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Article ; Online: Sedation Practices for Lumbar Punctures in Patients With Acute Lymphoblastic Leukemia: A Multicenter Retrospective Study Using Pediatric Health Information Systems.

Wright, Mariah L / O'Brien, Sarah H / Schloss, Brian / Stanek, Joseph R / Reed, Suzanne

Journal of pediatric hematology/oncology

2022 Volume 44, Issue 7, Page(s) e982–e987

Abstract: Background: Sedation is often used to reduce pain and anxiety in pediatric patients with acute lymphoblastic leukemia (ALL) undergoing lumbar punctures (LPs). There is a potential for long-term effects on neurocognition with repeat sedative exposures in ...

Abstract	Background: Sedation is often used to reduce pain and anxiety in pediatric patients with acute lymphoblastic leukemia (ALL) undergoing lumbar punctures (LPs). There is a potential for long-term effects on neurocognition with repeat sedative exposures in young children. The purpose of this study is to determine the practice habits regarding sedation for LPs in pediatric patients with ALL among multiple institutions. Methods: This is a retrospective study of 48 hospitals in the Pediatric Health Information Systems (PHIS) between October 2015 and December 2019. Children 1 to 18 years old with ALL who received intrathecal chemotherapy in an outpatient setting were included. We analyzed the prevalence of anesthesia usage and the types of anesthetics used. Results: Of the 16,785 encounters with documented use of anesthetic medications, intravenous and inhaled anesthetics were used in 16,486 (98.2%) and local anesthetics alone in 299 (1.8%). The most commonly used medications used for sedation were propofol (n=13,279; 79.1%), midazolam (n=4228; 25.2%), inhaled fluranes (n=3169; 18.9%), and ketamine (n=2100; 12.5%). Conclusion: The majority of children's hospitals in the United States use intravenous and inhaled anesthetics for routine therapeutic LPs in pediatric patients with ALL. Propofol is one of the most common medications used for sedation.
MeSH term(s)	Acute Disease ; Adolescent ; Anesthesia ; Anesthetics, Local/therapeutic use ; Child ; Child, Preschool ; Conscious Sedation ; Health Information Systems ; Humans ; Hypnotics and Sedatives/therapeutic use ; Infant ; Ketamine ; Lipopolysaccharides/therapeutic use ; Midazolam ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy ; Propofol ; Retrospective Studies ; Spinal Puncture
Chemical Substances	Anesthetics, Local ; Hypnotics and Sedatives ; Lipopolysaccharides ; Ketamine (690G0D6V8H) ; Midazolam (R60L0SM5BC) ; Propofol (YI7VU623SF)
Language	English
Publishing date	2022-03-16
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1231152-2
ISSN	1536-3678 ; 1077-4114 ; 0192-8562
ISSN (online)	1536-3678
ISSN	1077-4114 ; 0192-8562
DOI	10.1097/MPH.0000000000002446
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Zs.A 1537: Show issues

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Article ; Online: Pulmonary Hemorrhage During Computed Tomography-Guided Percutaneous Lung Biopsy: A Case Report and Review of the Literature.

Staker, Kathryn / Schloss, Brian / Tobias, Joseph D

AANA journal

2019 Volume 85, Issue 3, Page(s) 166–170

Abstract: Percutaneous lung biopsy represents a minimally invasive method of obtaining lung tissue to aid in the diagnosis of various pulmonary diseases. Although the technique has major advantages, including being less invasive and having a more rapid recovery ... ...

Abstract	Percutaneous lung biopsy represents a minimally invasive method of obtaining lung tissue to aid in the diagnosis of various pulmonary diseases. Although the technique has major advantages, including being less invasive and having a more rapid recovery than open thoracotomy, complications such as bleeding may occur. To date, there is limited information regarding the complications and their treatment associated with this procedure. We describe a 22-year-old man with chronic granulomatous disease who experienced a pulmonary hemorrhage after percutaneous lung biopsy using computed tomography guidance while he was under general endotracheal anesthesia. Potential treatment algorithms and strategies are presented.
Language	English
Publishing date	2019-09-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	603605-3
ISSN	2162-5239 ; 0094-6354
ISSN (online)	2162-5239
ISSN	0094-6354
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Zs.A 1286: Show issues

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Article ; Online: Cardiac output assessment in children: playing catch-up.

