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1. Selecting a Program: A Guide for Parents of Infants & Preschoolers with Visual Impairments.

Author

Blind Childrens Center, Los Angeles, CA., Chen, Deborah, and McCann, Mary Ellen

Abstract

Intended for parents of infants and preschoolers with visual impairments, this booklet encourages parent involvement in all aspects of educational programming for their children and provides guidelines for selection of a suitable program. The first section examines the stresses involved during transitions from one program to another. Parents are urged to be active members of the child's educational team by making observations, creating a "snapshot" of the child for the team, identifying what the family thinks is important, keeping records, planning for meetings, and dealing effectively with professionals. The relationship of program choice to the overall family situation is noted. General and specific guidelines in selecting a program are addressed, including general atmosphere; social environment; physical environment; learning environment; and specific features of infant programs, preschool programs, and kindergarten programs. Specific guidelines are also offered to help evaluate a program from the child's point of view. These include looking at the learning environment, teacher competency, and transition issues. Also included are some suggestions for helping the child during the first few weeks of a new program. (DB)

Published
1993

2. Eligiendo un Programa: Guia para los padres de infantes y pre-escolares con incapacidades visuales (Selecting a Program: A Guide for Parents of Infants & Preschoolers with Visual Impairments).

Author

Blind Childrens Center, Los Angeles, CA., Chen, Deborah, and McCann, Mary Ellen

Abstract

Translated into Spanish, this booklet is intended for parents of infants and preschoolers with visual impairments or blindness. The guide focuses on the parent's role in selecting an appropriate program and helping the child make a positive transition into the program. The first section looks at feelings about transitions and positive steps parents can take, including questions to ask other parents and professionals. Next, the parent's important role on the child's team is stressed, noting the importance of making observations, creating a snapshot of the child, identifying what the family thinks is important, keeping records, planning for meetings, and dealing with professionals. The importance of considering family needs and values in program selection is stressed. Specific guidelines for selecting a program are offered, including where to start and what to look for. Criteria for program evaluation are presented in terms of how well the program meets the unique learning needs of young children with visual impairments. The booklet ends with suggestions for handling the first few weeks in a new program and thoughts on ongoing parent involvement. (DB)

Published
1993

3. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Author

Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, Williams, Robert, Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, and Williams, Robert

Abstract

Background In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes. Methods In this international, assessor-masked, equivalence, randomised, controlled trial conducted at 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand, we recruited infants of less than 60 weeks' postmenstrual age who were born at more than 26 weeks' gestation and were undergoing inguinal herniorrhaphy, without previous exposure to general anaesthesia or risk factors for neurological injury. Patients were randomly assigned (1:1) by use of a web-based randomisation service to receive either awake-regional anaesthetic or sevoflurane-based general anaesthetic. Anaesthetists were aware of group allocation, but individuals administering the neurodevelopmental assessments were not. Parents were informed of their infants group allocation upon request, but were told to mask this information from assessors. The primary outcome measure was full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III), at 5 years of age. The primary analysis was done on a per-protocol basis, adjusted for gestational age at birth and country, with multiple imputation used to account for missing data. An intention-to-treat analysis was also done. A difference in means of 5 points was predefined as the clinical equivalence margin. This completed trial is registered with ANZCTR, number ACTRN12606000441516, and ClinicalTrials.gov, number NCT00756600. Findings Between F

Published
2019

4. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial

Author

Leerstoel Baar, Development and Treatment of Psychosocial Problems, Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, Williams, Robert, Leerstoel Baar, Development and Treatment of Psychosocial Problems, Mccann, Mary Ellen, De Graaff, Jurgen C, Dorris, Liam, Disma, Nicola, Withington, Davinia, Bell, Graham, Grobler, Anneke, Stargatt, Robyn, Hunt, Rodney W, Sheppard, Suzette J, Marmor, Jacki, Giribaldi, Gaia, Bellinger, David, Hartmann, Penelope L, Hardy, Pollyanna, Frawley, Geoff, Izzo, Francesca, Von Ungern-sternberg, Britta, Lynn, Anne, Wilton, Niall, Mueller, Martin, Polaner, David M, Absalom, Anthony R, Szmuk, Peter, Morton, Neil S, Berde, Charles, Soriano, Sulpicio, Davidson, Andrew J, Arnup, Sarah, Lee, Katherine, Hunt, Rod W, Ormond, Gillian D, Takagi, Michael J, Taylor, Kaitlyn, Malarbi, Stephanie, Doyle, Melissa, Ragg, Philip, Costi, David, Wilton, Niall C, Knottenbelt, Graham, Furue, Koto, Gagnon, Hélène, Mameli, Leila, Pini Prato, Alessio, Mattioli, Girolamo, Wolfler, Andrea, Bova, Stefania M, Krachmalnicoff, Arianna, Guuva, Claudia, Van Der Werff, Desiree Bm, Van Gool, Jose Tdg, Van Loon, Kim, Kalkman, Cor J, Van Baar, Anneloes L, Hoekstra, Frouckje M, Volkers, Martin, Oostra, Martine, Pownall, Jaycee, Waldman, Jack, Hind, Ruth, Symonds, Joseph D, Bagshaw, Oliver, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Haret, Denisa, Steiner, Jeffrey, Kravitz, Brian, Farrow-gillespie, Alan, Suresh, Santhanam, Hays, Stephen, Taenzer, Andreas, Maxwell, Lynne, and Williams, Robert

