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Children
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New Insights into Pain Management and Sedation in Children
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New Insights into Pain Management and Sedation in Children

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Anesthesiology, Pain Medicine and Palliative Care".

Deadline for manuscript submissions: 10 January 2026 | Viewed by 527

Special Issue Editors

Prof. Dr. Chris Darrel Glover

E-Mail Website
Guest Editor
Pediatrics-Anesthesiology, Baylor College of Medicine, Houston, TX, USA
Interests: pediatric anesthesiology; perioperative and pain medicine; pediatric pain control; pediatric regional anesthesia
Dr. Amod A. Sawardekar

E-Mail Website
Guest Editor
Phoenix Children's Hospital, Phoenix, AZ, USA
Interests: pediatric anesthesiology; congenital cardiac anesthesia; regional anesthesia; acute pain management; airway management
Dr. Nihar Patel

E-Mail Website
Guest Editor
Texas Children's, Houston, TX, USA
Interests: pediatric anesthesiology; acute pain management for post-operative patients; ultrasound to guide the regional blockade for surgical procedures

Special Issue Information

Dear Colleagues,

Pain management and sedation in pediatric patients have evolved significantly over the past two decades, driven by advancements in pharmacology and technology, as well as a deeper understanding of developmental physiology. Despite progress, gaps remain in optimizing safe, effective, and equitable care across clinical settings.

This Special Issue aims to highlight innovative approaches and evidence-based strategies that are shaping the future of pediatric pain and sedation. We seek contributions that offer new perspectives, emerging techniques, and interdisciplinary solutions, including translational research, quality improvement, and health equity initiatives.

We welcome original research, systematic reviews, clinical trials, implementation science, and expert perspectives. Submissions should reflect cutting-edge science and be relevant to clinical practice in anesthesiology, critical care, pain medicine, or perioperative services.

Prof. Dr. Chris Darrel Glover
Dr. Amod A. Sawardekar
Dr. Nihar Patel
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric pain
  • sedation
  • multimodal analgesia
  • non-pharmacologic interventions
  • regional anesthesia
  • pediatric anesthesiology
  • patient-centered care
  • neurodevelopment
  • procedural anxiety
  • quality improvement

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

13 pages, 406 KB  
Article
Reduction in Perioperative Risk in Patients with Spinal Muscular Atrophy Following the Release of Disease-Modifying Therapies: An Analysis of the National Surgical Quality Improvement Program Database
by Erin Toaz, Nisha Pinto, Keith Kilner and Eric Cheon
Children 2025, 12(9), 1255; https://doi.org/10.3390/children12091255 - 18 Sep 2025
Abstract
Background/Objectives: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease resulting in proximal muscle weakness and paralysis. SMA treatment has radically changed in the past 10 years thanks to the development of novel therapies such as nusinersen and onasemnogene abeparvovec. Since the advent [...] Read more.
Background/Objectives: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease resulting in proximal muscle weakness and paralysis. SMA treatment has radically changed in the past 10 years thanks to the development of novel therapies such as nusinersen and onasemnogene abeparvovec. Since the advent of new treatments, the incidence and perioperative risk factors of patients with SMA undergoing longer, higher-risk surgeries are unknown. We hypothesized that patients with SMA would be at an overall elevated risk for postoperative pulmonary complications (PPC) and prolonged length of stay compared to the general population, but that this would be reduced in patients undergoing surgery in the years after the release of new therapies. Methods: Patients who underwent surgery at a continuously enrolled American College of Surgeons National Surgery Quality Improvement Program-Pediatric hospital from 1 January 2012, to 31 December 2021, were included in this study. Cases with missing covariate or primary outcome data were excluded from the analysis. Patients with ages greater than 17 years, preoperative tracheostomy, preoperative mechanical ventilation, missing covariate or primary outcome data were excluded. Patients with SMA were identified by their ICD-9 and 10 codes. A cutoff year of 2018 was chosen for analysis of the primary outcomes as this was a full year after nusinersen received FDA approval. Results: On univariable analysis, the risk for PPC in patients with SMA was reduced in patients undergoing surgery in 2018 or later compared to pre-2018 (pre-2018 OR 4.44, 95% CI 1.56–9.6, p = 0.008; post-2018 OR 3.48, 95% CI 0.84–9.12, p = 0.08). On multivariable analysis, the association between SMA and PPC substantially decreased in 2018 and after but was no longer statistically significant (pre-2018 OR 1.96, 95% CI 0.80–4.80, p = 0.14; post-2018 OR 1.03, 95% CI 0.33–3.26, p = 0.96). SMA was positively associated with LOS in the pre-2018 cohort, with a coefficient from a log linear model of 0.67 (95% CI 0.32–1.01; p < 0.001), and SMA adding an additional 1.93 days in LOS. For data post-2018, the effect of SMA on LOS was no longer statistically significant. Conclusions: Utilizing a large dataset, we found a reduced association between SMA and PPC a year following widespread implementation of SMN antisense oligonucleotide therapy, and a statistically significant reduction in LOS in patients with SMA after 2018. This may reflect improved motor outcomes and respiratory mechanics in the new treatment era. Full article
(This article belongs to the Special Issue New Insights into Pain Management and Sedation in Children)
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11 pages, 861 KB  
Article
Assessing Discharge Readiness After Propofol-Mediated Deep Sedation in Pediatric Dental Procedures: Revisiting Discharge Practices with the Modified Aldrete Recovery Score
by Merve Hayriye Kocaoglu and Cagil Vural
Children 2025, 12(9), 1155; https://doi.org/10.3390/children12091155 - 29 Aug 2025
Viewed by 407
Abstract
Background: Efficient and safe discharge is critical in pediatric dental procedures performed under deep sedation in non-operating room anesthesia (NORA) settings. Traditional institutional criteria may delay discharge due to subjectivity. Objective: This study compared the Modified Aldrete Recovery Score (MAS) and institutional [...] Read more.
Background: Efficient and safe discharge is critical in pediatric dental procedures performed under deep sedation in non-operating room anesthesia (NORA) settings. Traditional institutional criteria may delay discharge due to subjectivity. Objective: This study compared the Modified Aldrete Recovery Score (MAS) and institutional discharge criteria to determine which provides faster and reliable discharge decisions. Methods: In this prospective observational study, 100 children (ages 2–10, ASA I–III) undergoing deep sedation for dental treatment were evaluated. Two nurse anesthetists independently assessed discharge readiness every five minutes using either MAS or institutional criteria. Demographic data, BMI percentile, ASA class, anesthesia duration, and propofol dose were recorded. Discharge times were compared using Wilcoxon signed-rank and subgroup analyses and correlation tests. Results: MAS allowed significantly earlier discharge than institutional criteria (24.75 ± 7.33 vs. 36.79 ± 8.59 min, p = 0.01). The agreement between methods was poor (ICC = 0.06). Discharge time varied significantly by BMI percentile (p = 0.01); obese children had shorter recovery times, while time differences were greater in overweight children. No adverse events or readmissions occurred. Conclusions: MAS provides a quicker and equally safe discharge assessment in pediatric dental sedation. Its use may enhance workflow efficiency and standardize recovery decisions in NORA settings lacking formal PACUs. Full article
(This article belongs to the Special Issue New Insights into Pain Management and Sedation in Children)
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