BackgroundCaudal block increases optic nerve sheath diameter (ONSD), but its temporal dynamics vary considerably across centers. Injection speed is one of the unstandardized factors in caudal block, and whether it influences ONSD dynamics remains unclear.PurposeWe therefore evaluated the effect of injection speed on ONSD changes during caudal block in children.DesignA prospective, randomized, observer-blinded trial.MethodsThis study enrolled children aged 1–3 years undergoing perineal surgery. Participants received a caudal block with 0.2% ropivacaine (0.5 mL/kg) at either 1 mL/s (high-speed) or 0.1 mL/s (low-speed). ONSD was measured at baseline, immediately after injection, and at 10, 20 and 40 min time points. The primary outcome was ONSD change over time. Linear mixed-effects models were used for analysis.ResultsEighty children were analyzed. At T2, ONSD was significantly higher in the high-speed group (4.73 ± 0.43 mm) than in the low-speed group (4.52 ± 0.35 mm, P = 0.027); at T3, ONSD was significantly higher in the low-speed group (4.73 ± 0.57 mm) than in the high-speed group (4.49 ± 0.42 mm, P = 0.010). Both groups showed significant ONSD increases from T1 onward (P < 0.05), without return to baseline by T4. A significant time-by-group interaction (P < 0.001) indicated different temporal patterns. The maximum ONSD value did not differ between groups (4.8 mm, p = 0.537). No significant differences were observed in mean arterial pressure, heart rate, or end-tidal carbon dioxide at any time point (P > 0.05). No adverse events occurred.ConclusionAt an injection volume of 0.5 mL/kg, both speeds were well tolerated. Faster injection advances the observed ONSD peak; slower injection produces a more gradual rise and is therefore recommended for routine practice.Clinical trial registrationhttps://www.chictr.org.cn, identifier ChiCTR2200057459.

The application of low-temperature plasma technology in pediatric tonsillectomy has become the current main surgical procedure,and perioperative pain management for tonsillectomy exerts a direct impact on the postoperative recovery process of children.At present,there remains a deficiency in the standardized perioper-ative pain management for pediatric tonsillectomy in China,especially in aspects such as the selection of pain as-sessment tools,the development of multimodal analgesic protocols,and the formulation of individualized interven-tion strategies,where a unified consensus has not yet been established.The guideline development expert panel formulated this guideline by reviewing the literature and two rounds of modified Delphi method voting.This guideline systematically elaborates on four key aspects:common pain assessment methods after pediatric tonsillec-tomy,perioperative analgesic strategies,surgical approaches and operative techniques,and the influence of dietary factors on pain.It is intended to provide clinical practice guidance for otorhinolaryngology head and neck surgeons,anesthesiologists,and relevant medical staff in day surgery units,further promoting the standardization and sys-tematization of perioperative pain management in pediatric tonsillectomy,and ultimately achieving the goals of fa-cilitating the rapid recovery of children after tonsillectomy and reducing the incidence of perioperative complica-tions.

