Effective pain management following orthopedic surgery is crucial for patients' recovery and quality of life. Traditional single electronic patient-controlled analgesia (PCA) pumps have certain limitations, including suboptimal pain control and poor patient compliance. This study aims to evaluate the efficacy of a novel doctor-nurse-patient integrated PCA pump management model based on a wireless analgesia management system (WAMS) in improving postoperative pain management among orthopedic patients. This is a single-center, prospective, randomized controlled trial. A total of 150 patients undergoing orthopedic surgery will be randomly assigned to either the intervention group (receiving the integrated PCA management model based on WAMS) or the control group (receiving standard electronic PCA pump management). The primary outcome is postoperative pain, assessed at multiple time points using the Numerical Rating Scale (NRS). Secondary outcomes include incidence of adverse events, sleep quality, functional mobility, and other indicators to comprehensively evaluate the effectiveness and safety of the intervention. Data collection and analysis will be conducted in accordance with strict ethical guidelines and quality control standards. The study protocol has been approved by the Clinical Research Ethics Committee of Shenzhen Second People's Hospital (Approval ID: 2024–518-03PJ). Informed consent will be obtained from all participants prior to enrollment. Findings will be disseminated through peer-reviewed journals, conference presentations, and other academic channels to ensure transparency and reliability. ChiCTR2500098757.
Abstract Background Liver dysfunction is associated with a rebalanced but fragile hemostatic system, in which alterations in coagulation factor synthesis and activity contribute to both bleeding and thrombotic risks. During liver transplantation, this fragile equilibrium is further challenged by major physiological stress. This study aimed to characterize the phase-specific intraoperative dynamics of coagulation factors V, VIII, and XIII (FV, FVIII, and FXIII) to better understand hemostatic modulation and its clinical implications during liver transplantation. Methods A subset of 17 liver transplant recipients receiving transfusion support without administration of recombinant FVIII or FXIII was analyzed. Measurements were obtained at three defined intraoperative time points: T1 anesthesia induction, T2 end of anhepatic phase, T3 end of surgery. Activities of FV, FVIII, and FXIII were quantified and analyzed for temporal trends. Results All three coagulation factors declined during surgery. FV was already markedly reduced at T1 (37% (22/55)) and further decreased to 26% at T3 ((19/34); p = 0.0309). FVIII showed supranormal levels at T1 (193% (160/254) and declined to near-normal levels at T3 (109% ((67/143); p < 0.0001). FXIII remained close to the lower limit of normal (T1: 68% (50/85)); T3: (63% (55/78)) without significant change. Conclusion This prospective analysis reveals distinct, phase-specific trajectories of FV, FVIII, and FXIII during liver transplantation. Understanding these differential patterns may help identify critical periods of hemostatic vulnerability and guide individualized factor-specific therapeutic interventions to optimize perioperative coagulation management in liver transplant recipients. Trial registration German Clinical Trials Register (DRKS00032827).
Abstract Background The contact activation system is triggered when blood comes into contact with artificial surfaces. Cardiopulmonary bypass (CPB) induces such activation, however the extent of factor XII (FXII) reduction and its reflection in routine coagulation assays remain unclear. Methods In this prospective observational study, 20 adult patients undergoing elective cardiac surgery with CPB (10 coronary artery bypass grafting (CABG), 10 aortic aneurysm repair) were analyzed. Blood samples were collected immediately prior to anesthesia induction (T1) and three minutes after protamine administration (T2). Laboratory analyses included FXII, factor VIII (FVIII), and factor V (FV) activities, activated partial thromboplastin time (aPTT), prothrombin time (Quick/INR), fibrinogen, and viscoelastic testing (ROTEM). Results FXII activity decreased significantly after CPB (whole cohort: 98% (79/122) vs. 62% (51/83); CABG: 108% (83/124) vs. 64% (47/85); aortic: 92% (75/119) vs. 61% (52/82), p < 0.001 each). FV declined, whereas FVIII tended to increase. aPTT prolongation was minimal and remained within the normal range. A strong correlation between FXII decline and aPTT change was observed only in CABG patients (ρ = − 0.835, p = 0.003). ROTEM clotting times were moderately prolonged after CPB but showed no correlation with FXII activity. Conclusions CPB induced a significant reduction in FXII activity. Global coagulation assays such as aPTT or ROTEM have limited sensitivity for contact factor deficiencies. Isolated prolongation of these parameters after CPB should be interpreted cautiously and, in the absence of clinical bleeding, should not routinely prompt hemostatic interventions. Future studies should address subgroup differences (CABG vs. aortic surgery) in larger cohorts. Trial registration The trial was registered in the German Clinical Trials Register (DRKS00034174).
