Paediatr Anaesth [JOURNAL]
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200 papers
Perceived Risk of Imaging for Developmental Delay: A Cross-Sectional Survey Study Across Multiple Centers and Specialties.
Conley CM, Dienes E, He XA … +11 more , Chao JH, Callahan MJ, Onisei AM, Bennett EE, Stein ALS, Alperin S, Kalin J, Mukerji S, Safavi A, Diaz CD, Cravero J
Paediatr Anaesth · 2026 Mar · PMID 41467346 · Publisher ↗
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Bilateral Transcranial Doppler Monitoring During Neonatal Cardiac Surgery; Guidance for Clinical and Scientific Use.
Martherus BV, Alderliesten T, Fonteyn EMR … +9 more , Ceelie I, van Vriesland DJ, Nijman J, Talacua H, Nievelstein RAJ, Dudink J, Benders MJNL, Buhre WFFA, van Loon K
Paediatr Anaesth · 2026 Apr · PMID 41439495 · Full text
INTRODUCTION: Neonates undergoing cardiac surgery face a high risk of neurological injury and neurodevelopmental complications. Transcranial Doppler monitoring is used and validated in adults to measure cerebral blood fl...
INTRODUCTION: Neonates undergoing cardiac surgery face a high risk of neurological injury and neurodevelopmental complications. Transcranial Doppler monitoring is used and validated in adults to measure cerebral blood flow and can provide valuable insights into cerebral perfusion in neonates. Nevertheless, it has not been widely introduced in neonatal cardiac surgery. AIMS: This study aims to evaluate the feasibility of continuous bilateral transcranial Doppler monitoring for assessing cerebral perfusion during neonatal cardiac surgery. METHODS: Continuous transcranial Doppler monitoring was employed during neonatal cardiac surgery with a commercially available transcranial Doppler system and fixation materials. Cerebral blood flow velocity, invasive arterial blood pressure, and other key physiological parameters were measured throughout the procedures. RESULTS: A total of 44 procedures were monitored. Four were excluded due to storage problems (n = 2), inadequate time to apply the probes (n = 1), and subject drop-out due to lower surgery severity (n = 1). Bilateral sufficient signal quality was obtained in all patients at the start. Unilateral signal deterioration occurred in 1 (2.5%) of left middle cerebral artery measurements and in 3 (7.5%) of right middle cerebral artery measurements. Mean (SD) left/right MCA CBFV were: pre-bypass 17.2 (6.4)/15.4 (6.8) cm/s, during bypass 10.8 (4.0)/10.2 (4.3) cm/s, and post-bypass 18.4 (5.9)/16.1 (5.1) cm/s. Mean (SD) ABP was 38.1 (4.4) mmHg pre-bypass, 38.0 (5.1) mmHg during bypass, and 47.8 (4.7) mmHg post-bypass. CONCLUSIONS: This study demonstrates that bilateral transcranial Doppler monitoring is feasible during neonatal cardiac surgery when performed within the recommended operational safety limits. Transcranial Doppler provides real-time information on cerebral blood flow, complementing existing tools. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04713605.
Evaluation of the Efficacy of Telemedicine for Pre-Anesthetic Check-Up in Pediatric Patients Undergoing Elective Surgery: A Pilot Randomized Controlled Trial.
Shah Y, Prasad N, Sinha A … +1 more , Wadhawan S
Paediatr Anaesth · 2026 Apr · PMID 41432233 · Publisher ↗
BACKGROUND: Telemedicine has emerged as a valuable tool in healthcare, especially in the wake of the COVID-19 pandemic, showcasing high satisfaction rates across various medical fields. But its potential benefits for pre...
