BACKGROUND Better understanding of risk factors for adverse events during monitored anaesthesia care (MAC) for paediatric gastrointestinal endoscopy may improve outcome in children. OBJECTIVES To identify the prevalence and predictors of adverse events during MAC for paediatric endoscopy. DESIGN An observational study. SETTING Tertiary university hospital, single-centre cohort, from January 2010 to August 2016. PATIENTS The prospectively collected electronic anaesthetic records of 3435 children aged up to 16 years who underwent diagnostic gastrointestinal endoscopy under MAC were analysed retrospectively. Children with an American Society of Anesthesiologists’ physical status at least 4, and those requiring mechanical ventilation and therapeutic or urgent endoscopy were excluded. MAIN OUTCOME MEASURES The prevalence and predictors of adverse events during MAC for paediatric gastrointestinal endoscopy, with particular reference to the use of different anaesthetic or sedative agents. RESULTS Mean ± SD age of the children was 8.5 ± 4.4 years. The incidences of adverse events and adverse respiratory events were 3.4 and 3.3%, respectively. Multivariate analysis identified 12 independent predictors: age [odds ratio (OR) 0.92, P = 0.002], children's size for example underweight (OR 1.78, P = 0.039), overweight (OR 2.20, P = 0.039), (morbid) obesity (OR 4.25, P = 0.006), presence of respiratory comorbidities (OR 8.18, P < 0.001), recent respiratory infection (OR 23.55, P < 0.001) or both (OR 17.46, P < 0.001), neurological comorbidities (OR 2.18, P = 0.007), upper gastrointestinal endoscopy (OR 5.66, P < 0.001), propofol co-administration with ketamine (OR 10.34, P < 0. 001) or after sevoflurane induction (OR 44.95, P < 0.001), and propofol induction dose (OR 18.97, P < 0.001). Posthoc secondary analyses revealed a significantly higher risk of adverse events (OR 3.9, P < 0.0001) and also significantly more respiratory comorbidities and respiratory infections (P < 0.0001) in children aged less than 2 years when compared with children aged at least 2 years. No cardiovascular events were observed and outcome was uneventful. CONCLUSION The present cohort demonstrated the feasibility and safety of MAC for paediatric gastrointestinal endoscopy by an experienced team. Although adverse events occurred rarely, their predictive factors were clinically identifiable. Applying this information in risk assessment and modifying anaesthetic management accordingly could improve outcome. TRIAL REGISTRATION ISRCTN70362666.

Background: Magnetic resonance imaging (MRI) is the diagnostic imaging modality of choice for pediatric patients. However, it can be challenging to scan young children awake while maintaining a high image quality with an efficient, patient-friendly workflow. Objective: We investigated if an audio-visual intervention with specially designed pediatric content could reduce MRI-related patient anxiety and workflow-issues in children during an awake MRI. Materials and methods: In six European hospitals, children (n = 175; aged 6–12 years) were scanned with child-friendly content (intervention) or without (control). Staff recorded children’s stress levels before, during, and after the MRI on a 6-point Likert scale. Scan issues (i.e., repeat scans and interruptions) were recorded by staff and extracted from the MRI logfiles. Results: The stress level of young children (aged 6–10 years) in the intervention group decreased more strongly from before to after the MRI compared to the control group, F _(2,96) = 7.84, P < 0.001. They also had significantly fewer scan issues as reported by staff, F _(1,169) = 8.36, P = 0.004, Cohen’s d = 0.58, and as logged by the MRI system, F _(1,156) = 8.10, P = 0.005, Cohen’s d = 0.45. The used pediatric content showed no significant effects on older children (aged 10 + years). Conclusion: A child-friendly audio-visual intervention can help reduce stress levels of young children (aged 6–10 years) and support a smooth workflow. Trial registration number: NCT05089955, date: 2021–10-22. Graphical