Background: Neonates and infants requiring anaesthesia are at risk of physiological instability and complications, but triggers for peri-anaesthetic interventions and associations with subsequent outcome are unknown. Methods: This prospective, observational study recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. The primary aim was to identify thresholds of pre-determined physiological variables that triggered a medical intervention. The secondary aims were to evaluate morbidities, mortality at 30 and 90 days, or both, and associations with critical events. Results: Infants (n¼5609) born at mean (standard deviation [SD]) 36.2 (4.4) weeks postmenstrual age (35.7% preterm) underwent 6542 procedures within 63 (48) days of birth. Critical event(s) requiring intervention occurred in 35.2% of cases, mainly hypotension (>30% decrease in blood pressure) or reduced oxygenation (SpO 2 <85%). Postmenstrual age influenced the incidence and thresholds for intervention. Risk of critical events was increased by prior neonatal medical conditions, congenital anomalies, or both (relative risk [RR]¼1.16; 95% confidence interval [CI], 1.04e1.28

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO 2 <90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions:The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348.

Amaç: Postoperatif kusma genel anestezi sonrasında en sık karşıla-şılan problemlerden biridir. Etiyolojide pek çok faktörün tek başı-na veya birlikte etkili olduğu bilinmektedir. Akupunktur, Dünya Sağlık Örgütünün tamamlayıcı tedavi metodu olarak kabul ettiği bir medikal tekniktir. Burada çocuk hastalarda adenoidektomi ve/ veya tonsillektomi sonrasında görülen kusmanın tedavisi amacıyla Akupunktur deneyimimiz sunulmaktadır.Yöntemler: Çalışmaya genel anestezi altında adenoidektomi ve/ veya tonsillektomi uygulanan, 2-14 yaş arasında, ASA I-II, (n=70) hastalar dahil edildi. Hastalar çalışma ve kontrol grubu olarak, rastgele iki gruba ayrıldılar. Çalışma grubunda, akupunktur iğnesi intraoperatif dönemde 20 dakika P6 noktasında uygulandı. Gruplara postoperatif dönemde antiemetik herhangi bir tedavi verilmedi. Hastalar postoperatif dönemde grupları bilmeyen hemşireler tarafında takip edildi. Bulgular: Yaş, cinsiyet, girişim türü, anestezi süresi, girişim süresi, cerrahi uygulama ve ASA skorları göz önüne alındığında gruplar arasında istatistiksel olarak anlamlı farklılık saptanmadı. Grupların kusma sayıları karşılaştırıldığında ise anlamlı farklılık olduğu saptandı. Akupunktur uygulanan grupta kusma sıklığının diğer gruba göre 0,28 kat daha az olduğu görüldü.Sonuç: Çalışmamızın sonuçları, akupunktur uygulamasının postoperatif kusmayı azaltmada açık bir etkinliği olduğunu gös-termektedir. Akupunkturun rutin kullanımı postoperatif hasta konforuna katkıda bulunmanın yanısıra tedavi veya profilaksi amacıyla ilaç kullanımını azaltacaktır.Anahtar kelimeler: Akupunktur, postoperatif kusma, adenoidektomi, tonsillektomi Objective: Postoperative vomiting (POV) is one of the most common problems following general anaesthesia, and many factors, either solely or in combination, may play a role in aetiology. Acupuncture is a technique that the World Health Organization has accepted as a complementary treatment. This study presents our experience with acupuncture for POV treatment in a study of paediatric tonsillectomy cases. Methods:The study included ASA I-II patients (n=70) aged 2-14 years who underwent tonsillectomy and/or adenoidectomy under general anaesthesia. The patients were randomly divided into the following two groups: control and study group. In the study group, an acupuncture needle was intraoperatively applied to the P6 acupuncture point for 20 min. Antiemetics were not administered to either group because of the standard applications in the preoperative period. The patients were postoperatively evaluated by nurses who were unaware about the techniques used in either group.Results: No statistically significant difference was determined between the groups with regard to age, sex, nature of the operation, duration of anaesthesia, duration of the operation, surgical method and ASA scores. A statistically significant difference was determined between the groups with respect to vomiting rates. The acupuncture group presented with 0.28-times fewer vomiting episodes than the control group. Conclusion:The results of the stud...

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