Background Ethanol sclerotherapy is a primary treatment for arteriovenous malformations, yet acute pulmonary hypertension remains a life-threatening complication. The hemodynamic dynamics during pediatric AVM embolization are not fully characterized, particularly the dose-response relationship and cumulative effects of repeated injections. Methods This prospective observational study included 29 pediatric patients (33 sessions) undergoing ethanol sclerotherapy under general anesthesia with real-time pulmonary artery pressure monitoring via right heart catheterization. Bispectral Index (BIS), regional tissue oxygen saturation (rSO 2 ), and hemodynamic parameters were recorded at baseline (T0) and after each ethanol injection (T1-T3). Results The mean pulmonary artery pressure rose significantly from 21.65 ± 3.84 mmHg at T0 to 26.33 ± 4.48 mmHg at the last injection (p < 0.001, Cohen’s d = 1.230, large effect). A total of 94% (31/33) of patients exhibited an increase in mean pulmonary artery pressure, with 12% (4/33) demonstrating a > 10 mmHg increase. No significant correlation was found between pulmonary artery pressure elevation and total ethanol volume (Spearman ρ = −0.073, p = 0.685) or ethanol volume per body weight (ρ = −0.124, p = 0.493). BIS decreased significantly from 56.13 ± 9.53 to 52.19 ± 13.73 (p = 0.015, Cohen’s d = − 0.477). rSO 2 decreased from 74.30 ± 2.54% to 73.19 ± 3.62% (p = 0.002, Cohen’s d = − 0.511). Systemic vital signs (blood pressure, heart rate, SpO 2 ) remained stable. rSO 2 was preserved in all patients except one with severe pulmonary hypertension. Conclusion Acute pulmonary hypertension is frequent and unpredictable in children undergoing ethanol sclerotherapy, occurring even at low doses. Real-time pulmonary pressure monitoring is essential for early detection and intervention. The transient reduction in BIS supports systemic ethanol absorption, though preserved rSO 2 suggests adequate cerebral oxygenation under general anesthesia. No significant linear dose-response relationship was identified.

Objective: The aim of this study was to evaluate the intraoperative safety of the laryngeal mask airway (LMA) in pediatric laparoscopic surgery by assessing regurgitation and aspiration events. Methods: This study included 220 pediatric patients aged 1 to 6 years, weighing 9 to 30 kg, with an American Society of Anesthesiologists physical status I or II, scheduled for elective laparoscopic high ligation of the hernia sac under general anesthesia. Quantitative ultrasonographic assessment of the gastric antrum was performed preoperatively to evaluate gastric emptying. Following the procedure, LMA removal was conducted after the return of spontaneous regular respiration. Salivary pH values were measured at the ventilatory surface of the laryngeal side, the surrounding area of the laryngeal side, and the lingual surface of the LMA using precision pH test strips to detect intraoperative regurgitation or aspiration. Results: Two patients were excluded due to qualitative ultrasonographic findings indicating a high risk of aspiration, leading to the postponement of surgery. Among the remaining 218 patients, suspected regurgitation was noted in 41 cases (18.8%) and suspected aspiration in 24 cases (11.0%). No confirmed cases of regurgitation or aspiration were identified. Conclusions: With adherence to strict preoperative fasting protocols and appropriate patient selection, the use of LMA in pediatric patients undergoing laparoscopic high ligation of the hernia sac appears to be a feasible and safe method of airway management.

OBJECTIVE:There is a paucity of literature regarding the application of nonintubated anesthesia in pediatric thoracoscopic surgery. This study provides a systematic description of the authors' anesthetic regimen and evaluates the feasibility and safety of nonintubated anesthesia in pediatric video-assisted thoracoscopic surgery. DESIGN:A retrospective observational study. SETTING:Operating room in a tertiary teaching hospital. PARTICIPANTS:Ninety-two pediatric patients underwent thoracoscopic surgery. INTERVENTIONS:Patients received either general anesthesia with endotracheal intubation or nonintubated general anesthesia. MEASUREMENTS AND MAIN RESULTS:Data from patients who underwent thoracoscopic surgery with nonintubated anesthesia from April 2024 to April 2025 was retrospectively reviewed. The anesthetic procedure was systematically documented. The primary outcome measure was the conversion rate from laryngeal mask airway to endotracheal intubation. Secondary outcomes of interest encompassed comprehensive perioperative safety assessments and complication parameters. A total of 94 patients were identified, with 92 meeting inclusion criteria for final analysis. The cohort comprised patients with the following primary diagnoses: pulmonary sequestration (n = 24), congenital cystic adenomatoid malformation (n = 19), mediastinal mass (n = 26), and pectus excavatum (n = 23). The conversion rate from laryngeal mask airway to endotracheal intubation was 2.1% (2/94). Secondary outcomes demonstrated clinically acceptable results across multiple parameters, including intraoperative surgical field view, vital signs, postoperative pain score, and incidence of nausea and vomiting. Furthermore, comparative analysis with historical data suggested potential benefits of nonintubated anesthesia, including reduced extubation time, decreased incidence of postoperative pulmonary complications, and shorter duration of postoperative hospital stay. CONCLUSION:Nonintubated anesthesia demonstrates both feasibility and safety in pediatric thoracoscopic surgery, representing a valuable addition to contemporary anesthetic practice. However, further prospective, multicenter trials with larger sample sizes are warranted to validate these preliminary findings.

