Paediatric anaesthesia: Overview

Abstract
Intrahospital transport of anesthetized and critically ill children is a routine event that carries myriad risks. Patients with a vast array of conditions are transported between the intensive care unit, procedural and diagnostic imaging suites, emergency department, and other areas. Given this complexity, the range of potential adverse events is large. Improving safety during transport will require a broad and holistic approach. This review will inform pediatric anesthesiologists on the best approach to improve their care and patient safety during transport by identifying common error traps, with both individual- and system-level countermeasures. The error traps include the failure to fully weigh all risks, costs, and benefits associated with transport for a procedure or test; secure appropriate resources for transport and at every destination; provide pertinent information during transfers of care; anticipate physical and physiological changes associated with transport; and execute the plan effectively as a team. Countermeasures include multidisciplinary discussion and resource optimization; use of systematic tools, standardized communication, and checklists to improve processes of care; encouraging the prioritization of a culture of safety around transport; and adapting the team composition and leadership style to suit the specific clinical scenario.

Abstract
Purpose of review: Fetal surgery has evolved into a transformative field, offering hope for the management of complex prenatal conditions. The purpose of this review is two-fold: to provide a brief overview of fetal anesthetic considerations, and to examine recent advancements which have significantly improved maternal safety and expanded the scope of treatable fetal anomalies.

Recent findings: Enhanced imaging technologies, such as high-resolution ultrasound and fetal MRI, have enabled precise diagnoses and surgical planning to improve outcomes. Innovations in techniques, expanded indications for fetal surgery, and adoption of maternal anesthesia protocols have all helped to minimize complications and enhance recovery. Placental research shows no immune response or pathology from fetal surgery, suggesting it does not contribute to preterm delivery.

Summary: Advancements in fetal intervention collectively underscore the field's commitment to delivering optimal outcomes for both mother and child while paving the way for future breakthroughs in prenatal care.

Abstract
Background: Perioperative anaphylaxis (PA) is a rare life-threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA).

Methods: Patients ≤18 years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes.

Results: Eleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT.

Results: A culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta-lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3-bag, 12-step protocol.

Conclusion: The most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase correlated with PA. BAT served as adjunctive diagnostic tests. Desensitization to cisatracurium was possible.