Full text: https://onlinelibrary.wiley.com/doi/10.1111/pan.14602

This randomized, parallel, double-blinded clinical trial performed in an outpatient endoscopic clinic between October 2018 and December 2021 was designed to determine if intravenous anaesthesia was effective at reducing post operative behavioural changes in children undergoing ambulatory endoscopic procedures when compared to inhalational anaesthesia.

164 children between the ages of 1-12 yrs , ASA I -III, undergoing endoscopic day surgery procedures, were included and analysed in the study and randomised to receive either inhalational or intravenous maintenance of anaesthesia post induction. All children received inhalational induction with sevoflurane. The intravenous group was then maintained with propofol post placement of a peripheral intravenous cannula.

Full text: https://journals.lww.com/ejanaesthesiology/Abstract/2023/03000/Intranasal_dexmedetomidine_sedation_for_paediatric.8.aspx

This Scandinavian study adds to the evidence base around needle-free sedation techniques for paediatric imaging, itself the subject of a recent systematic review (https://www.bjanaesthesia.org/article/S0007-0912(22)00517-7/fulltext), summarised elegantly by Dr Burton in the January-February edition of this forum (Needle-free pharmacological sedation techniques in paediatric patients for imaging procedures: a systematic review and meta-analysis – SPANZA).

The authors identify access to paediatric anaesthetic services as a common rate-limiting step for the timely provision of paediatric MRI, and moreover suggest an alternative model that is both largely needle- and anaesthetist-free.

Full text: https://journals.lww.com/anesthesia-analgesia/Abstract/2023/04000/Ultrasound_Assessment_of_Gastric_Fluid_Volume_in.16.aspx

This small randomized single-blinded controlled trial is the second such trial comparing gastric fluid volumes after a 1-hour versus a 2-hour clear fluid fast in children undergoing general anaesthesia for elective surgery.  It is the first utilising ultrasound. The authors (from a major university hospital in Cairo, Egypt) postulated that a 1-hour fast would result in significantly higher gastric volumes. They did indeed demonstrate that the volumes roughly doubled, and suggest that a 1-hour fast may result in an unsafe stomach. The questions the reader is specifically interested in, however, are: Is there a gastric fluid volume at which the risk of aspiration is significantly increased? Does a 1-hour fluid fast lead to a significantly greater proportion of patients having gastric volumes above this threshold?

Full text: https://onlinelibrary.wiley.com/doi/10.1111/pan.14584

This review article looks at methadone use in the paediatric perioperative population summarising the benefits and risks.

A brief description of the pharmacokinetics and pharmacodynamics is presented, along with potential benefits of using methadone perioperatively and the unknowns in this population. The article deduces that dosing strategies would likely be similar to that of adults. However, they also state that the minimal effective analgesic concentration has still not been ascertained in children.

Full text: https://www.sciencedirect.com/science/article/abs/pii/S2210844023000229

This article is a narrative review exploring the utility, benefits and pitfalls of the use of videolaryngoscopy in children with a specific focus on the current practice of neonatal tracheal intubation. The authors conducted a Medline search on all published articles between 2010 and 2022 and ultimately included 20 articles in their narrative review including randomised control trials, observational studies, review articles, meta-analyses and editorials.

Full text: https://www.researchgate.net/publication/367533091_Rapid_sequence_induction_in_Paediatric_Anaesthesia_A_narrative_review

Bronchial aspiration – dangerous for our patients and medico-legally and morally dangerous for providers. This narrative review presents an overview of rapid sequence induction (RSI) as it pertains to paediatric patients.

Few large studies have examined the incidence of pulmonary aspiration in children and its risk factors. The Near 4 Kids trial found a 4% incidence of regurgitation during intubation, with 0.7% incidence of clinical aspiration, with age >8 and haemodynamic instability among the risk factors. The APRICOT study found 0.1% of their patients had aspiration, with roughly 50% at induction and 50% at emergence / maintenance.

Full text: https://www.sciencedirect.com/science/article/abs/pii/S2352556822001710

This study examined the effects of hyperventilation versus normoventilation on cerebral oxygenation in children undergoing posterior fossa surgery.

Fifty children were enrolled and randomised into two groups; an early hyperventilation group (ETCO2 target: 26-30 mmHg) and an early normoventilation group (ETCO2 target: 31-35 mmHg). The study was a cross-over trial, so after 30 minutes in the prescribed ventilation strategy (phase 1) the patient was then switched to the alternative ventilation strategy for a further 30 minutes (phase 2). Near infrared spectroscopy (NIRS) was used to assess cerebral oxygen saturation with measurements taken at baseline and then every 5 minutes until then end of phase 2. Other measurements collected were: three intracranial pressure (ICP) measurements and a neurosurgical score of brain relaxation at the end of phase 1.

This article presents the results of an audit of blank anaesthetic charts from 132 hospitals accredited for training by ANZCA. The charts were evaluated for 17 data fields describing tracheal intubation, supraglottic airway use and bag-mask ventilation, with the intent of assessing how useful the charts might be in documenting which airway techniques worked, and which ones did not. The median number of prompts, of the 17 fields examined, was 7 (range 0 – 15).

Report of a single centre, retrospective, case–control study comparing complications after anaesthesia within 90 days of a known positive PCR, as compared to matched controls. The study period was between January 3–October 7, 2020. The complications looked for were at the serious end of the scale (unexplained escalation in care <48hrs post anaesthesia, cardiac, respiratory, thrombotic, and haemorrhagic events within 30 days), in addition to 30- day mortality and hospital length of stay. The cohort included 114 patients who were PCR positive, and 227 controls matched to age and type of surgery. The risk of postoperative complications was not increased in patients who had a positive PCR test more that 7 days prior to anaesthesia compared to matched controls.

Results of a survey sent to US paediatric institutions to explore the pre-operative testing protocols in use at the time (Feb 2022, repeated June 2022). The results from 27/62 (44%) responding institutions were collated. The major change was a move away from PCR testing only (69% –> 52%) and towards protocols involving both PCR and RAT (27% –> 44%).