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Background: The administration of intravenous lidocaine during the peri-operative period may improve pain management after paediatric surgery., Objective: To explore the decrease in postoperative pain intensity and opioid consumption associated with peri-operative lidocaine administration in the paediatric population., Design: A systematic review with meta-analysis of randomised controlled trials and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis., Data Sources: Extensive literature review., Eligibility Criteria: This study includes clinical trials conducted during surgery that examined the effect of intravenous lidocaine compared with placebo on postoperative pain management., Results: Lidocaine administration decreased pain intensity in PACU (standardised mean difference (SMD) = -1.89 [-3.75, -0.03], I2  = 97%, P of I2  < 0.001) and on postoperative day 1 (SMD = -2.02 [-3.37, -0.66], I2  = 96%, P of I2  < 0.001, number of studies = 5). Lidocaine was associated with a decrease in opioid consumption on postoperative day 1 (SMD = -1.2 [-2.19, -0.2], I2  = 93%, P of I2  < 0.001) but not on postoperative day 2 (SMD = -1.73 [-3.9, 0.44], I2  = 96%, P of I2  < 0.001). GRADE analyses resulted in low-quality results. Subgroup analyses revealed that pain intensity in PACU and opioid consumption on postoperative day 1 decreased when lidocaine was administered during both the intra-operative and postoperative periods., Conclusions: The use of lidocaine is associated with improved pain management. However, further studies are needed to increase the level of evidence and determine the optimal administration regimen for pain management., (Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Background: For many years, blood-saving techniques and the enhanced recovery after surgery approach have been used to optimise the quality of care and shorten hospital stays. The creation of dedicated spine teams combining surgeons and anaesthesiologists specialised in spine surgery has been proven beneficial in adults. The objective of this study was to determine whether involving a spine team in the management of paediatric patients with scoliosis treated by posterior spinal fusion was associated with shorter hospital stays., Hypothesis: The hospital stay would be shorter in patients managed by a spine team., Materials and Methods: This single-centre, non-randomised, comparative study was initiated after approval by the local ethics committee. One group of patients was managed by a spine team composed of an anaesthesiologist and a surgeon with over 10 years of experience and the control group by an anaesthesiologist and a surgeon with less than 5 years of experience. The primary outcome was hospital stay length (median [interquartile range])., Results: The study included 157 paediatric patients who underwent spinal fusion in 2021 for adolescent idiopathic scoliosis (AIS, n = 106) or secondary scoliosis (n = 51). The spinal team was involved for 48 (45%) AIS procedures and 38 (74.5%) secondary-scoliosis procedures. Both operative time and anaesthesia time were significantly shorter in the spinal-team group, by 10% and 15% (p < 0.001 for both comparisons), respectively, for SIA and by 20% (p = 0.002) and 25% (p < 0.001), respectively, for secondary scoliosis. The spinal-team group had a shorter median hospital stay, the difference being significant for AIS (in days, 5 [4-7] versus 7.1 [5-10], p = 0.03) and nearly significant for secondary scoliosis (6.9 [5-10] versus 9 [6-23], p = 0.07). Fewer patients required blood transfusion in the spine-team group than in the control group (AIS: 0% versus 8.8%, p = 0.05; and secondary scoliosis, 28% versus 58%, p<0.01)., Conclusion: Involvement of a spine team optimises the peri-operative management of patients with AIS, thus shortening the hospital stay. Further work is needed to assess the potential associations of spine team involvement with complication rates., Level of Evidence: III; non-randomised comparative study., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Bleeding and transfusion remain important concerns during surgical correction of scoliosis even when multiple conservative strategies, such as preoperative recombinant erythropoietin and/or antifibrinolytic agents, are used. The current work aimed to determine the impact of other potential risk factors, especially the volume of intraoperative fluid intake, on the perioperative risk of allogenic transfusion during surgical correction of adolescent idiopathic scoliosis., Methods: This prospective study included all cases of adolescent idiopathic scoliosis operated in a single center during 2 years (2018-2020). Predictors analyzed were as follows: body mass index, preoperative hemoglobin concentration, thoracoplasty, preoperative halo-gravity, volume of intraoperative crystalloid administration, use of esophageal Doppler (for goal-directed fluid therapy), and duration of surgery. Statistical analyses were performed using a multivariable logistic regression model., Results: Two hundred patients were included in the analysis. Multivariable analysis found: an increased volume of intraoperative crystalloid administration as a significant predictor of allogenic blood transfusion. Receiving operator characteristics analysis found the model exhibiting an area under the curve of 0.85 (95% confidence interval: 0.75-0.95). Optimizing stroke volume using esophageal Doppler was associated with a decrease in intraoperative crystalloid intake., Conclusion: These results indicate a statistical association between the increase in crystalloid intake and the risk of allogenic blood transfusion during surgical correction of adolescent idiopathic scoliosis. Controlled studies are needed to address the causative relation between intraoperative fluid intake and the risk of allogenic transfusion., (© 2023 John Wiley & Sons Ltd.)

