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Editor's Choice
2025
In this Issue: April
Pediatric Awake Craniotomy: An Educational Review
One of the most challenging anesthetics in pediatric anesthesia, but also the most satisfying when all goes well.
BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial
Using BIS reduces the sevo consumption.
The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial
Look at the Density Spectral Array and the wake up is a bit faster and you use a bit less anesthetic.
Electroencephalography and Anesthetic Depth in Children Under 2 Years of Age: A Prospective Observational Study
On step closer to understanding the EEG in infants during anesthesia.
Mucositis Pain and Its Temporal Relationship to White Cell Count
An intriguing relationship between analgesia and white cell count.
Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method
Transthoracic echocardiography can be used in children to confirm the correct position of the central venous catheter.
Case Series of Anesthetic Management of Gene Therapy in Children With Aromatic L‐Amino Acid Decarboxylase Deficiency
An anesthetic based on atropine, ketamine, sevoflurane, and a titrated infusion of norepinephrine is safe and reproductible in this population.
In this Issue: January
Common error traps in anesthesia for neonatal surgical emergencies
The common and important error traps in our highest risk patients.
Erector Spinae Plane Block versus Intravenous Opioid for Analgesia in Pediatric Cardiac Surgery: A Systematic Review and Meta-analysis
Looks like they do have a place, and don’t miss the accompanying editorial.
Perioperative intravenous lignocaine for pediatric postoperative pain—A systematic review and meta‐analysis
Low quality evidence for benefit.
Evaluation of propofol‐based procedural sedation in pediatric hemato‐oncological patients provided by physician assistants in anesthesia
Safe in the right patients, in the right units with the right protocols.
Long‐term maintenance‐related complications of brachiocephalic vein cannulations in neonates: A retrospective evaluation
Factors that predict this theoretically preventable complication.
Intravenous lidocaine infusion therapy and intraoperative neurophysiological monitoring in adolescents undergoing idiopathic scoliosis correction: A retrospective study
Looks like lidocaine doesn’t impact on the monitoring.
Trauma‐induced coagulopathy across age pediatric groups: A retrospective cohort study evaluating testing and frequency
Younger children are not at lower risk of trauma-induced coagulopathy.
Use of real‐time respiratory function monitor improves neonatal face mask ventilation
It helps.
2024
In this Issue: December
What an anesthesiologist should know about pediatric arrhythmias
Comprehensive and clear: essential reading for all of us
A review of the perioperative management of direct oral anticoagulants for pediatric anesthesiologists
A great and timely review as we see more of these drugs in our practice
Anesthetic‐sparing effect of dexmedetomidine during total intravenous anesthesia for children undergoing dental surgery: A randomized controlled trial
Adding dexmedetomidine allows less propofol and remifentanil
Perioperative anesthetic management of patients with hypoplastic left heart syndrome undergoing the comprehensive stage II surgery—A review of 148 cases
A decent sized cohort and good summary of practice
Auricular laser acupuncture as an adjunct for parental anxiety management during children's surgery: A randomized-controlled study
An intriguing way to reduce parental anxiety
Links between mutations in functionally separate arms of mitochondrial complex I and responses to volatile anesthetics
Complex 1 has a role.
The effect of intraoperative methadone on postoperative opioid requirements in children undergoing orchiopexy: A randomized clinical trial
Another study showing that methadone prolongs post op analgesia
Assessment of the antinociceptive effect of a single fentanyl bolus dose in children: A pharmacokinetic and pharmacodynamic analysis based on the nociception level index during sevoflurane general anesthesiaThe nociceptive index works very well.
Assessment of accuracy of two pulse oximeters in infants with cyanotic and acyanotic congenital heart diseases
The oximeters don’t work so well when the saturation is low.
In this Issue: April
Negative pressure suction test: An intraoperative airway maneuver to assess effectiveness of surgical correction of tracheobronchomalacia
A useful maneuver very well described here.
Awake caudal anesthesia in ex-premature infants undergoing lower abdominal surgery: A narrative review
A very comprehensive review evaluating this technique.
Incidence of emergence agitation in children undergoing sevoflurane anesthesia compared to isoflurane anesthesia: An updated systematic review and meta-analysis
More with Sevoflurane; as expected.
A pragmatic methodology to extract anesthetic and physiological data from the electronic health record
An easier way to extract data from your electronic health record.
Second infant spinal anesthetic: Incidence, dose modification, and adverse events after initial failure
Beware of high blocks when repeating the spinal.
Inverse ratio ventilation versus conventional ratio ventilation during one lung ventilation in neonatal open repair of esophageal atresia/tracheoesophageal fistula: A randomized clinical trial
The inverse ratio may better in these cases.
Comparison of preformed microcuff and preformed uncuffed endotracheal tubes in pediatric cleft palate surgery—A randomized controlled trial
The cuffed ones are a bit better.
New postoperative pain instrument for toddlers—Secondary analysis of prospectively collected assessments after tonsil surgery
A promising new tool for assessing pain.
Surgical neonates: A retrospective review of procedures and postoperative outcomes at a quaternary children's hospital
Important outcome data in this vulnerable group.
In this Issue: March
Regional anesthesia and sickle cell crisis in pediatric patients: An educational-focused review
A concise review of regional management for this significant and common condition.
Noninvasive respiratory support preventing reintubation after pediatric cardiac surgery—A systematic review
Promising but more evidence required.
Erector spinae plane blocks: A narrative update
All you need to know about this new block.
Failure to rescue following postoperative pneumonia in pediatrics: Is there a racial disparity?
In this case no difference.
Emergency front-of-neck access in infants: A pragmatic crossover randomized control trial comparing two approaches on a simulated rabbit model
The scalpel and bougie tracheotomy technique looks better, at least in rabbits.
Anesthesia and intensive care unit care in pediatric kidney transplantation: An international survey
Our management varies a lot.
The pediatric anesthesiology publication activity and landscape over the past two decades: A longitudinal scientometric analysis
The number of papers published is growing by 7% per year and authors are increasingly from China and India.
Capnodynamic end-expiratory lung volume assessment in anesthetized healthy children
Simpler way to determine end expiratory lung volume.
Intravenous dexamethasone does not prolong the duration of pudendal nerve block in infants and children undergoing hypospadias surgery: A randomized clinical trial
Doesn’t extend the block.
Immediate postdelivery airway management of neonates with prenatally diagnosed micrognathia: A retrospective observational study
A good sized case series describing these extraordinarily challenging cases.
In this Issue: January
Registries in pediatric anesthesiology: A brief history and a new way forward
An excellent review of the strengths, opportunities and weaknesses of our registries. A must read for all academic pediatric anesthesiologists.
Fascial plane blocks in children—Scientifically supported or not?
A provocative and insightful review arguing they are still to find their place.
Error traps in the perioperative management of children with type 1 diabetes
Excellent tips for anesthetizing children with this significant and not uncommon condition.
Analysis of the factors contributing to residual weakness after sugammadex administration in pediatric patients under 2 years of age
Who may need a second does.