The airway management of complex tracheoesophageal fistula repairs in pediatric patients presents unique challenges, particularly in cases involving pre-existing tracheostomy and tracheal stenting. The combination of restricted mouth opening, altered airway anatomy secondary to tracheal stents, and the presence of a tracheostomy creates significant technical obstacles in establishing effective one-lung ventilation during thoracoscopic procedures. This report describes a novel and successful one-lung ventilation strategy in a complex pediatric case, demonstrating the feasibility of one-lung ventilation under these challenging anatomical constraints. A 5-year-old patient presenting with iatrogenic tracheoesophageal fistula secondary to corrosive airway injury underwent thoracoscopic surgical repair, with a complex clinical course marked by tracheal stenosis, tracheal stent placement, and tracheostomy. Successful intraoperative one-lung ventilation was achieved through flexible electronic bronchoscopy-guided orotracheal intubation with a 4.0-mm endotracheal tube, followed by precise positioning of a disposable bronchial blocker in the right main bronchus. Transoral use of a bronchial blocker combined with an existing tracheostomy tube demonstrated technical feasibility for achieving pulmonary isolation in children with tracheal stent and tracheostomy. However, the generalizability of this approach requires further validation through larger cohort studies.

BACKGROUND:Postoperative emergence delirium (ED), a frequent complication following general anesthesia, poses significant clinical risks including traumatic injuries and cardiorespiratory compromise. The primary objective of this study was to evaluate the effects of laryngeal mask airway versus endotracheal intubation on the incidence of ED in pediatric patients undergoing endoscopic-assisted coblation adenoidectomy. The secondary objective of this study was to evaluate and compare additional intraoperative and postoperative outcomes. METHODS:A total of 78 patients aged three - six years undergoing same-day endoscopic-assisted coblation adenoidectomy under general anesthesia were randomly allocated to either laryngeal mask airway group (Group L) or endotracheal intubation group (Group T). ED and pain were assessed using the Pediatric Anesthesia Emergence Delirium (PAED) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale, respectively. The primary outcome was the incidence of ED within 30 minutes post-extubation. The secondary outcomes included the highest FLACC score, vital signs, the duration of surgery, anesthesia time, extubation time, length of Post-Anesthesia Care Unit (PACU) stay, adverse events post-extubation, sore throat score, and the satisfaction levels of ward nurses and caregivers. RESULTS:The incidence of ED was significantly lower in Group L than in Group T (15.4% vs. 41%, P<0.05). The systolic blood pressure (106.8±14.4 mmHg vs. 122.5±17.6 mmHg), diastolic blood pressure (60.9±12.6 mmHg vs. 76.8±16.7 mmHg), and heart rate (99.8±15.4 beats/min vs. 111.4±16.6 beats/min) in Group L were significantly lower than those in Group T at post-intubation (P<0.05 for all). The extubation time (6.1±2.0 min vs. 8.6±2.1 min) and length of stay in PACU (12.5±6.1 min vs. 15.8±7.1 min) were significantly shorter in Group L compared with Group T (P<0.05 for both). The incidence of airway complications (2.6% vs. 30.8%) and hypoxemia (2.6% vs. 20.5%) were significantly lower in Group L compared to Group T after extubation (P<0.05 for both). The sore throat score at discharge was significantly lower in Group L than in Group T (0 [0 to 2] vs. 2 [0 to 4], P<0.05). Additionally, nurses' overall satisfaction was significantly higher in Group L than Group T (5 [5 to 5] vs. 5 [2 to 5], P<0.05). CONCLUSIONS:The use of laryngeal mask airway effectively reduces the incidence of ED in children undergoing same-day endoscopic-assisted coblation adenoidectomy compared to endotracheal intubation. Additionally, it provides several advantages, including shorter extubation time, attenuated hemodynamic responses to intubation stress, and reduced rates of airway complications and postoperative sore throat.

