ABSTRACTIntroductionLidocaine is widely used in pediatric anesthesia for airway topicalization to modulate undesirable airway and circulatory reflexes, yet its effectiveness remains unclear. Therefore, we aimed to perform a meta‐analysis evaluating the impact of topical lidocaine on respiratory adverse events in children undergoing airway management.MethodsPubMed, Embase, and Cochrane databases were systematically searched for studies comparing topical lidocaine with placebo, no intervention, or intravenous lidocaine for pediatric airway management. Statistical analysis was performed using R (version 4.4.1). Odds ratios (ORs) were used for binary outcomes and mean differences for continuous outcomes, with 95% confidence intervals (CIs) computed using a random‐effects model.ResultsFourteen randomized controlled trials comprising 1937 pediatric patients were included, of whom 917 (47%) received airway topicalization. In those receiving topical lidocaine, there was a significant reduction in the incidence of laryngospasm (OR 0.50; 95% CI 0.27 to 0.95; p = 0.033), desaturation (OR 0.49; 95% CI 0.25 to 0.98; p = 0.043), and sore throat (OR 0.31; 95% CI 0.16 to 0.58; p < 0.001). However, no significant differences were observed for bronchospasm (OR 0.50; 95% CI 0.11 to 2.35; p = 0.382), cough (OR 0.56; 95% CI 0.28 to 1.11; p = 0.099), severe cough (OR 1.30; 95% CI 0.18 to 9.51; p = 0.793), hoarseness (OR 1.41; 95% CI 0.17 to 11.96; p = 0.754), vomiting (OR 1.95; 95% CI 0.47 to 7.99; p = 0.355), and heart rate (beats/min) (MD 0.08; 95% CI −6.31 to 6.47; p = 0.98).ConclusionOur findings suggest that topical lidocaine may reduce the incidence of undesirable airway reflexes such as laryngospasm, desaturation, and sore throat in children undergoing airway management. However, its benefit for other perioperative respiratory adverse events requires further investigation, especially in high‐risk populations.Trial RegistrationPROSPERO registration number: CRD42024614863

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Tonsillectomy is associated with a high rate of postoperative nausea and vomiting (PONV), ranging between 40% and 73%, and dexamethasone has been found to have a prophylactic effect on PONV in children undergoing tonsillectomy. In 2020, there was a sudden, severe shortage of intravenous dexamethasone given its role in treating patients with COVID-19. The primary aim of this study was to investigate the viability of an alternative: non-inferiority of oral versus intravenous dexamethasone for preventing PONV. Secondary objectives included pain and surgical complication outcomes. One hundred twenty-six patients aged 3 to 7 years old undergoing tonsillectomy were prospectively randomized to receive 0.5 mg/kg oral or intravenous dexamethasone (maximum dose 8 mg). PONV data were recorded from the post-anesthesia care unit and post-op day 3 to 5 nursing phone calls. Pain was assessed using the numeric pain scale 0 to 10 or the Faces, Legs, Arms, Crying, Consolability (FLACC) Scale. Seventy-two (57.1%) males and 54 (42.9%) females with a mean age of 5.36 years were included in the analysis. Sixty-three (50.0%) patients received oral dexamethasone, and 63 patients received intravenous dexamethasone. Three patients were noted to have nausea in the post-anesthesia care unit, all of whom received oral dexamethasone (2.4%), an absolute risk difference of 4.8% (95% CI 1.6% to 9.5%). Four patients had vomiting in the post-anesthesia care unit, all of whom received oral dexamethasone (3.2%), an absolute risk difference of 6.3% (95% CI 1.6% to 11.1%). Fifteen patients reported nausea and vomiting after discharge; 6/15 (40%) received oral dexamethasone and 9/15 (60%) received intravenous dexamethasone (absolute risk difference -5.4% (95% CI -15.6% to 4.9%)). Substituting oral dexamethasone in place of intravenous dexamethasone resulted in a non-inferior rate of PONV for pediatric patients undergoing tonsillectomy. Oral dexamethasone is a reasonable substitute for intravenous dexamethasone, particularly during an immediate, unexpected medication shortage.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Earthquakes are chaotic events that cause severe physical and psychological devastation. Due to their anatomical and physiological differences and fragile nature, pediatric earthquake survivors require special attention in anesthesia management. This retrospective study aims to share our experiences and anesthesia techniques applied to pediatric earthquake victims in our tertiary care pediatric hospital. Furthermore, the study aimed to determine the time spent under rubble cutoff value for the development of crush syndrome and creatine kinase cutoff value for the development of acute kidney injury in child earthquake victims. Child earthquake victims under the age of 18 who underwent anesthesia in our hospital after the earthquake that occurred on February 6, 2023, were included in this study. Demographic data, Glasgow Coma Scale scores at admission, the time spent under rubble, existing injuries, Injury Severity Score, presence of crush syndrome and acute kidney injury, need for hemodialysis, length of hospital and intensive care unit stay, type of surgical intervention, and preoperative and discharge laboratory results were analyzed. The type of anesthetic agents used and airway management techniques were recorded. A total of 45 pediatric earthquake victims underwent 362 surgical interventions. Extremity injuries were more common in our patients. We most frequently administered the MAC technique to our patients using sedation and ketamine-based general anesthesia. For airway management, nasal O2 support (44.0%) and SGA (43.2%) were most commonly used. The mean Injury Severity Score was calculated as 22.18 (95% CI: 19.17-25.18). We found that a cutoff value of ≥ 22.5 min spent under debris strongly predicted the development of crush syndrome, and a creatine kinase cutoff value of ≥ 32 029 IU/L strongly predicted the development of AKI. The findings of our study may serve as a guide for anesthesia management and perioperative processes in pediatric earthquake victims in future disaster scenarios. ClinicalTrials.gov identifier: NCT06310265.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Assess Postoperative Care Following Pediatric Outpatient SurgeryA great tool for assessing how your day surgery is going. Error Traps in Infant Spinal AnesthesiaGems to help you succeed in one of our most satisfying techniques. Hemodynamic Effects of Altering Tidal Volume During Positive Pressure Ventilation in the Fontan Circulation: A Randomized Crossover TrialEssential reading for anyone who looks after these challenging cases; maybe the tidal volume isn't as critical as we thought Thrombotic Complications of Low-Dose Versus High-Dose Four-Factor Prothrombin Complex Concentrate for Massive Bleeding in Pediatric Cardiovascular SurgeryNo increased thrombotic risk. Insights From the Child's Perspective-Validation of the English Version of the Pictorial Version of the Quality of Recovery-15 QuestionnaireAnother great tool for measuring outcomes.