Wiley: Pediatric Anesthesia: Table of Contents

Effect of Low Fresh Gas Flows on Intraoperative Hypothermia Among Neonates Undergoing Abdominal Surgeries: A Randomized Controlled Trial

Thu, 16 Apr 2026 02:09:49 -0700

ABSTRACT

Introduction

Intraoperative hypothermia remains a frequent and under-recognized complication in neonates undergoing surgery despite standard preventive measures. Low-flow anesthesia, by increasing rebreathing and conserving heat and humidity, may offer a thermo-protective effect. In this study, we compare the incidence of intraoperative hypothermia between low-flow (1 L/min) vs. routine-flow (2 L/min) anesthesia in neonates undergoing abdominal surgery.

Methods

After obtaining written informed consent from parents or legal guardians, 160 neonates scheduled for elective or emergency abdominal surgery were randomized into two groups: Group L (low-flow, 1 L/min) and Group C (control, 2 L/min). Core temperature was continuously monitored intraoperatively. The primary outcome was the incidence of intraoperative hypothermia (core temperature < 36°C). Secondary outcomes included changes in core temperature, minimum and maximum intraoperative temperature, percentage of surgical time spent under hypothermia, time to extubation, blood loss, transfusion requirements, use of inotropes, and postoperative ventilation.

Results

The incidence of intraoperative hypothermia was significantly lower in group L compared to group C (75% vs. 90%, p = 0.01). The median (IQR) drop in core temperature from baseline was smaller in group L as compared to group C [0.80°C (0.60–1.10) vs. 1.20°C (0.90–1.50), p < 0.001]. Minimum core temperature was higher in group L [35.5°C (35.20–35.90) vs. 35°C (34.80–35.40), p < 0.001]. The percentage of surgical time spent under hypothermia (< 36°C) was significantly lower in group L [50.3% (95% CI: 43.3–57.3)] compared to group C [65.6% (95% CI: 58.6–72.6), p = 0.003]. While intraoperative blood loss was slightly higher in the low-flow group, the clinical impact was minimal. Other outcomes, including extubation time, inotrope use, and hypoxia incidence, were comparable between groups.

Conclusion

Low-flow anesthesia technique at 1 L/min is a safe and effective approach for reducing the incidence and duration of intraoperative hypothermia in neonates undergoing abdominal surgery.

Trial Registration: Clinical Trial Registry of India (www.ctri.nic.in): CTRI/2022/11/047532

Extended Reality Works: Why Isn't It Routine in Pediatric Care?

Kathryn Handlogten — Thu, 16 Apr 2026 02:01:29 -0700

Pediatric Anesthesia, EarlyView.

Developing a Pediatric Pain Curriculum for Pediatric Anesthesia Fellows in Sub‐Saharan Africa: A Delphi Study

Tue, 14 Apr 2026 22:16:52 -0700

ABSTRACT

Background

Comprehensive pain management in children requires a specialized skillset, with a limited number of clinicians possessing the level of expertise required to successfully navigate the complexities of holistic care. The emergence of pediatric anesthesia fellowship programs in sub-Saharan Africa presents an opportunity to embed a pediatric pain curriculum for trainees, improving the availability of specialist skill and knowledge in the field. Existing pain curricula fall short in addressing the sociocultural aspects of pediatric pain identified through research as being unique to the African context, and do not include elements of leadership and advocacy training required to navigate the complexities of resource-constrained healthcare settings.

Methods

A Delphi survey including literature review, iterative rounds of surveys and expert consensus was used to establish a pediatric pain curriculum for pediatric anesthesia fellows undertaking advanced training in sub-Saharan Africa. The 22-member expert panel included anesthetists, nurses, surgeons, pharmacists, pediatricians, a physiotherapist and a patient-caregiver dyad with a lived experience of pain. After completing three rounds of surveys, a steering committee of five members was assembled to resolve outstanding items to achieve the final curriculum.

Results

The process yielded a curriculum containing 20 knowledge items and 23 skills items. Attitudes are a key component of the curriculum and were grouped into six themes. A further aspect of the process was the identification of foundational knowledge with which trainees should enter a fellowship training program. This was termed the foundational curriculum.

Conclusion

Using a Delphi method, consensus has been achieved on a pediatric pain curriculum for pediatric anesthesia fellows in sub-Saharan Africa with potential to meet the identified need for transformative pain care in this patient population.

A Blunt Instrument for a Delicate Task

Gillian Crowe, Robert Ghent — Tue, 14 Apr 2026 22:15:20 -0700

Pediatric Anesthesia, EarlyView.

Does Combining Dexmedetomidine and Esketamine Truly Improve Pediatric Premedication Outcomes?

Mattia Madeo, Zaninni Caroleo, Eugenio Garofalo, Andrea Bruni — Tue, 14 Apr 2026 22:14:56 -0700

Pediatric Anesthesia, EarlyView.

Is Non Intubated Anesthesia the Key Determinant in Pediatric Thoracoscopic Surgery?

Mattia Madeo, Zaninni Caroleo, Eugenio Garofalo, Andrea Bruni — Mon, 13 Apr 2026 07:24:42 -0700

Pediatric Anesthesia, EarlyView.

Reduced and Personalized Fasting Regimens to Avoid Metabolic Complications in Pediatric Anesthesia

Benjamin J. Blaise, Hugh Lemonde, Philip Arnold — Mon, 13 Apr 2026 02:47:18 -0700

Pediatric Anesthesia, EarlyView.

Unplanned Post‐Operative Pediatric Intensive Care Unit Admissions After Elective Upper Airway Procedures: A Retrospective Case–Control Study

Sat, 11 Apr 2026 00:10:06 -0700

ABSTRACT

Background

Elective pediatric upper airway procedures are generally safe; however, some patients require unplanned pediatric intensive care unit admission, increasing care complexity.

Aims

To identify perioperative risk factors associated with unplanned pediatric intensive care unit admission following elective pediatric upper airway surgery.

Methods

We performed a retrospective case–control study at a single tertiary care center, identifying all unplanned pediatric intensive care unit admissions between January 2017 and June 2022. Among 151 such admissions, 29 followed elective upper airway surgery; of these, 22 cases were successfully matched on procedure type, age, and date of surgery in a 1:2 ratio to controls without unplanned pediatric intensive care unit admission based on procedure type, age, and date of surgery. Demographic, clinical, and perioperative variables were compared between cases and controls.

Results

The unplanned pediatric intensive care unit admission (n = 22) and control (n = 44) groups were comparable with respect to age and weight; however, median apnea-hypopnea index was higher in the unplanned pediatric intensive care unit cohort (12.7 [IQR 7.9–33.7] vs. 6.6 [IQR 3.7–25.2] events/h; p = 0.033). In unadjusted conditional logistic regression analyses, American Society of Anesthesiologists physical status > 2 was associated with increased odds of unplanned pediatric intensive care unit admission (OR 7.92, 95% CI 2.25–27.92; p = 0.001), as were prior neonatal intensive care unit admission (OR 23.19, 95% CI 3.03–177.38; p = 0.003), chronic lung disease (OR 14.00, 95% CI 1.72–113.79; p = 0.014), and longer operative duration (OR 1.03 per minute, 95% CI 1.003–1.058; p = 0.032). Apnea-hypopnea index, analyzed using multiple imputed values, was not significant (OR 1.03 per unit increase, 95% CI 0.996–1.069; p = 0.082). In a multivariable conditional logistic regression model, only prior neonatal intensive care unit admission remained independently associated with unplanned pediatric intensive care unit admission (adjusted OR 14.65, 95% CI 1.23–175.05; p = 0.034).

Conclusion

Several clinical factors were seen to be associated with increased risk of unplanned pediatric intensive care unit admission after upper airway surgery including American Society of Anesthesiologists physical status > 2, chronic lung disease, prior neonatal intensive care unit admission, and longer operative duration. Controlling for these clinical factors, prior neonatal intensive care unit admission best predicted the need for unplanned pediatric intensive care unit admission. Recognition of these risk factors may help inform perioperative risk stratification and postoperative resource planning.

MRI in Febrile Children: Temperature Changes in Sedated or Anesthetized Pediatric Patients With Initial Body Temperature ≥ 38.5°C

Sat, 11 Apr 2026 00:00:19 -0700

Pediatric Anesthesia, EarlyView.

Monitoring Cerebral Oxygenation During Neonatal Cardiac Surgery: Limitations of Conventional NIRS

Fri, 10 Apr 2026 03:59:00 -0700

Pediatric Anesthesia, EarlyView.

Chinese Society of Pediatric Anesthesiology Guideline for Pediatric Sedation (2025)

Fri, 10 Apr 2026 03:54:56 -0700

ABSTRACT

Background

With the increasing variety of pediatric diagnostic procedures, a growing number of children require sedation for diagnostic examinations. Appropriate sedation protocols guarantee the safety of children during sedation and improve its efficiency. Currently, there are significant differences in pediatric sedation practices across countries, regions, and medical institutions.