Ultrasound-guided selective supraclavicular nerve block for postoperative pain control in children receiving Hickman catheter or chemoport insertion: A randomized controlled trial
The block works.
Characterization of infant spinal anesthesia using surface electromyography: An observational study
A clever way to show how long spinals last.
Vomiting after intrathecal chemotherapy under anesthesia in pediatric patients with hematologic cancers: A cohort study
A high proportion vomit.
An analysis of a new rapid difficult airway response team in a vertically built children's hospital
Interesting reading for those that work in tall buildings.
The accuracy of the ultrasound measured transverse cricoid diameter and the epiphyseal transverse diameter of the distal radius in predicting the pediatric endotracheal tube size
More ways to predict the optimal size tube.
Anesthetic management of children with medically refractory pulmonary hypertension undergoing surgical Potts shunt
I doubt you can find a more difficult anesthetic challenge than this.
In this issue: December
The role of WhatsApp™ in pediatric difficult airway management: A study from the PeDI Collaborative
Using social media for constructive discussion and timely advice
A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting
An update of recent changes toward more liberal drinking
Continued challenges in pediatric anesthesia during COVID-19 in 2022: An international survey from the pediatric anesthesia COVID-19 collaborative
The impact of COVID-19 continues
Pediatric cardiac anesthesia training and staffing in the National Health Service
Many new faces
The eXpectations of Parents regarding Anesthesiology Study (XPAS) from a parental perspective: a two-phase observational cross sectional cohort study
Consumer engagement is crucial; hence the great relevance of this paper.
Postoperative outcome of neonatal emergency surgeries in a tertiary care institute—A prospective observational study
Outcome data in resource poor settings are scarce. This important paper helps shine some light on this.
Opioid prescription rates associated with surgery among adolescents in the United States from 2015 to 2020
Surgery is now the major reason for prescribing opioids.
Application of behavioral economic strategies to enhance recruitment into a pediatric randomized clinical trial for postoperative pain relief: A randomized clinical trial
The video didn’t help.
Effect of vertical pump position on start-up fluid delivery of syringe pumps used for microinfusion
Position the pump before you connect it.
In this issue: October 2023
Pharmacokinetic pharmacodynamic modeling of analgesics and sedatives in children
The science behind the right dose.
Perioperative management of infant inguinal hernia surgery; a review of the recent literature
A nice review highlighting the great variation in practice.
Benefits and challenges of combined pediatrics-anesthesiology residency programs: A qualitative study
Lots of benefits but the training is long.
Efficacy of an expanded preoperative survey during perioperative care to identify illicit substance use in teenagers and adolescents
The parents report less than their children.
A prospective comparison of invasive and non-invasive blood pressure in children undergoing cardiac catheterizationNon-invasive blood pressure measurement is unreliable in these cases.
Evaluation of quality of care in neonatal anesthesia using a bundle of intraoperative parameters
Oxygen saturation and heart rate seem to be the only parameters we maintain.
The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery
Increased use of intra-op crystalloid is associated with increased need for blood transfusion.
Effect of central venous pressure on fluid delivery during start-up of syringe infusion pumps for microinfusion
The central venous pressure matters.
Functional near-infrared spectroscopy guided mapping of frontal cortex, a novel modality for assessing emergence delirium in children: A prospective observational study
An intriguing finding.
Monitoring anesthesia depth with patient state index during pediatric surgery
In children, the PSI behaves not unlike the other processed EEG indices.
Perioperative maintenance of hybrid closed loop insulin pump systems in youth with type 1 diabetes mellitus: A case series
A useful description of use of this new technology in the pediatric peri-operative setting.
In this issue: September 2023
A service evaluation of the impact of parental information provision on analgesia administration at home posttonsillectomy
Parents want more information about this common but tricky problem.
Outcomes for 41,260 Pediatric Surgical Patients with Opioid-Free Anesthesia: One Center’s Experience
This center’s experience is that most pediatric ambulatory cases can be done without opioids.
A machine-learning approach for decision support and risk stratification of pediatric perioperative patients based on the
Great use of machine learning
Intraoperative transfusion practice and associated outcomes following neonatal surgery in a middle-income country: A 5-year single center retrospective review
Important work describing blood management in a resource poor setting
Reducing the environmental impact of mask inductions in children: A quality improvement report
Compulsory reading for any pediatric anesthetist that values the environment
Pediatric anesthetic for tracheobronchial foreign body extraction: A survey of practice in France
Practice varies a lot.
Risk factors and outcomes associated with unplanned intraoperative extubation of the pediatric surgical patient: An analysis of the NSQIP-P database
Factors that predict one of our nightmare scenarios
Intraoperative fluid administration volumes during pediatric liver transplantation and postoperative outcomes: A multicenter analysis
The volume of fluid given only weakly predicts post-op duration of mechanical ventilation.
In this issue: August 2023
Perioperative gabapentin usage in pediatric patients: A scoping review
Not enough data yet in the perioperative period to support the routine use of this promising analgesic. Young researchers, there is work to do here!
Error traps in Pediatric Patient Blood Management in the Perioperative Period
These are pure pearls. A must read for all pediatric anesthesiologists.
Anesthesia management protocol for liver transplantation as treatment for ornithine transcarbamylase deficiency
A definitive description of how to manage these rare but challenging cases
Identifying behaviors that characterize emergence delirium: An observational study
Important work helping us understand this enigmatic problem.
The effect of intranasal dexmedetomidine administration on emergence agitation or delirium in pediatric patients after general anesthesia: A meta-analysis of randomized controlled trials
It works.
Quality comparison of remote anesthetic consultation versus on-site consultation in children with sedation for a magnetic resonance imaging examination—A randomized controlled trial
A great study showing that remote consultation can be as good as face to face in some cases. It’s one good thing to come out of the pandemic.
An exploratory analysis of pediatric anesthesia activity on X using the #pedsanes hashtag
If you don’t already know about #pedsanes on X, you should.
In this issue: June 2023
Anxiety in children: A review on how to address it in the perioperative setting post-pandemic
COVID has left its mark
The role of local inflammation in complications associated with intubation in pediatric patients: A narrative review
A thorough discussion around an interesting angle to a common procedure
Diversity, equity, and inclusion within the Society for Pediatric Anesthesia: A mixed methods assessment
A must read for all in leadership roles
Trends in pediatric non-operating room anesthesia: Data from the National Anesthesia Clinical Outcomes Registry
A fifth of our work is in on-operating rooms settings.
Pediatric intraoperative cardiopulmonary arrests: A survey to evaluate if Medical Emergency Teams are utilized in pediatric operating rooms
Practice varies as to whether or not the MET team comes to the operating room.