BACKGROUND: Telemedicine has emerged as a valuable tool in healthcare, especially in the wake of the COVID-19 pandemic, showcasing high satisfaction rates across various medical fields. But its potential benefits for pre-anesthetic evaluation in children have not been widely studied. METHOD: This pilot randomized controlled trial involves 70 pediatric patients aged 3-12 years compares telemedicine (Group T) with conventional, that is, in-person assessments (Group C), with the primary outcome being the number of visits required for pre-anesthetic checkup, while secondary outcomes include cancellation rates on the day of surgery, duration of consultation, parent/guardian satisfaction rates and concordance of pre-anesthesia checkups between anaesthesiologists. RESULT: Telemedicine demonstrated comparable effectiveness to in-person assessments, with no statistically significant difference in the number of visits required for anesthesia clearance (mean visits: 1.54; 95% CI: 1.27-1.81 in group T vs. 1.69; 95% CI: 1.42-1.96 in group C). Surgical cancellations or delays occurred in fewer than one case per group. The duration required for primary anesthesia clearance during the initial session in Group T took longer (17 min 22 s; 95% CI: 15 min 25 s-19 min 20s) than in Group C (13 min 19 s; 95% CI: 11 min 47 s-14 min 50s). This difference may be attributed to parental/guardian unfamiliarity with Zoom and the challenges of home-based assessments, but high satisfaction scores (mean total 5-point likert satisfaction score = 20.74 ± 1.93 out of 25) suggest acceptance among parents/guardians. Concordance rates between anaesthesiologists for medical history, investigations, documentation, ASA status, and anesthesia plan were high (> 85% of cases) using telemedicine except for airway assessment as it was in agreement in only 45.7% of cases. CONCLUSION: Telemedicine is offering similar clinical outcomes, high parental satisfaction, and greater accessibility and thus underscores its potential to enhance accessibility and convenience in pediatric pre-anesthesia evaluations without compromising clinical quality. TRIAL REGISTRATION: Clinical trial number: CTRI/2022/11/047193.
A Pilot Randomized Controlled Trial to Determine the Efficacy of an auGmented reAlity gaMe in pediatrIc caNcer Patients Who Are Opioid Naïve Undergoing Surgery to Reduce Postoperative Opioid Use (The GAMING-ON Study).
Cata JP, Guerra-Londono JJ, Aveni P … +9 more , Cortes-Mejia N, Gloria JM, Choi JE, Kim Hye M, Owusu-Agyemang P, Feng L, Fuller C, Beel ER, Sinton J
Paediatr Anaesth · 2026 Apr · PMID 41427500 · Publisher ↗
INTRODUCTION: Pediatric musculoskeletal and cancer surgeries often lead to significant postoperative pain. Augmented reality (AR), a non-pharmacological approach to pain modulation, has been insufficiently studied for it...
INTRODUCTION: Pediatric musculoskeletal and cancer surgeries often lead to significant postoperative pain. Augmented reality (AR), a non-pharmacological approach to pain modulation, has been insufficiently studied for its potential role in reducing opioid use following major surgery in children. METHODS: In this pilot trial, we randomly assigned pediatric patients undergoing major surgery, in a 1:1 ratio, to an AR versus non-AR scavenging game postoperatively. Randomization was stratified according to the study site. The primary endpoint was the rate of persistent opioid use measured at 90 days after hospital discharge. Secondary endpoints included pain intensity, opioid use, inpatient ambulation or "out of bed", movement, length of stay, and adverse events. We considered the trial a success if the rate of opioid use at 90 days postoperatively was significantly lower in the AR arm than in the non-AR arm. RESULTS: A total of 66 patients underwent randomization (n = 33 in each arm). The median age of each group was 12 years old. There were more females (72.7%) in the AR group than in the non-AR group (48.5%). Most patients (80%) had undergone oncological surgeries. The primary endpoint was met in over 95% of the patients. The overall rate of opioid use was low in both groups of patients (AR: 6.1% and non-AR: 9.7%) and did not reach statistical significance (p = 0.667). There were no statistically significant differences in secondary outcomes. CONCLUSION: In conclusion, this pilot study does not support the use of AR aimed at reducing the rate of persistent opioid use following pediatric surgery.
Effect of Dexmedetomidine on Rocuronium-Induced Neuromuscular Blockade and Intubation Condition in Children: A Randomized Controlled Trial.
Kouna N, Matsota P
Paediatr Anaesth · 2026 Mar · PMID 41420428 · Publisher ↗
BACKGROUND: Dexmedetomidine is an a-adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has gained remarkable attention in the adult and pediatric population predominantly because of its minima...
