European Society of Anaesthesiology.

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.

Objectives: Pediatric preoperative anxiety (PPOA) has been a concerning matter for the past decades with a high prevalence and several adverse outcomes branching into social, developmental, behavioral and perioperative fields. The management of anxious children is a priority for minimizing PPOA of the upmost importance. The aim of the study was to assess the levels of preoperative anxiety and their relation to a group of selected variables in a pediatric population being submitted to ambulatory surgery under general anesthesia.Methods: Children's anxiety was assessed using the modified Yale Preoperative Anxiety Scale-Short Version at the preoperative holding area (Time 1) and at the operation room during induction of anesthesia (Time 2). A cutoff value of 30 was used to differentiate anxious children from non-anxious children (scores ≤ 30).Results: 67 children were included in the study. 9 (13.4%) were anxious children at T1 and 24 (35.8%) at T2. A gender difference was not present (p=0.634 for T1, p=0.303 for T2), but the boys presented higher scores at both times and tend to have a significant increase from T1 to T2 (p=0.049). An overall change in the anxiety status from T1 to T2 does not tend to occur (p=0.01). Younger children tend to have higher scores although not statistically significant. No statistical significant difference was found between the remaining variables. Conclusions:The prevalence of anxious children presented is lower than the estimated worldwide and reveals both the result of correct practices and best use of resources. However, the scarcity of national studies exploring this topic renders an indication to implement similar future studies, with larger samples and further studying of the potential predisposing and contributing variables. The never-ending purpose should be to institute more customized programs for minimizing PPOA by means of multimodal combinations of anxiolytic practices.

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