Schloss, Brian / Tobias, Joseph D

Paediatric anaesthesia

2015 Volume 25, Issue 2, Page(s) 113–114

MeSH term(s)	Cardiac Output/physiology ; Cardiac Surgical Procedures ; Female ; Heart Defects, Congenital/surgery ; Humans ; Male ; Monitoring, Intraoperative/instrumentation ; Monitoring, Intraoperative/methods ; Stroke Volume/physiology
Language	English
Publishing date	2015-02
Publishing country	France
Document type	Comment ; Editorial
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.12567
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Zs.A 3306: Show issues

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Article: Hemodynamic and Respiratory Effects of Regadenoson During Radiologic Imaging in Infants and Children.

Schloss, Brian / Bekiroglu, Ismail / O'Connor, Colin / Lee, Simon / Rice, Julie / Kim, Stephani S / Tobias, Joseph D

Cardiology research

2021 Volume 12, Issue 6, Page(s) 329–334

Abstract: Background: Myocardial perfusion imaging using radionuclides is a well-validated, noninvasive method to aid in the diagnosis of patients with suspected or known myocardial ischemia. To increase the sensitivity of the technique, pharmacologic agents ... ...

Abstract	Background: Myocardial perfusion imaging using radionuclides is a well-validated, noninvasive method to aid in the diagnosis of patients with suspected or known myocardial ischemia. To increase the sensitivity of the technique, pharmacologic agents which induce coronary vasodilatation are administered. Regadenoson is a novel selective A2A receptor agonist that has similar efficacy to adenosine for cardiac magnetic resonance imaging (MRI) with a more favorable adverse effect profile and is the most widely used pharmacologic stress agent. While widely used in adults, there is limited experience with it in pediatrics, particularly young children. Methods: The current study retrospectively reviews our experience with stress cardiac MRI using regadenoson in children requiring general anesthesia. The study cohort included eight patients, all male, ranging in age from 2 to 6.2 years (mean age of 4.2 years) and in weight from 10 to 30.5 kg (mean weight of 18.5 kg). All patients received general anesthesia with endotracheal intubation and a volatile anesthetic agent. Results: Heart rate 1 min prior to regadenoson was 99 ± 19.2 (mean ± standard deviation (SD)) beats per minute. Peak heart rate was achieved at an average of 4 min post regadenoson administration with a mean heart rate of 122 ± 15 beats per minute. The average of the mean arterial pressure 1 min prior to regadenoson was 53.4 ± 5.2 mm Hg. Mean arterial pressure nadir was noted at 6 min post regadenoson with a value of 44.1 ± 6.3 mm Hg. Blood pressure support with phenylephrine was required in four of the eight (50%) of patients. No adverse respiratory events were noted. Only one of the eight (13%) patients had a perfusion defect but had preserved ventricular function and recovered without incident. Conclusions: Use of regadenoson in pediatric patients requiring general anesthesia is safe and feasible.
Language	English
Publishing date	2021-12-08
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2598593-0
ISSN	1923-2837 ; 1923-2829
ISSN (online)	1923-2837
ISSN	1923-2829
DOI	10.14740/cr1323
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Article: Pulse Pressure Analysis to Guide Intraoperative Phlebotomy Prior to Cardiac Surgery.

Schloss, Brian / Tumin, Dmitry / Naguib, Aymen / Rice, Julie / Galantowicz, Mark / Tobias, Joseph D

Cardiology research

2017 Volume 8, Issue 6, Page(s) 276–279

Abstract: Background: The aim of this study was to evaluate the response of the LiDCO-rapid™ during intraoperative phlebotomy in anesthetized children prior to surgery for congenital heart disease.: Methods: After the induction of general anesthesia and ... ...

Abstract	Background: The aim of this study was to evaluate the response of the LiDCO-rapid™ during intraoperative phlebotomy in anesthetized children prior to surgery for congenital heart disease. Methods: After the induction of general anesthesia and endotracheal intubation, baseline vital signs were recorded, along with pulse pressure variability (PPV) and stroke volume variability (SVV) from the LiDCO-rapid™ and cerebral oxygenation (rSO Results: The study cohort included 30 patients (mean age of 21 ± 11 years). Statistically significant changes during the study period were observed in rSO Conclusion: Baseline values as well as changes in the PVV and SVV from the LiDCO-rapid™ did not predict or correlate with changes in cerebral oxygenation measured by NIRS during intraoperative phlebotomy. Our preliminary data suggest that these parameters (PVV and SVV) are not useful in monitoring patient stability or the need for volume replacement during intraoperative phlebotomy prior to cardiac surgery.
Keywords	covid19
Language	English
Publishing date	2017-12-22
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2598593-0
ISSN	1923-2837 ; 1923-2829
ISSN (online)	1923-2837
ISSN	1923-2829
DOI	10.14740/cr634w
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Article: A case report of a retained and knotted caudal catheter.

