Background: Pain is one of the most common complaints among all age groups. Adult patients can express pain more clearly. Unfortunately, pediatric patients cannot perform this. This study aimed to assess the extent of knowledge of healthcare providers regarding acute pediatric pain management. Methods: A cross-sectional study was conducted utilizing the modified Knowledge and Attitude Survey Regarding Pain (KASRP) questionnaire through face-to-face interviews. The modified version included 34 questions (24 true/false questions and 10 MCQs). This study targeted anesthesiologists, pediatricians, and pediatric nurses through interviews. Demographic and educational data were analyzed as factors affecting the results of the KASRP questionnaire. The total score was classified as poor, fair, or good. Results: A total of 137 participants were enrolled in this study. The mean age was 31.8 years, and of the participants, 62.8% were women, 30.0% were anesthesia physicians, 25.5% were pediatric physicians, and 44.5% were pediatric nurses. The participants scored an average of 20.7 out of 34. Performance was categorized as poor, fair, or good, with 22.6%, 64.2% and 13.2% of participants falling into each category, respectively. The mean score of correct responses was higher for anesthesiologists (p = 0.0001). Specialists achieved higher mean scores than residents. Completion of pediatric pain management courses and the use of assessment tools were linked to higher performance. Conclusions: Pediatric nurses achieved lower scores for knowledge of acute pediatric pain management than physicians. Anesthesiologists achieved the highest score, probably because of their training in pain management. All healthcare providers should attend pain management courses.

Background: Congenital insensitivity to pain (CIPA) is an extremely rare syndrome that is caused by a mutation in the NTRK gene. CIPA is characterized by recurrent episodes of unexplained fever, infections, skeletal complications, anhidrosis, mental retardation, and ocular injuries due to the absence of reaction to painful stimuli. Several musculoskeletal complications have been reported and included fractures, avascular necrosis, joint dislocations, soft tissue, and bone infections. The severity of these complications presented complex diagnostic and therapeutic dilemmas. The collaboration of medical professionals from different specialties to provide appropriate medical care is needed. Case Presentation: We present a case of a 1-year-old girl, diagnosed with CIPA, admitted to our center complaining of wound discharge and fever from a previously repaired left forearm fracture with nail insertion, which was found to be infected after a failed trial of nail removal. A multidisciplinary- management from anesthesia, orthopedics, ophthalmology, and pediatrics was conducted. The patient underwent successful nail removal, wound debridement, and radius bone reduction with the appropriate anesthetic protocol that did not include analgesic medications. The follow-up course was uneventful with proper alignment and virtually stable health status, with no apparent skeletal or ocular complications. Conclusion: This report shows a case of CIPA with complicated forearm fracture. Patients with CIPA should be afforded a multidisciplinary healthcare approach in order to improve their quality of life and decrease the rate of complications. Parents and patients should be educated promptly. Orthopedics complications imply significant morbidity and require prompt surgical intervention with intense follow-up.

Background: The influence of obstetric anesthesia on neonates is still under investigation. We aimed to investigate the influence of type of anesthesia; either general anesthesia (GA) or spinal anesthesia (SA); during elective or emergency cesarean section (CS) on neonatal outcomes. Methods: A retrospective cohort study was conducted and all neonatal admissions to the neonatal intensive care unit for mothers who underwent elective or emergency CS as the mode of delivery during the period from 2017 to 2021 were enrolled in the study. The primary outcome of the study was to investigate the difference between SA and GA. The enrolled cohort was divided into two groups: GA and SA groups. Results: A total of 997 patients were included in the study cohort. Among these, 628 patients underwent CS under SA. On univariate analysis, it was revealed that SA was associated with better Apgar score (8.56 ± 0.04 vs 8.16 ± 0.05, P =0.0001), less incidence of respiratory distress syndrome (RDS) (35.5% vs 42.3%, P =0.02), intraventricular hemorrhage (IVH) (0.8% vs 13.6%, P =0.0001), and neonatal thrombocytopenia (12.4% vs 17.3%, P =0.021). Moreover, GA was linked to higher mortality rates (10.8% vs 4%, P =0.0001) and more birth depression (10.6% vs 4.3%, P =0.0001). On the other hand, GA was related to less incidence of transient tachypnea of the newborn (TTN) (6.2% vs 12.6%, P =0.001). On multivariate logistic regression analysis, mode of anesthesia was related to RDS, TTN, IVH, birth depression and neonatal death. Conclusion: GA use may be related to more adverse and worse neonatal outcomes. This is related to the utilization of GA more frequently in higher-grade emergencies and is associated with more adverse baseline predictors including lower gestational age, lower birth weight, and greater obstetric complications. SA could offer a localized effect for the anesthetic drugs. Further prospective trials are needed to justify the risk of both types of anesthesia.

Pediatric tracheostomy is a common procedure, with a substantial proportion of cases performed on infants, often due to chronic respiratory failure or complex airway anomalies. This case report details a critical intraoperative event involving a three-month-old infant undergoing tracheostomy for a laryngeal mass. The patient experienced immediate and profound ventilation failure following the insertion of a fenestrated tracheostomy tube. Mechanical obstruction was ruled out by passing a suction catheter through the tube. Furthermore, switching ventilatory modes to pressure-controlled volume-guaranteed (PC-VG) or volume-controlled ventilation (VCV) was also ineffective in restoring adequate ventilation. This was managed using a completely unfenestrated tube. The tube was placed and the breathing circuit connected, a large portion of the air leak was successfully eliminated, and appropriate ventilation parameters were restored. Fenestrated tracheostomy tubes have established benefits in adults; however, this case highlights a cautionary observation in ventilated infants due to potential air leak and ventilatory failure, underscoring careful tube selection.

Background: Cesarean delivery is commonly performed under either spinal or general anesthesia. While both techniques are widely used, their differential effects on maternal neurochemical profiles, particularly excitatory neurotransmitters such as glutamate, remain incompletely understood. Glutamate plays a central role in stress response, nociception, and neuroendocrine regulation. This study aimed to compare maternal salivary glutamate concentrations between spinal and general anesthesia during cesarean delivery. Method: In this prospective study, 66 women undergoing cesarean delivery were included: 32 received spinal anesthesia and 34 received general anesthesia. Unstimulated saliva samples were collected perioperatively and analyzed using a colorimetric enzymatic assay. Clinical and demographic variables were extracted from electronic medical records. Results: Baseline maternal and neonatal characteristics were comparable between groups (all p > 0.05). Glutamate concentrations were not normally distributed. Median salivary glutamate levels were significantly higher in the general anesthesia group compared with the spinal anesthesia group (8.05 nmol/µL [IQR 4.81–11.69] vs. 5.19 nmol/µL [IQR 3.05–8.39]; p = 0.041) After adjustment for maternal and perinatal covariates, anesthesia type was not independently associated with glutamate levels (p = 0.21). Conclusion: General anesthesia was associated with higher unadjusted maternal salivary glutamate levels compared with spinal anesthesia during cesarean delivery; however, this association did not persist after multivariable adjustment. These findings suggest that anesthesia technique alone may not independently influence perioperative glutamatergic responses. Further research is warranted to clarify the clinical significance of these neurochemical changes for maternal and neonatal outcomes.