Patients undergoing wide surgical resection and endoprosthesis of the proximal femur experience complications such as wound complications due to postoperative bleeding, complications related to blood replacement, infections related to surgical drains, and mobilization problems, increasing hospital length of stay and costs. Our aim is to evaluate the reduction in these problems in patients with postoperative tranexamic acid use. All patients received a bolus of intravenous tranexamic acid at a dose of 15 cc/kg preoperatively, and local tranexamic acid was used during closure. This was applied to Group 1, while Group 2 received additional intravenous tranexamic acid at a dose of 1 g/day for 3 days postoperatively. Patients' risk of postoperative thromboembolic events, blood transfusion rates, postoperative wound healing problems, infection rates, mobilization times, physiotherapy initiation and hospital stay, and surgical drain removal times were compared retrospectively. Patients belonging to Group 2 (who received postoperative tranexamic acid) had earlier mobilization, initiation of physiotherapy, and shorter hospital stay (P < 0.001). They also had shorter surgical drain removal times and less blood transfusion volume (P < 0.001 for both). There were no significant differences in hematoma-related infection, age, gender, and primary/metastasis rates between the groups. We believe that postoperative tranexamic acid use will reduce complications related to blood replacement, reduce hospital-acquired infections and costs through earlier surgical drain removal and shorter hospital stays, and provide better protection against thromboembolic events and allow the patient to regain vital functions more quickly through earlier mobilization and initiation of physiotherapy.
Abstract Background Major surgeries like pancreatoduodenectomy carry high risks for perioperative complications, especially in older patients and those with comorbidities. While perioperative care has improved, the role of prehabilitation—defined as structured preoperative physical and nutritional preparation—remains underexplored in pancreatic surgery. This study evaluated the impact of a multimodal prehabilitation program on postoperative outcomes in patients undergoing pancreatoduodenectomy. Methods A retrospective single-center matched-pair analysis was conducted including patients who underwent elective pancreatoduodenectomy after implementation of a structured prehabilitation program (January 2023-October 2024) and a historical control group. Matching criteria were sex, ASA class, and type of procedure. The multimodal home-based prehabilitation program comprised physical exercise, breathing training, and individualized nutritional support. Primary outcomes were postoperative complications, length of hospital stay, and recovery parameters. Multivariable logistic regression and propensity score-based inverse probability of treatment weighting (IPTW) analyses were performed to adjust for confounding. Results Of 116 eligible patients, 36 completed prehabilitation and were matched to 36 controls. Overall postoperative complications were lower after prehabilitation (44.4% vs. 66.7%, p = 0.053), while severe complications (Clavien-Dindo 3–4) were significantly reduced (16.7% vs. 38.9%, p = 0.042). Postoperative blood transfusion rates were lower (5.6% vs. 22.2%, p = 0.041), and hospital stay was shorter (13 vs. 16 days, p = 0.017). IPTW-adjusted analyses confirmed a consistent reduction in postoperative complications (OR 0.425), although statistical significance was not consistently reached. Subgroup analysis of patients ≥ 80 years demonstrated a significant reduction in complications (25% vs. 100%, p = 0.028). Conclusions Prehabilitation is feasible and associated with improved postoperative outcomes after pancreatoduodenectomy, particularly regarding severe complications and length of hospital stay. Although limited by sample size and adherence, the findings suggest that prehabilitation may enhance recovery, especially in elderly patients. Larger prospective studies are warranted to confirm these results. Trial registration The study was registered on June 18, 2025 in the German Clinical Trials Register (DRKS) under the identification number DRKS00037231.