Published
2019

5. Estimating pediatric general anesthesia exposure: Quantifying duration and risk.

Author

Bartels, Devan Darby, Bartels, Devan Darby, McCann, Mary Ellen, Davidson, Andrew J, Polaner, David M, Whitlock, Elizabeth L, Bateman, Brian T, Bartels, Devan Darby, Bartels, Devan Darby, McCann, Mary Ellen, Davidson, Andrew J, Polaner, David M, Whitlock, Elizabeth L, and Bateman, Brian T

Abstract

INTRODUCTION:Understanding the duration of pediatric general anesthesia exposure in contemporary practice is important for identifying groups at risk for long general anesthesia exposures and designing trials examining associations between general anesthesia exposure and neurodevelopmental outcomes. METHODS:We performed a retrospective cohort analysis to estimate pediatric general anesthesia exposure duration during 2010-2015 using the National Anesthesia Clinical Outcomes Registry. RESULTS:A total of 1 548 021 pediatric general anesthetics were included. Median general anesthesia duration was 57 minutes (IQR: 28-86) with 90th percentile 145 minutes. Children aged <1 year had the longest median exposure duration (79 minutes, IQR: 39-119) with 90th percentile 210 minutes, and 13.7% of this very young cohort was exposed for >3 hours. High ASA physical status and care at a university hospital were associated with longer exposure times. CONCLUSION:While the vast majority (94%) of children undergoing general anesthesia are exposed for <3 hours, certain groups may be at increased risk for longer exposures. These findings may help guide the design of future trials aimed at understanding neurodevelopmental impact of prolonged exposure in these high-risk groups.

Published
2018

6. The GAS trial - Authors' reply

Author

Davidson, Andrew J., Disma, Nicola, De Graaff, Jurgen C., Withington, Davinia E., McCann, Mary Ellen, Davidson, Andrew J., Disma, Nicola, De Graaff, Jurgen C., Withington, Davinia E., and McCann, Mary Ellen

Published
2016

7. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS) : an international multicentre, randomised controlled trial

Author

Davidson, Andrew J, Disma, Nicola, de Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, von Ungern Sternberg, Britta S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Frawley, Geoff, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, McCann, Mary Ellen, GAS consortium, Davidson, Andrew J, Disma, Nicola, de Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, von Ungern Sternberg, Britta S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Frawley, Geoff, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, McCann, Mary Ellen, and GAS consortium

Published
2016

8. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial

Author

Development and Treatment of Psychosocial Problems, Davidson, Andrew J, Disma, Nicola, De Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, Von Ungern Sternberg, Britta S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Frawley, Geoff, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, Mccann, Mary Ellen, Development and Treatment of Psychosocial Problems, Davidson, Andrew J, Disma, Nicola, De Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, Von Ungern Sternberg, Britta S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Frawley, Geoff, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, and Mccann, Mary Ellen

Published
2016

9. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial.