Methods

The Pediatric Anesthesiology Group of the Chinese Society of Anesthesiology organized experts from multiple countries to develop the “Chinese Society of Pediatric Anesthesiology Guideline for Pediatric sedation (2025)” based on evidence-based medicine, considering the safety and efficacy, the preferences of children and parents, and drug accessibility.

Results

The guideline provided 28 recommendations addressing 12 clinical issues related to pre-sedation assessment, safety measures for sedation personnel and facilities, sedation protocols, sedation monitoring, and post-sedation recovery.

Conclusions

The guideline is planned to be disseminated globally through multiple channels, aiming to standardize the management of pediatric sedation and improve its safety and efficacy.

Relative Resuscitation Capacity: A Practical Framework for Pediatric Intravenous Access

Michael Hafeman, Matthew J. Rowland — Wed, 08 Apr 2026 22:37:39 -0700

ABSTRACT

Background

Adequate intravenous (IV) access is a key component of anesthetic care, but this concept is often discussed in qualitative rather than quantitative terms, particularly within the pediatric subspecialty.

Aims

We propose a concept termed relative resuscitation capacity as a framework to standardize IV catheter sizes across patients of different sizes.

Methods

Manufacturer-reported IV catheter flow rates were used to calculate time to replace estimated blood volume (EBV). A short 16G catheter in an adult was defined to have a relative resuscitation capacity of 1, which serves as a reference point. Equivalent calculations were performed across a range of pediatric ages and catheter sizes and were normalized to this adult reference.

Results

The following catheter-age pairings have a relative resuscitation capacity near 1, indicating a similar time to replace EBV compared to a 16G catheter in an adult: 6-month-old with 24G, 1-year-old with 22G, 6-year-old with 20G, 10-year-old with 18G.

Conclusions

Relative resuscitation provides a practical framework to equate IV catheter selection across patients of all ages. This approach helps to translate adult-based heuristics to pediatric practice and to define large-bore access quantitatively.

Prophylactic Dexmedetomidine Reduces Junctional Ectopic Tachycardia and Facilitates Postoperative Recovery in Pediatric Cardiac Surgery: A Systematic Review and Meta‐Analysis of Prospective Trials

Wed, 08 Apr 2026 05:41:56 -0700

ABSTRACT

Objective

To evaluate the efficacy and safety of prophylactic dexmedetomidine in preventing Junctional Ectopic Tachycardia (JET) and its impact on postoperative recovery in pediatric congenital heart surgery, restricting analysis to prospective trials.

Methods

We systematically searched PubMed, Scopus, and CENTRAL through October 16, 2025, for prospective randomized and quasi-randomized trials. Retrospective cohorts were excluded. The primary outcome was postoperative JET incidence. Secondary outcomes included mechanical ventilation duration, ICU length of stay (LOS), Vasoactive-Inotropic Score (VIS), and safety. Data were synthesized using random-effects models and certainty of evidence was assessed using the GRADE framework.

Results

Five prospective trials (n = 639) met the inclusion criteria. Prophylactic dexmedetomidine was associated with a significant reduction in postoperative JET incidence (OR 0.37; 95% CI 0.23–0.58; p < 0.0001; I ² = 0%), supported by moderate-certainty evidence. For secondary outcomes, pooled analyses suggested reductions in mechanical ventilation (MD −4.80 h) and ICU LOS (MD −19.83 h), but these were characterized by substantial clinical heterogeneity and low to very-low certainty of evidence. A significant reduction in VIS emerged only in the sensitivity analysis; these findings remain hypothesis-generating. No significant differences were observed for mortality or hypotension.

Conclusions

In prospective pediatric cardiac surgery trials, prophylactic dexmedetomidine was associated with reduced postoperative JET, supported by moderate-certainty evidence. While dexmedetomidine may help facilitate earlier recovery, its impact on secondary outcomes remains suggestive rather than definitive due to low evidence certainty. Future large-scale, multicenter randomized trials are required to confirm if these potential benefits translate into consistent clinical improvements.

Parental Perspectives on Using the FLACC Scale for Postoperative Pain at Home After Orchiopexy

Fie Juul Praastrup, Lone Nikolajsen, Camilla Gaarsdal Uhrbrand — Tue, 07 Apr 2026 04:41:02 -0700

Pediatric Anesthesia, EarlyView.

Issue Information

Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 473-473, May 2026.

Correction to “The Effect of Augmented Reality on Preoperative Anxiety in Children and Adolescents: A Randomized Controlled Trial”

Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 584-584, May 2026.

Sustainable Healthcare Practices in Pediatric Anesthesia

Andrea P. A. Yap, Rebecca McIntyre, Forbes McGain — Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Healthcare accounts for 4%–5% of global CO₂ equivalent (CO₂e) emissions, of which hospitals form a considerable component. Identifying evidence-based targets for carbon reduction in pediatric anesthesia can help guide meaningful reductions in healthcare-related environmental harm.

Methods

A narrative review was conducted integrating published data on carbon emissions associated with anesthetic agents, perioperative workflows, waste generation, and hospital energy systems. Quantitative CO₂e estimates were incorporated when available.

Results

Preoperative strategies with measurable carbon savings include early anesthesia assessment, telehealth consultations, and standardization of diagnostic testing. Intraoperatively, avoidance of nitrous oxide and desflurane yield the largest individual reductions. Propofol waste can be reduced through dose calculators and optimized vial selection. Switching to reusable equipment further limits environmental harm. Institutional actions, including decommissioning nitrous oxide pipeline systems, enhancing sustainability training, and optimizing heating, ventilation, and air conditioning systems, offer the largest measurable carbon reductions.

Conclusions

Pediatric anesthetists can reduce environmental harm while optimizing patient care. While individual clinician choices -in particular avoiding desflurane and nitrous oxide use—are impactful, the largest and most sustainable emissions reductions derive from coordinated institutional and systems level changes.

The Analgesic Effect of Extended Reality (XR) on Acute and Postoperative Pain in Children: A Systematic Review and Meta‐Analysis

Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Acute and postoperative pain in children is often undertreated, with effects on patient comfort and postoperative recovery. Extended reality (XR) interventions offer non-pharmacological pain management by distracting patients from discomfort. While effective for procedural pain, its impact on prolonged pain episodes remains underexplored.

Objectives

To systematically review and meta-analyze findings from previous studies on the efficacy of XR interventions in managing acute and postoperative pain in children, compared to standard care.

Eligibility Criteria

Studies involving children (≤ 18 years) with acute or postoperative pain were included if they compared XR interventions to standard care. Studies focusing on procedural or chronic pain were excluded.

Methods

A systematic search was conducted on January 23, 2025, in MEDLINE, EMBASE, Web of Science, CINAHL, and PsycINFO for studies evaluating XR interventions for acute and postoperative pain in children, using validated pain measures. Pain outcomes were extracted for an exploratory meta-analysis, with self-report as the primary and observer-report as the secondary outcome. Two reviewers independently extracted data and assessed study quality using CONSORT and TREND.

Results

From 1793 records, nine studies were included, all evaluating virtual reality (VR) interventions. Seven focused on postoperative pain, two on acute pain. The primary meta-analysis (n = 6) showed a moderate but nonsignificant effect in self-reported pain (SMD = −0.61; 95% CI, −1.58 to 0.36). The secondary meta-analysis (n = 6) for observer-reported pain showed a large but nonsignificant effect (SMD = −1.04; 95% CI, −2.18 to 0.11).

Conclusion

This meta-analysis found no significant analgesic effect of VR on acute or postoperative pain in children. However, moderate effect sizes were observed, but the lack of statistical significance indicates that XR interventions require further investigation in pediatric pain management. Future research should prioritize pain as a primary endpoint and assess the effects of VR type, timing, and age on acute pain using validated measures.

Ultrasound Versus MRI for Pediatric Tracheal Diameter Measurement: A Science Letter

Frédéric Anthony Paul Brillouet — Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 571-572, May 2026.

Pediatric Regional Anesthesia Survey in South Africa (PRASSA): A Descriptive, Cross‐Sectional Survey of Knowledge, Attitudes, and Practices Among South African Anesthetists

Shauneen Kelber, Alexandra Torborg, Hyla‐Louise Kluyts — Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 573-575, May 2026.

Hypoxemia on Emergence in Neonates and Young Infants: Incidence and Risk Factors in Patients < 2 Months Undergoing Inguinal Herniorrhaphy or Pyloromyotomy

Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 576-579, May 2026.

Rocuronium and Sugammadex Use Among Canadian Pediatric Anesthesiologists: A National Cross‐Sectional Survey

MengQi Zhang, Jonathan G. Bailey, Tristan Dumbarton, Mathew B. Kiberd — Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 567-570, May 2026.