Assessing the utility of ultrasound-guided vascular access placement with longer catheters in critically ill pediatric patients
Use the ultrasound
An exploratory study of distractions during the induction phase of pediatric procedural sedation with propofol
Distractions are a common problem
Comparison of Ambu laryngeal mask for controlled ventilation in children undergoing minor surgical procedures under general anesthesia: A prospective randomized controlled study
BlockBuster laryngeal mask better than Ambu AuraGain
Bleeding and ketorolac use in pediatric circumcision
Bleeding is uncommon
Relationship between decrement time and recovery time in pediatric total intravenous anesthesia with propofol and remifentanil
Recovery after TCI is unpredictable
In this issue: March 2023
Evaluating the Women's Empowerment and Leadership Initiative: Supporting mentorship, career satisfaction, and well-being among pediatric anesthesiologists
Programs such as this are useful.
Medication safety in pediatric anesthesia: An educational review and a call to action
Why children under anaesthesia care are still at an unacceptably high risk of medication error.
Point-of-care ultrasonography to predict fluid responsiveness in children: A systematic review and meta-analysis
POCUS is maybe not the ideal answer to the difficult problem of predicting fluid responsiveness.
Supplemental intraoperative crystalloids for pediatric postoperative nausea and vomiting—A systematic review and meta-analysis
Giving fluid helps.
Acetaminophen pharmacokinetics in infants and children with congenital heart disease
They're essentially the same as for kids without congenital heart disease.
Comparative efficacy of finger versus forehead Plethysmographic Variability Index monitoring in pediatric surgical patients
The forehead may be a little better.
Factors associated with immediate and early extubation in pediatric living-donor liver transplant recipients
Who are extubated earlier.
Y-site administration of electrolyte solutions and injectable acetaminophen—A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia
What shouldn't go with what.
Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study
They are at increased risk of complications.
In this issue: January 2023
Evaluating the Women's Empowerment and Leadership Initiative: Supporting mentorship, career satisfaction, and well-being among pediatric anesthesiologists
Programs such as this are useful.
Medication safety in pediatric anesthesia: An educational review and a call to action
Why children under anaesthesia care are still at an unacceptably high risk of medication error.
Point-of-care ultrasonography to predict fluid responsiveness in children: A systematic review and meta-analysis
POCUS is maybe not the ideal answer to the difficult problem of predicting fluid responsiveness.
Supplemental intraoperative crystalloids for pediatric postoperative nausea and vomiting—A systematic review and meta-analysis
Giving fluid helps.
Acetaminophen pharmacokinetics in infants and children with congenital heart disease
They're essentially the same as for kids without congenital heart disease.
Comparative efficacy of finger versus forehead Plethysmographic Variability Index monitoring in pediatric surgical patients
The forehead may be a little better.
Factors associated with immediate and early extubation in pediatric living-donor liver transplant recipients
Who are extubated earlier.
Y-site administration of electrolyte solutions and injectable acetaminophen—A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia
What shouldn't go with what.
Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study
They are at increased risk of complications.
2022
In this issue: October 2022
The German guidelines for medication safety in pediatric emergencies
Sensible guidelines aiming to reduce the risk of error in emergent situations.
Interactions of the protease inhibitor, ritonavir, with common anesthesia drugs
A drug used for treating COVID drug which has significant interactions with some drugs we use.
Induction of anesthesia with sevoflurane in children: Curiosities and controversies
An excellent commentary around a controversial topic. 8% is ok.
Enhanced recovery after cleft palate repair: A quality improvement project
The bundle is good.
Delayed concentration effect models for dabigatran anticoagulation
Important PK data for this potential alternative to heparin.
Comparison of two point-of-care measurements of hemoglobin against standard laboratory values during pediatric liver transplantation: A retrospective review
Neither as good as a CBC.
Invasive and non-invasive assessment of macro- and micro-circulatory effects of vasopressors during sevoflurane anesthesia in a pediatric experimental model: A randomized trial
We need to pay more attention to measuring the microcirculation.
Reflecting back to move forward: Lessons learned about COVID-19 safety protocols from pediatric anesthesiologists
Alas, many of us will find these issues all too familiar.
Incidence and characteristics of errors detected by a short team briefing in pediatric anesthesia
An effective way to prevent serious errors.
Intravenous ondansetron reduced nausea but not pruritus following intrathecal morphine in children: Interim results of a randomized, double-blinded, placebo-control trial
Doesn’t stop the itch in children.
Scheduled methadone reduces overall opioid requirements after pediatric posterior spinal fusion: A single center retrospective case series
This methadone regimen may mean no need for PCA.
In this issue: September 2022
Error traps in acute pain management in children
Another great error trap article. Clear and pertinent pearly of wisdom for anyone who manages pain in children.
Fluid bolus administration in children, who responds and how? A systematic review and meta-analysis
An excellent synthesis of a very relevant, complex, and controversial topic.
Videolaryngoscopes versus direct laryngoscopes in children: Ranking systematic review with network meta-analyses of randomized clinical trials
Videolaryngoscopes may be better, but the devil is in the detail.
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit
A useful teaching method with no risk of complications.
Practice what you teach: An approach to integrate airway education for experienced anesthesia clinicians
An effective way to teach.
Effect of a carbohydrate lollipop on the gastric volume of fasted pediatric patients
This lollipop doesn’t increase gastric volume.
Carotid doppler ultrasonography as a method to predict fluid responsiveness in mechanically ventilated children
Another way to effectively predict fluid responsiveness.
The association between carotid flow time and fluid responsiveness in children under general anesthesia
Indicates fluid status but not responsiveness.
Target insertion depth of nasopharyngeal temperature probes in children: A prospective observational study analyzing magnetic resonance images
A neat way to know where the probe is.
Randomized controlled trial of low vs high oxygen during neonatal anesthesia: Oxygenation, feasibility, and oxidative stress
An important step toward knowing the optimal inspired oxygen concentration in neonatal anesthesia.
In this issue: August 2022
Setting a universal standard: Should we benchmark quality outcomes for pediatric anesthesia care?
This timely paper discusses the great need for establishing important safety outcomes for pediatric anesthesia.
The association of severe pain experienced in the pediatric intensive care unit and post-discharge health-related quality of life: A retrospective cohort study
Severe pain in PICU is not uncommon and associated with worse outcomes.
Dexmedetomidine as a sole sedative for procedural sedation in preterm and neonate infants: A retrospective analysis
It works in these infants.
Risk factors for administration of additional reversal following neuromuscular blockade with rocuronium in children: A retrospective case–control study
Important paper adding to a currently hot topic of interest.
Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency
An excellent example of using Qi methodology to improve efficiency.
Patient and operative factors associated with unanticipated intensive care admission and outcomes following posterior fossa decompressions in children: A retrospective study
When things go wrong, they go to PICU.
Pediatric lower limb peripheral nerve blocks: Indications, effectiveness, and the incidence of adverse events
A unique data set of these less often described blocks.
Remote after-care using smartphones: A feasibility study of monitoring children’s pain with automated SMS messaging
Worth trying SMS.
The impact of modified fluid gelatin 4% in a balanced electrolyte solution on plasma osmolality in children—A noninterventional observational study
Behaves as if it’s isotonic.
In this issue: July 2022
Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room
Helps you be forewarned as to which kids will be difficult.
Perioperative critical events and morbidity associated with anesthesia in early life: Subgroup analysis of United Kingdom participation in the NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective multicenter observational study
Critical events are common.
Comparison of the Newborn Infant Parasympathetic Evaluation NIPE™ index to changes in heart rate to detect intraoperative nociceptive stimuli in healthy and critically ill children below 2 years: An observational study
More important work exploring the best ways to measure nociception.
Modified fluid gelatin 4% for perioperative volume replacement in pediatric patients (GPS): Results of a European prospective
Optimal fluid management is core to good pediatric anesthesia. In spite of this evidence is often poor. This paper helps address that.
Performance time of anesthesiology trainees for cricothyroid membrane identification and characteristics of cricothyroid membrane in pediatric patients using ultrasonography
Using ultrasound helps.
Comparison of the oropharyngeal leak pressure between three second generation supraglottic airway devices during laparoscopic surgery in pediatric patients
I gel better here.
Comprehensive Risk Assessments and Anesthetic Management for Children with Osteogenesis Imperfecta: A Retrospective Review of 252 Orthopedic Procedures Over 5 Years
A large data set providing valuable information about how we manage these difficult cases.
Compatibility of intravenous acetaminophen with morphine, fentanyl and ketamine in acute pediatric pain setting
Ok to mix in the line.
Temperature change in children undergoing magnetic resonance imaging—An observational cohort study
They get warmer.
In this issue: June 2022
Novel utilization of strand-specific reverse transcription polymerase chain reaction in perioperative clinical decision making for SARS-CoV-2 polymerase chain reaction positive patients
A novel idea to address the problem of when to schedule anesthesia after a COVID positive test.
Impact of surgery and anesthesia during early brain development: A perfect storm
A paradigm shift to the approach to the risk anesthesia and the neonatal brain.
Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports
Yes, it has a role.
Pharmacokinetic modelling and simulation to understand diamorphine dose-response in neonates, children, and adolescents
An easy to read tutorial on modelling using diamorphine as an example.
Consistency of remifentanil concentrations in propofol–Remifentanil infusions. A laboratory-based study
If you are one of those that do mix them then this paper provides some reassurance.
Outcomes following formation of a dedicated pediatric liver transplant anesthesia team
Having a dedicated team is a good idea.
Correlation between bispectral index and patient state index in children under sevoflurane anesthesia
Equally good; or equally poor.
Analysis of the radial and ulnar arteries using ultrasound and a vascular visualization device in children
Ulna is as big as radial.
Effect of end-tidal carbon dioxide level on the optic nerve sheath diameter measured by transorbital ultrasonography in anesthetized pediatric patients: A randomized trial
A clever way to show intracranial pressure does change under inhalational anesthesia.
Intraarterial papaverine for relief of catheter-induced peripheral arterial vasospasm during pediatric cardiac surgery: A randomized double-blind controlled trial
A way to keep the line patent.
In this issue: May 2022
Developing an extubation strategy for the difficult pediatric airway—Who, when, why, where, and how?
A great paper about an important problem.
Role of information and preparation for improvement of pediatric perioperative care
A comprehensive approach to the various aspects of preparation.
Down syndrome and the autonomic nervous system, an educational review for the anesthesiologist
One reason why these children may be a challenge to anesthetize.
Pediatric spinal anesthesia at a tertiary care hospital: Eleven years after
It’s effective.
Perioperative use of glucose containing solutions in infants less than 6 months of age: A clinical practice survey among US academic centers
Considerable variation of practice.
Morbidity and mortality following noncardiac surgical procedures among children with autosomal trisomy
An alarmingly high mortality.
Prediction of fluid responsiveness following liver compression in pediatric patients with single ventricle physiology
Liver compression predicts fluid responsiveness.
Initial results from an enhanced recovery program for pediatric cardiac surgical patients
It’s feasible and promising.
Validation of the parent's postoperative pain measure with an age-appropriate reference pain scale for children 2–12 years old during a 14-day recovery after tonsillectomy: A prospective cohort study
Important work validating outcome measures. We can’t improve analgesia without acurately measuring pain.
Anticholinergics and serious adverse events in pediatric procedural sedation: A report of the pediatric sedation research consortiums
Anticholinergic use is associated with adverse events; but is it causation?
Trends and patterns in the practice of pediatric sedation for magnetic resonance imaging in Japan: A longitudinal descriptive study from 2012 to 2019
Recipes changing over time.
In this issue: April 2022
New European Resuscitation Council Guidelines for Pediatric Life Support and Their Implications for Pediatric Anesthesia; & The New European Resuscitation Council Guidelines on Newborn Resuscitation and Support of the Transition of Infants at Birth: An Educational Article
Two absolute “must read” papers highlighting what is new in these important guidelines.
Anesthesia and Neurotoxicity Study Design, Execution, and Reporting in the Nonhuman Primate: A Systematic Review
Non-human primate studies are critical for translational research. This, along with the significant ethical and resources issues, means they should be as rigorous as possible. This disturbing article implies we could be doing better.
The Effects of Intraoperative Magnesium Sulfate Administration on Emergence Agitation and Delirium in Pediatric Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials
More reasons to consider this curious cation. Don’t forget to also read Rajeev’s accompanying editorial.
Comparison of the Success with Two Bending Angles for Lighted Stylet Intubation in Children: A Prospective Randomised Study
Bend it like Zhang et al.
Attitudes and Perceptions of Caregivers Regarding Their Presence at Induction of Anesthesia
Why they want to be there at induction, and why we should be mindful of cultural differences.
The Relationship Between Nitrous Oxide Sedation and Psychosocial Factors in the Pediatric Outpatient Setting
Nitrous oxide is widely used for sedation away from the operating rooms. Given its widespread use, research such as this which seeks to help optimize its efficacy is of great importance.
Association Between Implementation of a Coordinated Care Pathway in Idiopathic Scoliosis Patients and a Reduction in Perioperative Outcome Disparities
Equity is a goal we should all be striving for. Here we see that co-ordinated care helps reduce racial and ethnic disparities in care.
Central Venous Catheter-Related Thrombosis in Pediatric Surgical Patients: A Prospective Observational Study
Clots are more common than we would like to think.
Impact of Airway and a Standardized Recruitment Maneuver on CT Chest Imaging Quality in a Pediatric Population: A Retrospective Review
Using a tracheal tube rather than a supraglottic device makes everyone happy.
In this issue: February 2022
Propofol Context-Sensitive Decrement Times In Children.
The science behind predicting awakening times in children.
Functional Near-Infrared Spectroscopy To Assess Pain In Neonatal Circumcision.
A fascinating paper showing NIRS does change with pain.
Clinical Significance Of Assessing Cerebral Blood Volume By Time-Domain Near-Infrared Spectroscopy In Children With Congenital Heart Disease.
A more advanced form of NIRS monitoring provides more useful information.