Author

Davidson, AJ, von Ungern Sternberg, BS, Frawley, G, Disma, Nicola, de Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, McCann, Mary Ellen, Davidson, AJ, von Ungern Sternberg, BS, Frawley, G, Disma, Nicola, de Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, and McCann, Mary Ellen

Abstract

Preclinical data suggest that general anaesthetics affect brain development. There is mixed evidence from cohort studies that young children exposed to anaesthesia can have an increased risk of poor neurodevelopmental outcome. We aimed to establish whether general anaesthesia in infancy has any effect on neurodevelopmental outcome. Here we report the secondary outcome of neurodevelopmental outcome at 2 years of age in the General Anaesthesia compared to Spinal anaesthesia (GAS) trial. In this international assessor-masked randomised controlled equivalence trial, we recruited infants younger than 60 weeks postmenstrual age, born at greater than 26 weeks' gestation, and who had inguinal herniorrhaphy, from 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand. Infants were randomly assigned (1:1) to receive either awake-regional anaesthesia or sevoflurane-based general anaesthesia. Web-based randomisation was done in blocks of two or four and stratified by site and gestational age at birth. Infants were excluded if they had existing risk factors for neurological injury. The primary outcome of the trial will be the Wechsler Preschool and Primary Scale of Intelligence Third Edition (WPPSI-III) Full Scale Intelligence Quotient score at age 5 years. The secondary outcome, reported here, is the composite cognitive score of the Bayley Scales of Infant and Toddler Development III, assessed at 2 years. The analysis was as per protocol adjusted for gestational age at birth. A difference in means of five points (1/3 SD) was predefined as the clinical equivalence margin. This trial is registered with ANZCTR, number ACTRN12606000441516 and ClinicalTrials.gov, number NCT00756600. Between Feb 9, 2007, and Jan 31, 2013, 363 infants were randomly assigned to receive awake-regional anaesthesia and 359 to general anaesthesia. Outcome data were available for 238 children in the awake-regional group and 294 in the general anaesthesia group. In the as

Published
2016

10. Summary of the Update Session on Clinical Neurotoxicity Studies.

Author

Pinyavat, Teeda, Pinyavat, Teeda, Warner, David O, Flick, Randall P, McCann, Mary Ellen, Andropoulos, Dean B, Hu, Danquig, Sall, Jeffrey W, Spann, Marisa N, Ing, Caleb, Pinyavat, Teeda, Pinyavat, Teeda, Warner, David O, Flick, Randall P, McCann, Mary Ellen, Andropoulos, Dean B, Hu, Danquig, Sall, Jeffrey W, Spann, Marisa N, and Ing, Caleb

Abstract

During the Fifth Pediatric Anesthesia Neurodevelopmental Assessment Symposium, experts and stakeholders met to present and discuss recent advances made in the study of neurodevelopmental outcomes after exposure to anesthetic drugs in infants and children. This article summarizes the update of 5 ongoing clinical studies: General Anesthesia compared to Spinal Anesthesia, Toxicity of Remifentanil and Dexmedetomidine, Mayo Anesthesia Safety in Kids, the University of California San Francisco human cohort study, and Columbia University Medical Center Neonatal Magnetic Resonance Imaging study. The purpose of this summary is to discuss the contributions and limitations of these studies, how they fit into the published literature, and what questions remain to be answered.

Published
2016

11. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial

Author

Medische staf Anesthesiologie, Brain, Davidson, Andrew J, Disma, Nicola, de Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, von Ungern Sternberg, Britta S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Frawley, Geoff, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, McCann, Mary Ellen, GAS consortium, Medische staf Anesthesiologie, Brain, Davidson, Andrew J, Disma, Nicola, de Graaff, Jurgen C, Withington, Davinia E, Dorris, Liam, Bell, Graham, Stargatt, Robyn, Bellinger, David C, Schuster, Tibor, Arnup, Sarah J, Hardy, Pollyanna, Hunt, Rodney W, Takagi, Michael J, Giribaldi, Gaia, Hartmann, Penelope L, Salvo, Ida, Morton, Neil S, von Ungern Sternberg, Britta S, Locatelli, Bruno Guido, Wilton, Niall, Lynn, Anne, Thomas, Joss J, Polaner, David, Bagshaw, Oliver, Szmuk, Peter, Absalom, Anthony R, Frawley, Geoff, Berde, Charles, Ormond, Gillian D, Marmor, Jacki, McCann, Mary Ellen, and GAS consortium

Published
2016

12. The GAS trial - Authors' reply

Author

Medische staf Anesthesiologie, Brain, Davidson, Andrew J., Disma, Nicola, De Graaff, Jurgen C., Withington, Davinia E., McCann, Mary Ellen, Medische staf Anesthesiologie, Brain, Davidson, Andrew J., Disma, Nicola, De Graaff, Jurgen C., Withington, Davinia E., and McCann, Mary Ellen