Pediatric Lamellar Ichthyosis

Joanne Du, Noah Ashley, Nicole McCoy, Jennifer Smith — Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 582-583, May 2026.

Non‐Intubated Video‐Assisted Thoracoscopic Surgery in a Pediatric Patient With Airway Obstruction

Dana Karol, Michael Segal, Yuri Peysakhovich, Yelena Zeitlin — Mon, 06 Apr 2026 22:36:24 -0700

Pediatric Anesthesia, Volume 36, Issue 5, Page 580-581, May 2026.

Perioperative Care for Pediatric Patients Undergoing Lung Surgery: Retrospective Single Center Review

Rianne P. Wauters, Andrea Baumert, Ignacio Malagon — Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Procedures involving lung surgery in the pediatric population are relatively uncommon and tend to be centralized in a limited number of institutions. Anesthesia literature is also sparse.

Aims

To have a clear overview of frequency, underlying pathologies, ICU and hospital stay, anesthetic techniques, one lung ventilation, and perioperative analgesia.

Methods

We conducted a retrospective review in a single-center tertiary hospital, from January 2014 to 2023. We included children aged 0–16 years who underwent major lung surgery and received anesthesia managed by the pediatric anesthesia team. Patients with congenital diaphragmatic hernia, esophageal atresia, or those undergoing surgery for pectus excavatum were excluded. Our main outcome measures include the type of underlying pathology and surgical procedure, ICU and hospital stay, methods of one-lung ventilation, source of perioperative analgesia, and the incidence of (postoperative) complications.

Results

We included 73 patients, 55% male and 45% female. The median age was 2.8 years and the median weight was 12.9 kg. Congenital pulmonary airway malformation was diagnosed in 43%, and 45% underwent a (partial) lobectomy. The proportion of video-assisted thoracoscopic surgery was comparable to that of open thoracotomy. One-lung ventilation (OLV) was used in 81%, primarily facilitated by a bronchial blocker. Epidural catheterization with ropivacaine for perioperative pain management was used in 71%. The proportion of patients receiving intravenous morphine on postoperative Days 1, 2, 3, 4, and 5 was 40%, 34%, 19%, 15%, and 11%, respectively. Insufficient pain control was reported in 14%. 70% were admitted to the ICU for one night. The average length of hospital stay was 8 days.

Conclusions

We addressed the anesthetic care of pediatric lung surgery procedures. OLV was required in the majority of the population and a bronchial blocker was the preferred method. Epidural analgesia was the preferred choice to tackle perioperative pain.

Child's Temperament as Risk Factor for Preoperative Anxiety—A Secondary Analysis of the ALPAKA Trial

Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Preoperative anxiety is common in young children and may impair cooperation during anesthesia induction. Some temperament traits have been associated with higher anxiety levels in the preoperative phase. While midazolam is widely used for anxiolysis, individual responses vary and may be influenced by underlying psychological characteristics such as temperament.

Aims

This study aimed to examine the association between specific temperament traits and preoperative anxiety in young children and to determine whether these associations persist after midazolam administration.

Methods

This secondary analysis of the ALPAKA trial examined associations between temperament and perioperative anxiety in children aged 2–8 years undergoing elective surgery. Temperament was assessed using the parent-reported Integrative Child Temperament Inventory (ICTI). Anxiety was rated at two time points before (T1) and after (T2) midazolam administration using the modified Yale Preoperative Anxiety Scale—Short Form (mYPAS-SF). Additional variables included the Strengths and Difficulties Questionnaire (SDQ) scores, baseline characteristics and prior emotional distress. Spearman correlation (r _s), multivariable and univariate logistic regression analyses were conducted to identify predictors of elevated anxiety (defined as mYPAS-SF > 30).

Results

Eighty-nine children were included in the final analysis. Behavioral inhibition was associated with anxiety at both T1 (r _s = 0.35, 95% CI 0.15–0.53, p = 0.001) and T2 (r _s = 0.46, 95% CI 0.28–0.62, p < 0.001). No significant associations were found for other IKT or SDQ subscales. Logistic regression showed that male sex (OR 3.16, 95% CI 1.36–7.19, p = 0.011) and prior anesthesia experience (OR 4.28, 95% CI 1.78–10.39, p = 0.001) were independently associated with elevated anxiety at T1. A multivariable logistic regression for behavioral inhibition adjusted by sex and prior anesthesia showed for T1 a positive association with elevated anxiety (OR 1.02, 95% CI 1.00–1.05). For T2, the corresponding model showed limited explanatory power.

Conclusion

Behavioral inhibition is a robust predictor of perioperative anxiety in young children, both before and after midazolam administration. Brief screening for inhibition may help identify children at increased risk and guide individualized, risk-adapted strategies in pediatric anesthesia.

Trial Registration

German Clinical Trial Registration number: DRKS00025411. Principal investigator: Armin Sablewski (15/02/2022, https://drks.de/search/en/trial/DRKS00025411)

Cognition and Anesthesia Exposure in Adolescent and Young Adult Retinoblastoma Survivors

Paula J. Belson, Jesse L. Berry, Mark W. Reid, Nancy A. Pike — Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Retinoblastoma (RB) is the most common intraocular malignancy diagnosed in early childhood. Treatment is extensive, requiring multiple general anesthetics to facilitate eye examinations. However, little is known how repeated exposure to general anesthesia in early childhood affects cognitive function in RB survivors.

Purpose

The purpose of this cross-sectional study was to examine the effects of anesthesia exposure on cognition in 14- to 26-year-old RB survivors compared with those in healthy controls.

Methods

Patients who previously received care for RB (n = 98) were recruited and compared to a cohort of healthy subjects (n = 97). Participants' cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA). MoCA scores were compared between groups using Wilcoxon rank-sum tests. Relationships between MoCA scores and anesthesia exposure were assessed using Spearman's rank correlation coefficients. Multiple regression was used to evaluate the effect of anesthesia (both before the age of three and throughout childhood) on cognition.

Results

RB patients scored significantly lower than controls on the MoCA and several of its subscales (Naming, Attention, Language, and Abstraction; adjusted ps < 0.05). Total childhood anesthesia exposure was negatively associated with MoCA total scores (ρ = −0.19, p = 0.009) and some subscale scores. In regression models adjusted for covariates, each time anesthesia was administered before the age of three (β = −0.06, p = 0.02) or throughout childhood (β = −0.04, p = 0.005) was associated with a small but statistically significant decrease in cognition. Hollingshead socioeconomic status (β = 0.04, p = 0.001) and public insurance (β = −1.75, p < 0.0001) were stronger predictors of MoCA total scores than anesthesia exposure.

Conclusion

Despite any effects of repeated anesthesia exposure in early childhood on cognition, MoCA scores for RB survivors were in the normal range. These findings add to the developing research on neurocognitive effects of anesthesia in early childhood in a population with large anesthesia exposure and minimal confounding factors. Future research should include additional measures of neurodevelopmental functioning and focus on the at-risk low socioeconomic status population. Continued follow-up and assessment of visual function in bilateral survivors are imperative.

Perioperative Outcomes and Sickle Cell Crisis in Children With Sickle Cell Disease: A Retrospective Observational Study

Max M. Feinstein, Ling Guo, Anthony Habib, May Hua, Guohua Li, Caleb Ing — Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Sickle cell disease (SCD) is an inherited hemoglobinopathy affecting approximately 100 000 Americans, disproportionately affecting Black individuals. Sickling of hemoglobin S red blood cells due to conditions in the perioperative period including hypoxemia, hypothermia, surgical stress, and pain can reduce organ perfusion and lead to adverse outcomes including pain crisis, acute chest syndrome, and stroke.

Aims

This study evaluates perioperative outcomes and risk factors for sickle cell crisis in children with SCD undergoing common inpatient surgical procedures.

Methods

A retrospective cohort was created using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) 2003–2019. Hospital admissions for children < 18 years of age undergoing a selected group of surgical procedures (cholecystectomy, appendectomy, congenital cardiac surgery, and posterior spinal fusions) commonly requiring inpatient stay were included. Diagnoses and procedures were identified using ICD-9/ICD-10 codes. Perioperative outcomes included post-operative length of stay (LOS), blood transfusions, hematologic, and infectious complications. Children with SCD were compared to those without SCD using multivariable Poisson regression to adjust for surgical procedure and sociodemographic, clinical, and hospital characteristics.