BACKGROUND: Dexmedetomidine is an a-adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has gained remarkable attention in the adult and pediatric population predominantly because of its minimal respiratory depression. However, in the pediatric population, very limited information is available regarding the action of intravenous dexmedetomidine on neuromuscular blockade and on anesthesia induction. The aim of this study was to investigate the impact of dexmedetomidine on rocuronium-induced neuromuscular blockade and on anesthesia induction with propofol in children. MATERIAL AND METHOD: A total of 60 children undergoing elective surgery, ages 4-12 years, were enrolled in the study. Before the induction of anesthesia with propofol, 30 children received dexmedetomidine 0.5 μg/kg given over 10 min (group D). Another group of 30 children received the same volume of N/S 0.9% over 10 min as well (group P). We recorded time to achieve TOF = 0 from the end of rocuronium infusion, time for BIS < 60 from the end of propofol infusion, intubation conditions, haemodynamic changes, intubation attempts, and adverse effects. RESULTS: The onset time of rocuronium was significantly lower in group D compared to group P (177.8 s, 95% CI 161.1-194.0 s vs 205 s, 95% CI 188.0-222.0 s; p = 0.021). Time for BIS to reach a value < 60 (34.3 s, 95% CI 29.1-39.6 s for group D vs 33.2 s, 95% CI 27.2-39.2 s for group P, p = 0.772) was unaffected by dexmedetomidine infusion. Intubation conditions showed a more stable haemodynamic response in group D (systolic, diastolic, mean arterial pressure, and heart rate were significantly lower in group D at intubation). No difference was found regarding intubation attempts and adverse effects. CONCLUSION: Our results showed that dexmedetomidine infusion before induction of anesthesia with propofol reduced the onset time of rocuronium and provided a better hemodynamic profile during endotracheal intubation in children. TRIAL REGISTRATION: The study protocol was registered in ClinicalTrials.gov (NCT03923075).
A Cultural Shift: Implementing Reusable Anesthesia Circuits in US Pediatric Anesthesia to Address Supply Chain and Environmental Challenges.
Hansen EE, Cockrell HC, McGain F … +4 more , Righter-Foss K, Rampersad S, Martin LD, Chiem JL
Paediatr Anaesth · 2026 Mar · PMID 41416664 · Publisher ↗
INTRODUCTION: Healthcare contributes significantly to global plastic waste, with single-use disposable (SUD) materials being a major culprit. Reusable anesthesia machine breathing circuits are used in many parts of the w...
INTRODUCTION: Healthcare contributes significantly to global plastic waste, with single-use disposable (SUD) materials being a major culprit. Reusable anesthesia machine breathing circuits are used in many parts of the world. Their adoption in the United States (US) remains limited, driven by institutional policies and fear of litigation. METHODS: This perspective piece reflects on our single institution multi-site experience using a variety of anesthesia machine breathing circuits, including SUD and reusable, with both daily and weekly circuit changes for pediatric anesthesia care in the US. RESULTS: We report survey results on the attitudes and opinions of a pediatric anesthesia team regarding the sustainability and costs of these products, as well as the results of anonymous safety concern reporting during the October 2022 and January 2025 observation period. In our pediatric ambulatory surgery setting, weekly changes of reusable circuits with individual patient filters proved to be a safe alternative to daily changes or SUD circuits. Challenges to reusable circuit use were identified through reporting and survey data and included supply chain constraints and buildup of water vapor if circuits were not properly drained. We estimated plastic waste reduction to be 27.8 kg per week (84% reduction) compared to SUD and 17.5 kg (53% reduction) compared to daily reusable circuit changes. DISCUSSION: We did not complete a full cost analysis or perform microbiologic studies as this has been previously reported. Monitoring for water vapor buildup within the reusable anesthesia breathing circuit and vigilance in performing a leak test prior to patient use remain key patient safety components. Our experience demonstrates the feasibility of reusable anesthesia circuit use with appropriate protocols.
The Role of Anesthesiologists in Multidisciplinary Care for Patients With Trisomy 13: Supporting Shared Decision-Making in Family and Healthcare Team.
Ishihara T, Kariya T, Kuwajima K … +1 more , Uchida K
Paediatr Anaesth · 2026 Mar · PMID 41404839 · Publisher ↗
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J-Shaped Guidewire-Assisted Nasotracheal Intubation in the Dental Treatment of Children-A Retrospective, Observational Study.
Zhang X, Gao L, Jiang X … +1 more , Liu Y
Paediatr Anaesth · 2026 Mar · PMID 41404829 · Full text
BACKGROUND: The challenges of nasotracheal intubation (NTI) often arise from the misalignment of the oral, pharyngeal, and laryngeal axes. We sought to assess the success and complication rate of an economically reusable...