Laparoscopic surgery has significantly improved surgical outcomes in several areas of abdominal surgery. Laparoscopy is increasingly being used as a diagnostic tool for the diagnosis and therapeutic intervention of abdominal trauma. Laparoscopic techniques have been widely accepted by surgeons. This study aimed to explore the diagnostic and therapeutic significance of laparoscopic surgery in patients with abdominal trauma. This retrospective study included 65 patients with abdominal trauma who underwent surgery. Five patients (7.69
Abstract Background Hypertension is a major modifiable risk factor for perioperative morbidity and mortality, particularly in low- and middle-income countries where the burden of chronic disease is rising. Understanding its determinants among surgical patients is essential for improving perioperative safety and optimizing clinical outcomes. Methods A cross-sectional study was conducted among 318 adult patients who were planned to undergo surgery. Socio-demographic, behavioral, clinical, and perioperative characteristics were collected using a questionnaire and chart review. Hypertension status was determined using standard blood pressure measurements. Logistic regression analyses were performed to identify factors associated with hypertension, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. Statistical significance was set at p < 0.05. Results The prevalence of hypertension among patients evaluated in the preoperative anesthesia clinic was 26.7% (95% CI: 21.9%–32.0%). Older age, behavioral factors, and clinical status were significantly associated with hypertension. Patients aged > 60 years had higher odds of hypertension compared to younger adults. Modifiable lifestyle factors including high salt intake (AOR = 2.3; 95% CI: 1.98–5.54), regular physical exercise (AOR = 0.49; 95% CI: 0.34–0.96), smoking (AOR = 2.73; 95% CI: 1.87–4.49), and current alcohol use (AOR = 1.6; 95% CI: 1.42–5.3) were significantly associated with hypertension. Comorbidity was associated with increased odds of hypertension (AOR = 2.58; 95% CI: 1.34–4.96). Conclusion The overall prevalence of hypertension among surgical patients was found to be high. Its occurrence is strongly associated with modifiable lifestyle behaviors, existing comorbidities, and higher ASA status.
BACKGROUND: Inadvertent perioperative hypothermia, a common complication secondary to anaesthesia and surgical exposure, affects patients globally and is associated with adverse outcomes. Interventions to prevent perioperative normothermia include consistent core temperature monitoring and active warming strategies. Forced-air warming is the key active warming strategy recommended in guidelines and requires consistent perioperative application to prevent hypothermia. Implementation of guidelines varies across the Asian Australasian Regional Section (AARS), characterised by diverse healthcare systems and resource constraints. An advisory panel was convened to identify regional challenges and propose recommendations for perioperative normothermia guideline implementation, including forced air warming. METHODS: An expert advisory panel of 15 healthcare professionals, including anaesthesiologists, registered nurses, and perioperative normothermia research experts from Australia, Japan, Korea, Malaysia, Singapore and Thailand, convened during October 2024. Panellists reviewed relevant literature, shared clinical experiences, discussed challenges, and proposed evidence-based recommendations for safe practices. Meeting outcomes are summarised in this publication. DISCUSSION: Obstacles for guideline implementation of perioperative hypothermia prevention were identified and classified into four areas: 1) economic constraints, 2) practical limitations, 3) educational gaps, and 4) environmental challenges. Limited insurance coverage for forced air warming systems, resource limitations, time pressures and inconsistent technology availability were among the identified barriers. The panel recommended leveraging cost-effectiveness studies and conducting future analyses to support hypothermia prevention, emphasising long-term financial benefits of avoiding complications associated with hypothermia. Panel members advocated for the adoption of established guidelines and simplifying and customising them to align with the unique contexts of individual institutions. They recommended improved access to accurate non-invasive monitoring devices within each institution, and for training regarding continuous temperature monitoring. To enhance knowledge among surgical teams, the panel emphasised the importance of establishing ongoing comprehensive training and structured workflow systems, supplemented by regular audits. The panel identified incorrect use of forced air warming systems as a significant barrier to perioperative hypothermia prevention. Members stressed the necessity of incorporating proper usage training into a comprehensive educational program detailing correct application of forced air warmers, infection control, and liability awareness. This work aims to enhance patient safety, improve clinical outcomes, and reduce economic burdens across diverse AARS healthcare systems.