Results

Of 5 75 005 children studied, 2357 (0.4%) had SCD. Relative to children without SCD, those with SCD had a longer post-operative LOS (adjusted incidence rate ratio [aIRR]: 1.29; 95% CI [1.26–1.32], p < 0.001). Children with SCD hospitalized for a surgical procedure were also more likely to receive a blood transfusion (adjusted risk ratio [aRR]: 13.1; 95% CI [12.1–14.2], p < 0.001). Significantly increased associated risks of hematologic and infectious complications, however, were not observed. Of children with SCD, 17.5% experienced a sickle cell crisis during hospitalization. The odds of sickle cell crisis in non-elective admissions were more than three times as high as in elective admissions (aOR 3.36; 95% CI [2.46–4.60], p < 0.001). Children with sickle cell crisis had a longer post-operative hospital stay (aIRR: 1.58; 95% CI [1.49–1.67]) than those without a crisis.

Conclusions

The perioperative course in children with SCD was associated with longer postoperative length of stay and higher blood transfusion rates relative to those without SCD undergoing similar surgical procedures. Perioperative sickle cell crisis was present in more than one out of six admissions, more common in non-elective admissions, and is associated with excess length of stay.

Tunneled, Noncuffed, Central Venous Catheters: High Success Rates When Used in Children Less Than 2 Years for Intravenous Antibiotics

Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Aims

Tunneled noncuffed central venous catheters (tncCVCs) have been used in pediatric populations for years. This study examines whether their use is efficacious and explores the reasons for complications and failure.

Methods

This 6-year case series examines the success rate of tncCVCs inserted in patients less than 2 years old receiving intravenous antibiotics in a single institution and the reasons for device complications and failure.

Results

Three hundred and thirty-one devices were inserted into 311 patients. Median patient age was 0.7 years (IQR 0.15–1.27) and median weight 7.8 kg (4.8–10.6). Median CVC dwell time was 13 (IQR 9.2–18.2) days. The success rate in completing prescribed treatment with the device was 94.9%, with 17 failures. Thirteen failures were due to accidental dislodgement (3.9% of all comers, 77% of failures). A large majority (79%) of patients received outpatient antibiotic therapy. Patients with any history of previous CVC insertion were more likely to have failed devices. All neonatal patient devices successfully completed treatment. A total of 55 different proceduralists inserted the devices.

Conclusions

Success rates for tncCVCs when used in infants to complete a median of 13 days of antibiotic therapy on a single device appear acceptable.

The Effect of Binaural Sound on the Occurrence of Emergence Delirium in Children Undergoing Strabismus Surgery: A Randomized Controlled Trial

Jung‐Bin Park, Ji‐Hyun Lee, Yoon Jung Kim, Dong Ju Lee, Jeong‐Hwa Seo — Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Binaural beats, which induce brainwave entrainment, have reduced anxiety and sedative use. This study evaluated the effect of binaural beats on emergence delirium (ED) in children undergoing strabismus surgery under general anesthesia.

Methods

This randomized controlled trial included 73 pediatric patients aged 2–7 years receiving binaural beats (n = 36) or noise-canceled silence (n = 37) during general anesthesia. ED was defined as a Pediatric Anesthesia Emergence Delirium (PAED) score > 12 or Watcha score > 2. Primary outcome was the incidence of ED. Secondary outcomes included PAED, Watcha, and Faces Legs Activity Cry Consolability (FLACC) scores in the postanesthesia care unit (PACU), intraoperative electroencephalogram band power differences, and PACU stay duration.

Results

The incidence of ED did not significantly differ between groups (38.89% vs. 54.05%; relative risk 1.39 [95% confidence interval (CI), 0.84–2.31]; p = 0.287). However, PAED scores at PACU arrival, at 20 min, and the highest score during PACU stay were significantly lower in the binaural group (median difference −1 [95% CI, −3 to 0]; p = 0.026 at arrival; −4 [95% CI, −4 to 0]; p = 0.035 at 20 min; −1 [95% CI, −3 to 0]; p = 0.048 for the highest score). Watcha and FLACC scores, band powers, and PACU stay duration did not differ significantly between groups.

Conclusions

Binaural beat application during general anesthesia did not significantly reduce the incidence of ED. Exploratory analyses suggested a reduction in maximum PAED score, but this requires further study.

Trial Registration

NCT05883280 (registered at http://clinicaltrials.gov (registration number, principal investigator: Jeong-Hwa Seo, registration date: May 22, 2023))

Family Engagement With Pediatric Anesthetic Records: A Qualitative Study of Provider‐Guardian Communication and Record Design

Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

In recent years, health systems worldwide have increasingly expanded patient and guardian access to clinical records. While adult patient perspectives on anesthetic records have been explored, little is known about how pediatric guardians interpret and engage with their child's anesthetic documentation.

Aims

To explore how guardians of pediatric patients engage with their child's anesthetic record and to identify elements they perceive as meaningful, confusing, or emotionally impactful.

Methods

We conducted a qualitative study using semi-structured video conference interviews between April 2023 and August 2024 with guardians of pediatric patients undergoing outpatient surgery under general anesthesia at a quaternary academic pediatric hospital. Twenty English-speaking guardians of children classified as American Society of Anesthesiologists Physical Status I–II and receiving anesthesia via endotracheal tube or supraglottic airway were recruited using a semi-purposive convenience sampling approach. During interviews, guardians reviewed their child's record via screen share and provided real-time feedback. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive and deductive thematic coding until thematic saturation was reached.

Results

Guardians identified several elements of the anesthetic record as meaningful, including medications administered, provider involvement, event timelines, and their child's reactions to anesthesia. However, they reported confusion due to unexplained abbreviations, medical jargon, non-chronological data presentation, unclear visual formatting, and perceived inaccuracies. Interpretation was influenced by guardians' comfort level with health information, emotional state, and considerations unique to pediatric care. Emotional responses ranged from reassurance to anxiety; while some guardians found the record useful for future care planning, others described elements as distressing or difficult to interpret.

Conclusions

Guardians face substantial barriers when interpreting pediatric anesthetic records. As patient-accessible records become increasingly common across health systems globally, improving anesthetic record design is essential. Plain-language summaries, visual annotations, and pediatric-specific contextual guidance could improve comprehension, reduce misinterpretation, and facilitate better collaboration between guardians and clinicians during perioperative care.

Determining Parental Attitudes Toward Day of Surgery Consent for Research

Mon, 06 Apr 2026 22:36:24 -0700

ABSTRACT

Background

Satisfying ethical principles of voluntary consent within workflow constraints can be challenging, particularly for anesthesia research, where patients are met on the day of surgery. For parents, the added burden of being a surrogate decision maker may impact willingness to be approached for research on the day of surgery. Our aims were to determine parental attitudes to day of surgery approach for research consent and if study type had any influence.

Methods

We iteratively developed a questionnaire using stakeholder interviews regarding day of surgery approach for research consent. Particular attention was given to (a) research study designs, (b) previous research experience, and (c) types of surgeries. Participants were stratified according to a child's age, child's previous surgical experience, and any family research experience. Enrolment continued until saturation was reached. Interviews were transcribed and analyzed for themes. The final questionnaire included questions designed to determine parental perceptions of the appropriateness of the same day approach, and whether ethical principles would be satisfied if approached on the day of surgery. The second section presented a series of scenarios describing different study types designed to determine if studies with increasing levels of perceived risk would impact parental perception.

Results

Most parents reported that this approach would satisfy ethical principles for voluntary informed consent. Study type was not a determinant except for RCTs, where only half felt a day of surgery approach would be appropriate. The most cited reason for reluctance for RCTs was insufficient time to review details. Parents of younger children (61.1% infants, 56.2% toddlers) were more likely to prefer an alternative time of approach compared to teenagers (36%).

Conclusions

The results of this study are reassuring for pediatric researchers, identifying majority acceptance for day of surgery research consent approaches for most studies. We identified subgroups who preferred alternative timing for approach. Alternate strategies are advised to target these subgroups.

Trial Registration

ClinicalTrials.gov identifier: NCT04613505

Comparison of Dexmedetomidine Administration Strategy for Propofol‐Based Pediatric Sedation for Magnetic Resonance Imaging: A Retrospective Study

Fri, 03 Apr 2026 03:03:51 -0700

ABSTRACT

Background

Intravenous dexmedetomidine is a safe and effective adjunct in propofol-based sedation. Dexmedetomidine is typically administered as a loading dose, followed by continuous infusion or not. Whether the addition of a maintenance infusion of dexmedetomidine after a loading dose in propofol-based sedation for pediatric magnetic resonance imaging (MRI) can be beneficial in terms of propofol consumption or adverse events is not clear.

Aims

We aimed to study whether maintaining dexmedetomidine infusion after loading dose can help reduce propofol consumption and minimize airway and cardiovascular interventions during sedation.

Methods

We retrospectively reviewed 884 medical records of pediatric sedation for MRI using both propofol and dexmedetomidine, performed at a single tertiary hospital between May 2021 and January 2023. We compared patients who received dexmedetomidine loading + maintenance (group LM) and dexmedetomidine loading only (group L) as an adjunct to propofol-based sedation. The consumption of propofol and time to recovery were measured. We also compared the incidence of airway rescue maneuver and hypotension requiring intervention during sedation.