Rational preoperative fasting can reduce the risk of regurgitation and aspiration, enhance anesthesia safety and efficiency, and mitigate the adverse effects of prolonged fasting. This study investigates the existing practices of preoperative fasting management in Chinese pediatric patients and explores the real duration of preoperative fasting. This is a cross-sectional study. A questionnaire on fasting management in children was developed and an online survey was conducted among anesthesiologists. The survey mainly included the real implementation of pediatric fasting protocols, anesthesiologists’ understanding of pediatric fasting management, and the application of gastric ultrasound. Moreover, data on pediatric preoperative fasting durations were collected from different hospitals across China. A total of 770 questionnaires and 1285 records of preoperative fasting cases were obtained. The survey indicated variations in preoperative fasting protocols among hospitals. Most hospitals recommended fasting for clear fluids for 2 h, while the new 1-h regimen and the liberal regimen were less implemented due to concerns regarding regurgitation and aspiration risks. Fasting for breast milk, formula milk, and solid food was mainly based on traditional protocols, with fasting durations of 4 h, 6 h, and 8 h, respectively. Most anesthesiologists have experienced regurgitation and aspiration, but there were significant differences in their awareness of the prevention and prognosis of regurgitation and aspiration. Utilization of gastric ultrasound was limited, with a lack of equipment and familiarity among anesthesiologists. Real preoperative fasting durations for children were significantly longer than those recommended in the guidelines. Factors contributing to prolonged fasting were identified. There is a big gap between preoperative fasting practices and the guidelines, and the real fasting durations of children before surgery are significantly longer than the guideline recommendations. Anesthesiologists should strengthen their understanding of preoperative fasting management in pediatric patients, master the skills of gastric ultrasound assessment, and timely address inefficiencies in pediatric preoperative fasting management.

Background: Postoperative sore throat (POST) is a common postoperative complication.Complication: Chewing gum can inhibit the growth of oral bacteria, cleanse, and lubricate the oral cavity, which can help reduce postoperative sore throat. We hypothesize that chewing gum before surgery could relieve POST.Methods: Patients planned to undergo total thyroidectomy under general anesthesia with tracheal intubation were randomized to swallow saliva twice or chew 1.4 g/2.8 g of gum for 2 minutes before surgery. A standard anesthesia protocol was performed. The numerical rating scale scores of POST at 1, 24, and 48 h after surgery were collected. The primary outcome was the incidence of moderate/severe POST (numerical rating scale score >3) within 48 h.Results: Data from 148 patients (control group, n = 50; 1.4 g group, n = 48; and 2.8 g group, n = 50) were included in the analysis. Within 48 h, there was a significant difference among the three groups in the incidence of moderate/severe POST (control group: 74% vs. 1.4 g group: 65% vs. 2.8 g group: 50%. P = 0.04). The 2.8 g group had less incidence of moderate/severe POST than the control group (Odds Ratio = 0.351 95% Confidence Interval: (0.152 and 0.814) P = 0.02).Conclusion: Chewing 2.8 g gum before total thyroidectomy can reduce the incidence of moderate/severe POST within 48 h after surgery.

