Paediatr Anaesth [JOURNAL]
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200 papers
Avoidance of Hyperoxemia Versus Routine Hyperoxia During Cardiopulmonary Bypass in Children With Cyanotic Congenital Heart Disease-A Systematic Review and Meta-Analysis.
Fischer J, Arobo A, Almehandi A … +8 more , Leidens EC, Apostu EB, Passos FS, Kirov H, Doenst T, Kerst G, Loukanov T, Caldonazo T
Paediatr Anaesth · 2026 Jun · PMID 41878857 · Publisher ↗
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...
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 = 15%). Also, no significant differences were observed for ICU LOS (SMD: -0.04; 95% CI: -0.46-0.38; p = 0.859; I = 64%), hospital LOS (SMD: 0.24; 95% CI: -0.01-0.50; p = 0.064; I = 0%), operative duration (SMD: -0.66; 95% CI: -1.90-0.58; p = 0.294; I = 84%), and epinephrine use (OR: 0.66; 95% CI: 0.28-1.57; p = 0.350; I = 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.
Hibino T, Okui Y, Toba Y … +8 more , Kondo S, Ikegami H, Suzuki K, Ogura F, Masui H, Kitamoto N, Koide M, Yamazaki T
Paediatr Anaesth · 2026 Jun · PMID 41873655 · Full text
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 patient...
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.
Abouleish A, Vinta SR, Shabot SM … +1 more , Simon M
Paediatr Anaesth · 2026 Jun · PMID 41854181 · Publisher ↗
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Remimazolam and Emergence Delirium in Children: Encouraging Signals, Incomplete Certainty.
Quintão VC, Hansen TG, Engelhardt T
Paediatr Anaesth · 2026 Jun · PMID 41847949 · Publisher ↗
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Milk Fasting Times and Aspiration in Infants.
Newton R, Engelhardt T, Anderson BJ
Paediatr Anaesth · 2026 Jun · PMID 41841253 · Publisher ↗
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The Electronic Faces Thermometer Scale (eFTS)-Construct Validity for Pain Assessment in Pediatric Postoperative Care in Sweden.
Höök A, Hylén M, Nilsson S … +1 more , Castor C
Paediatr Anaesth · 2026 Jun · PMID 41841241 · Publisher ↗
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Non-Intubated Spontaneous Ventilation Versus Endotracheal Intubation Anesthesia for Pediatric Thoracoscopic Lung Resection: A Retrospective Propensity-Score-Matched Study.
Chen Y, Han D, Zhang X … +3 more , Wu Y, Pan S, Yan F
Paediatr Anaesth · 2026 Jun · PMID 41823064 · Publisher ↗
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 reg...
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.
Wang S, Li M, Meng B … +5 more , Wu Y, Zhang H, Wei D, Zhang H, Diao M
Paediatr Anaesth · 2026 Jun · PMID 41817130 · Publisher ↗
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 stratificati...
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.
Lateiresh M, Altayf A, Qatza A … +3 more , Alghazal A, Al-Sakkaf H, Elhadi M
Paediatr Anaesth · 2026 Jun · PMID 41806259 · Full text
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...
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.
McManus SJ, Buchmiller TL, Staffa SJ … +1 more , Goobie SM
Paediatr Anaesth · 2026 Jun · PMID 41806167 · Publisher ↗
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 hem...
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 cm (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 cm (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.
Correction to "The Effect of Augmented Reality on Preoperative Anxiety in Children and Adolescents: A Randomized Controlled Trial".
Paediatr Anaesth · 2026 May · PMID 41805106 · Publisher ↗
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A Study of the Differences in Central Venous Pressure Between the Distal Lumen and Proximal Lumen of Central Venous Catheters in Pediatric Patients.
Yamamoto T, Shiraishi S
Paediatr Anaesth · 2026 Jun · PMID 41805088 · Publisher ↗
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 v...
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.
Shao Y, Pan J, Chen L
Paediatr Anaesth · 2026 Jun · PMID 41800493 · Publisher ↗
BACKGROUND: Preoperative anxiety is prevalent in children undergoing supernumerary tooth extraction and can exacerbate physiological stress responses. Nonpharmacological interventions like immersive gaming interventions...
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.
The Analgesic Effect of Extended Reality (XR) on Acute and Postoperative Pain in Children: A Systematic Review and Meta-Analysis.
Meulenkamp-Yilmaz L, El Bardai S, Hillegers MHJ … +3 more , Legerstee J, Dierckx B, Staals L
Paediatr Anaesth · 2026 May · PMID 41795162 · Full text
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 dis...
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.
Effects of Prolonged Preoperative Fasting on Blood Glucose Levels in Pediatric Elective Surgeries: A Systematic Review and Meta-Analysis.
Ramachandran S, Kundra P, Velayudhan S … +4 more , Deepthy MS, Mathew JL, Loganathan S, Sharma M
Paediatr Anaesth · 2026 Jul · PMID 41795161 · Publisher ↗
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...
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 = 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.
Berens RJ, Striker AB, Jablonski MM … +4 more , Scott JP, Tanem JM, Mikhailov TA, Hoffman GM
Paediatr Anaesth · 2026 Jun · PMID 41795157 · Publisher ↗
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 frequ...
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.
Markus M, Panagiotou F, Spies C … +1 more , Koch S
Paediatr Anaesth · 2026 Jun · PMID 41787671 · Full text
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...
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.
Kim JN, Na HS, Shin HJ
Paediatr Anaesth · 2026 Jun · PMID 41787660 · Full text
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 pedia...
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.
Determining Parental Attitudes Toward Day of Surgery Consent for Research.
Caldeira-Kulbakas M, Pehora C, Williams RJ … +2 more , Soni L, Taylor KL
Paediatr Anaesth · 2026 May · PMID 41744088 · Publisher ↗
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 bu...
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.
Design for a Reusable High-Fidelity Pediatric Epidural and Caudal Phantom for Haptic Learning.
Sunder RA, Le H
Paediatr Anaesth · 2026 Jun · PMID 41732884 · Full text
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