Preoperative preparation is a complex series of steps aimed at establishing the conditions for selecting an individualized perioperative plan, bringing the child to the best possible state of health state, stabilizing higher-risk patients and reducing them to a lower-risk stage, informing parents about the type of anesthesia planned and the potential risks and complications, and minimizing parental anxiety. However, anticipation and the route to surgery create preoperative anxiety in children and their parents. Under conditions of increased stress, the child’s cooperativeness decreases, the requisite dosages of medications for premedication and induction increase, delirium may occur, and wound healing and recovery as a whole are prolonged. Sensitivity to pain also increases, leading to longer hospital stays and less satisfaction among patients and parents. Premedication is tailored to each patient based on age, body weight, health status, psychological profile, and the extent of the intervention. A thorough discussion with the anesthesiologist, a detailed examination, and an individualized anesthetic plan can minimize these effects. This paper describes pharmacological methods of preoperative preparation, provides recommended dosages, and draws attention to the potential side effects of the medications.

Background/Objectives: Prediction of a difficult airway during pre-anesthetic evaluation is of great importance because it enables an adequate anesthetic approach and airway management. As there is a scarcity of prospective studies evaluating the role of anthropometric measures of the face and neck in predicting difficult airways in infants with an apparently normal airway, we aimed to identify the aforementioned predictors of difficult facemask ventilation and intubation in infants. Methods: A prospective, observational study that included 97 infants requiring general endotracheal anesthesia was conducted. Anthropometric and specific facial measurements were obtained before ventilation and intubation. Results: The incidence of difficult facemask ventilation was 15.5% and 38.1% for difficult intubation. SMD (sternomental distance), TMA (tragus-to-mouth angle distance), NL (neck length) and mouth opening were significantly lower in the difficult facemask ventilation group. HMDn (hyomental distance in neutral head position), HMDe (hyomental distance in neck extension), TMD (thyromental distance), SMD, mandibular development and mouth opening were significantly different in the intubation difficulty group compared to the non-difficult group. HMDn and HMDe showed significantly greater specificities for difficult intubation (83.8% and 76.7%, respectively), while higher sensitivities were observed in TMD, SMD and RHSMD (ratio of height to SMD) (89.2%, 75.7%, and 70.3%, respectively). Regarding difficult facemask ventilation, TMA showed greater sensitivity (86.7%) and SMD showed greater specificity (80%) compared to other anthropometric parameters. In a multivariate model, BMI (body mass index), COPUR (Colorado Pediatric Airway Score), BOV (best oropharyngeal view) and TMA were found to be independent predictors of difficult intubation, while BMI, ASA (The American Society Physical Status Classification System), CL (Cormack–Lehane Score), TMA and SMD predicted difficult facemask ventilation. Conclusions: Preoperative airway assessment is of great importance for ventilation and intubation. Patient’s overall condition and facial measurements can be used as predictors of difficult intubation and ventilation.

The beginnings of pediatric anesthesiology go back to the center of nineteenth century, and it’s associated with a rural physician Crawford W. Long, MD, who in the 1842 recorded the first case of giving diethyl ether anesthesia to an eight-year-old boy. The start of development of contemporary pediatric anesthesia is considered to be in 1930: which marked two periods of progress. In the first period were developed anesthesia techniques and accessories adjusted to different children's ages. In the second period, modern anesthetic medications and supervision are introduced into everyday clinical practice in order to better protect vital organs and their functions in the child's body. In 1955 was established the first multidisciplinary pediatric intensive care unit at the Children’s Hospital of Goteburg in Sweden. Dr. Branka Mitrovic is considered to be the beginner of pediatric anesthesiology in our country, as she founded the Department of anesthesiology and reanimation in the University children's hospital in 1955. The history of pediatric regional anesthesia began after it’s introduction in adults, which occurred after the invention of cocaine in 1884. The Ministry of Health of the Republic of Serbia, in 2018, approved a specialisation in pediatric anesthesiology. The development of pediatric anesthesia is fascinating because it completely followed the development of pediatric surgery. Modern pediatric anesthesiology is entirely prepared to meet the needs of the most complex surgical interventions, as well as the treatment of critically ill children, and significantly contribute to the better outcomes of the treatment of pediatric surgical patients.

?Refeeding syndrome? is described in the literature as a range of metabolic and electrolyte disorders that result from starting nutritional rehabilitation in malnourished patients. Without a universally accepted definition, data on ?refeeding syndrome? incidence are heterogeneous. In most cases, a clinician will subjectively identify ?refeeding syndrome,? many authors have developed their purposes and criteria for it in their studies. Using the PubMed database and the appropriate filters (?refeeding syndrome?-related terms: refeeding syndrome, pediatrics, child, nutrition support, nutrition assessment, malnutrition), a search of the published literature was conducted. The American Society for Parenteral and Enteral Nutrition?s 2020 recommendations are the only guidelines for identifying children with or at risk for ?refeeding syndrome?. High-quality scientific evidence regarding the clinical syndrome is absent, so we need further research in all ?refeeding syndrome?-related areas, from validation to better identification of risk factors, definitions of ?refeeding syndrome,? and standardization of treatment protocols. For now, clinicians must remain vigilant to protect patients from the potentially devastating consequences of the ?refeeding syndrome.?