Background: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia. Methods: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search. Results: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management. Conclusions: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children.

The analysis of survey data is a frequently arising issue in clinical trials, particularly when capturing quantities which are difficult to measure. Typical examples are questionnaires about patient's well‐being, pain, or consent to an intervention. In these, data is captured on a discrete scale containing only a limited number of possible answers, from which the respondent has to pick the answer which fits best his/her personal opinion. This data is generally located on an ordinal scale as answers can usually be arranged in an ascending order, for example, “bad”, “neutral”, “good” for well‐being. Since responses are usually stored numerically for data processing purposes, analysis of survey data using ordinary linear regression models are commonly applied. However, assumptions of these models are often not met as linear regression requires a constant variability of the response variable and can yield predictions out of the range of response categories. By using linear models, one only gains insights about the mean response which may affect representativeness. In contrast, ordinal regression models can provide probability estimates for all response categories and yield information about the full response scale beyond the mean. In this work, we provide a concise overview of the fundamentals of latent variable based ordinal models, applications to a real data set, and outline the use of state‐of‐the‐art‐software for this purpose. Moreover, we discuss strengths, limitations and typical pitfalls. This is a companion work to a current vignette‐based structured interview study in pediatric anesthesia.

In pediatric anesthesia, deviations from normothermia can lead to many complications, with infants and young children at the highest risk. A measurement method for core temperature must be clinically accurate, precise and should be minimally invasive. Zero-heat-flux (ZHF) temperature measurements have been evaluated in several studies in adults. We assessed the agreement between the 3M Bair Hugger^™ temperature measurement sensor (T_ZHF) and esophageal temperature (T_Eso) in children up to and including 6 years undergoing surgery with general anesthesia. Data were recorded in 5 min-intervals. We investigated the accuracy of the ZHF sensor overall and in subgroups of different age, ASA classification, and temperature ranges by Bland–Altman comparisons of differences with multiple measurements. Change over time was assessed by a linear mixed model regression. Data were collected in 100 children with a median (1st–3rd quartile) age of 1.7 (1–3.9) years resulting in 1254 data pairs. Compared to T_Eso (range from 35.3 to 39.3 °C; median 37.2 °C), T_ZHF resulted in a mean bias of +0.26 °C (95% confidence interval +0.22 to +0.29 °C; 95% limits of agreement −0.11 to +0.62 °C). Lin’s concordance correlation coefficient was 0.89. There was no significant or relevant change of temperature over time (0.006 °C per hour measurement interval, p = 0.199) and no relevant differences in the subgroups. Due to the mean bias of +0.26 °C in T_ZHF, the risk of hypothermia may be underestimated, while the risk of hyperthermia may be overestimated. Nevertheless, because of its high precision, we consider ZHF valuable for intraoperative temperature monitoring in children and infants.

Background: Managing preoperative anxiety in pediatric anesthesia is challenging, as it impacts patient cooperation and postoperative outcomes. Both pharmacological and nonpharmacological interventions are used to reduce children’s anxiety levels. However, the optimal approach remains debated, with evidence-based guidelines still lacking. Health care professionals using social media as a source of medical expertise may offer insights into their management approaches. Objective: A public survey targeting health care professionals was disseminated via social media platforms to evaluate current practices in anxiety management in children. The same questions were posed during an annual meeting of pediatric anesthesiologists with their responses serving as reference. The primary objective was to compare pediatric anesthesia expertise between the groups, while secondary objectives focused on identifying similarities and differences in preoperative anxiety management strategies hypothesizing expertise differences between the groups. Methods: Two surveys were conducted. The first survey targeted 100 attendees of the German Scientific Working Group on Pediatric Anesthesia in June 2023 forming the “Expert Group” (EG). The second open survey was disseminated on social media using a snowball sampling approach, targeting followers of a pediatric anesthesia platform to form the “Social Media Group” (SG). The answers to the 24 questions were compared and statistically analyzed. Questions were grouped into 5 categories (pediatric anesthesia expertise, representativity, structural conditions, practices of pharmacological management, and practices in nonpharmacological management). Results: A total of 194 responses were analyzed (82 in EG and 112 in SG). The EG cohort exhibited significantly greater professional experience in pediatric anesthesia than the SG cohort (median 19 vs 10 y, P<.001), higher specialist status (97.6% vs 64.6%, P<.001), and a greater pediatric anesthesia volume (43.9% vs 12% with more than 500 cases per year, P<.001). Regarding the representativity, 2 items out of 4 were statistically significant (level of care of institution, annual caseload of institution). Regarding the overall anxiety management practices used, there is a heterogeneous response pattern within both groups. Conclusions: Despite heterogeneous approaches, health care professionals using social media demonstrated less expertise in pediatric anesthesia but showed minimal differences in the daily management of preoperative anxiety compared with pediatric anesthesia experts. Our study highlights the potential for meaningful use of social media but future studies should explore the impact of social media health care professionals’ knowledge in other specific topics. Additionally, regarding preoperative anxiety, further recommendations are needed that could help to standardize and improve anxiety levels in children.

