Reviewing the Safety of Providing Out of Operating Room Anesthesia for Acute Burns in Pediatric Patients.

Is inpatient monitoring necessary in pediatric patients with comorbidities following routine dental procedures? A retrospective analysis

Children and young adults with severe pre-existing conditions frequently require dental treatment under general anesthesia (GA) and are commonly scheduled for postoperative inpatient surveillance due to presumed elevated anesthetic or surgical risks. Although this approach prioritizes safety, it may contribute to prolonged or unnecessary hospitalization, increased healthcare costs, and potential psychological burden, particularly in patients with neurodevelopmental or congenital disorders. In light of the reportedly low incidence of severe complications following dental treatment under GA, this study aims to evaluate the necessity of routine inpatient admission in pediatric patients (< 18 years of age) with comorbidities and to assess the frequency and severity of perioperative complications. All pediatric patients with pre-existing conditions who underwent planned inpatient surgical dental treatment under GA at the Department of Oral and Maxillofacial Surgery at Hannover Medical School between 2014 and 2025 were included. The indications for inpatient treatment, anesthesiological parameters such as the American Society of Anesthesiologists (ASA) classification, and severe perioperative complications (corresponding to grade ≥ 2 of the Clavien-Dindo classification) were analyzed. It was assessed whether the ASA classification or the type of pre-existing condition significantly influenced the occurrence of perioperative complications. A total of 199 patients were analyzed. Patients who underwent surgery were mainly categorized as ASA II (n = 80, 40.2%) and III (n = 102, 51.3%), and mostly presented with cardiovascular (n = 68, 34.2%) or hematological/oncological preconditions (n = 47, 23.6%). Perioperative complications occurred in 8 cases (4.2%); of those, 6 were intraoperative (3.1%), and 2 were postoperative (1.0%). The probability of perioperative complications did not correlate with ASA classification or pre-existing conditions (p [Fisher] = 0.166, and p [Fisher] = 0.571, respectively). Age significantly influenced the probability of complications (U = 451.00, p = 0.050), indicating that older patients were more likely to experience complications than younger patients. As postoperative complications occur very rarely, even in patients with pre-existing conditions, inpatient surveillance should warrant thoughtful consideration to liberate hospital capacities. Interdisciplinary pre-, intra-, and postoperative assessment of the need for inpatient surveillance should ensure patient safety and provide further insights into risk factors for peri- and especially postoperative complications. The authors recommend validating risk scores and algorithms for decision-making regarding inpatient surveillance.

Pushing the Limits: Spinal Anesthesia in Children Undergoing Extended Urologic Surgeries

Introduction: Spinal Anesthesia (SA) is a promising alternative to General Anesthesia (GA) in pediatric surgery, offering advantages in respiratory safety, hemodynamic stability, and better perioperative pain control. However, it remains underused in routine practice, often due to concerns about its limited duration of block (<90 minutes). Objective: This case report aimed to explore the application of SA in pediatric patients of different ages and to highlight its potential role as an alternative to GA. Case Series: We reported 3 cases of SA used in pediatric patients of different ages who underwent urologic surgeries at Airlangga University Hospital. One child had intermittent asthma, while two were obese. All patients received SA with Bupivacaine, combined with different intravenous adjuvants. Intraoperative hypotension requiring sympathomimetic support occurred in the oldest child. The longest duration of spinal block was 240 minutes, and postoperative pain was mild in all three patients, without the need for rescue analgesia. No Perioperative Respiratory Adverse Events (PRAEs) occurred, and no conversion to GA was required. Discussion: SA in pediatric patients provided good perioperative pain control without the need for airway manipulation, thereby reducing the risk of airway related complications, which is particularly beneficial in patients with high-risk airway. Younger children tended to demonstrate more stable hemodynamic responses during SA due to their immature sympathetic nervous system. The use of intravenous adjuvants in SA prolonged the spinal block duration and improved block quality, while potentially reducing the toxicity of local anesthetic agent used. Conclusion: In these cases, SA was shown to be a safe and beneficial anesthetic technique for pediatric patients undergoing urologic surgery.

Risk Factors for Intraoperative Hypothermia in Pediatric Burn Surgery: A Single-Center University Hospital Experience.

Burns are a significant cause of morbidity and mortality in children, ranking third among the causes of injury-related deaths. Maintaining body temperature in burn patients is challenging, with the literature reporting an incidence of hypothermia up to 60%. This study aimed to determine the incidence and independent risk factors of intraoperative hypothermia in pediatric burn surgery. This retrospective observational cohort study included pediatric burn patients who underwent surgery in the pediatric surgery operating room between January 2016 and December 2019, comprising 396 procedures. Hypothermia was defined as a decrease in body temperature to below 36°C. The patients were divided into two groups: Group I (body temperature below 36°C) and Group II (body temperature ≥ 36°C). The study included patients with a median age of 30 months (1-204), and 57.3% were male. The hypothermia group exhibited a higher burn degree (25.3% vs. 10.7%, p < 0.001) and a higher percentage (10 [2-65] vs 6 [2-60], p < 0.001). Hypothermia was significantly higher in patients with flame burns than in those with scald burns (p < 0.001) and higher in the intratracheal general anesthesia group than in the laryngeal mask and mask/sedation groups (p < 0.001). Multivariable logistic regression analysis demonstrated that female gender (odds ratio [OR]: 3.358, p = 0.013), higher American Society of Anesthesiologists (ASA) score (OR: 3.440, p = 0.032), presence of a flame burn (OR: 5.685, p = 0.003), and prolonged duration of anesthesia (OR: 1.011, p = 0.022) were all independent risk factors for hypothermia. In our patient cohort, a high rate of intraoperative hypothermia (38.9%) was identified in pediatric burn patients. Female gender, higher ASA score, presence of a flame burn, and prolonged duration of anesthesia were all independent risk factors for hypothermia.

Bridging Acuity and Anesthesia: A Novel Tiered Framework for Anesthetic Stratification in Operative Burn Management.

Characterizing the Safety and Efficacy of Propofol in Critically Ill Pediatric Patients.

Propofol was safely used to facilitate extubation and decreased baseline sedative exposure when used for sedation washout in a complex critically ill pediatric population and was tolerated by most patients at doses commonly exceeding guideline- recommended maximum rate and duration.

Evaluation of Adverse Effects of Epidural Anesthesia in Obstetric Patients: A Clinical Study

Background: “ Epidural anesthesia is widely used for labor analgesia and cesarean delivery, offering effective pain relief with a generally favorable safety profile. However, complications (ranging from minor to severe) can occur and warrant careful monitoring. Aim: To assess the incidence, pattern, and severity of complications associated with epidural anesthesia in obstetric patients. Methodology: A descriptive, hospital-based observational study was conducted at the Department of Anesthesia, Sadar Hospital, Koderma, Jharkhand, India over 8 months. Ninety obstetric patients aged 18–40 years, ASA I–II, and receiving epidural anesthesia for labor or cesarean section were included. Demographics, procedure details, and intraoperative and postpartum complications were recorded and analyzed using descriptive statistics. Results: Among 90 patients, 50% experienced some complication. Intraoperative events occurred in 33.3%, with hypotension (16.7%), shivering (13.3%), and nausea/vomiting (11.1%) being most common. Postpartum complications were less frequent, including urinary retention (5.6%) and post-dural puncture headache (3.3%). Major complications were rare (6.7%), with no cases of total spinal anesthesia or persistent neurological deficits. Conclusion: Epidural anesthesia in obstetric patients is generally safe, with minor, manageable complications predominating. Vigilant monitoring, careful technique, and individualized dosing are essential to maintain maternal and fetal safety