Neuromuscular blocking agents are routinely used in laparoscopic surgery to optimize operative conditions. We compared the effect of a deep and moderate neuromuscular blockade (NMB) on surgical conditions and postoperative outcomes in children undergoing major laparoscopic surgery. Sixty children aged 2–14 years scheduled to undergo major laparoscopic surgery were randomly allocated to deep (post-tetanic count 1–2 twitches) or moderate (train-of-four 1–2 twitches) NMB groups. The anesthesia was maintained with propofol and remifentanil, and the NMB was maintained with a rocuronium continuous infusion. At the end of the operation, the NMB were antagonized with sugammadex. The intra-abdominal pressure, airway pressure, Leiden Surgical Rating Scale, intraoperative hemodynamics, drug usages, duration of surgery, postoperative recovery time, pain, and complications were compared between the groups. The maximum and mean intra-abdominal pressure, the peak inspiratory pressure, and mean airway pressure were significantly lower in the deep NMB group than in the moderate NMB group (p < 0.001). The Leiden Surgical Rating Scale and the dosage of rocuronium were significantly higher in the deep NMB group than the moderate NMB group (p < 0.001). The intraoperative hemodynamics, duration of surgery, post-operative recovery time, pain, and the incidence rate of complications were not significantly different between the groups (p > 0.05). A deep NMB provided better operative conditions and similar recovery profiles compared with a moderate NMB as reversed with sugammadex in children undergoing major laparoscopic surgery. Chinese Clinical Trial Registry, No. ChiCTR2100053821.

Background and objectives:The intercornual distance in the sacral hiatus has yet to be studied precisely in children. This age-stratified, observational study aimed to clarify the changes in sacral hiatus dimensions and to quantify the correlations between the intercornual distance of the sacral hiatus and age, height, weight, and head circumference by using real-time ultrasonography. Methods:The patients were stratified into three groups: neonates and infants, toddlers, and schoolchildren. In the operating room, the ultrasonic probe was placed at the sacral cornua to obtain a transverse view of the sacral hiatus, and the intercornual distance was measured three times in millimetres. Results:The study included a total of 156 patients. The mean ± SD (95%CI) of intercornual distance in neonates and infants (<12 months) was 11.58 ± 1.79 (11.11-12.04) mm, 13.29 ± 1.97 (12.71-13.86) mm in toddlers (13-36 months), and 13.36 ± 2.49 (12.64-14.08) mm in schoolchildren (>36 months).The mean values of neonates and infants were different from those of toddlers and schoolchildren (p < 0.001), but it was similar between toddlers and schoolchildren (p > 0.05, 95 % CI mean difference -1.10 to 0.95).Intercornual distance was correlated with age, height, weight, and head circumference before one year of age (Spearman's R values > 0.7), but there was no correlation thereafter (Spearman's p value > 0.05). Conclusion:In the first year after birth, the intercornual distance increases rapidly with body growth; after one year of age, the sacral hiatus dimension changes significantly. Ultrasound is superior for assessing the gradually ossified cartilage components in older children.

Objectives The effects of anesthetics on electroencephalograms and cerebral perfusion remain understudied in children with congenital heart disease. With regard to this, we compared inhalational anesthesia induction and intravenous anesthesia induction. Design A randomized controlled trial. Setting Operating room in 2 tertiary hospitals. Participants A cohort of 116 pediatrics patients undergoing cardiac surgery. Measurements and Main Results The patients were randomly assigned to either the intravenous group (n = 58) or the inhalational group (n = 58). The inhalational group received anesthesia induction with 4% to 6% sevoflurane and a bolus of pipecuronium 0.2 mg/kg, whereas the intravenous group received anesthesia induction with intravenous midazolam 0.2 mg/kg, pipecuronium 0.2 mg/kg, and sufentanil 1 μg/kg. Ten minutes after tracheal intubation, the following parameters were measured: spectral edge frequency, burst suppression event, patient state index, middle cerebral artery blood flow velocity, cerebral oxygen saturation, and hemodynamic parameters. In comparison with the intravenous group, the inhalational group exhibited significant increases in 95% spectral edge frequency, ratio of burst suppression event, blood flow velocity in the middle cerebral artery, and cerebral oxygen saturation (p < 0.05 for all), as well as decreases in systolic pressure, diastolic pressure, cardiac index, and the maximal slope of systolic upstroke (p < 0.05 for all). Conclusions The administration of sevoflurane for anesthesia induction results in more burst suppression, while also demonstrating superior cerebral perfusion when compared with the use of intravenous medications for anesthesia induction. Trial registration Chinese Clinical Trial Registry (ChiCTR1800015946).