We aimed to observe the effects of perioperative meticulous nursing in patients with digestive system diseases undergoing general anesthesia. This randomized controlled trial included 90 patients with digestive system diseases who underwent surgery under general anesthesia in our hospital from August 2024 to October 2024. Using a random number table, patients were allocated to a control group (n = 45) and an observation group (n = 45). Both groups received anesthesia recovery nursing. The control group received routine perioperative nursing, while the observation group received perioperative meticulous nursing. The quality of anesthesia recovery was evaluated by recording the time to recovery of spontaneous breathing, recovery of consciousness, endotracheal extubation, and full awakening. Core body temperature was measured before anesthesia induction (T0), 30 min after anesthesia induction (T1), at the end of surgery (T2), and 30 min after surgery (T3). Stress indicators, including adrenaline (AD), norepinephrine (NE), and cortisol (Cor), were measured before anesthesia induction and at the time of endotracheal extubation. Psychological status was assessed before nursing intervention (1 day preoperatively) and after intervention (within 24 h postoperatively) using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). The incidence of adverse events (nausea and vomiting, hypothermia, shivering, and agitation) and nursing satisfaction were also compared between the two groups. The observation group showed significantly shorter times to recovery of spontaneous breathing, recovery of consciousness, endotracheal extubation, and full awakening compared with the control group (all p < 0.05). Core body temperatures at T1, T2, and T3 were lower than those at T0 in both groups, but were significantly higher in the observation group than in the control group (p < 0.05). Serum levels of AD, NE, and Cor at extubation were higher than pre-induction levels in both groups, but were significantly lower in the observation group (p < 0.05). After nursing intervention, SAS and SDS scores decreased in both groups, with significantly lower scores in the observation group (p < 0.05). The incidence of postoperative nausea and vomiting, hypothermia, shivering, and agitation was significantly lower in the observation group (p < 0.05). Nursing satisfaction was significantly higher in the observation group than in the control group (p < 0.05). Perioperative meticulous nursing combined with anesthesia recovery nursing can significantly improve the quality and safety of anesthesia recovery in patients with digestive system diseases undergoing general anesthesia surgery, and is beneficial for stabilizing core body temperature and reducing stress responses.
Perioperative diastolic dysfunction has been proposed as an independent predictor of postoperative major adverse cardiac events (MACE) after noncardiac surgery. However, prior studies have largely focused on elective procedures and employed heterogeneous echocardiographic approaches to assess diastolic function. We sought to evaluate the association between abnormal diastolic echocardiographic parameters and postoperative MACE and mortality in patients undergoing hip fracture surgery using a contemporary, multiparametric assessment of diastolic function. In this retrospective cohort study, adult patients undergoing hip fracture repair between April 2016 and June 2021 with available preoperative transthoracic echocardiography were included. Abnormal diastolic parameters were defined as average E/e′ >14, tricuspid regurgitant velocity (TRV) > 2.8 m/s, and left atrial volume index (LAVI) > 34 mL/m². Patients were stratified by the number of abnormal parameters into two groups: 0–1 abnormal versus 2–3 abnormal. The primary outcome was postoperative MACE, defined as myocardial infarction, heart failure, pulmonary edema, or death within 30 days of surgery. Secondary outcomes included 1-year and 2-year all-cause mortality. Among 148 patients included in the analysis, postoperative MACE occurred in 15.5
With an aging population and high prevalence rate of atrial fibrillation (AF) in older individuals, more elderly patients with AF receive lumbar operations. Nevertheless, there has been little study discussing the perioperative outcomes of AF in lumbar surgery, especially using a national database. A population-based, retrospective cohort survey was conducted on adults receiving lumbar surgery who were divided into 2 cohorts based on the diagnosis of AF or not, using the 2016–2019 Nationwide Inpatient Sample database. Propensity score matching was applied to eliminate selection bias. Univariate and multivariate analyses were performed to explore the impact of AF on postoperative complications following AF. Overall, 222,557 lumbar surgical patients were finally involved in the present study, 10,929 (4.9