BACKGROUND: The challenges of nasotracheal intubation (NTI) often arise from the misalignment of the oral, pharyngeal, and laryngeal axes. We sought to assess the success and complication rate of an economically reusable J-shaped stainless-steel guidewire for NTI during dental treatment in children. MATERIALS AND METHODS: Pediatric patients undergoing dental treatment under general anesthesia who were nasally intubated during January 2016-December 2023 were retrospectively analyzed. The following variables were collected: details of relative position between endotracheal tube (ETT) tip and glottis, peri-intubation vital signs, and incidence of related complications. The primary observation indicator was the bullseye probability, defined as the probability of the ETT directly aligning with the glottis after glottic exposure. RESULTS: Data were obtained from 692 pediatric patients. The bullseye probability was 49.4%. The probability of ETT tip pointing toward the tongue base was 11.3%, and the probability of ETT tip pointing toward the esophageal entrance was 1.9%. The probability of ETT tip being at the same horizontal plane with glottis was 86.8%. Additional assistance was required to advance the tube smoothly in 48.4% of cases. The total intubation time was 63.1 (Q1-Q3, 54.3-72.3) s with a 100% overall success rate. The incidence of severe lip and mucosal trauma was 0.7%. CONCLUSIONS: The J-shaped stainless-steel guidewire is a suitable and economic auxiliary tool to assist NTI for outpatient dental procedures in children. The occurrence of severe lip and mucosal trauma was lower than reported in other studies.
Response to the Letter Regarding "Dynamics of Oxygen Reserve Index and Arterial Oxygen Partial Pressure in Children".
Kim JT, Lee JH
Paediatr Anaesth · 2026 Mar · PMID 41395994 · Publisher ↗
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Perioperative Respiratory Adverse Events and Associated Factors Among Pediatric Patients in Ethiopian Hospitals: A Multi-Centre Observational Study.
Seid S, Essa K, Fentie Y … +4 more , Teshome D, Mekete G, Fenta E, Adane H
Paediatr Anaesth · 2026 Mar · PMID 41388794 · Publisher ↗
BACKGROUND: Respiratory adverse events increase morbidity and mortality rates throughout the perioperative period. It also account for most of the critical incidents in pediatric anesthesia. The incidence of these events...
BACKGROUND: Respiratory adverse events increase morbidity and mortality rates throughout the perioperative period. It also account for most of the critical incidents in pediatric anesthesia. The incidence of these events in Ethiopian health care is unknown. OBJECTIVES: This study aimed to determine the incidence of perioperative respiratory adverse events and associated factors among pediatric surgical patients from June 2022 to April 2023, at three selected north-west Ethiopian hospitals. METHODS: A hospital-based prospective cohort study was conducted among pediatric surgical patients who had undergone a variety of surgeries. A total of 424 patients were included, including elective and emergency cases. RESULTS: 138 (32.5%, 95% CI: 28.3-36.9) patients developed perioperative respiratory adverse events. Variables that showed association with respiratory adverse events included ketamine maintenance of anesthesia, history of allergy, having moderate to severe pain level, history of active upper respiratory tract infection, above neck procedures, and endotracheal intubation. CONCLUSION: Perioperative respiratory adverse events incidence was high compared with other studies. Clinicians need to give careful attention to patients with a history of allergy, moderate to severe pain, upper respiratory tract infection, ENT surgery, intravenous anesthesia maintenance, and endotracheal intubation to decrease adverse respiratory events.
Anesthesia-Related Adverse Events in Infants With Gastroschisis at a South African Tertiary Pediatric Hospital: A Retrospective Cohort Study.
Heald A, Gray RM, Arnold M … +1 more , Meyer HM
Paediatr Anaesth · 2026 Mar · PMID 41386713 · Publisher ↗
BACKGROUND: Infants with gastroschisis represent a high-risk surgical population, particularly in low- and middle-income countries (LMICs) where perioperative resources are constrained. While survival in high-income sett...
BACKGROUND: Infants with gastroschisis represent a high-risk surgical population, particularly in low- and middle-income countries (LMICs) where perioperative resources are constrained. While survival in high-income settings exceeds 90%, reported mortality in Sub-Saharan Africa ranges from 58.1% to 100%. Anesthesia-related adverse events (ARAEs) may contribute to poor perioperative risk, yet data on their incidence and associated factors in this population are limited. AIMS: To describe the incidence and nature of ARAEs in infants with gastroschisis and identify associated risk factors. A secondary aim was to assess the frequency and safety of general anesthesia administered solely for central venous catheter (CVC) procedures. METHODS: A retrospective cohort study of all infants with gastroschisis admitted to Red Cross War Memorial Children's Hospital between 2012 and 2021. ARAEs were defined using criteria from APRICOT and NECTARINE studies. Generalized estimating equations (GEE) were used to account for repeated anesthetic exposures per patient. RESULTS: Sixty-five infants underwent 196 general anesthetics (median 2 [IQR 1-4] per patient). Sixteen infants underwent 4 or more GAEs for CVC procedures alone. ARAEs occurred in 79 procedures (40.3%), affecting 51 patients (78.5%). Cardiovascular instability was most common, followed by respiratory complications. ARAEs were significantly more frequent during pathology-related surgery than during CVC procedures (45.7% vs. 12.5%; adjusted OR 0.17, 95% CI 0.08 to 0.35, p < 0.001). CONCLUSIONS: ARAEs are common in infants with gastroschisis, particularly during pathology-related procedures. Potential lessons include careful fluid management, anticipatory extubation planning, and reducing repeated anesthetic exposure. Strengthening perioperative data systems in LMICs and conducting prospective studies are needed to identify modifiable risks and develop safe, context-specific care pathways to improve outcomes for infants with gastroschisis in resource-limited settings.
Predicting Anxiety in Children Aged 2-6 During Preoperative Anesthesia Consultation-A Prospective Observational Study.
Sablewski A, Neitzel C, Grosser M … +5 more , Krebs K, Karstensen A, Balandin A, Selpien H, Becher T
Paediatr Anaesth · 2026 Mar · PMID 41363541 · Full text
BACKGROUND: Preoperative Anxiety in Young Children Is Common and Can Lead to Adverse Outcomes. In Clinical Routine, Anesthesiologists Must Often Predict Anxiety Based on Limited Interaction. AIMS: This study aimed to eva...
BACKGROUND: Preoperative Anxiety in Young Children Is Common and Can Lead to Adverse Outcomes. In Clinical Routine, Anesthesiologists Must Often Predict Anxiety Based on Limited Interaction. AIMS: This study aimed to evaluate the accuracy of early anxiety predictions and to identify early predictors of heightened anxiety at anesthesia induction. METHODS: In this prospective observational study, anesthesiologists and parents of children aged 2-6 years undergoing elective procedures were asked during the preoperative consultation to predict the child's anxiety at anesthesia induction using the visual analog scale (VAS). These predictions were compared to observed anxiety during induction, measured with the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Prediction accuracy was assessed using Spearman's correlation (r) and receiver operating characteristics (ROC) analysis. Potential predictors of significant anxiety defined as a mYPAS-SF > 30 were analyzed. RESULTS: A total of 92 prediction sets were analyzed. Correlation between predicted and observed anxiety was weak for parents (r = 0.220, 95% CI 0.01-0.41) and very weak for anesthesiologists (r = 0.106, 95% CI -0.11-0.31). Predictive performance was limited for parents (AUC = 0.643) and negligible for anesthesiologists (AUC = 0.517). Children who responded positively to a greeting ('high-five') during consultation showed significantly lower anxiety during anesthesia induction (median mYPAS-SF score 34.4 [22.9-65.1] vs. 75.0 [45.8-90.6], p < 0.001). Significant anxiety was also associated with younger age of both children and parents, migration background, and inhalational induction. CONCLUSIONS: Anxiety at induction remains difficult to predict during preoperative consultation. While parents performed slightly better than anesthesiologists, both lack sufficient precision. Simple behavioral cues, such as a response to a greeting, may help identify at-risk children early. Future strategies should involve children and parents in individualized anxiety management. TRIAL REGISTRATION: German Clinical Trials Registry, registration number: DRKS00035033.
Incidence and Risk Factors for Intra-Operative Hypothermia in Very Low Birth Weight (≤ 1500 g) Neonates Undergoing General Anesthesia and Digestive Surgery.
Cui Y, Zhang D, Gong T … +2 more , Huang Q, Zhang C
Paediatr Anaesth · 2026 Jan · PMID 41362006 · Publisher ↗
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Enhancing Communication in Pediatric Anesthesia: The Impact of Language Barriers on Caregiver and Clinician Interaction.
Branche K, Gallardo P, Carreon Y … +1 more , Ehie O
Paediatr Anaesth · 2026 Mar · PMID 41358554 · Publisher ↗
BACKGROUND: Effective communication is crucial in perioperative healthcare settings. However, language barriers hinder this communication. In the United States, 8% of individuals over age 5 have a non-English language pr...
BACKGROUND: Effective communication is crucial in perioperative healthcare settings. However, language barriers hinder this communication. In the United States, 8% of individuals over age 5 have a non-English language preference (NELP). Lack of language concordance between patients and healthcare clinicians has been linked to poorer healthcare metrics and outcomes. Despite these challenges, limited research has focused specifically on language barriers in perioperative settings, and few studies have captured experiential data from both caregivers and clinicians. AIMS: This study aimed to explore whether language discordance between clinicians and caregivers is associated with lower perceived quality of care by either caregivers or clinicians. We also explored whether the interpreting modality impacts perceptions of care by either caregivers or clinicians. METHODS: This study employed a mixed-methods approach, composed of 9-item 5-point Likert scale questionnaires and explanatory sequential semi-structured interviews of caregivers and clinicians in a large academic medical center. We analyzed caregiver quantitative data using a Mann-Whitney U test. Interview transcripts from caregivers and clinicians underwent thematic analysis. RESULTS: The caregiver and clinician participant response rates were 60% and 69%, respectively. Analysis of caregiver surveys revealed no significant differences between NELP and ELP caregiver responses. Clinician survey analysis revealed significant discrepancies between awareness of interpretation services and true availability of these services in perioperative areas. Major themes identified in caregiver interviews included informational quality, trust, perceived understanding, and overall satisfaction. Major themes identified in clinician interviews included communication barriers, system improvement suggestions, and communication facilitators. CONCLUSIONS: This study underscores the importance of preoperative patient/caregiver education to ensure adequate comprehension and understanding in the perioperative setting, particularly within NELP populations. Additionally, the results suggest that in-person interpretation services may improve patient and clinician satisfaction.
A 10-Year Retrospective Study: To Evaluate the Anesthetic and Surgical Management for Pulmonary Hydatid Cyst in Children.
Roja EDN, Sundar H, Kumar LA … +1 more , Rai E
Paediatr Anaesth · 2026 Mar · PMID 41351357 · Publisher ↗
BACKGROUND: Pulmonary hydatid disease (PH) remains a significant health challenge in children from endemic regions. The anesthetic and surgical management of PH is complex, particularly in the presence of ruptured cysts,...
BACKGROUND: Pulmonary hydatid disease (PH) remains a significant health challenge in children from endemic regions. The anesthetic and surgical management of PH is complex, particularly in the presence of ruptured cysts, which pose risks such as airway obstruction and anaphylaxis. METHODS: A 10-year retrospective cohort study was conducted on children ≤ 18 years undergoing surgery for PH at our tertiary care center between January 2012 and December 2022. Data were collected from medical records, operative notes, and imaging reports. RESULTS: There were 37 cases with diagnosis of pulmonary hydatid disease in last decade, we have included 28 children with complete records. Three had bilateral disease, totaling 31 procedures. Ruptured cysts were noted in 12 cases. Common symptoms included cough, fever, and hemoptysis. One lung ventilation (OLV) was achieved in 96% of cases with DLT (45%), Arndt blocker (33%) and Fogarty blocker (13%) commonly used. Complications included desaturation (75%), transient bradycardia (29%), and three major perioperative events, all in children with ruptured cysts. The mean OLV duration was longer in complicated cases (3.42 vs. 2.3 h, p = 0.019). Postoperative air leaks occurred in 10 children, with three requiring re-surgery. All patients were extubated on-table, with mean length of stay of 7 days and no long-term morbidity or mortality. CONCLUSION: OLV is critical in minimizing spillage and facilitating surgical management in pediatric PH. The incidence of intraoperative complications was higher in those with bilateral Pulmonary hydatid disease. The duration of One Lung Ventilation (OLV) and hospital stay was prolonged in those with complicated pulmonary hydatid cyst.
Exploring Barriers and Facilitators to Incorporating New Practices and Innovations in the Pediatric Perioperative Ecosystem in Sub-Saharan Africa: A Mixed Methods Study.
Bhettay A, Parker R, Maswime S … +4 more , Korsah EK, Cunningham C, Trifa M, Gray R
Paediatr Anaesth · 2026 Mar · PMID 41346173 · Full text
BACKGROUND: Integrating evidence-based findings into perioperative medicine is key to allowing improvements in care. The perioperative environment involves multiple stakeholders and processes that require coordination to...
