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Paediatric Anaesthesia: Clinical Updates and Perspectives
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Paediatric Anaesthesia: Clinical Updates and Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 25 October 2025 | Viewed by 1855

Special Issue Editors

Prof. Dr. Peter Marhofer

E-Mail Website
Guest Editor
Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, 1090 Wien, Austria
Interests: regional anesthesia; pediatric anesthesia; pharmacology of local anesthetics
Dr. Philipp Opfermann

E-Mail Website
Guest Editor
Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, 1090 Wien, Austria
Interests: regional anesthesia; pediatric anesthesia, peri-operative medicine; epidemiology; cardio-thoracic anesthesia; neuro-anesthesia
Dr. Markus Zadrazil

E-Mail Website
Guest Editor
Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, 1090 Wien, Austria
Interests: regional anesthesia; pediatric anesthesia, peri-operative medicine

Special Issue Information

Dear Colleagues,

The progress in science has constantly improved the principles and practices in the demanding field of pediatric anesthesia during the recent decades. All these advances ultimately serve one goal: to maximize safety for children and minimize the risk of anesthesia. For example, the use of ultrasound alone has opened up completely new possibilities for regional anesthesia in infants and premature babies. However, despite the ever-increasing wealth of knowledge, there are still hot topics that need to be scrutinized much more closely. This special Issue highlights “hot topics” being in the mind of the pediatric anesthesia community. The “clinical updates” section includes potential neurotoxicity of anesthesia, hemostasis and neuroaxial blocks in infants, hemodynamics and volume substitution in pediatric patients, anesthesia for pediatric patients with complex syndromes, post-anesthesia emergence delirium, and techniques to address difficult venous access, particularly in a completely uncooperative child. The “perspectives section” addresses innovations with the use of virtual and augmented reality, artificial intelligence, and non-pharmacological neuromodulation in the pediatric anesthesia population.

We welcome authors to submit papers dealing with the above-mentioned topics.

Prof. Dr. Peter Marhofer
Dr. Philipp Opfermann
Dr. Markus Zadrazil
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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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 anesthesia
  • anesthesia
  • conduction
  • ultrasonography
  • conscious sedation
  • deep sedation
  • drug-related side effects and adverse reactions
  • neurotoxicity syndromes

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Published Papers (4 papers)