BACKGROUND: Limited data exist regarding the use of the esketamine-propofol combination (esketofol) in pediatric surgery. This study aimed to investigate the effect of esketofol versus propofol alone on the perioperative characteristics of children undergoing minor surgery.METHODS: Eighty-four children aged two to six years were randomly assigned to either the propofol group or the esketofol group. Intraoperative outcomes included bispectral index, dosage of anesthetics, and extubation time. Postoperative outcomes comprised oropharyngeal airway usage, time to orientation, time to eye-opening, length of stay in the post-anesthesia care unit, the need for rescue opioids, pain rating using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Pediatric Anesthesia Emergence Delirium Score, nausea and vomiting, and psychotomimetic symptoms. The FLACC pain score was the primary outcome, and the remaining parameters were considered secondary outcomes.RESULTS: The FLACC Score (2 [1, 3.3] vs. 4 [3, 5.3], P<0.001) and frequency of rescue opioids (14.3% vs. 33.3%, P=0.040) were significantly lower, while Bispectral Index (BIS) was higher (P<0.001) in the esketofol group compared with the propofol group. Moreover, the time to orientation and length of stay in the post-anesthesia care unit (PACU) were significantly longer in the esketofol group compared with the propofol group (P=0.029 and P =0.025, respectively). The other outcomes were similar between the two groups.CONCLUSIONS: Esketofol reduces postoperative pain and the need for rescue opioids, but it extends recovery time in the PACU and increases BIS without affecting other outcomes.

目的 探讨一次性术野扩张器在小儿腹膜后间隙腔镜手术建腔中的应用效果.方法 选取2020 年 1 月至 2021年12月首都儿科研究所附属儿童医院胸部及肿瘤外科收治的6月龄至14岁择期采用腹腔镜行腹膜后间隙入路手术的肾肿瘤或肾上腺肿瘤患儿共60例,其中,2020年1月至12月住院的30例患儿为对照组,采用传统自制水袋扩张腹膜后间隙;2021年1月至12月住院的30例患儿为研究组,采用一次性术野扩张器.比较两组术中建腔时间、并发症、出血量以及手术操作者建腔满意度等.统计学方法采用t检验、χ2 检验或秩和检验.结果 研究组腹膜后间隙建腔时间短于对照组[(2.3±0.5)与(18.8±4.5)min,t=20.117,P=0.001)];研究组建腔操作中出血量少于对照组[(5.5±3.6)与(8.7±7.9)ml,t= 2.039,P<0.05)].研究组手术操作者对建腔满意度均为优;对照组为优43.3%(13/30)、良 40.0%(12/30)、差16.7%(5/30),差异有统计学意义(Z=4.774,P<0.05).研究组一次性建腔成功率为100%,无球囊破裂;对照组 1 例 2 次建腔,1 例出现球囊破裂.结论 小儿腹膜后间隙腔镜手术时,采用一次性术野扩张器,与传统方式相比,建腔时间短、出血量小、相关并发症少,是一种有效的建腔方法.

