Background/Objectives: Long-gap esophageal atresia (LGEA) is most commonly associated with Gross types A and B, which are usually diagnosed preoperatively, but may also be encountered in Gross type C, where the long gap is recognized intraoperatively, during fistula ligation. This study aimed to describe and explore outcomes associated with two native esophagus-preserving procedures, delayed primary anastomosis (DPA) and the Foker procedure (FP), and to assess their respective roles in the management of LGEA. Methods: We analyzed a population-representative cohort of 38 patients with LGEA treated at two tertiary centers in Belgrade between 2003 and 2023. Patients treated with DPA (n = 20) or FP (n = 18) were evaluated regarding Gross type, gap length, gastrostomy, treatment duration, complications, major adverse outcomes (including esophageal replacement, redo surgery, or death), and hospital stay. Results: Gross types A and B were analyzed together and were more frequently treated with DPA, whereas FP predominated in type C (p = 0.001). Sex, gestational age, birth weight, and gap length did not differ between treatment groups. Gastrostomy was performed in all DPA cases and in 50% of FP cases. No statistically significant differences in complication rates or major adverse outcomes were observed between the DPA and FP groups. Hospital stay was significantly longer in the DPA group (p < 0.001), although this may be partially influenced by temporal bias related to the later introduction of FP. Conclusions: FP may offer practical advantages in type C LGEA, where thoracic access is already required for fistula ligation, whereas DPA may be a suitable approach in types A/B, avoiding an additional thoracic procedure. These findings suggest that anatomical subtype may be an important consideration in treatment selection in LGEA, although validation in larger multicenter prospective studies is warranted.

BackgroundPulsed dye laser (PDL) therapy is the gold standard for treating port-wine stains (PWS) in children but frequently requires procedural analgosedation due to pain and the need for immobility. The optimal sedative agent for repeated outpatient procedures remains unclear.ObjectiveTo compare the safety and efficacy of propofol- versus ketamine-based analgosedation in children undergoing PDL therapy, with a primary focus on respiratory depression.MethodsIn this prospective, randomized, controlled study, children aged 1–18 years (ASA I–II) were assigned to receive propofol or ketamine for PDL therapy. Standardized monitoring included electrocardiography, noninvasive blood pressure, pulse oximetry, and end-tidal CO₂. The primary outcome was respiratory depression, defined by predefined clinical and capnographic criteria. Secondary outcomes included hemodynamic instability, adverse events, drug consumption, procedural duration, sedation depth, and recovery time. Receiver operating characteristic (ROC) analysis was used to identify predictors of respiratory depression.ResultsA total of 310 procedures were analyzed. Respiratory depression was significantly more frequent in the propofol group compared with the ketamine group (19.5% vs. 2.6%, p < 0.01). Ketamine was associated with higher rates of hypertension, tachycardia, psychomimetic effects, and postoperative nausea and vomiting (p < 0.01), whereas propofol was associated with more hypotension. Sedation and recovery times were longer with ketamine (p < 0.01), while sedation depth was comparable between groups. A procedural duration ≥13.5 min predicted respiratory depression in the propofol group (AUC 0.755).ConclusionBoth propofol and ketamine provide effective analgosedation for pediatric PDL therapy. Propofol is associated with a higher risk of respiratory depression, particularly during longer procedures, whereas ketamine offers greater respiratory stability but more other adverse effects. These findings support individualized anesthetic selection based on procedural duration and patient risk factors.

?Refeeding syndrome? is described in the literature as a range of metabolic and electrolyte disorders that result from starting nutritional rehabilitation in malnourished patients. Without a universally accepted definition, data on ?refeeding syndrome? incidence are heterogeneous. In most cases, a clinician will subjectively identify ?refeeding syndrome,? many authors have developed their purposes and criteria for it in their studies. Using the PubMed database and the appropriate filters (?refeeding syndrome?-related terms: refeeding syndrome, pediatrics, child, nutrition support, nutrition assessment, malnutrition), a search of the published literature was conducted. The American Society for Parenteral and Enteral Nutrition?s 2020 recommendations are the only guidelines for identifying children with or at risk for ?refeeding syndrome?. High-quality scientific evidence regarding the clinical syndrome is absent, so we need further research in all ?refeeding syndrome?-related areas, from validation to better identification of risk factors, definitions of ?refeeding syndrome,? and standardization of treatment protocols. For now, clinicians must remain vigilant to protect patients from the potentially devastating consequences of the ?refeeding syndrome.?

