title: Improved outcomes in paediatric anaesthesia: contributing factors.
abstract: OBJECTIVE
  To discuss developments in paediatric anaesthesia and explore the factors which have contributed to improved anaesthetic-related patient outcomes.
  
  
  METHODS
  Narrative review of findings in the literature retrieved from MEDLINE/Pubmed and manual search.
  
  
  RESULTS
  Adverse perioperative outcomes related to anaesthesia have been extensively debated over the past few decades, with studies implicating factors such as major human error and equipment failure. Case series and event registries have enlightened physicians on sources of error and patient risk factors such as extremes of age, comorbidity and emergent circumstances. Anaesthetic-related deaths in children fell from 6.4 per 10,000 anaesthetics in the early 1950s to as low as 0.1 per 10,000 anaesthetics by the end of the century. Advances in anaesthetic agents, techniques, monitoring technologies and training programmes in paediatric anaesthesia play a vital role in driving this downward trend.
  
  
  CONCLUSIONS
  Despite substantial progress, there is still much room for improvement in areas such as adverse-event reporting, anaesthetic-related risk and late neurocognitive outcomes. Systematic reviews comparing paediatric patient outcomes after neuroaxial block versus general anaesthesia are currently unavailable. The future of paediatric anaesthesia will most likely be influenced by much-needed large prospective studies, which can provide further insight into patient safety and service delivery.
authors.affiliation: Anesthesiology Department, Pediatric Anesthesia Unit, Bnai Zion Medical Center, Technion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, P.O.B 4940, 31048, Haifa, Israel. somri_m@yahoo.com
authors.forename: Mostafa
authors.initials: M
authors.lastname: Somri
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Coran
authors.forename: Christopher
authors.initials: C
authors.lastname: Hadjittofi
authors.forename: Constantinos A
authors.initials: CA
authors.lastname: Parisinos
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Mogilner
authors.forename: Igor
authors.initials: I
authors.lastname: Sukhotnik
authors.forename: Luis
authors.initials: L
authors.lastname: Gaitini
authors.forename: Riad
authors.initials: R
authors.lastname: Tome
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Matter
mesh_terms: D000758:Anesthesia / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000592:standards; D002648:Child; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D010348:Patient Care Team; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome