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 kn...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.
BACKGROUND: Healthcare accounts for 4%-5% of global CO equivalent (COe) emissions, of which hospitals form a considerable component. Identifying evidence-based targets for carbon reduction in pediatric anesthesia can hel...BACKGROUND: Healthcare accounts for 4%-5% of global CO equivalent (COe) 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 COe 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.
Jacobi T, Walter S, Pickartz A
… +4 more, Baller G, Becher T, Lautenschläger I, Sablewski A
Paediatr Anaesth
· 2026 May · PMID 41706036
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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. Whil...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), 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 = 0.35, 95% CI 0.15-0.53, p = 0.001) and T2 (r = 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).
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...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.
Paediatr Anaesth
· 2026 May · PMID 41670069
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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 clea...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.
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 surger...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)).
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....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.