Results

Overall, 695 patients were included in the analysis (group LM, n = 351, group L, n = 344). The total sedation duration was similar between the two groups (52 vs. 50 min, p = 0.255). Group LM showed significantly less total propofol consumption (6.62 vs. 7.63 mg·kg⁻¹·h⁻¹, p = 0.001). The incidence of airway rescue maneuver did not differ significantly between the two groups (0.9 vs. 1.5%, p = 0.501); however, the incidence of hypotension requiring intervention was lower in group LM than in group L (4.3 vs. 8.1%, p = 0.040). The recovery time did not differ significantly between the two groups (34 vs. 34 min, p = 0.932).

Conclusion

In propofol-based sedation for pediatric MRI, maintenance infusion of dexmedetomidine after a loading dose reduces total propofol consumption and hemodynamic instability requiring intervention without prolonging recovery time, compared with dexmedetomidine bolus without maintenance.

Error Traps in Pediatric Adenotonsillectomy: Clinical Patterns, Cognitive Pitfalls, and Evidence‐Informed Mitigation Strategies

Samuel Percy, Casey A. Quinlan, Kimmo Murto, Amber Franz, Kim Strupp — Thu, 02 Apr 2026 03:28:15 -0700

ABSTRACT

Adenotonsillectomy is one of the most common elective pediatric surgeries. However, its routine occurrence can mask substantial preventable risks arising from practitioner inexperience, underappreciated comorbidities, airway proximity to the surgical field, and challenging postoperative pain management. This review highlights common “error traps” that contribute to perioperative adverse events and outlines evidence-based mitigation strategies. Key preoperative challenges include unrecognized moderate-to-severe obstructive sleep apnea (OSA) and recent upper respiratory infections (URIs), both of which markedly increase perioperative respiratory adverse events (PRAEs). Intraoperative hazards include challenging airway management at induction and emergence, risk of airway fire, and excessive opioid administration. Postoperatively, inadequate analgesia and inappropriate disposition planning remain major preventable causes of morbidity. Perioperative management of the child with post-tonsillectomy hemorrhage is uniquely challenging. Structured OSA and URI screening and mitigation strategies, multimodal opioid-sparing analgesia, and institution-specific discharge algorithms are strongly recommended. A systematic, team-based approach emphasizing awareness of cognitive biases, vigilance, protocolized management, and hospital outcome monitoring can significantly reduce preventable complications and improve safety in pediatric adenotonsillectomy.

Serum Glucose and Ketone Concentrations in Fasted Children Aged 6–12 Months Having Elective Surgery

Abigail Wong, Philip Ragg, Andrew Davidson, Suzette Sheppard, Ian Hughes — Mon, 30 Mar 2026 05:11:43 -0700

ABSTRACT

Background

Perioperative hypoglycemia during elective surgery may have serious consequences in neonates; however, infants under 12 months of age have traditionally been assumed to be at lower risk of hypoglycemia and ketosis.

Aims

The aim of this multi-centre prospective observational study was to identify the incidence of hypoglycemia and ketosis in children aged 6–12 months having elective surgery. Secondary aims were to identify factors associated with serum glucose concentrations and ketone concentrations at the beginning and end of anesthesia.

Methods

Serum glucose and ketone concentrations were tested at the induction of anesthesia and at the end of anesthesia. For this study, hypoglycemia was defined as glucose < 3.0 mmol/L and ketosis was defined as ketones being > 0.6 mmol/L. Data on types of fluids given, fasting time for fluids, milks and solids, and vital signs were collected.

Results

The study enrolled 158 participants between 2019 and 2021 at three tertiary pediatric hospitals in Australia. There were 6 cases of hypoglycemia (3.8%) recorded at induction of anesthesia with only 1 at the end of the case. At induction, 54 (34.6%) patients were ketotic with 76 ketotic (48.7%) at the end of the procedure. At induction there was no evidence for a difference between states with differing fasting guidelines in the incidence of hypoglycemia; The Royal Children's Hospital (RCH) 4 (4.1%), Queensland hospitals 2 (3.6%) risk ratio 1.13, and no evidence for a difference in ketosis; RCH 31 (32%), Queensland hospitals 18 (47.4%) risk ratio 0.76, 95% CI 0.45 to 1.17, p = 0.22. There was also no evidence for a difference in serum glucose concentrations; RCH mean 4.6 mmol/L (SD 0.84), Queensland hospitals' mean 4.7 mmol/L (SD 0.83), differences in mean −0.07 (95% CI −0.35 to 0.20) p = 0.60. However, there was evidence for a difference in ketones with median at RCH at 0.4 (IQR 0.2,0.7), Queensland at 0.6 mmol/L (IQR 0.3,0.9) however it is clinically insignificant. Serum glucose and ketone concentrations are related to milk fasting time. Increasing milk fasting times increases ketone concentrations and decreases serum glucose concentrations.

Conclusions

The study showed that for young children undergoing elective surgery, there is a risk of hypoglycemia and ketosis.

Correction to “Augmented Reality Medical Simulation: A Multi‐Site Study of Factors That Influence Acceptance”

Thu, 26 Mar 2026 01:58:04 -0700

Pediatric Anesthesia, EarlyView.

Avoidance of Hyperoxemia Versus Routine Hyperoxia During Cardiopulmonary Bypass in Children With Cyanotic Congenital Heart Disease—A Systematic Review and Meta‐Analysis

Wed, 25 Mar 2026 02:25:10 -0700

ABSTRACT

Background

Children with cyanotic congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass (CPB) are exposed to varying oxygenation strategies, and the optimal oxygenation strategy and the impact of limiting hyperoxic exposure remain uncertain. This study aimed to compare oxygenation strategies designed to avoid hyperoxemia versus routine hyperoxic management in this population.

Methods

A systematic search was conducted in four databases. The primary outcome was postoperative intubation time. Secondary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, total operative duration, and epinephrine requirement. Standardized mean difference (SMD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated for continuous and categorical outcomes, respectively. A random-effects model was applied to all outcomes.

Results

Seven studies (six randomized controlled trials; one observational) met all the inclusion criteria. Strategies avoiding hyperoxemia did not significantly reduce postoperative intubation time compared with routine hyperoxia (SMD: −0.25; 95% CI: −0.52–0.03; p = 0.077; I ² = 15%). Also, no significant differences were observed for ICU LOS (SMD: −0.04; 95% CI: −0.46–0.38; p = 0.859; I ² = 64%), hospital LOS (SMD: 0.24; 95% CI: −0.01–0.50; p = 0.064; I ² = 0%), operative duration (SMD: −0.66; 95% CI: −1.90–0.58; p = 0.294; I ² = 84%), and epinephrine use (OR: 0.66; 95% CI: 0.28–1.57; p = 0.350; I ² = 0%).

Conclusions

No significant differences in postoperative outcomes were observed between oxygenation strategies aimed at avoiding hyperoxemia and routine hyperoxic management during CPB.

Impact of Priming Volume Reduction on Hematocrit Retention in Pediatric Cardiopulmonary Bypass: A Retrospective Analysis

Tue, 24 Mar 2026 03:00:56 -0700

ABSTRACT

Background

Retrograde autologous priming and venous antegrade priming replace the cardiopulmonary bypass circuit crystalloid with patient blood to mitigate hemodilution. However, their effectiveness in pediatric patients, particularly when analyzed as continuous variables, remains unclear.

Aims

We aimed to evaluate the effects of autologous priming techniques on blood conservation and patient safety during pediatric cardiac surgery.

Methods

This retrospective cohort study included 191 patients (age 0–14 years; weight > 6 kg) who underwent repair of ventricular and/or atrial septal defects. The primary endpoint was the correlation between the priming volume reduction rate (proportion of priming solution replaced) and the hematocrit retention ratio (hematocrit immediately after cardiopulmonary bypass initiation divided by pre-bypass hematocrit). Secondary outcomes, including transfusion rates, regional cerebral oxygen saturation, and lactate levels, were compared between a retrograde autologous priming group (n = 144) and a control group (n = 47). All patients underwent venous antegrade priming.

Results

The priming volume reduction rate correlated positively with the hematocrit retention ratio (Spearman's ρ = 0.545, p < 0.001). Multiple regression confirmed this independent association: a 0.1 increase in the priming volume reduction rate corresponded to a 0.5% absolute increase in hematocrit at bypass initiation. The retrograde autologous priming group had a significantly higher transfusion-free surgery rate (93.1% vs. 76.6%; relative risk ratio 1.22; p = 0.005). Regarding safety and the postoperative course, no significant intergroup differences were found in trends in regional cerebral oxygen saturation (Time × retrograde autologous priming interaction) or in lactate levels. Similarly, intensive care unit and hospital lengths of stay did not differ significantly between groups. Safety analyses suggested no evidence of cerebral perfusion suppression during retrograde autologous priming.

