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Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia-related risk and treatment options

Perioperative respiratory adverse events are the most common cause of critical events in children undergoing anesthesia and surgery. While many risk factors remain unmodifiable, there are numerous anesthetic management decisions which can impact the incidence and impact of these events, especially in at-risk children.

Without training, they lacked knowledge. Without knowledge, they lacked confidence. Without confidence, they lacked victory (Julius Caesar)

Britta Regli-von Ungern-Sternberg AM FAHMS MD, PhD, DEAA, FANZA Chair of Paediatric anaesthesia, University of Western Australia; Consultant

HPLC-UV assay of tramadol and O-desmethyltramadol in human plasma containing other drugs potentially co-administered to participants in a paediatric population pharmacokinetic study

Multimodal analgesia is employed in paediatric pain management to maximise analgesia and minimise side effects. Tramadol is dosed at 1–1.5 mg/kg to treat severe pain in children but the assay for tramadol in plasma samples for pharmacokinetic and toxicology studies does not often consider concurrently administered medications.

Error traps in pediatric difficult airway management

Difficult airway management in children is associated with significant morbidity. This narrative review on error traps in airway management aims to highlight the common pitfalls and proposes solutions to optimize best practices for pediatric difficult airway management. We have categorized common errors of pediatric difficult airway management into three main error traps.

Behavioural and neuropsychological outcomes in children exposed in utero to maternal labour epidural analgesia

Recent studies report conflicting results regarding the relationship between labour epidural analgesia (LEA) in mothers and neurodevelopmental disorders in their offspring. We evaluated behavioural and neuropsychological test scores in children of mothers who used LEA.

Feasibility of the pre-operative measurement of fractional exhaled nitric oxide and respiratory mechanics to predict respiratory outcomes in children undergoing general anaesthesia

Peri-operative respiratory adverse events remain a major cause of morbidity and mortality in children undergoing general anaesthesia; those with asthma are at higher risk. The aim of this feasibility study was to determine whether pre-operative measurements of fractional exhaled nitric oxide and the forced oscillation technique are feasible in children, and to explore whether these measurements can predict peri-operative respiratory adverse events.

Topical Lidocaine During Airway Manipulation in Pediatric Anesthesia: A Systematic Review and Meta-Analysis

Lidocaine is widely used in pediatric anesthesia for airway topicalization to modulate undesirable airway and circulatory reflexes, yet its effectiveness remains unclear. Therefore, we aimed to perform a meta-analysis evaluating the impact of topical lidocaine on respiratory adverse events in children undergoing airway management.

Current post-tonsillectomy analgesia practices among Australian and New Zealand anesthetists, and opinions on non-opioid alternatives

Children experience significant pain following extracapsular tonsillectomy surgery, and while opioids are often prescribed to treat this, clinicians may be wary of their adverse side effects, leading to variation in practice. There is a need for improved post-tonsillectomy pain management in children. 

Using head-mounted augmented and virtual reality devices for anaesthesia education: a scoping review

Head-mounted devices (HMDs) have been explored in anaesthesia education for their unique ability to have head-tracked immersive simulations adaptable to diverse clinical scenarios. This scoping review examines how HMD-based augmented or virtual reality enhances anaesthetic skill learning in clinicians, trainees, and students.

Association of preoperative nocturnal hypoxaemia nadir and fentanyl ventilatory sensitivity in children with obstructive sleep apnoea undergoing general anaesthesia

Obstructive sleep apnoea (OSA) has been thought to increase the risk of respiratory depression from opioids. The primary aim of this study was to assess whether preoperative hypoxaemia by sleep study pulse oximetry imparts greater opioid sensitivity.