Emergency surgical procedures carry substantial risk, with increased morbidity, mortality, and unplanned intensive care unit (ICU) admissions. Identifying perioperative factors associated with postoperative ICU requirement is essential for improving outcomes and optimizing resource allocation. This study evaluated anesthesia management practices in a large emergency surgery cohort and investigated independent predictors of postoperative ICU admission. This retrospective cohort study included 1,984 patients who underwent emergency surgical procedures at a tertiary center between 2022 and 2023. Demographics, trauma status, ASA classification, airway management, anesthetic technique, hemodynamic support, transfusion, and postoperative analgesia were recorded. The primary endpoint was postoperative ICU admission. The ICU admission rate was 12.1
Surgery is a well-known trigger of Diabetes Ketoacidosis, DKA. Post-surgical DKA is poorly studied in the current literature. This study investigated post-surgical DKA association with poor glycemic control before surgery. Unmatched case–control study sampling all post-surgical DKA cases admitted to ICU during the period from 1st of March 2019 to 1st of December 2022 in King Saud Medical City, Riyadh, Saudi Arabia. The control group comprises all other adult post-surgical subjects admitted to ICU without DKA during the same period. Poor glycemic control was considered when the glycosylated hemoglobin, HbA1C, was equal to or more than 7
Abstract Myocardial injury after noncardiac surgery (MINS) occurs in approximately 13% of adults ≥ 45 years of age who undergo major inpatient noncardiac surgery and is associated with an increased risk of 30-day and 1-year mortality. Routine perioperative troponin monitoring is needed to avoid missing the majority of MINS events. Although there are challenges to the implementation of MINS surveillance, there has been enormous growth in the uptake of MINS monitoring across Canadian centres. In this paper, we explore challenges to routine screening for MINS and strategies to overcome them. The key challenges were stratifying who to monitor, management strategies and outcomes requiring further research, and resource limitations. Several groups have documented high uptake of perioperative troponin monitoring at centres that have established institutional protocols. Strategies to facilitate implementation of the MINS guidelines include multidisciplinary collaboration, standardized clinical pathways, and audit and feedback. Implementation of a routine MINS monitoring program requires concerted multidisciplinary effort throughout the perioperative period, encompassing the preadmission clinic, postoperative wards, and outpatient clinics.
Postoperative delirium (POD) is a frequent and serious complication, especially in older adults and high-risk surgical patients. Intranasal insulin has emerged as a potential neuroprotective intervention, possibly modulating neuroinflammation and preserving cognitive function. This study aimed to evaluate the efficacy and safety of preoperative intranasal insulin in reducing POD incidence. A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched through March 2025 for randomized controlled trials (RCTs) comparing intranasal insulin versus placebo in adult surgical patients. The primary outcome was the incidence of POD. Secondary outcomes included inflammatory biomarkers (IL-6, TNF-α, CRP), glucose levels, and insulin resistance (HOMA-IR). Odds ratios (OR) and mean differences (MD) with 95
Chronic post-surgical pain (CPSP) impacts approximately one in four patients following total knee arthroplasty (TKA) and is associated with reduced function and quality of life. We will conduct a systematic review of prospective studies to identify eligible data and establish an international repository of individual patient data (IPD) on prognostic factors for chronic pain after TKA. This repository will be then used to develop and validate a prediction model for CPSP following TKA. We will identify eligible studies through a search of MEDLINE, CINAHL, EMBASE, and Cochrane CENTRAL from January 2005 to August 2025. We will include prospective studies that: (1) enrolled adults undergoing elective TKA, (2) assessed perioperative risk factors for CPSP, and (3) measured knee pain longitudinally at least 3 months post-surgery. Pairs of reviewers will independently screen titles and abstracts of retrieved citations and review the full texts of potentially eligible studies. We will reach out to principal investigators or authors of eligible studies to notify them of our initiative and request to receive their IPD into a secured repository, based on a data sharing agreement. We will use a one-stage approach for IPD meta-analysis of factors associated with CPSP following TKA, and development of a risk prediction model. We will use anonymized de-identified data for our IPD meta-analysis. This protocol was reviewed and approved by the Hamilton Integrated Research Ethics Board (HiREB). We will develop an online calculator to support our risk assessment model for research and clinical use. This IPD meta-analysis will facilitate the development of a robust prognostic model to guide clinical decisions or enrolment in interventional studies, with the ultimate goal of identifying pathways to effective CPSP prevention strategies after TKA. CRD42024591329.