Conclusion

These findings suggest that even partial retrograde autologous priming is effective to mitigate hemodilution and is independently associated with improved hematocrit retention and a significant reduction in transfusion risk after initiation of cardiopulmonary bypass in pediatric patients.

Trial Registration

This study was registered with the UMIN Clinical Trials Registry, Japan, prior to commencement (Trial ID: R000067879)

Adding Institutional Examples to the ASA Physical Status Classification System Improves Inter‐Rater Reliability

Amr Abouleish, Sandhya R. Vinta, Sarah M. Shabot, Michelle Simon — Thu, 19 Mar 2026 04:54:51 -0700

Pediatric Anesthesia, EarlyView.

Remimazolam and Emergence Delirium in Children: Encouraging Signals, Incomplete Certainty

Vinícius Caldeira Quintão, Tom Giedsing Hansen, Thomas Engelhardt — Wed, 18 Mar 2026 03:19:47 -0700

Pediatric Anesthesia, EarlyView.

Milk Fasting Times and Aspiration in Infants

Richard Newton, Thomas Engelhardt, Brian J. Anderson — Tue, 17 Mar 2026 01:54:21 -0700

Pediatric Anesthesia, EarlyView.

The Electronic Faces Thermometer Scale (eFTS)—Construct Validity for Pain Assessment in Pediatric Postoperative Care in Sweden

Angelica Höök, Mia Hylén, Stefan Nilsson, Charlotte Castor — Tue, 17 Mar 2026 01:50:28 -0700

Pediatric Anesthesia, EarlyView.

Non‐Intubated Spontaneous Ventilation Versus Endotracheal Intubation Anesthesia for Pediatric Thoracoscopic Lung Resection: A Retrospective Propensity‐Score‐Matched Study

Ying Chen, Ding Han, Xian Zhang, Yurui Wu, Shoudong Pan, Fuxia Yan — Fri, 13 Mar 2026 02:43:08 -0700

ABSTRACT

Background

Non-intubated spontaneous ventilation anesthesia is increasingly used in adult thoracoscopic surgery, but pediatric evidence remains limited.

Aims

To compare perioperative outcomes between two anesthetic regimens in children undergoing thoracoscopic anatomical lung lesion resection: a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia and a conventional endotracheal intubation anesthesia.

Methods

This single-center retrospective cohort study included children undergoing thoracoscopic anatomical lung lesion resection for pulmonary sequestration or congenital pulmonary airway malformation between April 2024 and May 2025. Children received either a conventional endotracheal intubation anesthesia or a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia. One-to-one propensity score matching was performed. The primary outcome was the overall incidence of postoperative pulmonary complications before discharge. Secondary outcomes were conversion to endotracheal intubation, intraoperative lowest peripheral oxygen saturation, highest end-tidal carbon dioxide, postanesthesia care unit length of stay, chest tube indwelling time, and postoperative length of hospital stay. Other perioperative variables were exploratory.

Results

Among 198 eligible children, 50 matched pairs were analyzed. Postoperative pulmonary complications occurred in 6 of 50 children (12.0%) in the endotracheal intubation group and in 0 of 50 children (0%) in the non-intubated spontaneous ventilation group (absolute risk reduction 12.0%, 95% confidence interval 3.0–21.0; p = 0.027). In a sensitivity analysis using Firth's logistic regression model adjusting for thoracic paravertebral block, the non-intubated regimen remained associated with a lower observed incidence of postoperative pulmonary complications (adjusted odds ratio 0.06, 95% confidence interval 0.0004–0.76; p = 0.029). No child in the non-intubated spontaneous ventilation group required conversion to endotracheal intubation. Secondary outcomes showed modest between-group differences in unadjusted analyses. However, after Holm-Bonferroni adjustment, adjusted p values for secondary outcomes ranged from 0.060 to 0.208.

Conclusion

In this retrospective propensity-score-matched pediatric cohort, a laryngeal mask airway-assisted non-intubated spontaneous ventilation anesthesia was feasible and was not associated with worse perioperative outcomes than a conventional endotracheal intubation anesthesia. A lower observed incidence of postoperative pulmonary complications was noted. Given regimen-level differences, prospective studies with standardized analgesia are needed to confirm safety and potential benefits.

A Novel Preoperative Risk Score Incorporating Non‐Invasive Hemodynamics to Predict Prolonged Mechanical Ventilation in Infants Undergoing VSD Repair

Thu, 12 Mar 2026 05:15:51 -0700

ABSTRACT

Background

Infants with ventricular septal defect (VSD) and concurrent respiratory compromise exhibit significant heterogeneity in their recovery after surgical repair. Objective tools for preoperative risk stratification are lacking.

Aims

The primary aim of this study was to determine if preoperative hemodynamic data, acquired noninvasively using Electrical Cardiometry (EC), could predict prolonged mechanical ventilation (PMV) in infants undergoing VSD repair.

Methods

We conducted a retrospective study of 51 infants. EC monitoring (ICON) was performed from admission to the day before surgery. A composite risk score was developed using Principal Component Analysis (PCA) of clinical characteristics and EC-derived hemodynamic parameters. The predictive performance of this score for PMV (defined as ≥ 12 h) was assessed using correlation and receiver operating characteristic (ROC) curve analysis. Leave-One-Out Cross-Validation (LOOCV) was used to assess the model's stability.

Results

N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the change in the Index of Contractility (∆ICON) were identified as key parameters correlating with clinical classifications of cardiac dysfunction (r = 1.517 and 1.470, OR = 4.560 and 4.350 respectively, p < 0.05). A PCA-derived composite score was identified as a potential predictor of PMV with r = −0.522 in correlation (p < 0.001) and AUC = 0.856 (SE = 0.857, SP = 0.773, LOOCV AUC = 0.830), outperforming individual clinical variables alone.

Conclusions

A composite risk score integrating individual data and EC hemodynamics monitoring can effectively identify infants at high risk for PMV following VSD repair. This approach may provide a valuable tool for perioperative management and resource allocation.

Efficacy and Safety of Dexmedetomidine‐Esketamine Versus Dexmedetomidine Alone as Premedication for Pediatric Anesthesia Induction: A Systematic Review, Meta‐Analysis, and Trial Sequential Analysis

Tue, 10 Mar 2026 08:44:47 -0700

ABSTRACT

Background

Emergence delirium (ED) is a common complication in pediatric anesthesia. Although intranasal dexmedetomidine (DEX) is widely used, its application is constrained by a slow onset, residual risk of ED in some patients, and risks such as bradycardia and hypotension. Esketamine (ESK), an NMDA receptor antagonist, may provide a faster onset and reduce these side effects.

Objective

This study compared the efficacy and safety of intranasal DEX-ESK combination versus DEX alone as premedication for anesthesia induction in pediatric patients undergoing surgery.

Methods

Electronic databases (PubMed, Web of Science, Scopus, CINAHL, and Embase) were systematically searched for randomized controlled trials (RCTs). The primary outcomes included the ED incidence and the onset of sedation. Secondary outcomes included mask acceptance score, FLACC pain score, post-anesthesia care unit (PACU) length of stay, and adverse events. A random-effects model generated pooled effect estimates—risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. Prediction intervals were also reported to reflect the expected range of effects in future similar studies. Trial Sequential Analysis was performed. The certainty of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Results

Five RCTs encompassing 466 pediatric patients were included in the quantitative synthesis. The DEX-ESK combination was associated with a reduction in ED incidence (RR = 0.58; 95% CI: 0.35–0.97; p = 0.04) and a shorter time to sedation onset (MD = −3.95 min; 95% CI: −4.77 to −3.14; p < 0.01). Secondary analyses demonstrated improved mask acceptance (MD = −0.77; 95% CI: −1.27 to −0.27; p < 0.01), reduced FLACC pain scores (MD = −0.36; 95% CI: −0.70 to −0.02; p = 0.04), and shorter PACU length of stay (MD = −1.83 min; 95% CI: −2.75 to −0.91; p < 0.01). Adverse event incidence did not differ significantly between groups.

Conclusion

The intranasal DEX-ESK combination was associated with improved outcomes compared with DEX monotherapy for pediatric premedication including reductions in ED incidence, a modest acceleration in sedation onset, improved mask acceptance, and slightly shorter PACU length of stay, without an increased risk of adverse events. This combination may represent a feasible and safe premedication option for pediatric patients.