The beginnings of pediatric anesthesiology go back to the middle of the 19th century and it is associated with a rural physician Crawford W. Long, MD, who in the 1842 recorded the first case of giving diethyl ether anesthesia to an eight-year-old boy. The start of development of contemporary pediatric anesthesia is considered to be in 1930, which marked two periods of progress. In the first period, anesthesia techniques and accessories adjusted to different children?s ages were developed. In the second period, modern anesthetic medications and supervision were introduced into everyday clinical practice in order to better protect vital organs and their functions in the child?s body. The first multidisciplinary pediatric intensive care unit at the Children?s Hospital of Gothenburg in Sweden was established in 1955. Dr. Branka Mitrovic is considered to be the founder of pediatric anesthesiology in Serbia, as she founded the Department of Anesthesiology and Reanimation at the University Children?s hospital in 1955. The history of pediatric regional anesthesia began after its introduction in adults, which occurred after the invention of cocaine in 1884. The Ministry of Health of the Republic of Serbia approved a specialization in pediatric anesthesiology in 2018. The development of pediatric anesthesia is fascinating because it completely followed the development of pediatric surgery. Modern pediatric anesthesiology is entirely prepared to meet the needs of the most complex surgical interventions, as well as the treatment of critically ill children, and significantly contributes to better treatment outcomes of pediatric surgical patients.

Preoperative medication or premedication is the administration of medications before surgery, to reduce anxiety, which is common in these patients, and as prophylaxis of side effects of anesthesia like heart rhythm disorders, blood pressure variations, hypersalivation, etc. Benzodiazepines are the usual agents used in premedication to provide relief of anxiety, anterograde amnesia, and light sedation. The most common benzodiazepines used for premedication are midazolam, Diazepam and lorazepam. They are usually given intramuscularly or orally in children. The time of use should be correlated with the moment of maximum effect depending on the method of administration. Time varies from twenty minutes for intramuscularly administered midazolam to two hours for peroral administered lorazepam. The choice of a particular Benzodiazepine, used for premedication, depends on its effects, duration of action, active metabolites, and side effects. The dose should be carefully tailored to provide the expected reduction of anxiety and light sedation and to avoid sleep and especially respiratory depression.

Louis-Bar Syndrome is a synonym for a very rare complex neurodegenerative disorder ataxia-telangiectasia (A-T). This is an autosomal recessive inherited disease that encompasses abnormalities in the cerebellum, multisystem degeneration, immunodeficiency, increased risk for malignancy and consecutive respiratory insufficiency. Most of the patients are radiosensitive and any exposing to ionization may lead to progression of the disease. Potential risks from anesthesia, mechanical ventilation, and postoperative complications in these patients have been insufficiently discussed in the literature. We present a successful anesthetic and respiratory management with one-lung ventilation in a patient with Louis-Bar Syndrome who underwent video assisted thoracoscopy (VATS) for recurrent pleural effusion.

Children frequently experience more painful, stressful, and traumatic medical procedures and treatments in the pediatric intensive care unit (PICU) than when they are hospitalized in general wards. An essential part of care in the PICU is providing critically ill children with appropriate sedation and analgesia. Finding the perfect combination of adequate analgesia and sufficient sedation in a patient group with a wide range of ages, sizes, and developmental stages can be challenging. Administration of sedatives and analgesics to critically ill patients may be challenging and complicated by unpredictable pharmacokinetics (PK) and pharmacodynamics (PD). It is important to keep in mind that optimal agents for procedural sedation and analgesia (PSA) differ from those used for long-term sedation in the PICU. In addition to pharmacological measures, different non-pharmacological methods can be applied and have been shown to be effective for pain relief in children. Efforts are being made to improve PSA management with the use of national surveys, recommendations and guidelines.