From the Department of Anaesthesia, Capital Institute of Paediatrics, Beijing, China (DH, SP) Correspondence to Ding Han, Department of Anaesthesia, Capital Institute of Paediatrics, No. 2 Chaoyang District, Beijing, China Tel: +86 010 85695681; e-mail: [email protected]

Background Previous studies have reported that children who were admitted to the ICU experienced a significant decrease in sleep quality compared to home. We investigated the effects of dexmedetomidine as an adjunct to sufentanil on the sleep in children admitted to the ICU on the first night after major surgery. Methods This is a prospective study From January to February 2022. Clinical trial number: ChiCTR2200055768, http://www.chictr.org.cn. Fifty-four children aged 1–10 years old children undergoing major laparoscopic surgery were recruited and randomly assigned to either the DEX group, in which intravenous dexmedetomidine (0.3 ug/kg/h) and sufentanil (0.04 ug/kg/h) were continuously infused intravenously for post-operative analgesia; or the SUF group, in which only sufentanil (0.04 ug/kg/h) was continuously infused. Patients were monitored with polysomnography (PSG) on the first night after surgery for 12 h. PSG, sleep architecture, physiologic variables and any types of side effects related to anesthesia and analgesia were recorded. The differences between the two groups were assessed using the chi-square and Wilcoxon rank-sum tests. Results Fifty-four children completed data collection, of which thirty-four were 1–6 years old and twenty were aged >6 years. Compared to the SUF group, subjects in the DEX group aged 1–6 years displayed increased stage 2 sleep duration (P = 0.02) and light sleep duration (P = 0.02). Subjects aged >6 years in the DEX group also displayed increased stage 2 sleep duration (P = 0.035) and light sleep duration (P = 0.018), but decreased REM sleep percentage (P = 0). Additionally, the heart rate and blood pressure results differed between age groups, with the heart rates of subjects aged >6 years in DEX group decreasing at most time points compared to SUF group (P < 0.05). Conclusion Dexmedetomidine prolonged N2 sleep and light sleep duration in the pediatric ICU after surgery but had different effects on the heart rate and blood pressure of subjects in different age groups.

Purpose: Placement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intrao-perative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambula-tory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia.Design: Randomized controlled trial.Methods: Children aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anes-thesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accord-ingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demo-graphics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery.Findings: A total of 90 children (30 in each group) were included in the analysis. General information, intrao-perative hemodynamic variables, bispectral index score, and duration of surgery were not significantly differ-ent among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] mg/kg/min, 0.33[0.33 to 0.33] mg/kg/min; 0.17[0.17 to 0.20] mg/kg/ min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postop-erative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both).Conclusions: AWNB is associated with a lower intraoperative remifentanil requirement and a lower postoper-ative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.(c) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Optimal perioperative fluid management is essential for reducing complications in children undergoing thoracoscopic surgery. The study aimed to assess the performance of 2 dynamic preload parameters – pulse pressure variation (PPV) and stroke volume variation (SVV)- either used alone or combined into a multivariable regression model for predicting fluid responsiveness in children undergoing video-assisted thoracoscopic surgery with one-lung ventilation. Children aged 1 to 6 years old undergoing video-assisted pulmonary segmentectomy or lobectomy were enrolled. Volume loading with 5 mL/kg of hydroxyethyl starch was administered over 15 minutes after establishment of artificial pneumothorax. PPV, SVV, cardiac index, cardiac cycle efficiency, and the difference between systolic blood pressure and dicrotic pressure were recorded using the pressure recording analytical method before and after volume loading. Patients with an elevation in cardiac index greater than 10% were defined as responders, and the remaining patients were nonresponders. Of 40 children, 36 were included in the final analysis, containing 13 responders and 23 nonresponders. SVV had an accuracy of 74% (95% confidence interval, 55–93%) for predicting fluid responsiveness, and a best cutoff of 22% showed a sensitivity of 62% and a specificity of 96%. PPV was incapable of discriminating responders from nonresponders. The multivariate regression model did not perform better than SVV alone. We found PPV failed to predict fluid responsiveness, while SVV predicted fluid responsiveness reasonably in the present context. There was no enhancement in predictivity accuracy with multivariable regression models. The accuracy of these approaches was limited, and more discriminative methods need to be found.