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Research

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10 pages, 508 KiB  
Article
Assessment of Prehospital Care for Pediatric Patients with Thermal Injuries: A Retrospective Study
by Daniel Frank, Anna Forst, Christopher Ortmann, Stephan Gehring, Tatjana T. König and Eva Wittenmeier
J. Clin. Med. 2025, 14(12), 4063; https://doi.org/10.3390/jcm14124063 - 9 Jun 2025
Abstract
Background/Objectives: Accurate prehospital assessment of total body surface area burned (TBSA-B) is crucial for pediatric burn management, guiding resuscitation, fluid therapy, and transfer decisions. This study evaluates the accuracy of prehospital TBSA-B estimations compared to in-hospital expert assessment and examines their impact on [...] Read more.
Background/Objectives: Accurate prehospital assessment of total body surface area burned (TBSA-B) is crucial for pediatric burn management, guiding resuscitation, fluid therapy, and transfer decisions. This study evaluates the accuracy of prehospital TBSA-B estimations compared to in-hospital expert assessment and examines their impact on prehospital management. Methods: This retrospective study analyzed 104 pediatric burn cases (median 17 months; 5 days–14 years) from 2017 to 2021. The primary endpoint was the difference between prehospital TBSA-B estimation and clinical measurement, with a clinically significant discrepancy defined as >5%. Secondary endpoints included the relationship between TBSA-B estimation and fluid therapy, analgesia, and hospital stay duration. Results: Prehospital TBSA-B estimations ranged from 2% to 40% (mean: 13.9%, SD = 4.4%) with scalds being the most common burn type (90.4%). Bland–Altman analysis showed a mean TBSA-B overestimation (bias) of 6.35%, with limits of agreement ranging from −6.97% (CI: −9.42 to −4.51) to 19.67% (CI: 17.21 to 22.12). No significant patterns in overestimation were associated with age, gender, or burn location. Fluid therapy volumes were independent of prehospital TBSA-B estimates, and analgesic administration varied by gender, with girls receiving less analgesia than boys, but showed no association with burn extent or severity. Hospital stay duration correlated proportionally with in-hospital assessed TBSA-B. Conclusions: Prehospital TBSA-B estimation was systematically overestimated, yet it did not influence fluid therapy decisions. Gender differences were observed in analgesic administration, while hospital stay duration was directly related to burn extent. These findings highlight the need for improved training and standardized tools to enhance prehospital burn assessment in pediatric patients. Full article
(This article belongs to the Special Issue Paediatric Anaesthesia: Clinical Updates and Perspectives)
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9 pages, 479 KiB  
Article
Extended Postoperative Analgesia via Caudal Catheters for Major Surgery in Neonates—A 6-Year Retrospective Study
by Stefan Heschl, Brigitte Messerer, Corinna Binder-Heschl, Michael Schörghuber and Maria Vittinghoff
J. Clin. Med. 2025, 14(8), 2651; https://doi.org/10.3390/jcm14082651 - 12 Apr 2025
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Abstract
Background: Caudal anesthesia is an important regional anesthetic technique in neonates. The placement of a catheter can provide excellent analgesia for a prolonged period; the role of adjuvants, in particular morphine, however, remains unclear. We aimed to describe our experience with caudal [...] Read more.
Background: Caudal anesthesia is an important regional anesthetic technique in neonates. The placement of a catheter can provide excellent analgesia for a prolonged period; the role of adjuvants, in particular morphine, however, remains unclear. We aimed to describe our experience with caudal catheters for major surgery in neonates. Methods: We included all neonates who had a caudal catheter placed for major abdominal and thoracic surgery and explored postoperative pain management and catheter complications. This retrospective case series included neonates with caudal catheter placement from October 2012 to April 2018 at a tertiary university hospital. Results: A total of 33 caudal catheter placements in 32 neonates were included in this study, of which 28 (85%) were a laparotomy and 5 (15%) a thoracotomy. The mean catheter duration was 135 h with a postoperative failure rate of 3%. Patients who did not receive intravenous opioids postoperatively had a significantly shorter stay in the intensive care unit than those who did (341 h vs. 674 h, p = 0.01). All patients received continuous local anesthetics over the catheter, and 79% received additional intermittent epidural morphine postoperatively for a median period of 42 h. No infectious complications were reported. Conclusions: Caudal catheters are a valuable option for perioperative analgesia for major surgery in neonates. We found no serious catheter-related complication. Further research is needed to define the optimal approach and combination of different analgesic techniques. Full article
(This article belongs to the Special Issue Paediatric Anaesthesia: Clinical Updates and Perspectives)
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16 pages, 1906 KiB  
Article
A Meta-Analysis of the Impact of Intranasal Dexmedetomidine on Emergence Delirium and Agitation in Children and Adolescents Undergoing Tonsillectomy and/or Adenoidectomy
by Abbas Al Mutair, Yasmine Alabbasi, Bushra Alshammari, Awatif M. Alrasheeday, Hanan F. Alharbi and Abdulsalam M. Aleid
J. Clin. Med. 2025, 14(5), 1586; https://doi.org/10.3390/jcm14051586 - 26 Feb 2025
Viewed by 601
Abstract
Background: Tonsillectomy and adenoidectomy are two common pediatric operations that are frequently associated with postoperative problems like emergence agitation (EA) and emergence delirium (ED). Intranasal dexmedetomidine, which has anxiolytic and sedative qualities with low respiratory effects, is becoming increasingly popular as a premedication [...] Read more.
Background: Tonsillectomy and adenoidectomy are two common pediatric operations that are frequently associated with postoperative problems like emergence agitation (EA) and emergence delirium (ED). Intranasal dexmedetomidine, which has anxiolytic and sedative qualities with low respiratory effects, is becoming increasingly popular as a premedication in pediatric patients. However, there is limited evidence on its efficacy in tonsillectomy and/or adenoidectomy. This original research is a meta-analysis examining the impact of intranasal dexmedetomidine on EA, ED, and other perioperative outcomes in children having these procedures. Methods: A thorough search of the PubMed, Scopus, Web of Science, and Cochrane Library databases was performed for randomized controlled trials (RCTs) published by January 2025 of select studies on children undergoing tonsillectomy and/or adenoidectomy. The intervention was intranasal dexmedetomidine (1–2 µg/kg), whereas the comparator was placebo/no intervention. Results: Four RCTs with 669 children met our inclusion criteria. Intranasal dexmedetomidine substantially decreased the incidence of EA (RR = 0.39, 95% CI: 0.16 to 0.92, p = 0.03) and ED (RR = 0.45, 95% CI: 0.24 to 0.84, p = 0.01), despite significant heterogeneity. Pediatric Anesthesia Emergency Delirium (PAED) scores were also considerably lower in the dexmedetomidine group (MD = −2.11, 95% CI interval: −3.77 to −0.44, p = 0.01). We found significant changes in extubation time (p = 0.91) or PACU discharge time (p = 0.53). Conclusions: Intranasal dexmedetomidine may reduce the occurrence of EA and ED, while also lowering PAED scores in children undergoing tonsillectomy and/or adenoidectomy. And although it has demonstrated safety with few side effects, more research is needed to validate its impact on other perioperative outcomes and enhanced dosing regimens. Full article
(This article belongs to the Special Issue Paediatric Anaesthesia: Clinical Updates and Perspectives)
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Review