BACKGROUND: Integrating evidence-based findings into perioperative medicine is key to allowing improvements in care. The perioperative environment involves multiple stakeholders and processes that require coordination to deliver high-quality care. Various barriers can challenge the implementation of changes in this setting, but key facilitators may enable them. This research explored barriers and facilitators to implementing new practices and innovations in the pediatric perioperative ecosystem, as experienced by pediatric anesthetists returning to work in a sub-Saharan African country. METHODS: This was a mixed methods study following an explanatory sequential design. A survey was sent to 28 fellowship-trained pediatric anesthetists identified through fellowship leads of established programs, who had returned to work in sub-Saharan Africa post-fellowship. Respondents were invited to participate in interviews. Reflexive thematic analysis was used to represent the experiences described by the participants, and to categorize barriers and facilitators. RESULTS: Seventeen anesthetists from 10 countries responded to the survey (response rate 17/28, 61%). All respondents indicated that they had encountered barriers to change implementation (17/17, 100%), and 12/15 (80%) indicated that facilitators that enabled change existed. Resource constraints were the main barrier, followed by resistant behaviors by individuals and at the organizational level. Ten anesthetists were subsequently interviewed. Respondents attempted to bring about change in a variety of areas, including operational logistics, patient safety, clinical practice, and organizational culture. Key barriers were encountered at individual, environmental and organizational levels. Key enablers included personal traits such as persistence and adaptability, ongoing mentorship, supportive leadership, and the strategic contextualization of skills. CONCLUSION: Fellows experience significant challenges when attempting to implement changes based on the knowledge and skills acquired during advanced training. Facilitators enabling successful change implementation exist. Including training in leadership and change management in fellowship programs may better prepare those from sub-Saharan Africa to introduce their envisioned improvements to the perioperative environment upon their return.
Associations of Intraoperative Hypotension and Vasopressor Administration With Postoperative Acute Kidney Injury in Children Undergoing Liver Transplantation: A Retrospective Cohort Study.
Wingert T, Feldman K, Williams T … +5 more , Delaporte A, Lum M, Grogan T, Nguyen-Buckley C, Joosten A
Paediatr Anaesth · 2026 Mar · PMID 41324145 · Full text
BACKGROUND: Both intraoperative hypotension (IOH) and vasopressor administration are independently associated with postoperative acute kidney injury (AKI) in adults undergoing major noncardiac surgery. Whether these asso...
BACKGROUND: Both intraoperative hypotension (IOH) and vasopressor administration are independently associated with postoperative acute kidney injury (AKI) in adults undergoing major noncardiac surgery. Whether these associations extend to children undergoing major noncardiac surgery, such as liver transplantation, remains unknown. AIMS: This study aimed to evaluate whether IOH, defined as time spent with a mean arterial pressure (MAP) less than one standard deviation (SD) below age- and sex-adjusted normal, and vasopressor administration in children are associated with postoperative AKI in liver transplantation (LT). We hypothesized that both IOH and vasopressor use would be independent predictors of postoperative AKI after pediatric LT. METHODS: This single-center retrospective cohort study analyzed all patients < 18 years undergoing LT, excluding those with preoperative end-stage renal disease. The primary outcome was AKI, within 7 postoperative days defined according to KDIGO criteria. Multivariable logistic regression models were performed to determine whether IOH and vasopressor use, specifically maximum intraoperative epinephrine infusion, were independently associated with AKI. Exploratory K-means clustering was applied to IOH and vasopressor exposure to identify hemodynamic phenotypes, which were evaluated for associations with AKI and other outcomes. RESULTS: Of 144 pediatric LT cases, 22 were excluded for preexisting renal failure, leaving 122 for analyses. Postoperative AKI occurred in 39%. The mean cumulative duration MAP was < 1 standard deviation of age- and sex-adjusted mean was 26.6 versus 26.1 min, respectively, among patients who developed AKI versus those who did not (mean difference 0.52 min: 95% CI -15.03, 16.07, p = 0.948). In the multivariate analysis neither hypotension (by the same definition) nor maximum epinephrine appeared to be associated with AKI: adjusted odds ratio 1.003 (95% CI: 0.992-1.014) and 1.003 (95% CI: 0.994-1.012). Exploratory cluster analysis revealed distinct intraoperative hemodynamic phenotypes based on IOH and vasopressor use, which were significantly associated with some perioperative outcomes, highlighting the need for larger studies with more robust control of patient factors. CONCLUSIONS: IOH and vasopressor exposure were not independently associated with AKI in children undergoing LT.
The Ability of Infrared Thermography to Detect Successful Caudal Block in Children Undergoing Infra-Umbilical Surgery.
Helmy MA, Mohamed IH, Mostafa M … +4 more , Hasanin A, Mahmoud M, Elsonbaty M, Kamel MM
Paediatr Anaesth · 2026 Mar · PMID 41324137 · Publisher ↗
BACKGROUND: Caudal epidural block is commonly used in pediatric surgeries but may fail due to anatomical variations or operator experience. Early recognition of block effectiveness is useful for timely pain management, i...