Purpose: The aim of this work is to study a cohort of patients of ISS < 15 admitted to a TC, and to determine the number of patients that ultimately benefited from the skills and resources specific of a level 1 trauma center., Methods: Retrospective study from a prospective cohort of patients admitted to TC (Beaujon Hospital, APHP) for suspected severe trauma from January 2011 to December 2017. The main outcome criterion was the use of surgery or interventional radiology within the first 24 h after admission of patients with ISS < 15. The secondary outcomes were stratified into severe (mortality, resuscitation care, length of stay in intensive care units) and non-severe criteria (mild head injury, hospital discharge or transfer within 24 h)., Results: Of 3035 patients admitted during the study period, 1409 with an ISS < 15 were included, corresponding to a theoretical overtriage rate of 46.4%. Among these, 611 patients (43.4%) underwent emergency intervention within the first 24 h (586 surgical interventions, 19 direct transfers to the operating theater and 6 acts of interventional radiology), 238 (16.9%) of patients presented with severe and 531 (38%) with non-severe outcome criteria., Conclusion: This work demonstrates that in a cohort of patients classified as ISS < 15 admitted to a TC, a considerable amount of TC-specific resources are required, and patients present with severe outcome criteria despite being classified as overtriaged. These results suggest that triage of trauma patients should be based on resource use and clinical outcome rather than anatomic criteria., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The goal of the present study was to investigate intraoperative factors associated with major neurological complications at 1 year following surgery for necrotizing enterocolitis., Material and Methods: The study consisted of a retrospective review of medical charts of patients operated for over one calendar year in one institution. Data collected included demographic data, cardiac resuscitation at birth, Bell classification, antibiotics usage, time of day of surgery, surgical technique, surgical duration, type of ventilation, intraoperative vasoactive agents, and albumin use, nadir cerebral saturation, the decrease in cerebral saturation from baseline, the time period when cerebral saturation was at least 20% below baseline, and the mean arterial pressure at nadir cerebral saturation. Reported follow-up complications were assessed during formal neonatologist consultation and additional imaging exploration as needed. Analyses included descriptive statistics, and univariable and multivariable statistics., Results: The study included 32 patients with no prior clinical neurological complications, of which 25 had normal cerebral imaging. Severe neurological complications occurred in nine patients at 1 year: Intraventricular hemorrhage (N = 2) and Periventricular leukomalacia (N = 7). However, preoperative cerebral imaging was lacking in seven patients. Consequently, the observed neurological complications at 1 year might be present before the surgery. Multivariable analysis found the decrease in cerebral saturation ≥36% from baseline as the only factor associated with the occurrence of those complications., Conclusion: Intraoperative decrease of cerebral oxygen saturation below ≥36% from baseline is associated with severe neurological complications in neonates undergoing surgery for necrotizing enterocolitis., (© 2022 John Wiley & Sons Ltd.)

Dutch peatlands have been subsiding due to peat decomposition, shrinkage and compression, since their reclamation in the 11th century. Currently, subsidence amounts to 1-2 cm/year. Water management in these areas is complex and costly, greenhouse gases are being emitted, and surface water quality is relatively poor. Regional and local authorities and landowners responsible for peatland management have recognized these problems. In addition, the Netherlands Royal Meteorological Institute predicts higher temperatures and drier summers, which both are expected to enhance peat decomposition. Stakeholder workshops have been organized in three case study areas in the province of Friesland to exchange knowledge on subsidence and explore future subsidence rates and the effects of land use and management changes on subsidence rates. Subsidence rates were up to 3 cm/year in deeply drained parcels and increased when we included climate change in the modeling exercises. This means that the relatively thin peat layers in this province (ca 1 m) would shrink or even disappear by the end of the century when current practices continue. Adaptation measures were explored, such as extensive dairy farming and the production of new crops in wetter conditions, but little experience has been gained on best practices. The workshops have resulted in useful exchange of ideas on possible measures and their consequences for land use and water management in the three case study areas. The province and the regional water board will use the results to develop land use and water management policies for the next decades.