Trial Registration

PROSPERO: CRD420251236740

Perioperative Outcomes and Transfusion Practices in Neonates Undergoing Sacrococcygeal Teratoma Resection: A Single Center Retrospective Case Series

Sean J. McManus, Terry L. Buchmiller, Steven J. Staffa, Susan M. Goobie — Tue, 10 Mar 2026 08:41:55 -0700

ABSTRACT

Background

Sacrococcygeal teratomas (SCT), although rare, are the most common teratomas found in neonates. Anesthetic management of neonates undergoing SCT resection surgery is challenging, given the risk of massive hemorrhage and high mortality rate.

Aims

The primary aim of this single center retrospective study was to analyze neonates undergoing SCT resection over the last decade and report on perioperative outcomes, including blood product transfusion practices. The secondary aim was to describe patient and tumor characteristics that might place neonates undergoing SCT resection surgery at elevated risk for morbidity and mortality.

Methods

Retrospective chart review of neonates who underwent sacrococcygeal teratoma resection at Boston Children's Hospital between January 2012 and April 2024. Demographic data, tumor characteristics, transfusion data, perioperative respiratory and hemodynamic data, and 30-day outcomes were collected. Descriptive statistics for patient and tumor characteristics are reported. Univariate analyses using Fisher's exact test and the Wilcoxon rank sum test were used for analysis of transfusion data and clinically significant postoperative events.

Results

Seventeen patients were identified. The median age at the time of surgery was day of life 4 with a median weight of 3.3 kg. Thirty-nine percent of neonates experienced a clinically significant postoperative event within 30 days of surgery, defined as a composite outcome event. One patient died within 30 days of surgery. Fifty-nine percent of neonates received an intraoperative blood transfusion. The median transfusion volume of RBCs was 24.8 mL/kg (0, 43). Those transfused had a larger median tumor volume [947.3 cm³ (interquartile range: 354.2, 2048)] and tumor volume-to-weight ratio [0.31 (0.10, 0.77)] compared to those who were not transfused [48.6 cm³ (24.2, 367.5)] and [0.02 (0.01, 0.07)] respectively. The median duration of anesthesia in transfused patients was 7.8 h (6.4, 9.2) versus 5.8 h (3.7, 6.7) in patients not transfused. Although more neonates with non-cystic tumors got transfused (70% vs. 30%), there was no statistically significant difference in median volume of red blood cells transfused intraoperatively for cystic [28.1 mL/kg (0, 40)] versus non-cystic tumors [24.8 mL/kg (0, 60)].

Conclusions

Neonates undergoing SCT surgery had a high rate of blood transfusion (59%), replacing on average over a quarter of their blood volume, and a high composite adverse outcome rate (39%). Predictors of blood product transfusion include immature tumors, gestational age less than 37 weeks, larger median tumor volume, greater tumor volume-to-weight ratio, higher intraoperative estimated blood loss, and longer time under anesthesia. Predictors of clinically significant postoperative events within 30 days of surgery include Altman type 2 tumors, gestational age less than 37 weeks, and longer anesthesia times.

A Study of the Differences in Central Venous Pressure Between the Distal Lumen and Proximal Lumen of Central Venous Catheters in Pediatric Patients

Tomohiro Yamamoto, Shuichi Shiraishi — Tue, 10 Mar 2026 04:53:54 -0700

ABSTRACT

Background

The choice of a central venous catheter (CVC) lumen to connect the central venous pressure (CVP) measurement line varies by facility. However, if the CVP values differ based on the connected CVC lumen, this variation could significantly affect the interpretation of the CVP measurements, raising major concerns regarding circulatory management of the patient.

Aims

This study aimed to determine whether a difference exists in the CVP values between the proximal and distal lumens of the CVC in small pediatric patients undergoing cardiac surgery.

Methods

Seventeen pediatric patients with congenital heart disease, aged 1 to 31 months, who underwent cardiac surgery between November 2022 and November 2023, were included in this study. The CVC was inserted via the right internal jugular vein or right supraclavicular approach. Separate transducers were connected to the proximal and distal lumens. The CVP values from each were recorded simultaneously throughout the surgery. Differences were examined in the following phases: (1) after general anesthesia induction, (2) after initiation of cardiopulmonary bypass (CPB), and (3) after weaning from CPB.

Results

No statistically significant differences were observed in A-wave pressure, X-descent pressure, or mean CVP values measured from the distal and proximal lumens after general anesthesia induction or after weaning from CPB. The distal lumen showed significantly lower pressure than the proximal lumen after CPB initiation.

Conclusions

Our findings revealed no significant difference in the CVP values between the proximal and distal lumens of the CVC in small pediatric patients; moreover, the proximal lumen provided reliable CVP values, even during CPB. These findings support connecting the CVP line to the proximal lumen, offering the great advantage of early detection of CVC slippage through changes in the CVP values and waveforms.

Trial Registration

This study was registered in the UMIN Clinical Trials Registry (registration number: UMIN000052944)

Immersive Gaming Intervention Reduces Preoperative Anxiety and Improves Compliance in Children Undergoing Supernumerary Tooth Extraction: A Randomized Controlled Trial

Yihong Shao, Jie Pan, Liang Chen — Mon, 09 Mar 2026 03:12:35 -0700

ABSTRACT

Background

Preoperative anxiety is prevalent in children undergoing supernumerary tooth extraction and can exacerbate physiological stress responses. Nonpharmacological interventions like immersive gaming interventions (IGI) offer potential anxiolytic benefits, but robust evidence in pediatric dentistry is limited.

Methods

In this prospective RCT, 102 children aged 4–12 years scheduled for supernumerary tooth extraction under general anesthesia were randomized to IGI (n = 50) or standard care (n = 52). The IGI group received a multicomponent framework comprising structured therapeutic play, role-reversal simulation, and environmental modification. Anxiety-related emotional distress and somatic symptoms were assessed using the SCARED scale, heart rate (HR), and heart rate variability (LF/HF ratio) at baseline (T0), post-intervention (T1), and preoperatively (T2). Treatment compliance (Frankl scale) and parental satisfaction (100-point questionnaire) were secondary outcomes.

Results

IGI demonstrated substantial reduction in emotional distress across all measures, with large interaction effect sizes (partial eta squared range: 0.14–0.26). At the preoperative stage (T2), SCARED scores in the IGI group were significantly lower than controls (Mean Difference [MD]: 18.5, 95% CI: 16.3–20.7; Cohen's d = 3.42). Heart rate and LF/HF ratio also showed clinically meaningful improvements in the IGI group compared to controls (HR MD: 17.5 bpm, 95% CI: 13.9–21.1; LF/HF MD: 1.33, 95% CI: 1.03–1.63). IGI attenuated anxiety-physiology correlations, including a 65% reduction in the SCARED-LF/HF slope at T2 (unstandardized beta-intervention = 0.029 vs. beta-control = 0.082). The intervention group exhibited superior active cooperation (Risk Difference [RD]: 70.2%, 95% CI: 57.0%–83.4%) and higher “very satisfied” parental ratings (RD: 78.6%, 95% CI: 66.8%–90.4%).

Conclusions

IGI effectively alleviates perioperative emotional distress, decouples psychological–physiological stress responses, and improves cooperation in children undergoing supernumerary tooth extraction. It represents a robust nonpharmacological strategy to enhance the pediatric perioperative experience.

Trial Registration

ClinicalTrials.gov identifier: NCT07149727

Effects of Prolonged Preoperative Fasting on Blood Glucose Levels in Pediatric Elective Surgeries: A Systematic Review and Meta‐Analysis

Sat, 07 Mar 2026 21:58:58 -0800

ABSTRACT

Background

Albeit the numerous guidelines on pre-operative fasting in pediatric patients, clinical practice varies. Prolonged fasting can result in several complications, hypoglycemia being one of them. This systematic review and meta-analysis (SRMA) was conducted to assess the effect of prolonged pre-operative fasting on the incidence of hypoglycemia in pediatric patients posted for elective surgery.

Materials and Methods

Relevant studies (observational and randomized controlled studies [RCTs]) with fasting duration and incidence of hypoglycemia were identified from data sources (Medline, Scopus, Cochrane Library, Google Scholar) using a systematic search strategy. A pooled relative risk (RR) of hypoglycemia and ketosis due to prolonged fasting was calculated from the RCTs.

Results

This SRMA included 42 studies (15 RCTs and 27 observational studies) involving 5121 patients. There was a wide variation in the definition of hypoglycemia, fasting duration, and incidence of hypoglycemia across the studies. The pooled RR for hypoglycemia was 2.0 (95% CI: 0.57–7.03, I ² = 0.00%, p = 0.28) in the prolonged fasting group compared to the non-prolonged fasting group. Although statistical significance was not reached, the direction and magnitude of the pooled effect suggest a clinically meaningful trend toward a lower risk of hypoglycemia with adherence to recommended fasting durations compared with prolonged fasting.

