Magnesium is an essential chemical element in all organisms, intervening in most cellular enzymatic reactions; thus, its importance in homeostasis and as a therapeutic tool in highly challenging patients such as pediatrics. The primary purpose of this paper was to review the role of magnesium sulfate as an adjuvant drug in pediatric anesthesia. This compound already has the scientific backing in certain aspects such as analgesia or muscle relaxation, but only theoretical or empirical backing in others such as organ protection or inflammation, where it seems to be promising. The multitude of potential applications in pediatric anesthesia, its high safety, and low cost make magnesium sulfate could be considered a Super Adjuvant.

Spinal anesthesia is practical and safe in infants and toddlers and prevents perioperative complications including cardiorespiratory instability and apnea. Other perioperative advantages include reduced time from surgery completion to operating room exit and first feed. This article presents the case of an ex-premature infant who underwent laparoscopic inguinal hernia repair under spinal anesthesia. The infant remained calm and stable throughout the uneventful procedure and postoperative period. Spinal anesthesia may be feasible for laparoscopic herniotomy when pneumoperitoneum pressure and operative time are restricted to 8 mm Hg and 60 minutes, respectively, with sensory level at T10 or higher.

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Normal brain development in young children depends on a balance between excitation and inhibition of neurons, and alterations to this balance may cause apoptosis. During the perioperative period, both surgical stimuli and anesthetics can induce neurotoxicity. This article attempts to expand the perspective of a topical issue-anesthetic-induced neurotoxicity-by also considering the protective effect of general anesthetics against surgery-induced neurotoxicity, all of which may generate some controversy in the current literature. The "new" major factor influencing neurotoxicity-nociceptive stimulus-is discussed together with other factors to develop clinical and research strategies to obtain a balance between neurotoxicity and neuroprotection.

Background: Risk management in healthcare institutions begins by first identifying the potential risks within a certain organization or specific area and then goes on to develop further strategies to reduce harm. The most common tool for this type of analysis is Strengths–Weaknesses–Opportunities–Threats (SWOT). Methods: We conducted a SWOT analysis in our pediatric anesthesia program: key factors were identified in a matrix, prioritized in a score table, represented in a graph, and finally analyzed. Results: Items obtained partial scores from 20 to 120. The item “lack of clinical protocols” was given greater weight (60) and received a lower value (1), resulting in the highest partial score (60) among the negative key factors and indicating a need for greater efforts to improve this specific aspect. Conclusion: The SWOT tool proved effective in identifying safety and quality key factors, and it provided information for initiating an improvement program.

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Anesthesia-related critical incidents in pediatric patients occurred three times more frequently than in adults and, moreover, three times higher in infants (<1 year of age) than in children (>1 year of age). The overall incidence of critical events requiring intervention is 35%, most of them related to hypotension and hypoxemia episodes, occurring during the maintenance of anesthesia. The major risk factors in children undergoing anesthesia are age (<1 year), prematurity (<37 weeks of gestation), and comorbidity (American Society of Anesthesiologists [ASA] physical status ≥3). [1][2][3] Pediatric spinal anesthesia was initially described by August Bier in 1898, and its use was rather common before the advent of halogenated agents that made anesthesia safer. However, spinal block did not become popular again until 1980s, when Abajian first described the high-risk infant (subsequently defined as the ex-premature infant whose postmenstrual age [PMA] at surgery is <60 weeks) as a target patient for this technique, and over the last few years, due to the growing concern about the potential general anesthetic-induced neurotoxicity in young children. [4][5][6][7][8] While its current use is not so widespread, this technique has various advantages compared to general anesthesia, by reducing the risk of cardiorespiratory events (hypoxemia, bradycardia, and hypotension) associated with general anesthesia, especially in neonates and infants. The main limitation is the duration of the anesthetic block, which reduces the number of surgical procedures to be undertaken under this technique to those lasting less than 90 min. [9][10][11] The objective of this study was to review the pediatric spinal anesthesia program at our tertiary care center-Puerta del Mar

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