The objectives of this study were to determine whether there was a correlation between bispectral index (BIS) and Ramsey Sedation Scale (RSS) in regard to the type of sedation and total intravenous anesthesia (TIVA) during colonoscopy procedures in children, and to assess the utility of ketamine and propofol combination (ketofol) for this kind of procedures at children’s age. In our prospective study, 40 ASA I-II patients, 3 to 17 years of age, were randomly divided into two groups of 20 patients each. After premedication with atropine and midazolam, sedation was induced with propofol and fentanyl in Group PF, whereas in Group PK propofol and ketamine were used for induction. Both groups were further divided into two subgroups depending on whether anesthesia was maintained with intermittent doses or continuous infusion of propofol. Ketamine and/or fentanyl were administered as bolus doses. Heart rate (HR), peripheral oxygen saturation (SpO2), RSS and BIS values of all patients were recorded every 5 minutes throughout the colonoscopy procedures. The strongest degree of correlation between RSS and BIS existed when sedation or TIVA was maintained by the boluses of propofol and fentanyl. The use of ketamine significantly reduced the doses of propofol and fentanyl. BIS can be monitored in all pediatric patients in whom sedation and TIVA are administered during colonoscopy, but the effect of different anesthetics on the EEG signal should be considered in order to adequately assess the depth of sedation and anesthesia.Key words: awareness, monitoring, child, anesthetics, endoscopy

Interindividual variability in response to drugs used in anesthesia has long been considered the rule, not the exception. It is important to mention that in anesthesiology, the variability in response to drugs is multifactorial, i.e., genetic and environmental factors interact with each other and thus affect the metabolism, efficacy, and side effects of drugs. Propofol (2,6-diisopropylphenol) is the most common intravenous anesthetic used in modern medicine. Individual differences in genetic factors [single nucleotide polymorphisms (SNPs)] in the genes encoding metabolic enzymes, molecular transporters, and molecular binding sites of propofol can be responsible for susceptibility to propofol effects. The objective of this review (through the analysis of published research) was to systematize the influence of gene polymorphisms on the pharmacokinetics and pharmacodynamics of propofol, to explain whether and to what extent the gene profile has an impact on variations observed in the clinical response to propofol, and to estimate the benefit of genotyping in anesthesiology. Despite the fact that there has been a considerable advance in this type of research in recent years, which has been largely limited to one or a group of genes, interindividual differences in propofol pharmacokinetics and pharmacodynamics may be best explained by the contribution of multiple pathways and need to be further investigated.

Background and Aims Ultrasound-guided regional anesthesia and peripheral nerve catheters for postoperative pain management is a relatively recent aspect of the field of pediatric anesthesia. The goal of this prospective, blinded study was to evaluate cardiovascular and respiratory safety, clinical efficacy, and recovery following orthopedic surgery performed in peripheral nerve blocks using dexmedetomidine and propofol for sedation with spontaneous breathing. Methods The study included 90 children aged 1 to 18 who were randomly assigned to the dexmedetomidine or propofol groups, ASA-PS scores of I to III, since January 2022. We analyzed baseline characteristics: gender, age, body weight, hemodynamic and respiratory stability, the depth of anesthesia was determined with a modified Ramsay sedation score, presence of peripheral nerve catheter, duration of operation and anesthesia, and awakening time from anesthesia. Results The operation time was longer in the dexmedetomidine group (t = -2.988, DF = 88, p <0.01). The time of anesthesia was longer in the dexmedetomidine group (t = -22.301, DF = 88, p <0.05). Awakening time from anesthesia was longer in the propofol group (t = 10,884, DF = 88, p <0.01). Patients with neuromuscular disorders had a longer awakening time from anesthesia in the propofol group (t = -4808, DF = 43, p<0.01). Conclusions Our research has shown that dexmedetomidine and propofol are effective and safe for sedation in pediatric patients undergoing orthopedic surgery under regional anesthesia. Due to the rapid awakening from anesthesia, dexmedetomidine is the sedative of choice for patients with neuromuscular disorders.

