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To summarize recent evidence in pediatric total intravenous anesthesia (TIVA), highlighting advances in pharmacokinetics-pharmacodynamics, target-controlled infusion (TCI), electroencephalography (EEG)-guided titration, emerging agents, safety, and sustainability, and to provide clinicians with an updated, practical framework for pediatric TIVA practice.
Perioperative respiratory adverse events (PRAE) are a main cause of morbidity and mortality in paediatric anaesthesia. Clinicians need to be able to predict their patients' risk of PRAE to plan their care. Clinical risk prediction tools have been developed to assist with pre-operative risk stratification; however, validation outside the contexts of their development is limited. In this study, we test the ability of common risk prediction tools to identify patients at high risk of PRAE in general anaesthesia.
Obesity is linked to altered lung function and increased perioperative respiratory adverse events (PRAEs). We examined the effects of obesity, respiratory symptoms, and posture on PRAEs, lung mechanics, and ventilation distribution in children undergoing general anesthesia.
The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications.
Hypoxaemia occurs in approximately 30% of children during anaesthesia for flexible bronchoscopy. High-flow nasal oxygen (HFNO) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence if HFNO confers advantages over current standard practice in avoiding hypoxaemia. The aim is to investigate feasibility of HFNO use during anaesthesia for flexible bronchoscopy to reduce frequency of rescue oxygenation and hypoxaemia.
There is a paucity of data on the chosen anesthesia management for infant inguinal hernia surgery. We aimed to characterize self-reported anesthetic practice in Australia and New Zealand. We also aimed to identify the outcomes that matter to both anesthetists and to parents and carers.
Children are sometimes transported via fixed or rotary wing aircraft for medical care. If they are intubated with a cuffed endotracheal tube (ETT), changes in environmental pressure during transport can alter cuff pressure. Cuff management in this setting varies widely by region and by organization. In this historical review, we sought to delineate the evolution of ETT cuff management in children undergoing aeromedical retrieval in order to progress the field toward an optimum strategy in the future.
The relationship between anesthetic technique and pediatric oncological outcomes is an emerging field of interest. With significant improvements in childhood cancer survival in recent decades, there is an increased focus on optimizing the quality of survival and reducing the incidence of metastasis and recurrence. The aim of this narrative review article is to investigate and consolidate the current available evidence assessing the immunomodulatory effects of anesthesia in the pediatric oncology population.
Pediatric perioperative care can be described as a journey, starting when surgery is first contemplated, all the way through to a patient’s full recovery. For the child and their family, this journey spans from the time at home pre-operatively through a hospital stay and finishes with at-home recovery.
The social determinants of health, as described by the World Health Organisation (WHO), are 'the non-medical factors' that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. According to the WHO, social determinants of health account for between 30-55% of health outcomes, and children can be particularly vulnerable to their impacts.