Background: Scientometric analyses characterize the output of research publications using quantitative methods. While it has been reported that the number of publications in anesthesiology has been increasing for years, the global research activity in pediatric anesthesiology and its landscape is largely unknown.Aims: To examine the activity, developmental dynamics, and collaboration landscape of research publications in pediatric anesthesiology over the past two decades.Methods: PubMed and WebOfScience were searched for pediatric anesthesiology publications published between 2001 and 2020. The identified publications were exported into a database, matched, curated, and then assigned to one or more countries according to their affiliation field(s). The primary outcome was the publication activity and its growth rate. Secondary outcomes included the geographical distribution, the evolution of international collaborations (as indicated by articles affiliated with more than one country), and the main sources.Results: Thirty‐four thousand, three hundred and forty‐three pediatric anesthesiology publications were retrieved. The compound annual growth rate over the study period was +7.6%. The highest annual growth rate was +20.6% from 2019 to 2020. Corresponding authors were most often affiliated with USA (32.5%), Germany (5.5%), and China (5.5%). China (+22.9%), Iran (+21.7%), and India (+16.1%) had the highest compound annual growth rates. 6001 (17.5%) articles involved international collaboration, with a compound annual growth rate of +13.1%. The most frequent collaboration was between USA and Canada (716 articles together). The most prominent source was Pediatric Anesthesia (10.0%).Conclusions: Publication activity in pediatric anesthesiology has increased from 2001 to 2020 and has become more geographically diverse. With the volume of international collaborations even outpacing this growth, it is hoped that this will gradually lead to a larger evidence base in pediatric anesthesia.

Background: Maintenance of normothermia is an important quality metric in pediatric anesthesia. While inadvertent hypothermia is effectively prevented by forced‐air warming, this therapeutic approach can lead to iatrogenic hyperthermia in young children.Aims: To estimate the influence of external warming by forced air on the development of intraoperative hyperthermia in anesthetized children aged 6 years or younger.Methods: We pooled data from two previous clinical studies. Primary outcome was the course of core temperature over time analyzed by a quadratic regression model. Secondary outcomes were the incidence of hyperthermia (body core temperature >38°C), the probability of hyperthermia over the duration of warming in relation to age and surface‐area‐to‐weight ratio, respectively, analyzed by multiple logistic regression models. The influence of baseline temperature on hyperthermia was estimated using a Cox proportional hazards model.Results: Two hundred children (55 female) with a median age of 2.1 [1^st–3^rd quartile 1–4.2] years were analyzed. Mean temperature increased by 0.43°C after 1 h, 0.64°C after 2 h, and reached a peak of 0.66°C at 147 min. Overall, 33 children were hyperthermic at at least one measurement point. The odds ratios of hyperthermia were 1.14 (95%‐CI: 1.07–1.22) or 1.13 (95%‐CI: 1.06–1.21) for every 10 min of warming therapy in a model with age or surface‐area‐to weight ratio (ceteris paribus), respectively. Odds ratio was 1.33 (95%‐CI: 1.07–1.71) for a decrease of 1 year in age and 1.63 (95%‐CI: 0.93–2.83) for an increase of 0.01 in the surface‐to‐weight‐area ratio (ceteris paribus). An increase of 0.1°C in baseline temperature increased the hazard of becoming hyperthermic by a factor of 1.33 (95%‐CI: 1.23–1.43).Conclusions: In children, external warming by forced‐air needs to be closely monitored and adjusted in a timely manner to avoid iatrogenic hyperthermia especially during long procedures, in young age, higher surface‐area‐to‐weight ratio, and higher baseline temperature.