Conclusion

The findings of the review revealed the need for standardized outcome definitions and fasting protocols to enable comparisons across future studies. The meta-analysis revealed a variable relationship between fasting duration and hypoglycemia incidence. Structured interventions to facilitate the implementation of guidelines in clinical practice may mitigate the problem.

Perioperative Complications in Multispecialty Surgical Care for Patients With Trisomy 21: A Single Center Retrospective Cohort Study

Sat, 07 Mar 2026 21:49:13 -0800

ABSTRACT

Background

The medical comorbidities associated with trisomy 21 (T21) often necessitate multiple surgical and imaging procedures requiring general anesthesia, with perioperative complications occurring at a higher frequency than their age-matched peers. Combining multiple procedures by unrelated specialists under a single anesthetic is often suggested as a method to reduce anesthetic risks during induction, airway manipulation and emergence, in addition to potentially decreasing health care costs and time burdens on patients and families, but the safety advantage of this strategy has not been demonstrated.

Aim

To evaluate the association of multispecialty case strategies with perioperative safety events in children with T21.

Result

At Children's Wisconsin, we performed 219 626 anesthesia cases in 120 299 patients over a span of 9.6 years, compared to 3873 cases in 995 patients with T21. Of this cohort, 2871 cases were single specialty in nature while 1002 (17.5%) cases were multispecialty. Compared to the whole anesthesia population, the T21 cohort had a notably higher likelihood of multiple anesthetics per patient (OR = 8.02 [95% CI 7.11–9.04] p < 0.001), multispecialty care (OR = 3.95 [95% CI 3.6–4.3] p < 0.001), and risk of perioperative safety events (OR = 5.65 [95% CI 4.51–7.08] p < 0.001). The T21 cohort had lower age and weight, higher ASA-PS, more organ-based pathology, longer anesthesia case times, more cases, and higher multispecialty exposure per case. Detailed demographic comparison of the T21 cohort to the anesthesia population is shown in Table S2. Multivariable logistic regression identified independent risk factors associated with perioperative events as ASA-PS 4 (OR = 4.5 [95% CI 1.4–14.5]) or 5 (OR = 85.5 [95% CI 22.8–320.3]), Black or African American race (OR = 1.98 [95% CI 1.2–3.3]), anesthesia time (OR = 1.22 [95% CI 1.1–1.3]), and multispecialty case (OR = 2.6 [95% CI 1.6–4.3]); however, there was no increased risk with number of anesthetics per patient. No attempts were made to evaluate whether the families perceived benefit of either practice.

Conclusion

Multispecialty care is a highly utilized method of providing care for children with T21 within our institution, often used to ease the scheduling burden and risk of these children and families. Understanding the risk associated with this practice by parents and care providers may lead to a more thoughtful scheduling practice. With this understanding, patients in need of multispecialty care may benefit by either considering a single specialty case or limit multispecialty scheduling to a 4-h duration.

EEG Dynamics in Children Before, During and After General Anesthesia

Maximilian Markus, Feidias Panagiotou, Claudia Spies, Susanne Koch — Thu, 05 Mar 2026 21:23:24 -0800

ABSTRACT

Background

Age-specific EEG signatures during anesthesia are described in pediatrics, and perioperative monitoring is increasingly advocated; yet most indices and algorithms derive from adult data and may not generalize to early development.

Aims

The purpose of this study was to characterize perioperative frontal EEGs in young children younger than 8 years.

Methods

A total of 147 frontal EEGs from children ranging from 1 month to 8 years of age were recorded prospectively under general anesthesia at Charité—Campus Virchow Klinik (CVK). For data acquisition, the Narcotrend Monitor was used, and the raw EEG files were further analyzed in their frequency bands. The patient cohort was divided into four age groups (0–5, 6–11, 12–23, and > 24 months), and EEG signatures were compared between the age groups.

Results

Delta activity is the predominant frequency in all age groups already in the awake state before induction of anesthesia, with a step increase at loss of consciousness, which is more pronounced in older children. Intraoperatively, alpha- and beta-activity emerge at the age of 6 months and are greater in the older age groups. Infants (0–5 months) remain with a high amount of Delta activity intraoperatively. With the return of consciousness, the faster frequencies gradually decrease, and the EEG is characterized again by a predominant delta-activity in all age groups.

Conclusions

In this study, we characterized differences in the perioperative EEG signatures of children from 1 month to 8 years from the preoperative awake state during induction and general anesthesia until they regained consciousness from general anesthesia. The EEG readouts differ across age groups, and age-adapted monitoring systems are needed to protect this vulnerable patient group from over- and undersedation.

Trial Registration

This study was approved by the Charité—University Medicine Berlin's ethics committee (EA2/027/15) and was registered at clinicaltrials.gov (23rd of June 2015/NCT02481999)

The Effect of Remimazolam Administration on Emergence Delirium in Children After General Anesthesia: A Systematic Review With Meta‐Analysis of Randomized Controlled Trials

Ji‐Na Kim, Hyo‐Seok Na, Hyun‐Jung Shin — Thu, 05 Mar 2026 00:00:00 -0800

ABSTRACT

Background

Emergence delirium commonly occurs in pediatric patients after general anesthesia, causing distress and potential harm. Remimazolam, an ultra-short-acting benzodiazepine, has recently been introduced in pediatric anesthesia, but its preventive role against emergence delirium remains unclear.

Aims

This systematic review with meta-analysis evaluated the effect of remimazolam on the incidence and severity of emergence delirium in children undergoing general anesthesia.

Methods

PubMed, EMBASE, CENTRAL, Scopus, Web of Science, and Google Scholar were searched for relevant studies. The primary outcome was the incidence of emergence delirium. Secondary outcomes included Pediatric Anesthesia Emergence Delirium score, incidence of hypotension and bradycardia, extubation time, postanesthesia care unit stay, and postoperative nausea and vomiting incidence. Relative risks (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated using a random-effects model.

Results

Ten randomized controlled trials involving 1231 children were included. Remimazolam significantly reduced the incidence of emergence delirium (RR 0.38, 95% CI 0.23–0.63; p = 0.0002) and Pediatric Anesthesia Emergence Delirium score (MD −1.70, 95% CI −2.77 to −0.63; p = 0.0019). It also decreased bradycardia (RR 0.39, 95% CI 0.21–0.70; p = 0.0018). Although the overall incidence of hypotension did not differ significantly (RR 0.35, p = 0.0991), subgroup analysis showed a lower incidence with remimazolam than with propofol (RR 0.14, p = 0.0376). Overall extubation time was comparable (MD −0.75, p = 0.5088), but shorter with remimazolam than propofol (MD −3.36, p < 0.0001). No significant differences were found in postanesthesia care unit stay or postoperative nausea and vomiting.

Conclusions

Remimazolam may reduce the incidence and severity of emergence delirium in children after general anesthesia, without affecting hemodynamic stability or recovery time.

Trial Registration

PROSPERO: CRD420251236789

Design for a Reusable High‐Fidelity Pediatric Epidural and Caudal Phantom for Haptic Learning

Rani A. Sunder, Huy Le — Tue, 24 Feb 2026 01:55:24 -0800

Pediatric Anesthesia, EarlyView.

Comment on: Brachial Plexus Block for Peripherally Inserted Central Catheter Placement in Neonates and Pediatric Patients

Yasin Tire, Esma Karaarslan, Nuran Akıncı Ekinci — Mon, 23 Feb 2026 01:10:35 -0800

Pediatric Anesthesia, EarlyView.

Intermittent 0.25% Bupivacaine Bolus Administered Through a Serratus Posterior Superior Intercostal Plane Catheter for Postoperative Analgesia Following Posterolateral Thoracotomy

Poonam Kumari, Amarjeet Kumar, Aakanksha Hiremath, Prince Kumar — Wed, 04 Feb 2026 02:22:39 -0800

Pediatric Anesthesia, EarlyView.

Measurement of Airway Length in Neonates Using Fiberoptic Bronchoscopy

Faruk Cicekci — Tue, 27 Jan 2026 01:08:01 -0800

Pediatric Anesthesia, EarlyView.

Re: The Role of Anesthesiologists in Multidisciplinary Care for Patients With Trisomy 13—A Psychiatric Perspective on Longitudinal Shared Decision‐Making

Ting‐Yuan Huang, Lien‐Chung Wei — Mon, 26 Jan 2026 21:02:50 -0800

Pediatric Anesthesia, EarlyView.

Misevaluation of the Aims of Medical Missions and Coordination of Short‐ and Long‐Term Efforts

Bright O. Etumuse, Marissa S. Martinelli — Tue, 20 Jan 2026 23:19:50 -0800

Pediatric Anesthesia, EarlyView.

Methodological Considerations in the Validation of a Digital Pediatric Pain Scale

Mahmoud Daoud — Mon, 19 Jan 2026 04:10:26 -0800

Pediatric Anesthesia, EarlyView.