•Application of two peripheral nerve blocks procedures in gender affirmation surgery.•Effective postoperative pain management achieved by bilateral PECS and ESP block.•Peripheral nerve blocks reduce postoperative opiod use and allow patient activation.•Early activation of patients reduces the risk of thromboembolism and pneumonia.

Abstract Introduction: Perforated appendicitis (PA) in children is associated with a considerable risk for postoperative complications (POCs) such as wound infection and intra-abdominal abscess. The aim of this study was to determine the diagnostic accuracy of hematological parameters in the early POC detection in children after PA surgery. Materials and Methods: The study enrolled 71 patients with PA divided into two groups: 14 patients with POC (POC+ group) and 57 patients without POC (POC− group). Clinical and hematological parameters were followed preoperatively, prior to the surgery (PRO) and postoperatively on day 2 (POD2) and day 4 (POD4). Results: The POC+ group had longer duration of higher axillar temperature as well as extended intensive and inpatient care. This group also had a significantly lower absolute neutrophil count ratio between POD2 and POD4. According to the receiver operating characteristic curve analysis, relative neutrophil count on POD4 higher than 71.8% and the ratio of absolute neutrophil count between POD2 and POD4 lower than 44.5% were found to be useful for predicting POC. Conclusion: Absolute neutrophil count ratio between POD2 and POD4 and relative neutrophil count at POD4 could be efficient in identifying children at higher risk of developing POC after PA surgery.

The specific characteristics of the pediatric population, the lack of evidence, as well as the small number of studies made treatment of septic shock in children one of the biggest challenges in intensive care units. The Surviving Sepsis Campaign issued in 2020 new guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. The first guide on this topic was published in 2004, and has been reviewed every four years since. Sepsis is a leading cause of healthcare utilization for children worldwide, and early recognition and appropriate management of children with sepsis and sepsis-associated organic dysfunction are crucial for the outcome. Although the new guidelines covered publications up to May 2017, this review also included some recently published studies. Following the innovations in this area, practical application and implementation of guidelines are important for the management of septic shock and sepsis-associated organ dysfunction in children.

The ultrasound-guided erector spinae plane (ESP) block is a novel interfascial plane block technique providing analgesic effects in different localizations of the body, in accordance with the level of administration. Although ESP block is usually performed in the thoracic region in pediatric patients, it is possible to achieve ESP block in the lumbar region as well. Postoperative pain management is essential in patients undergoing operative hip treatment, one of the most common procedures in pediatric orthopedic surgery. We report on a case of effective intraoperative analgesia achieved by ultrasound-guided lumbar ESP block and another case of effective intra- and postoperative analgesia accomplished with perineural catheter placement in addition to lumbar ESP block, both performed in children surgically treated for developmental hip disorders.

Introduction: Women make up an increasing portion of the physician workforce in anesthesia, but they are consistently under-represented in academic anesthesiology and leadership positions. The objective of this study is to provide a current update on the role of women in anesthesiology in Belgrade, Serbia. Methods: A cross-sectional observational study was conducted during September and October 2013 amongst anesthesiologists at ten tertiary health care institutions in Belgrade. The study population was 272 anesthesiologists. Participants' consent and ethical approval were obtained. The questionnaire captured basic sociodemographic and work-related characteristic information: age, sex, level of academic and professional postgraduate education, the managerial position of the section or department. Sociodemographic characteristics were tested in relation to sex by Pearson's chi-squared test. Results: The response rate was 76.2%. Over two-thirds (70.7%) of respondents were women. One-third of female participants (34.5%) and 23.3% of male participants had obtained additional academic achievements; 35.2% of female participants and 40.0 % of male participants had been in managerial positions. Statistically significant gender discrepancies in the additional academic education and upper-rank leadership positions were not detected. Conclusion: Female anesthesiologists in Serbia have achieved parity with men in the highest academic ranks and leadership positions. These women may play an important role in mentoring future generations of female physicians and inspiring them to achieve their professional goals.