Joselyn, Anita / Bhalla, Tarun / Schloss, Brian / Martin, David / Tobias, Joseph

Saudi journal of anaesthesia

2014 Volume 8, Issue 3, Page(s) 424–427

Abstract: Caudal catheters advanced to the lumbar and thoracic regions can be used to provide excellent analgesia for pre-term neonates undergoing major abdominal and thoracic procedures. Despite their frequent use, attention to detail is mandatory to avoid ... ...

Abstract	Caudal catheters advanced to the lumbar and thoracic regions can be used to provide excellent analgesia for pre-term neonates undergoing major abdominal and thoracic procedures. Despite their frequent use, attention to detail is mandatory to avoid complications related to the medications used or the placement technique. We present a 2-day-old, 2 kg, pre-term infant who was born at 32 weeks gestational age with a tracheoesophageal fistula. Following anesthetic induction, a caudal epidural catheter was placed with the intent of threading it to the mid-thoracic level. The intraoperative and post-operative courses were uneventful with the epidural catheter providing adequate analgesia without the need for supplemental intravenous opioids. During catheter removal, resistance was noted and it could not be easily removed. With repositioning and various other maneuvers, the catheter was removed with some difficulty. On examination of the catheter, a complete knot was noted. Options for catheter advancement from the caudal space to the thoracic dermatomes are reviewed and techniques discussed for removal of a retained epidural catheter.
Language	English
Publishing date	2014-09-01
Publishing country	India
Document type	Case Reports
ZDB-ID	2562174-9
ISSN	0975-3125 ; 1658-354X
ISSN (online)	0975-3125
ISSN	1658-354X
DOI	10.4103/1658-354X.136644
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Article ; Online: The otolaryngologist's and anesthesiologist's collaborative role in a pandemic: A large quaternary pediatric center's experience with COVID-19 preparation and simulation.

Willer, Brittany L / Thung, Arlyne K / Corridore, Marco / D'Mello, Ajay J / Schloss, Brian S / Malhotra, Prashant S / Walz, Patrick C / Elmaraghy, Charles A / Tobias, Joseph D / Jatana, Kris R / Raman, Vidya T

International journal of pediatric otorhinolaryngology

2020 Volume 136, Page(s) 110174

Abstract: There has been a rapid global spread of a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which originated in Wuhan China in late 2019. A serious threat of nosocomial spread exists and as such, there is a critical ... ...

Abstract	There has been a rapid global spread of a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which originated in Wuhan China in late 2019. A serious threat of nosocomial spread exists and as such, there is a critical necessity for well-planned and rehearsed processes during the care of the COVID-19 positive and suspected patient to minimize transmission and risk to healthcare providers and other patients. Because of the aerosolization inherent in airway management, the pediatric otolaryngologist and anesthesiologist should be intimately familiar with strategies to mitigate the high-risk periods of viral contamination that are posed to the environment and healthcare personnel during tracheal intubation and extubation procedures. Since both the pediatric otolaryngologist and anesthesiologist are directly involved in emergency airway interventions, both specialties impact the safety of caring for COVID-19 patients and are a part of overall hospital pandemic preparedness. We describe our institutional approach to COVID-19 perioperative pandemic planning at a large quaternary pediatric hospital including operating room management and remote airway management. We outline our processes for the safe and effective care of these patients with emphasis on simulation and pathways necessary to protect healthcare workers and other personnel from exposure while still providing safe, effective, and rapid care.
MeSH term(s)	Airway Management ; Anesthesiologists ; Betacoronavirus ; COVID-19 ; Child ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Humans ; Otolaryngologists ; Otolaryngology ; Pandemics/prevention & control ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; Quaternary Prevention ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-06-10
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2020.110174
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Zs.A 1507: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Caudal epidural blockade in adolescents.

Schloss, Brian / Jayanthi, Venkata R / Bhalla, Tarun / Tobias, Joseph D

Saudi journal of anaesthesia

2013 Volume 7, Issue 1, Page(s) 57–60

Abstract: Background: Various options are available for the provision of analgesia following major surgical procedures including systemic opioids and regional anesthetic techniques. Regional anesthetic techniques offer the advantage of providing analgesia while ... ...

