Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis‐à‐vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications.

Background: The modifying effects of fentanyl on protective airway reflexes have not been characterized in children. The aim of this study was to assess the impact of increasing doses of fentanyl on laryngeal reflex responses in children anesthetized with sevoflurane. The authors hypothesized that the incidence of laryngospasm evoked by laryngeal stimulation is reduced with increasing doses of fentanyl. Methods: Sixty-three children, aged 2-6 yr, scheduled for elective surgery, were anesthetized with sevoflurane (1 minimum alveolar concentration). By using an established technique, laryngeal and respiratory responses were elicited by spraying distilled water on the laryngeal mucosa: (1) before the administration of fentanyl, (2) after the administration of 1.5 microg/kg fentanyl, and (3) after the administration of a second dose of 1.5 microg/kg fentanyl. In 10 children, serving as a time control, three successive laryngeal stimulations were performed without the administration of fentanyl. The responses were assessed by a blinded reviewer. Results: The study was completed in 60 patients. The incidence of laryngospasm was not reduced when up to two successive doses of 1.5 microg/kg fentanyl were administered. The incidence of laryngospasm lasting for more than 10 s was 26% before receiving fentanyl, 31% after recieving1.5 microg/kg fentanyl, and 18% after receiving a second dose of 1.5 microg/kg fentanyl (P = 0.36 and 0.78, respectively). This response was similar to that observed in the time control group (P = 0.21). Conclusion: Two successive doses of 1.5 microg/kg fentanyl did not effectively prevent laryngospasm in children, aged 2-6 yr, anesthetized with sevoflurane.

Introduction: Brace treatment is the gold standard for patients with mild adolescent idiopathic scoliosis (Cobb angle 20°–40°). However, negative psychosocial impacts, physical constraints and incompliance cause many patients and parents to seek for so-called holistic and apparently less harmful approaches within the field of complementary and alternative medicine (CAM). Osteopathy—manual interventions on the viscera and locomotor system—is widely used for scoliosis. There is, however, a complete lack of evidence regarding its efficacy. We, therefore, tested the hypothesis that osteopathy alters trunk morphology, a prerequisite to unload the concave side of the scoliosis, and that it halts curve progression. Methods: This was a prospective, controlled trial of 20 post-pubertal young women (20°–40° idiopathic scoliosis) randomly allocated to an observation (group 0) or osteopathic treatment (group 1). The latter comprised three sessions (5 weeks). Trunk morphology (clinical examination, video rasterstereography) and spine flexibility (MediMouse^®) were assessed at a pre- and post-intervention with a 3-month interval (blinded examiner). We chose scoliometer measurement (rib hump, lumbar prominence) as the main outcome parameter. Results: Two patients in the treatment group refused further treatment and the final examination, as they felt no benefit after two osteopathic treatments. Regression analysis for repeat measurements (independent statistician) revealed no therapeutic effect on rib hump, lumbar prominence, plumb line, sagittal profile and global spinal flexibility. Conclusions: We found no evidence to support osteopathy in the treatment of mild adolescent idiopathic scoliosis. Therefore, we caution against abandoning the conventional standard of care for mild idiopathic scoliosis. As for other CAM therapies, the use of osteopathy as a treatment option for scoliosis still needs to be clearly defined.