Intraoperative Cerebral Oxygen Saturation And Neurological Outcomes Following Surgical Management Of Necrotizing Enterocolitis.
Low NIRS predicts poor neurologic outcome in these high risk surgeries.
Validation Of A New Combined Transcutaneous tcPCO2 And tcPO2 Sensor In Children In The Operating Theatre.
Important data describing the strengths and limitations of transcutaneous monitoring.
Sugammadex For Reversal Of Neuromuscular Blockade In Pediatric Patients: Results From A Phase IV Randomized Study.
Carefully performed PK/PD trials are scarce in children and hence of great value. This one gives data to inform the dose of sugammadex in children.
Single Bolus Dexmedetomidine Versus Propofol For Treatment Of Pediatric Emergence Delirium Following General Anesthesia.
There are a great many studies describing how to prevent delirium but few exploring how to treat it. All pediatric anesthetists should read this paper.
Recovery Characteristics And Parental Satisfaction In Pediatric Procedural Sedation.
Parental reported outcomes are important but rarely studied. This paper is one of the exceptions.
A Novel Approach To Operating Room Readiness For Airborne Precautions Using Simulation-Based Clinical Systems Testing.
Using simulation to improve the safety when implementing new protocols; a particularly relevant paper during the pandemic.
Impact Of The COVID-19 Pandemic On The 2020 Pediatric Anesthesiology Fellowship Application Cycle: A Survey Of Program Directors.
The good and the bad of virtual interviewing during the pandemic.
Local Anesthetic Toxicity Following Erector Spinae Plane Block In A Neonate: A Case Report.
Another block where toxicity is possible.
2021
In this issue: December 2021
The Effect Of Oxygen Concentration On Atelectasis Formation During Induction Of General Anesthesia In Children: A Prospective Randomized Controlled Trial
Important information around why and how much we should try to limit oxygen concentration at induction
Anesthesiologist-related Factors Associated With Risk-adjusted Pediatric Anesthesia-related Cardiopulmonary Arrest: A Retrospective Two-level Analysis
Does seniority of experience make a difference?
Perioperative Respiratory Adverse Events In Children Undergoing Triple Endoscopy
A group particularly at risk of respiratory adverse events
“Cannot Intubate, Cannot Oxygenate”: A Novel 2-operator Technique For Cannula Tracheotomy In An Infant Animal Model—a Feasibility Study
There is little evidence on which to basis recommendations for this rare but critical procedure. This study adds to the evidence base.
Accuracy Of Predictive Equations In Guiding Tracheal Intubation Depth In Children: A Prospective Study & Point-of-care Ultrasound To Confirm Endotracheal Tube Cuff Position In Relationship To The Cricoid In The Pediatric Population
Two studies that help us put the tube at the right depth
Perioperative Airway Complications In Infants And Children With Crouzon And Pfeiffer Syndromes: A Single-center Experience
Bag and mask ventilation are often difficult but tracheal intubation is less so.
Oxycodone Target Concentration Dosing For Acute Pain In Children & Population Pharmacokinetics Of Oxycodone: Premature Neonates To Adults
Get to know oxycodone better
Volatile Anesthetic Agents For Life-threatening Pediatric Asthma: A Multicenter, Retrospective Cohort Study And Narrative Review
Still not clear if this therapy improves outcome
Evaluation Of Distal Radial Artery Cross-sectional Internal Diameter In Neonates And Infants By Ultrasound And Adequate Selection Of An Intra-arterial Catheter Size & The Ulnar Artery: A Site Suitable For Arterial Cannulation In Pediatric Patients
Use ultrasound to assess the size and consider using the ulnar artery
Who Let The Dog In?
Parental presence at induction is now widely accepted. Will pets be next?
In this issue: November 2021
Error Traps in Pediatric Regional Anesthesia
More pearls of wisdom from the error trap team
Association of dexmedetomidine with recovery room and hospital discharge times: a retrospective cohort analysis
Those that had dexmedetomidine had a marginally longer PACU stay
Gastric emptying time of two different quantities of clear fluids in children: A double-blinded randomized controlled study
Another study reinforcing that shorter fasting is appropriate
Neurosurgical intervention in children with ventricular assist devices: A single-center case series review
Good advice about how to manage a very challenging problem
Preoperative anxiety in preschool children: A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine
Midazolam better for anxiolysis, and less sedation compared to clonidine and dexmedetomidine
Risk factors for anesthetic-related complications in pediatric patients with a newly diagnosed mediastinal mass
Important reading for all that manage these children
In this issue: October 2021
Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: A prospective observational study
Children with behavioural issues post op are more likely to have had delirium. Now the question is if strategies reducing the delirium reduce the behaviour change.
Antibodies to human leukocyte antigens and their association with blood product exposures in pediatric patients undergoing cardiac transplantation
A case for strategies to reduce allogenic blood exposure in children that may need heart transplantation
Lessons from COVID-19: A reflection on the strengths and weakness of early consensus recommendations for pediatric difficult airway management during a respiratory viral pandemic using a modified Delphi method
Fascinating reading about not only what to do but also about how consensus processes struggle to keep up with rapidly evolving evidence.
Comparative Efficacy Of C-MAC® Miller Videolaryngoscope Versus McGrath® MAC Size ‘1' Videolaryngoscope In Neonates And Infants Undergoing Surgical Procedures Under General Anesthesia: A Prospective Randomized Controlled Trial
Better view with the C-MAC but similar times to intubation, however limited power to determine any difference in overall success rates.
Relationship between pre-incision Pupillary Pain Index and post-incision heart rate and pupillary diameter variation in children
More evidence that the Pupillary Pain Index may be a useful measure of “depth of analgesia.”
In this issue: September 2021
Publication misrepresentation amongst pediatric anesthesiology fellowship applicants: A retrospective single center cohort study
Worrying habits amongst some of our future profession
Factors Impacting Parental and Child Satisfaction in the Perioperative Setting
An excellent review of a fundamental issue
An assessment of opioids on respiratory depression in children with and without obstructive sleep apnea
More data helping inform an important and complex issue.
Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease: A feasibility randomized controlled trial
Optimal venous access is increasingly coming under the domain of the pediatric anesthesiologists. Research into this area is most welcome.
In Memoriam:
Professor Krister Nilsson 1944-2021
Dr Edward ‘Ted’ Sumner (17th August 1940 – 6th May 2021)
Humble but brilliant minds have brought us where we are
In this issue: August 2021
A practical and ethical toolkit for last-minute refusal of anaesthetic in children
A great help for a complex and common problem
The Covid-19 pandemic first wave in Sweden: a national registry study of the effects on pediatric anesthesia and surgery
How COVID impacted pediatric anesthesia services in Sweden
Associations of perioperative characteristics with motor function in preschool children born with esophageal atresia
More data about long terms outcomes in this vulnerable group
Tracheal intubation with or without a neuromuscular blocking agent for a short surgical procedure in children : Prospective, randomized, double-blind trial
Propofol alone is not as good
To relieve pain or avoid opioid-related risk? A comparison of parents’ analgesic trade-off preferences and decision-making in 2019 versus 2013 in a single U.S. pediatric hospital
Important work in understanding the family perspective; parents’ attitudes to analgesia have changed.