Abstract	Background: Various options are available for the provision of analgesia following major surgical procedures including systemic opioids and regional anesthetic techniques. Regional anesthetic techniques offer the advantage of providing analgesia while avoiding the deleterious adverse effects associated with opioids including nausea, vomiting, sedation and respiratory depression. Although used commonly in infants and children, there is a paucity of experience with the use of caudal epidural blockade in adolescents. Methods: We retrospectively reviewed the perioperative care of adolescents undergoing major urologic or orthopedic surgical procedures for whom a caudal epidural block was placed for postoperative analgesia. Results: The cohort for the study included 5 adolescents, ranging in age from 13 to 18 years and in weight from 42 to 71 kilograms. Caudal epidural analgesia was accomplished after the induction of anesthesia and prior to the start of the surgical procedure using 20-25 mL of either 0.25% bupivacaine or 0.2% ropivacaine with clonidine (1 μg/kg). The patients denied pain the recovery room. The time to first request for analgesia varied from 12 to 18 hours with the patients requiring 1-3 doses of analgesic agents during the initial 24 postoperative hours. Conclusions: Our preliminary experience demonstrates the efficacy of caudal epidural block in providing analgesia following major urologic and orthopedic surgical procedures. The applications of this technique as a means of providing postoperative analgesia are discussed.
Language	English
Publishing date	2013-05-23
Publishing country	India
Document type	Journal Article
ZDB-ID	2562174-9
ISSN	0975-3125 ; 1658-354X
ISSN (online)	0975-3125
ISSN	1658-354X
DOI	10.4103/1658-354X.109812
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Article: Caudal epidural blockade for major orthopedic hip surgery in adolescents.

Schloss, Brian / Martin, David / Tripi, Jennifer / Klingele, Kevin / Tobias, Joseph D

Saudi journal of anaesthesia

2015 Volume 9, Issue 2, Page(s) 128–131

Abstract: Background: There continues to be a significant focus on the value of regional and neuraxial anesthesia techniques for adjunctive use when combined with general anesthesia. The reported advantages include decreased patient opiate exposure, decreased ... ...

Abstract	Background: There continues to be a significant focus on the value of regional and neuraxial anesthesia techniques for adjunctive use when combined with general anesthesia. The reported advantages include decreased patient opiate exposure, decreased medication-related adverse effects, decreased postanesthesia recovery room time and hospital stay, and increased patient satisfaction. Materials and methods: The authors present a case-controlled series evaluating the use of a single caudal epidural injection prior to incision as an adjunct to general anesthesia for the open repair of slipped capital femoral epiphysis. Opiate consumption, pain scores, and hospital stay were compared between the two cohorts of 16 adolescent patients. All patients received a demand-only patient-controlled opiate delivery system. Results: Although the failed block rate was high (31%), there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block. Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block. Conclusion: The potential utility of caudal epidural block as an adjunct to general anesthesia during major hip surgery in adolescents is presented. Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.
Language	English
Publishing date	2015-03-29
Publishing country	India
Document type	Journal Article
ZDB-ID	2562174-9
ISSN	0975-3125 ; 1658-354X
ISSN (online)	0975-3125
ISSN	1658-354X
DOI	10.4103/1658-354X.152832
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Article: Intraoperative Anaphylactic Reaction: Is it the Floseal?

Bordes, Brianne / Martin, David / Schloss, Brian / Beebe, Allan / Samora, Walter / Klamar, Jan / Stukus, David / Tobias, Joseph D

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG

2016 Volume 21, Issue 4, Page(s) 358–365

Abstract: When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is ... ...

Abstract	When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is anaphylactic reactions. During anesthetic care, these most commonly involve neuromuscular blocking agents, antibiotics, or latex. Floseal is a topical hemostatic agent that is frequently used during orthopedic surgical procedures to augment local coagulation function and limit intraoperative blood loss. As these products are derived from human thrombin, animal collagen, and animal gelatin, allergic phenomenon may occur following their administration. We present 2 pediatric patients undergoing posterior spinal fusion who developed intraoperative hemodynamic and respiratory instability following use of the topical hemostatic agent, Floseal. Previous reports of such reactions are reviewed, and the perioperative care of patients with intraoperative anaphylaxis is discussed.
Language	English
Publishing date	2016-09-22
Publishing country	United States
Document type	Case Reports
ZDB-ID	3028543-4
ISSN	1551-6776
ISSN	1551-6776
DOI	10.5863/1551-6776-21.4.358
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