Lucile Marsac1,2, Daphné Michelet1,2, Chrystelle Sola3,4, Anne Didier-Vidal5, Sylvie Combet6, Frederic Blanc7, Gilles Orliaguet8,9, Jean-Vincent Aubineau10, Florence Julien-Marsollier1,2, Christopher Brasher11,12, Souhayl Dahmani1,2,13. 1. Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris, France. 2. PRES Paris Sorbonne Cité, Paris Diderot University (Paris VII), Paris, France. 3. Pediatric Anesthesia Unit, Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier University, Montpellier, France. 4. IGF, Montpellier University, CNRS, INSERM, Montpellier, France. 5. Department of Anesthesia and Intensive Care, Hôpital des Enfants, Groupe Hospitalier Pellegrin, Bordeaux Cedex, France. 6. Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Hopital Femme Mere Enfant, Bron, France. 7. Department of Anesthesia and Intensive Care, Assistance Publique Hôpitaux de Marseille, Timone Enfants Hospital, Aix-Marseille University, Marseille, France. 8. Department of Anesthesia and Intensive Care, Necker-Enfant Malades Hospital, Paris, France. 9. EA08, Pharmacologie et Évaluation des Thérapeutiques Chez L'enfant et la Femme Enceinte, Paris-Descartes and Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, Paris, France. 10. Department of Anesthesia and Intensive Care, Hôtel Dieu Hospital, Nantes, France. 11. Department of Anesthesia & Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia. 12. Anaesthesia and Pain Management Research Group, Murdoch Childrens' Research Institute, Parkville, Victoria, Australia. 13. DHU PROTECT, INSERM U1141, Robert Debré University Hospital, Paris, France.
Abstract
BACKGROUND: Renal transplantation is the best available therapeutic option for end-stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. MATERIAL AND METHODS: The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). RESULTS: Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. CONCLUSIONS: The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.
BACKGROUND: Renal transplantation is the best available therapeutic option for end-stage renal failure in both children and adults. However, little is known about anesthetic practice during pediatric renal transplantation. MATERIAL AND METHODS: The study consisted of a national survey about anesthetic practice during pediatric renal transplantation in France. French tertiary pediatric centers performing renal transplants were targeted, and one physician from each team was asked to complete the survey. The survey included patient data, preoperative assessment and optimization data, and intraoperative anesthesia data (drugs, ventilation, and hemodynamic interventions). RESULTS: Twenty centers performing kidney transplantation were identified and contacted to complete the survey, and eight responded. Surveyed centers performed 96 of the 122 pediatric kidney transplantations performed in France in 2017 (79%). Centers consistently performed echocardiography and ultrasound examinations of the great veins preoperatively and consistently employed esophageal Doppler cardiac output estimation and vasopressors intraoperatively. All other practices were found to be heterogeneous. Central venous pressure was monitored in six centers, and dopamine was administered perioperatively in two centers. CONCLUSIONS: The current study provides a snapshot of the perioperative management of pediatric kidney transplantation in France. Results emphasize the need for both standardization of practice and awareness of recent evidence against the use of CVP monitoring and dopamine infusions.
Authors: Marieke Voet; Elisabeth A M Cornelissen; Michel F P van der Jagt; Joris Lemson; Ignacio Malagon Journal: Paediatr Anaesth Date: 2021-08-20 Impact factor: 2.129