BACKGROUND: Caudal epidural block is commonly used in pediatric surgeries but may fail due to anatomical variations or operator experience. Early recognition of block effectiveness is useful for timely pain management, improving outcomes and analgesic strategies. AIMS: This study aimed to assess the ability of infrared thermography to determine caudal block success in children. METHODS: In this prospective observational study, children (2-12 years) undergoing infra-umbilical surgery received a caudal block after the induction of general anesthesia. FLIR C2 thermal camera was used to assess skin temperature at the dorsum of the foot, little toe, and suprapubic area at the baseline and 2, 5, 10, and 15 min after the block. Temperature change (Δ) was calculated as the difference from baseline. The primary outcome was the ability of Δ temperature at 10 min to detect a successful block, assessed via the area under the receiver operating characteristics curve (AUC). RESULTS: Data from 143 patients were analyzed; 29/143 (20%) patients had failed block. In the successful block group, the temperature increased over time and was significantly higher than that of the failed block group at 10 and 15 min. At 10 min, the AUC (95% confidence interval) for detecting successful block was higher at the dorsum of the foot (0.92 [0.86-0.96]) and little toe (0.87 [0.81-0.92]) compared to the suprapubic area (0.74 [0.66-0.81]). The positive predictive value for Δ temperature at the dorsum of the foot and little toe for detecting successful block was 95%-96% with cut-offs of 1.2°C and 1.4°C, respectively. CONCLUSION: In anesthetized children undergoing infra-umbilical surgeries, infrared thermography can accurately confirm successful caudal block. Ten minutes after the block, an increase in the skin temperature by 1.2°C-1.4°C at the dorsum of the foot and little toe can confirm block success with 95%-96% accuracy.
Audiovisual Distraction Increases Success Rates of Sedation-Free Pediatric Magnetic Resonance Imaging.
Zhang E, Jubane M, Rakshe S … +7 more , Ye S, Scroggins K, Levin A, Wilcoxon M, Pettersson D, Thiessen J, Kato M
Paediatr Anaesth · 2026 Feb · PMID 41324126 · Publisher ↗
BACKGROUND: The increasing utilization of magnetic resonance imaging (MRI) in pediatric populations necessitates strategies to mitigate the risks and logistical challenges associated with sedation. Sedation in pediatric...
BACKGROUND: The increasing utilization of magnetic resonance imaging (MRI) in pediatric populations necessitates strategies to mitigate the risks and logistical challenges associated with sedation. Sedation in pediatric MRI procedures poses significant risks and can increase healthcare costs. Therefore, alternative methods to facilitate successful unsedated scans are essential. AIMS: This study evaluates the impact of audiovisual MRI (AV-MRI) technology along with predictive patient factors to perform a diagnostic MRI without sedation. Additionally, image quality with motion artifacts was evaluated in sedated patients, versus unsedated patients with AV-MRI. METHODS: We analyzed pediatric MRI records from November 2015 to March 2017, comparing data before and after the introduction of AV-MRI. A total of 1167 scans were included, 590 before and 577 after AV-MRI implementation, matched based on age and type of MRI performed. The patient factors that were evaluated for successful unsedated scans include age, sex, AV-MRI vs. non-AV-MRI, procedure category, developmental delay, cerebral palsy, autism, ADD/ADHD, anxiety, behavioral problems, psychological disease, malignancy, seizures, use of an interpreter and first vs. subsequent MRI. Additionally, motion artifacts were examined in 102 pediatric patients who specifically underwent brain MRI scans utilizing a 4-point scale, comparing those completed with and without sedation. RESULTS: Post-implementation of AV assistance, there was a significant increase in unsedated MRI success rates (odds ratio 3.68, 95% CI: 2.24, 5.62, p < 0.001). Age was a strong predictor of success, with older children more likely to complete scans without sedation (OR 3.2, 95% CI: 1.02, 10.31, p = 0.046). Female children were more likely to complete unsedated scans compared to males. Children with behavioral issues were less likely to complete an unsedated scan. Motion artifact analysis showed more motion in unsedated scans, but all were diagnostic. CONCLUSIONS: AV-MRI technology increases the success rate of sedation-free MRI in pediatric patients, reducing risks and healthcare costs without compromising diagnostic quality. Age and sex are important predictors of success. The study advocates for the broader adoption of AV-MRI and similar technologies to minimize sedation use, thereby improving safety and operational efficiency in pediatric radiology. Future research should explore additional patient factors influencing sedation-free MRI success and extend motion artifact analysis to other MRI procedures.
Retrospective Review of Perioperative Neonatal Echocardiography for Non-Cardiac Surgery at a Quaternary Level Academic Hospital in Johannesburg, South Africa.
Krause BF, Motara F, Jooma Z
Paediatr Anaesth · 2026 Mar · PMID 41316846 · Full text
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