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13 pages, 2281 KiB  
Review
Recovery Time, Patient Satisfaction, and Safety of Intranasal Sedatives in Pediatric Dentistry: A Systematic Review and Meta-Analysis
by Selvakumar Haridoss, Sushmita Shan, Guna Shekhar Madiraju, Kavitha Swaminathan, Rohini Mohan, Faris Yahya I. Asiri, Yousef Majed Almugla and Mohammad Alhussein Hamidaddin
J. Clin. Med. 2025, 14(12), 4038; https://doi.org/10.3390/jcm14124038 - 7 Jun 2025
Viewed by 154
Abstract
Background: Intranasal sedation is commonly used in pediatric dentistry to manage dental anxiety and improve patient compliance. This systematic review and meta-analysis aimed to evaluate the recovery time, patient satisfaction, and adverse effects of the intranasal sedatives midazolam, dexmedetomidine, and ketamine in pediatric [...] Read more.
Background: Intranasal sedation is commonly used in pediatric dentistry to manage dental anxiety and improve patient compliance. This systematic review and meta-analysis aimed to evaluate the recovery time, patient satisfaction, and adverse effects of the intranasal sedatives midazolam, dexmedetomidine, and ketamine in pediatric dental procedures. Methods: A systematic search of PubMed, Scopus, the Web of Science, the Cochrane Library, Embase, and Google Scholar was conducted following the PRISMA 2020 guidelines. Only randomized controlled trials (RCTs) involving intranasal sedation in pediatric patients (≤18 years) were included. The revised Cochrane risk of bias tool (RoB 2) was employed to assess study quality. A meta-analysis using a random-effects model was performed to evaluate the recovery time. Results: Twenty-one RCTs were included in this review. A meta-analysis of seven studies revealed that dexmedetomidine was associated with significantly longer recovery times compared to midazolam and ketamine. Specifically, midazolam demonstrated the shortest recovery time (mean difference: −19.1 min, p < 0.05), followed by ketamine (mean difference: −15.6 min, p < 0.05). A qualitative analysis of adverse effects showed mild to moderate complications, including nasal irritation (midazolam), prolonged sedation (dexmedetomidine), and hypersalivation (ketamine). Patient satisfaction was found to be highest with dexmedetomidine, although midazolam was preferred for its faster onset of sedation. Conclusions: Intranasal sedation in pediatric dentistry is a safe and effective approach, with each agent exhibiting distinct recovery profiles and safety considerations. The findings emphasize the importance of standardized sedation protocols and the need for further research into the long-term outcomes of these sedatives in pediatric populations. Full article
(This article belongs to the Special Issue Paediatric Anaesthesia: Clinical Updates and Perspectives)
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