Published
2016

14. Erratum : Anesthesia and the developing brain: A way forward for clinical research (Pediatric Anesthesia (2015) 25 (447-452)

Author

Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Prato, Alessio Pini, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, Disma, Nicola, Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Prato, Alessio Pini, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, and Disma, Nicola

Published
2015

15. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes

Author

Frawley, Geoff, Bell, Graham, Disma, Nicola, Withington, Davinia E, de Graaff, Jurgen C, Morton, Neil S, McCann, Mary Ellen, Arnup, Sarah J, Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J, General Anesthesia compared to Spinal anesthesia (GAS) Consortium, Frawley, Geoff, Bell, Graham, Disma, Nicola, Withington, Davinia E, de Graaff, Jurgen C, Morton, Neil S, McCann, Mary Ellen, Arnup, Sarah J, Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J, and General Anesthesia compared to Spinal anesthesia (GAS) Consortium

Published
2015

16. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

Author

Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, Tibboel, Dick, Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, and Tibboel, Dick

Published
2015

17. Anesthesia and the developing brain : A way forward for clinical research

Author

Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Pini Prato, Alessio, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, Disma, Nicola, Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Pini Prato, Alessio, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, and Disma, Nicola

Published
2015

18. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial.

Author

Davidson, AJ, Frawley, G, von Ungern Sternberg, BS, Morton, Neil S, Arnup, Sarah J, de Graaff, Jurgen C, Disma, Nicola, Withington, Davinia E, Hunt, Rodney W, Hardy, Pollyanna, Khotcholava, Magda, Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Davidson, AJ, Frawley, G, von Ungern Sternberg, BS, Morton, Neil S, Arnup, Sarah J, de Graaff, Jurgen C, Disma, Nicola, Withington, Davinia E, Hunt, Rodney W, Hardy, Pollyanna, Khotcholava, Magda, Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, and McCann, Mary Ellen

Abstract

Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

Published
2015

19. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes.

Author

Davidson, AJ, Frawley, G, Bell, Graham, Disma, Nicola, Withington, Davinia E, de Graaff, Jurgen C, Morton, Neil S, McCann, Mary Ellen, Arnup, Sarah J, Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, AJ, Frawley, G, Bell, Graham, Disma, Nicola, Withington, Davinia E, de Graaff, Jurgen C, Morton, Neil S, McCann, Mary Ellen, Arnup, Sarah J, Bagshaw, Oliver, Wolfler, Andrea, and Bellinger, David

Abstract

Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure. This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic. RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46). The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.

Published
2015

20. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes

Author

Medische staf Anesthesiologie, Frawley, Geoff, Bell, Graham, Disma, Nicola, Withington, Davinia E, de Graaff, Jurgen C, Morton, Neil S, McCann, Mary Ellen, Arnup, Sarah J, Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J, General Anesthesia compared to Spinal anesthesia (GAS) Consortium, Medische staf Anesthesiologie, Frawley, Geoff, Bell, Graham, Disma, Nicola, Withington, Davinia E, de Graaff, Jurgen C, Morton, Neil S, McCann, Mary Ellen, Arnup, Sarah J, Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J, and General Anesthesia compared to Spinal anesthesia (GAS) Consortium

Published
2015

21. Erratum: Anesthesia and the developing brain: A way forward for clinical research (Pediatric Anesthesia (2015) 25 (447-452)

Author

Medische staf Anesthesiologie, Brain, Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Prato, Alessio Pini, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, Disma, Nicola, Medische staf Anesthesiologie, Brain, Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Prato, Alessio Pini, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, and Disma, Nicola

Published
2015

22. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

Author

Medische staf Anesthesiologie, Circulatory Health, Brain, Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, Tibboel, Dick, Medische staf Anesthesiologie, Circulatory Health, Brain, Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, and Tibboel, Dick

Published
2015

23. Anesthesia and the developing brain: A way forward for clinical research

Author

Medische staf Anesthesiologie, Brain, Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Pini Prato, Alessio, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, Disma, Nicola, Medische staf Anesthesiologie, Brain, Davidson, Andrew J., Becke, Karin, De Graaff, Jurgen, Giribaldi, Gaia, Habre, Walid, Hansen, Tom, Hunt, Rodney W., Ing, Caleb, Loepke, Andreas, McCann, Mary Ellen, Ormond, Gillian D., Pini Prato, Alessio, Salvo, Ida, Sun, Lena, Vutskits, Laszlo, Walker, Suellen, and Disma, Nicola

Published
2015

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