BACKGROUND Melatonin and dexmedetomidine have both been used as a premedication to decrease emergence delirium in children. The effectiveness of oral melatonin, compared with atomised intranasal dexmedetomidine, in this role is not well studied. OBJECTIVETo study the efficacy of pre-operative atomised intranasal dexmedetomidine versus oral melatonin in children scheduled for ophthalmic surgery under sevoflurane.DESIGN A prospective, randomised, double-blind trial.SETTING Ophthalmic surgery in a university teaching hospital, April 2021 to October 2021.PATIENTS A total of 120 children undergoing ophthalmic surgery with sevoflurane anaesthesia.INTERVENTION Children were randomised to receive preoperative intranasal dexmedetomidine 2 mg/kg via an atomiser device (dexmedetomidine group) or oral melatonin 0.5 mg kg À1 (melatonin group), 45 min before surgery.OUTCOMES MEASURED The primary outcome was the incidence of emergence delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included pre-operative sedation, quality of inhalational induction, postoperative sedation and pain. RESULTSThe incidence of emergence delirium was lower in the dexmedetomidine group than in the melatonin group (17 versus 37%, relative risk 0.45, 95% CI: 0.24 to 0.88; P ¼ 0.01). Children in the dexmedetomidine group were more sedated following premedication and in the postanaesthesia care unit (P < 0.05). Postoperative pain scores were lower in the dexmedetomidine group than in the melatonin group: 0 [0 to 3] versus 2.5 [0-4], (P ¼ 0.01). The requirement for and dose of rescue fentanyl analgesia postoperatively was comparable between the two groups.CONCLUSION Atomised intranasal dexmedetomidine significantly reduced emergence delirium in paediatric opthalmic procedures under sevoflurane anaesthesia compared to oral melatonin.TRIAL REGISTRATION Clinical Trials Registry of India CTRI/2021/03/032388 (www.ctri.nic.in)

Learning objectives By reading this article you should be able to: 1. Describe the specific indications for one-lung ventilation in adults. 2. Choose and position correctly a double lumen tube to achieve lung isolation. 3. Manage one-lung ventilation in patients with a difficult airway. 4. Effectively and safely manage hypoxaemia during one-lung ventilation.

Liberal intraoperative fluid therapy was found to be effective in reducing PONV in children undergoing lower abdominal surgery.

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Background Postoperative nausea and/or vomiting is a relatively frequent occurrence after general anesthesia in pediatric patients. Supplemental perioperative crystalloid fluid administration has been shown to have a positive effect on the incidence of nausea and/or vomiting in adults undergoing surgery. The question arises whether supplemental intraoperative intravenous fluids in pediatric patients offers beneficial results with regards to pediatric postoperative nausea and/or vomiting. Methods Pubmed, EMBASE, Google Scholar, and Web of Science were searched up to March 2022 to perform a systematic review with meta‐analysis of randomized controlled trials involving patients ≤18 years undergoing elective surgery under general anesthesia, with one group receiving conventional intraoperative fluids therapy and the other group receiving supplemental intraoperative fluid therapy, with intravenous crystalloids. The outcomes included incidence of postoperative vomiting, postoperative nausea and vomiting, the need for rescue anti‐emetics, postoperative thirst, and adverse events attributed to supplemental intravenous fluid therapy. Relative risk (RR) with 95% confidence intervals (CIs) were reported for the outcomes using a random or fixed effects model. Results Seven randomized controlled trials (864 patients) were included in the final analysis. Supplemental intraoperative crystalloids reduce postoperative vomiting (RR 0.56, 95% CI 0.39–0.80; p = .001), postoperative nausea and vomiting (RR 0.52, 95% CI 0.37–0.74; p = .0003), postoperative thirst (RR 0.21, 95% CI 0.13,0.34; p < .01), and the need for rescue anti‐emetics postoperatively (RR 0.60, 95% CI 0.49–0.74; p = .00001). Conclusion Supplemental intraoperative intravenous crystalloids significantly reduce several PONV outcomes in healthy children undergoing relatively simple and superficial surgeries under volatile agent‐based general anesthesia.

professional team training and the co-ordination of fellowships. The ESAIC could also take a stand and establish standards and recommendations in the field, such as provision of a detailed curriculum for high-fidelity simulation. Finally, as highlighted by the COVID-19 pandemic, there is a need to adapt and find alternative training solutions such as telesimulation activities 7 : here again the ESAIC could act as a facilitator.In conclusion, the status of SBET during residency across Europe is highly heterogeneous. Our findings suggest areas for improvement for which the ESAIC could play an essential role.