8
ISSN	1522-726X ; 1522-1946
ISSN (online)	1522-726X
ISSN	1522-1946
DOI	10.1002/ccd.25615
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Zs.A 1226: Show issues

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Article ; Online: Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind, randomised study.

Echaniz, Gaston / De Miguel, Marcos / Merritt, Glenn / Sierra, Plinio / Bora, Pranjal / Borah, Nabamallika / Ciarallo, Christopher / de Nadal, Miriam / Ing, Richard J / Bosenberg, Adrian

European journal of anaesthesiology

2018 Volume 36, Issue 1, Page(s) 40–47

Abstract: Background: Cleft defects are common craniofacial malformations which require early surgical repair. These patients are at high risk of postoperative airway obstruction and respiratory failure. Cleft surgery may require high doses of opioids which may ... ...

Abstract	Background: Cleft defects are common craniofacial malformations which require early surgical repair. These patients are at high risk of postoperative airway obstruction and respiratory failure. Cleft surgery may require high doses of opioids which may contribute to these complications. Objectives: To compare the effectiveness of proximal and distal approaches to blocking the maxillary nerve in patients undergoing cleft lip or cleft palate surgery. Design: Randomised, controlled and double-blind study. Setting: The current study was carried out in Guwahati (Assam, India) between April 2014 and June 2014. Patients: A total of 114 patients older than 6 months who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included coagulation disorders, peripheral neuropathy or chronic pain syndrome, infection in the puncture site, allergy to local anaesthetics, lack of consent and language problems or other barriers that could impede the assessment of postoperative pain. Interventions: Patients were randomly assigned to one of two groups: proximal group (bilateral suprazygomatic maxillary nerve blocks) and distal group (bilateral infraorbital nerve blocks for cleft lip repair and bilateral greater and lesser palatine nerve blocks and nasopalatine nerve block for cleft palate surgery). Main outcome measure: The primary endpoint was the percentage of patients requiring extra doses of opioids. Secondary endpoints included pain scores, respiratory and nerve block-related complications during the first 24 h. Results: In the intra-operative period, there was a significant reduction of nalbuphine consumption in the proximal group (9.1 vs. 25.4%, P = 0.02). The percentage of patients requiring intra-operative fentanyl was lower in the proximal group (16.4 vs. 30.5%, P = 0.07). There were no differences in either postoperative pain scores or in postoperative complications. No technical failure or block-related complications were reported. Conclusion: Bilateral suprazygomatic maxillary nerve block is an effective and safe alternative to the traditional peripheral nerve blocks for cleft lip and cleft palate surgery, in a mixed paediatric and adult population.
MeSH term(s)	Adolescent ; Anesthetics, Local/therapeutic use ; Bupivacaine/therapeutic use ; Child ; Child, Preschool ; Cleft Lip/surgery ; Cleft Palate/surgery ; Double-Blind Method ; Epinephrine/therapeutic use ; Female ; Humans ; India ; Infant ; Male ; Maxillary Nerve/drug effects ; Nerve Block/methods ; Palate/innervation ; Peripheral Nerves/drug effects
Chemical Substances	Anesthetics, Local ; Bupivacaine (Y8335394RO) ; Epinephrine (YKH834O4BH)
Language	English
Publishing date	2018-10-03
Publishing country	England
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	605770-6
ISSN	1365-2346 ; 0265-0215
ISSN (online)	1365-2346
ISSN	0265-0215
DOI	10.1097/EJA.0000000000000900
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Article: The impact of 1.5-T intraoperative magnetic resonance imaging in pediatric tumor surgery: Safety, utility, and challenges.

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Article ; Online: Ultrasound-guided maxillary nerve block: an anatomical study using the suprazygomatic approach.

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Article ; Online: Feasibility of awake craniotomy in the pediatric population.

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Article ; Online: Monopoly Airplane Lands in Esophagus Leading to Difficult Extraction: A Case Report on Anesthesia and Surgical Considerations.

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Article ; Online: Role of Postoperative Antimicrobials in Cleft Palate Surgery: Prospective, Double-Blind, Randomized, Placebo-Controlled Clinical Study in India.

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Article ; Online: Incidence and timing of hypotension after transcervical carotid artery stenting: correlation with postoperative complications.

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Article ; Online: Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind, randomised study.

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