Abstract Background Effective management in the post-anaesthesia care unit (PACU) is essential to ensure patient safety, comfort, and timely progression through the surgical care pathway. Many patients experience side effects such as nausea, vomiting, sore throat, hoarseness, dizziness, and disorientation. These symptoms can prolong recovery time. Ice-lollies are a pragmatic, non-pharmacologic intervention. We aim to test the hypothesis that offering ice-lollies in the PACU shorten the patients' length of stay in post-anaesthesia care. Methods Icesthesia is a prospective monocentric cluster-randomised single-blinded controlled clinical superiority trial in 3140 patients admitted to the PACU of a large university medical centre after anaesthesia. Days are randomised to intervention days with ice-lollies plus standard of care and control days with standard of care only. Anonymised patient data is collected. The primary outcome is the length of time spent in the PACU until decision to discharge. Secondary outcomes are pain medication consumption, nausea and vomiting, and postoperative delirium at discharge. Discussion This trial determines if offering ice-lollies to patients postoperatively reduces the length of stay in the PACU compared to standard of care. Trial registration German Clinical Trials Register (DRKS00037179) on 11th June 2025.
This research assessed the relationship between the neutrophil percentage-to-albumin ratio (NPAR) and mortality in perioperative chronic kidney disease (CKD) patients and explored sex-specific differences. Using the INSPIRE database (2011–2020), we retrospectively analyzed 2,474 surgical CKD patients that were categorized by admission NPAR tertiles. Cox regression was used to evaluate associations between the NPAR and mortality, and stratified curve fitting was used to reveal sex-specific differences. Analysis of the cohort (mean age 60.8 ± 14.8 years; 65.3
Although oxygen is critical in anesthesia, high-concentration exposure, even for short periods during preoxygenation, may contribute to oxidative stress. In the context of perioperative care optimization, minimizing unnecessary oxidative burden is essential for patient safety. This study investigated the acute effects of standard versus rapid preoxygenation strategies on thiol-disulfide homeostasis and blood gas parameters in patients undergoing laparoscopic cholecystectomy. This prospective observational study enrolled 62 ASA I–II patients scheduled for elective laparoscopic cholecystectomy. Patients received 100
Abstract Background Preoperative anxiety is a common challenge in paediatric anaesthesia. High anxiety levels are associated with adverse perioperative outcomes. Although risk factors for preoperative anxiety in children are well known, validated assessment tools are rarely used in everyday clinical practice. Instead, anaesthesiologists rely on clinical judgment during preoperative assessments. However, the accuracy of such anxiety predictions in clinical practice remains unclear. Methods This prospective observational study included children aged 7–12 years undergoing elective surgery or diagnostic procedures under general anaesthesia. During the preoperative consultation, anaesthesiologists, parents, and children were asked to predict the child’s anxiety on a Visual Analogue Scale (VAS), while actual anxiety during anaesthesia induction was assessed using the Modified Yale Preoperative Anxiety Scale – Short Form (mYPAS-SF). Spearman’s correlations (rs) between predicted and observed anxiety were calculated, and the predictive performance for clinically significant anxiety (defined as mYPAS-SF > 30) was evaluated using the area under the receiver operating characteristic curve (AUC). Potential predictors of preoperative anxiety, including demographic and psychosocial factors, were also evaluated. Results 91 datasets sets were analysed. Anxiety prediction by parents correlated moderate to children’s anxiety during anaesthesia induction (AUC 0.661; rs=0.327, 95% CI 0.12–0.51). Anxiety predictions by anaesthesiologists (AUC 0.604; rs=0.173, 95% CI -0.04–0.37) and children (AUC 0.612; rs=0.147, 95% CI -0.08–0.36) correlated weakly with children’s anxiety. Children reporting being worried before anaesthesia showed significantly higher anxiety during induction (mYPAS-SF 38.5 [22.9–57.3] vs. 22.9 [22.9–38.0]; P = 0.006). Children’s anxiety at consultation and on the ward correlated with increased anxiety during induction (rs=0.271, 95% CI 0.06–0.46 and rs=0.297, 95% CI 0.09–0.48, respectively). Intravenous induction was associated with lower anxiety compared with inhalational induction (mYPAS-SF 22.9 22.9 [22.9–38.0] vs. 38.5 [22.9–57.3]; P < 0.001). No significant associations were found for age, gender, prior medical experiences, or parental anxiety. Conclusions Clinical anxiety assessments in preoperative consultations are often inaccurate, with parents performing slightly better than anaesthesiologists and children. Structured screening approaches are needed to enhance the early identification of high-risk children and improve perioperative anxiety management. Trial registration German Clinical Trials Registry, registration number DRKS00033395. Date of registration: 06/05/2024.
