Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n¼5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]¼1.16; 95% confidence interval [CI], 1.04e1.28

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO 2 <90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions:The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348.

r e v p o r t e s t o m a t o l m e d d e n t c i r m a x i l o f a c . 2 0 1 5;5 6(1):63-67 Mandible Cuspid Pathology Impacted tooth a b s t r a c tTransmigration is a rare and special phenomenon in that intraosseous tooth migration takes place, through the midsymphyseal or mid palatine suture. Transmigration typically affects the mandibular canines. These teeth usually remain impacted and asymptomatic but in some cases they ectopically erupt in the midline or next to the contralateral side. Transmigrated teeth can cause neurologic symptoms and pressure resorption of the adjacent teeth roots. A 15-year-old girl was referred to our clinic complaining of pain in the inferior incisives. On intraoral examination, right mandibular deciduous canine was seen to be retained. Panoramic radiograph revealed a horizontally impacted right mandibular permanent canine migrated toward the midline and located below the apices of the incisives. The tooth was surgically removed under general anesthesia. The presence of an overretained mandibular deciduous canine should always be investigated radiographically. © 2015 Sociedade Portuguesa de Estomatologia e Medicina Dentária. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Transmigração de canino mandibular impactado -Caso Clínico Palavras-chave:Erupção dentária ectópica Mandíbula Canino Patologia Dente impactado r e s u m o A transmigração é um fenómeno raro no qual dentes não erupcionados migram através da linha média maxilar ou mandibular. A transmigração, geralmente, afeta os caninos mandibulares. Normalmente estes dentes permanecem impactados e assintomáticos mas em alguns casos podem erupcionar na linha média ou na região do canino contralateral. Os dentes transmigrados podem originar sintomas tais como dor ou reabsorção das raízes dos dentes adjacentes. Uma menina de 15 anos de idade compareceu a nossa consulta referindo dor nos incisivos inferiores. Ao exame clínico foi possível verificar a presença na arcada do canino mandibular direito decíduo. A radiografia panorâmica revelou que o canino permanente mandibular direito se encontrava impactado numa posição horizontal abaixo

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