Peat soils comprise a large part of the western and northern Netherlands. Drainage for agriculture has caused increased soil aeration which has stimulated decomposition and, hence, soil subsidence, currently amounting to 1-2 cm/yr. River water is supplied to these peat areas in summer to prevent drying out of the peat soils. Saltwater intrusion and evaporation make this surface water slightly brackish during drought periods. In addition, brackish seepage can surface more easily during such dry periods. We performed an incubation experiment in which the effects of salinization on aerobic decomposition and mineralization of shallow peat samples and anaerobic decomposition and mineralization of deep peat samples were studied. We considered four different types of peat samples: peat sampled in agricultural peat meadows and in nature reserves, originally formed under either eutrophic or oligotrophic conditions. The aerobic decomposition was approximately reduced by 50% after salinization, whereas the anaerobic decomposition rates remained unchanged. Remarkably, the response to salinization did not differ between the peat types and land uses. Ammonium concentrations increased while nitrate concentrations decreased after salinization, probably as a result of reduced nitrification. Especially in the oligotrophic peat, ammonium concentrations increased substantially. Phosphate concentrations increased, possibly caused by changes in desorption and adsorption processes due to higher ion concentrations. DOC concentrations decreased in the brackish samples due to precipitation. Furthermore, the eutrophic peat samples showed increasing sulfate concentrations, both in oxic and anoxic incubations, which was attributed to pyrite oxidation. Independently of salinization, nitrification rates were higher in the agricultural, fertilized, peat soils. In conclusion, while salinization might reduce subsidence rates, it will have adverse effects on water quality., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Extreme summer droughts are expected to occur more often in the future in NW Europe due to climate change. These droughts might accelerate the rate of peat oxidation in drained peat areas, with impacts on soil subsidence, GHG emission and water quality. This study aimed at providing more insight in the oxidation of deep peat layers that had not previously been exposed to air, the so-called secondary decomposition. We incubated two types of peat (eutrophic and oligotrophic), sampled from permanently anoxic peat layers from nature reserves and agricultural peat meadows. Peat samples were incubated for thirteen weeks under anoxic conditions, but were exposed to air for one to eight weeks. The production of CO2 and CH4 was quantified as a proxy for decomposition; concentrations of soluble nutrients and phenolic compounds were also measured. The results showed that oxygenation led to a steep increase in the rate of decomposition, indicated by higher carbon loss rates during and after oxygenation compared to non-oxygenated samples. Carbon loss rates increased more for eutrophic peat (agricultural area: 352%, nature reserve: 182%) than for oligotrophic peat (83% and 159% respectively). Most peat samples investigated showed higher post-oxygenation CO2 and/or CH4 production compared to the anoxic pre-oxygenation period. This indicates that oxygenation stimulates decomposition, even after anoxic conditions have returned. Contrary to the enzymic latch theory, no effects of oxygenation on the concentrations of soluble or condensed phenolic compounds were detected. Soluble nutrient concentrations did not change due to oxygenation either. Noteworthy is the occurrence of pyrite mineralization and associated acidification in eutrophic peat. Thus, low summer water levels, for example due to climate change, should be avoided in order to limit exceptionally high decomposition rates and associated problems such as increasing subsidence rates, greenhouse gas emission, sulfate release and acidification., (Copyright © 2014 Elsevier B.V. All rights reserved.)

In animal models, devices such as indwelling catheters and intracranial cannulae are often fixed on the skull to allow sampling or injection in the freely moving animal. The most commonly used method to fixate these devices is by embedding them in a 'helmet' of cement which is fixed to the skull with screws. Methylmethacrylate cement is commonly used for this purpose. The disadvantages of this cement are the high polymerization temperature, poor bonding to the bone and long hardening time. We have evaluated the use of glass ionomer cement, carboxylat cement and cyanoacrylic glue as alternative for methylmethacrylate cement. Temperature increase during polymerization of methylmethacrylate cement and glass ionomer cement was measured in the cement on the skull and in the brain of 14 rats in an acute model. In a chronic model, 52 rats and 91 mice were equipped with a 'helmet' of one of the cements. The glass ionomer 'helmets' were applied without or with pretreatment of the skull. The attachment of the cement to the skull was checked every day. After four weeks the bonding strengths of the cements were measured. The glass ionomer cement had less temperature increase during polymerization and good bonding capabilities when compared with methylmethacrylate cement. Mechanical pretreatment of the skull resulted in a significant increase in bonding strength of glass ionomer cement in mice and rats as compared with chemical pretreatment. Furthermore, glass ionomer cement had a shorter hardening time than methylmethacrylate cement, and when the glass ionomer cement was used in prepacked capsules, it was possible to apply the cement sterilely and easily. Cyanoacrylic glue had good bonding capabilities to the skull of mice and is also a good substitute for methylmethacrylate cement.