Pediatric mediastinal mass algorithm: A quality improvement Initiative to reduce time from presentation to biopsy
A nice example of how multidisciplinary standardisation of care works
In this issue: July 2021
Satisfaction measures in paediatric anaesthesia and perioperative care
A landmark review of an increasingly important topic
Diagnostic accuracy of stroke volume variation for predicting fluid responsiveness in children undergoing cardiac surgery: a systematic review
Stroke volume variation predicts fluid responsiveness.
Incidence of post-induction hypoxemia in children and the effect of induction gas composition
An interesting study that suggests keeping the oxygen above 60% may be worthwhile
In this issue: June 2021
Self-reported awareness during general anesthesia in pediatric patients: s Study from Wake Up Safe
A topic which has attracted less attention recently.
Differences in intubation outcomes for pediatric patients between pediatric and general emergency departments
Important and surprising data describing a very topical problem
Lactated Ringer’s solution versus normal saline in pediatric living-donor liver transplantation: A matched retrospective cohort study
This is an interesting finding in the ongoing quest for the best crystalloid. The context matters.
Primary spread of caudal blockade in children: the possible limiting role of the lumbar spinal cord enlargement in combination with the cerebrospinal fluid rebound mechanism
Prediction of levobupivacaine concentrations in neonates and infants following neuraxial rescue blocks
Two papers that put more science into understanding neuraxial blockade in children
In this issue: May 2021
Implications of anesthesia and vaccination
A useful update on a topic we need to know about
Statistics in quality improvement: measurement and statistical process control
QI has a subtly different statistical reporting. It’s important to understand this to do or appreciate appropriate QI.
Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery
More reason to worry about hypotension in infants
Food allergy history and reaction to propofol administration in a large pediatric population
No evidence for a link
Perianesthetic neurological adverse events in children: A review of the Wake-Up Safe Database
Interesting data about a rare but important problem
In this issue: April 2021
“You can’t make me!” Managing adolescent dissent to anesthesia
Every pediatric anesthetist facing this problem. A must read.
An approach to define newborns´ sniffing position using an angle based on reproducible facial landmarks
A fascinating study defining the angle behind the sniff
An assessment of perioperative adverse respiratory events and difficult intubation in pediatric patients with trisomy 21
Putting some science into the traditional teaching that these children are more likely to have airway issues.
An observational study of hypoactive delirium in the post-anesthesia recovery unit of a pediatric hospital
We are familiar with agitated emergence delirium, but hypoactive delirium is also common and worth further investigation
Race and major post-operative pulmonary complications following elective inpatient pediatric otolaryngology surgery
More evidence that race has a major impact on risk of complications
Perioperative anxiety in pediatric surgery: Induction Room vs. Operating Room
Using induction rooms is good for children
In this issue: March 2021
Error traps in anesthesia for fetal Interventions
The journal has launched Error Traps; A new way of presenting highly clinically relevant educational material.
Hypotension and adverse neurodevelopmental outcomes among children with multiple exposures to general anesthesia: Sub-analysis of the Mayo Anesthesia Safety in Kids (MASK) Study
Why is there sometimes an association between anesthesia in early childhood and poorer neurodevelopmental outcome? One of the most important papers to be published in this area; this analysis looks at hypotension being a factor.
The impact of parental health mindset on postoperative recovery in children
This important and fascinating paper reinforces the concept that it’s not just the child that needs it’s the family and not just the child that should be the target of interventions.
Comparative evaluation of one-handed versus two-handed mask holding techniques in children during inhalational induction of anesthesia: A randomized crossover study
Two is better than one.
In this issue: February 2021
Adult congenital heart disease and anesthesia: an educational review
An excellent review of the increasingly relevant issue of transitioning children with congenital heart disease, and the management of adults with congenital heart disease.
Regional anesthesia in neonates and infants outside the immediate perioperative period: a systematic review of studies with efficacy and safety considerations
An important review highlighting what is known, but also highlighting the large gaps in our knowledge.
Development and initial validation of self-report measures of general health, preoperative anxiety, and post-operative pain in young children using computer administered animation
Measuring outcomes after pediatric anesthesia is crucially important; but we have a limited number of easily administered well validated tools. This paper helps describe a new and valid way to measure these outcomes.
Audit of blood product utilization in the care of injured children
Important data for those planning for the possible use of this precious resource
Intraoperative dextrose rate during exploratory laparotomies in neonates and the incidence of postoperative hyperglycemia: a retrospective observational study
Little is known about optimal fluid and dextrose management for neonates having surgery. Decreasing the rate of dextrose intra-operatively may be the way to go.
Perioperative anaphylaxis in children: a report from the Wake-Up Safe collaborative
Important data about a rare but potentially lethal complication.
In this issue: January 2021
There may never be a more salient time to explore the wellbeing of the pediatric anesthesiologist than in the COVID-19 era. In this issue we explore multiple dimensions of physician wellbeing, combining insight with actionable strategy to promote professional fulfillment and career sustainability.
Stephanie Black & Francis Veyckemans
2020
In this issue: December 2020
2020 Guidelines for conducting plastic reconstructive short-term surgical projects in low-middle income countries
There are many organisations that perform short term plastic surgical projects in other countries. These guidelines are an important step to try and ensure the quality is maintained.
The safety profile and effectiveness of propofol-remifentanil mixtures for total intravenous anaesthesia in children
These are very important data describing the efficacy and safety of this increasingly popular but still controversial anesthetic technique.
De-mystifying the ‘Mixifusor’
The message here is clear. In spite of its popularity, mixing propofol and remifentanil in the same syringe is still fraught with potential danger.
Efficacy of caudal versus intravenous administration of α2 adrenoceptor agonists to prolong analgesia in pediatric caudal block: A systematic review and meta-analysis
Systematic reviews provide high levels of evidence. Placing the α2 adrenoceptor agonist in the caudal space is more effective than giving it intravenously.
Comparing oscillometric non-invasive and invasive intra-arterial blood pressure monitoring in term neonates under general anesthesia: A retrospective study
There is growing interest in understanding optimal blood pressure in neonates. This is an important paper describing the inaccuracies of oscillometric blood pressure measurements in this age group.
The relationship between parental factors, child symptom profile and persistent postoperative pain interference and analgesic use in children
This important paper helps us understand which children may be at risk of persistent post-operative pain.
Too noisy to sleep safely? – An observational study of noise levels and distractions during critical phases of pediatric anesthesia
We work in a noisy environment; that isn’t a good thing
Outcomes from Wake Up Safe, the Pediatric Anesthesia Quality Improvement Initiative
Preventing adverse events is a key aspect of our profession. This paper is a “must read” for every pediatric anesthesiologist.
