Neuromuscular blockade in clinical practice in paediatric anaesthesia: retrospective cohort trial in a tertiary paediatric anaesthesia centre

Background. Neuromuscular blockade is associated with improved airway conditions for intubation and superior conditions for surgical interventions (predominantly important in laparoscopic surgery). Residual neuromuscular blockade in the postoperative period is, according to recently published data, associated with a negative impact on perioperative morbidity and mortality. Aim. Te aim of the study was to describe daily practice in clinical paediatric anaesthesia in a tertiary children’s hospital. Methods. Data from anaesthesiology records during the period 1.1.2016 to 31.12.2016 were retrospectively screened. Primary outcomes included the rate of surgery cases with neuromuscular blockade, the incidence of cases with perioperative neuromuscular blockade monitoring and the incidence of neuromuscular pharmacologic block reversal. Secondary outcomes were myorelaxant usage according to the age of patients and duration of surgery. Results. Overall 8046 paediatric patients underwent general anaesthesia in the study period. Muscle relaxants were administered in 1650 cases (20.5%). Te most frequently administered muscle relaxant was mivacurium (48.2 %, n=795), followed by cis-atracurium (36.4 %, n=601), suxamethonium (10.3 %, n=170) and rocuronium (7.0 %, n=115). Neuromuscular blockade monitoring was used only in 2.5% (n=41) of cases. Active neuromuscular blockade reversal was administered in 5.8% (n=95) of cases. Conclusion. Neuromuscular blockade in paediatric anaesthesia was less frequent compared to adults. Te low rate of neuromuscular blockade monitoring in combination with the low rate of active block reversal can be considered dangerous due to the relatively high risk of potential residual postoperative blockade, that can negatively influence clinical outcome

Controversies in Pediatric Perioperative Airways

Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient