Advancements in pediatric anesthesia techniques; Safety, and outcomes: An updated review

Abstract

Recent advancements in paediatric anaesthesia have significantly improved safety, efficacy, and overall outcomes. Key innovations include the implementation of Enhanced Recovery After Surgery (ERAS) protocols, which promote reduced fasting times (1 hour for clear fluids), preoperative counselling, and avoiding routine pharmacological premedication, leading to quicker recovery and reduced stress for paediatric patients. Airway management has also advanced with the introduction of apnoeic oxygenation alongside preoxygenation, minimizing desaturation risks during intubation. Additionally, the integration of advanced monitoring technologies, such as Masimo Signal Extraction Technology (SET), Near-Infrared Spectroscopy (NIRS), and Bispectral Index (BIS) EEG, has enhanced the accuracy and safety of anaesthesia management. The shift from central neuraxial blocks to peripheral nerve blocks, including erector spinae and paravertebral blocks, has improved pain management with better safety. New pharmacological agents like remimazolam and articaine have offered enhanced pharmacokinetics for paediatric patients. Research from many studies has clarified the neurodevelopmental effects of anaesthesia, underscoring the need for further studies. Additionally, updates to the American Heart Association-Pediatric Advanced Life Support (AHA-PALS) guidelines have enhanced paediatric resuscitation protocols. While these advancements have significantly improved care, global disparities in healthcare access remain a challenge. This review article is on the advancements in paediatric anaesthesia, exploring the progress and ongoing challenges to enhance patient safety and outcomes.