In this issue: November 2020
Use of a simulation-based mastery earning curriculum to improve ultrasound-guided vascular access skills of pediatric anesthesiologists
A great example of an important new way to learn
Evaluation of the relationship between airway measurements with ultrasonography
A useful study looking at predicting difficult laryngoscopy in infants.
Infant peripherally inserted central catheter insertion without general anesthesia
Another study showing how fast, feed and wrap can avoid a general anesthetic.
Reducing paediatric exposure to environmental tobacco smoke: the effects of paediatric exposure to environmental tobacco smoke and the role of paediatric peri-operative care
An excellent review of the risks of children exposed to second hand smoke and what it means for us.
In this issue: October 2020
Enhanced recovery after surgical correction of adolescent idiopathic scoliosis
Enhanced Recovery after Surgery (ERAS) has become a popular concept in adult anesthesia. There are very few studies evaluating ERAS protocols in children. This is one of the few.
Epidemiology of pediatric surgery in the United States
An important study outlining the imbalances in which children have surgery.
Association between preoperative hemoglobin levels after iron supplementation and perioperative blood transfusion requirements in children undergoing scoliosis surgery
One step closer to understanding the role of iron supplementation
The predictive value of the Pleth Variability Index on fluid responsiveness in spontaneously breathing anaesthetized children - a prospective observational study
Another interesting study addressing the complex issue of fluid responsiveness in children under anesthesia
Femoral nerve catheters are associated with limb strength asymmetry at 6 months after primary anterior cruciate ligament reconstruction in pediatric patients
Controversial and worrying
In this issue: September 2020
A fascinating paper looking at caregiver anxiety and its impact on post op pain in children in a low-middle-income country setting
Post-operative pain and psychological outcomes following minimally invasive pectus excavatum repair: A report from the Society for Pediatric Anesthesia Improvement Network
An important insight into the link between early post-operative pain and ongoing psychological stress
Effects of hypothermia and hypothermia combined with hypocapnia on cerebral tissue oxygenation in piglets
Age-related cerebrovascular carbon dioxide reactivity in children with ventricular septal defect younger than 3 years
Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: a prospective observational study
Understanding the physiology of cerebral hemodynamics is crucial for us to provide optimal care for our most vulnerable patients. Data however are sparse. Thus these three papers provide a particularly valuable contribution to the science behind pediatric anesthesia.
In this issue: August 2020
Impact of clear fluids fasting on pulmonary aspiration in children undergoing general anesthesia: Results of the German prospective multicenter observational (NiKs) study
A study in over 10,000 children found no evidence that reducing fasting times increases regurgitation and pulmonary aspiration.
Ventilation in pediatric anesthesia: a French multicenter prospective observational study (PEDIAVENT)
It seems not all of us are following best practice when it comes to ventilating our patients.
Flow irregularities from syringe infusion pumps caused by syringe stiction
Why pumps don’t always deliver.
Intravenous cannula placement in children for induction of general anesthesia: prospective audit and identification of success factors
Important reading for those that are learning how to put an IV in children.
In this issue: July 2020
Anesthetic concerns for pediatric patients in the era of COVID-19
An excellent summary of how to manage pediatric anesthesia in children with COVID-19
Perioperative apnea in infants with hypertrophic pyloric stenosis: a systematic review
This study indicates there is still a lot to know about apnea in these children.
The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study
In low and middle income countries preoperative anemia is associated with an increased risk of postoperative complications.
Association of tidal volume during mechanical ventilation with postoperative pulmonary complications in pediatric patients undergoing major scoliosis surgery
High volumes are bad, especially in older children
Lung protective ventilation in infants undergoing cardiopulmonary bypass surgery for congenital heart disease: a prospective randomized controlled trial
Lung protective ventilation is a good thing to do in these children.
2019
In this issue: April 2019
There is very little research into what happens once the child goes home after ambulatory surgery. This study reveals that nausea is indeed a persistent problem.
Ultrasound has radically changed the way we obtain central venous access, but the basic tips of positioning are still very useful.
There is increasing research looking at optimal fluid management in major surgery for adults. It is proving to be a complex issue. There are almost no data in children so this observational study is an important first step.
More sophisticated “nociception monitors” are being developed. Anesthesia is not a simple construct that can be neatly divided into nociception, amnesia, hypnosis etc. Thus, like the “anesthesia depth monitors” that preceded them, the nociception monitors must be found to “work” and, more importantly, found to improve meaningful outcomes before they become standard practice. This study is a step along this evaluation process.
In this issue: March 2019
- Is prespecification taking the search out of research?
In this issue we publish an analysis plan for a prospective observational study and a special interest article describing why analysis plans are important – Both by Yuen and colleagues. Prospective analysis plans are important to avoid fishing and attaching undue significance to chance associations. It is, however, not quite as simple as that; as Jamie Sleigh points out in an accompanying editorial. Our approach to hypothesis testing is based on paradigms that were created centuries ago and are increasingly problematic. The arrival of BIG data is the catalyst for a revolution in how we use data to generate evidence. There are very exciting and disruptive times ahead…
Another important manuscript helping us manage some of our most vulnerable and understudied children undergoing anesthesia.
Blood management is a critical aspect of our care and evidence for best practice is constantly evolving. This is essential reading for every pediatric anesthesiologist, and anesthetist.
Medication errors are not uncommon in pediatric anesthesia and can have significant consequences. This is another paper that should be read by all pediatric anesthesiologists, and anesthetists.
In this issue: February 2019
Does it seem to you that nearly every child has an allergy band? In this fascinating study, Sommerfield et al. look closely at how many parent reported allergies are actually specialist confirmed and likely to be clinically relevant.
Is TIVA taking over? This survey indicates the use of TIVA in children in the UK is indeed steadily increasing but some of us still prefer the smelly stuff.
As we increasingly use more physiologically appropriate and hence safer IV solutions we need to know they are compatible with our commonly used drugs. These studies are essential reading for all anaesthetists.
Use of reconstituted solutions and dilution is common in pediatric anesthesia. This important study found that serial dilution is prone to error and degrades the chemical stability. Another must read for all peditric anesthesiologists.
In this issue: January 2019
This is a sobering account of the outcomes after major neonatal surgery in a resource poor setting.
The number of obese patients is increasing and getting the dose right is important. This paper helps us understand the optimal weight adjusted dose for acetminophen, one of the most commonly given analgesics.
The value of “BIG DATA” includes use of data from different sources in different formats. This is a good example of how to answer questions by merging outcome data with intra-op data.
Good post-operative pain relief remains a challenge for many pediatric procedures. Assessing the quality of pain management requires a valid assessment tool. This paper validates a questionnaire that fulfils this vital role.
This article sheds more light on the increased risk of adverse events in off-site anesthesia locations.
2018
In this issue: December 2018
The journal has published several articles describing the life of pediatric anesthesiologists that have made great contributions to our profession. This moving and important article describes the achievements and struggles of Estela Melman, an extraordinary woman.
- Peri-operative management of antithrombotic treatment in children
The rate of thrombosis is increasing in children. This is an excellent review of an important and rapidly evolving topic.
This systematic review found an error rate in pediatric anesthesia that is much lower than that reported in adults. Is this really true? The authors suggest this finding may be due to poor reporting.
Optimal anesthetic care for children is limited due to the lack of high quality PKPD research that has been done in children. This important paper sheds light on the interaction between remifentanil and propofol in children; essential data for TIVA users.
There is considerable interest in finding the optimal premedication drug for children. This study suggests that at least in some aspects, zolpidem is not quite as good as midazolam.
In this issue: November 2018
This is an excellent review of a complex and evolving subject; a must read for all those that give anesthesia to children.
Chronic pain is difficult to manage. This important paper reports the effectiveness of one aspect of therapy. The results are promising.
Health care priorities should be shaped by the patient experience. This paper is an important step in helping us understand what predicts parental satisfaction in pediatric anesthesia.
Reducing preoperative anxiety is a core element of good pediatric anesthetic care. This interesting study helps us understand how we can achieve this aim.
- A generalized multi-stage approach to oral and nasal intubation in infants with Pierre Robin sequence: a retrospective review
This interesting paper describes a successful approach to these difficult airway cases that includes the use of supraglottic airways.
In this issue: October 2018
An interesting paper exploring the science behind optimal dosing of multimodal analgesia.Chronic pain is difficult to manage. This important paper reports the effectiveness of one aspect of therapy. The results are promising.
An important paper that helps bring the pharmacology of volatile anesthetics into the 2st century.
Persistent pain after surgery in children is an important but relatively poorly studied area. This paper helps identify those children at risk of persistent pain after scoliosis surgery.
Is adding dexmedetomidine to a local anesthetic caudal any better than simply giving it intravenously. This paper suggests it isn’t.
Another interesting paper to feed the fasting debate.
An excellent focused review with practical suggestions.
In this issue: September 2018
Neonatal anesthesia is challenging for many reasons. This fascinating paper describes how a neonatl ventilator could be used to deliver volatile anesthesia.
Cuffed tubes have smaller internal diameters. This carefully perform study confirms that this will increase work of breathing in small children, but the difference can be mitigated with pressure support ventilation and “automatic tube compensation”.
It is challenging to provide optimal care when transferring ventilated critically ill children. This important study suggests using a portable ventilator is indeed better than manual techniques.
This important paper describes the successful use of this technique to reduce allogenic blood use.
More clues into who is at greatest risk of suffering after tonsillectomy.
In this issue: August 2018
A thoughtful editorial guides the way forward in a rapidly expanding but largely evidence free area.
This review explores the science behind antibiotic prophylaxis and the way to better guidelines.
A nice summary describes a classic piece of pediatric anesthesia equipment.
Infraorbital nerve blocks are of great value for cleft lip surgery. This important paper helps identify the anatomy for these.
It is important to generate high quality evidence from randomised trials that can evaluate the usefulness (or not) of both new, and established techniques. Ultrasound has many valuable applications but perhaps penile blocks are not one of them…
Data from the Pediatric Craniofacial Perioperative Registry compare patient characteristics and outcomes in children undergoing midface advancement with distraction osteogenesis.
Another study demonstrates the advantages of Xenon.
This intriguing trial tests the relatively novel idea of keeping the remifentanil going during recovery.
This intriguing trial tests the relatively novel idea of keeping the remifentanil going during recovery.
An important study highlights that cultural variables may influence preoperative anxiety
In this issue: May 2018
An invaluable guideline that should be downloaded for all pediatric anesthesia locations.
- Guidelines and checklists for short-term missions in global pediatric surgery Recommendations from the American Academy of Pediatrics Delivery of Surgical Care Global Health Subcommittee, American Pediatric Surgical Association Global Pediatric Surgery Committee, Society for Pediatric Anesthesia Committee on International Education and Service, and American Pediatric Surgical Nurses Association, Inc. Global Health Special Interest Group
Many readers will have been on short surgical missions to other countries. This important document is a very important step toward increasing the standard and safety of these missions. It is accompanied by an editorial which outlines further steps that are needed.
Much has been written recently about changing fasting guidelines. Here the Association of Paediatric Anaesthetists of Great Britain and Ireland publish their new guidelines and explain why they have changed
This is essential reading for all ethical researchers.
Ultrasound is becoming a regular tool for anesthesiologists. Lung ultrasound is another valuable use.
In this issue: April 2018
What really matters to patients and families? Do we have the best tools to measure these family centred outcomes? How can we do quality improvement or research without them? This editorial by Stricker et al. describes this problem along with a new global collaborative project to try to answer some of these questions; it is challenging exciting and immensely important endeavour.
This scale is increasingly used to assess delirium. The more psychometric validation the better…
This is one of several recent articles that examine the impact of race on various aspects of perioperative care in children.
A simple and comprehensive review of something all pediatric anesthesiologists need to understand
In this issue: January 2018
- New Tubing Connections to Reduce Wrong Route Medication Errors
- A retrospective comparison of thoracic epidural infusion and multimodal analgesia protocol for pain management following the minimally invasive repair of pectus excavatum
- Incidence and Predictors of 30-Day Postoperative Readmission in Children
- Introducing the 6-4-0 fasting regimen reduces the incidence of prolonged preoperative fasting in children
- The Anatomy of the Pediatric Airway: Has Our Knowledge Changed in 120 Years? A review of historic and recent investigations of the anatomy of the pediatric larynx
- Assessment of sedation level prior to neonatal intubation: a systematic review
2017
In this issue: October 2017
What actually is a periopertiave surgical home? The term is now frequently in the used in the US but it causes some confusion to others around the world. Is it operating at home? Is it a completely new concept for perioperative care, or is it what many institutions strive to do already? Lynne Ferrari’s excellent editorial explains.
The MEPA course is one of the great achievements of our profession. This inspiring paper describes the evolution from idea to globally used education program. It’s a great example of what determination and collaboration can achieve.
Mortality is an important peri-operative outcome measure, but it is surprisingly difficult to determine how much anesthesia contributes to that mortality. This excellent paper describes the data from a South African tertiary pediatric hospital. The outcomes are quite similar to other similar studies in developed countries. The next step is to better understand anesthesia related mortality in other African hospitals.
In clinical studies we always report sex and sometimes we even adjust for sex in our analyses. But does it actually matter clinically?
In this issue: November 2017
There is considerable publicity surrounding the subscription based “opioid epidemic” in North America. This excellent review focuses on the relevance to pediatric anesthesiologists.
- Infection Prevention in Pediatric Anesthesia Practice
Hospital acquired infection is a major cause of preventable morbidity. We may be partly to blame. There are well described standards that we should follow. This is another must read for all pediatric anesthesiologists.
- Suitability of the forearm for non-invasive blood pressure measurement in children
Does it matter where you put the cuff? Apparently it does.
Race influences some patterns of medical care in adults. In this center at least one aspect of pediatric anesthesia practice did not vary with race. More work needs to be done in this space.