title: A systematic review and meta-analysis of acute severe complications of pediatric anesthesia.
abstract: BACKGROUND
  Quantification of acute severe complications of pediatric anesthesia is essential to plan clinical guidelines and educational curricula.
  
  
  OBJECTIVE
  Our aim was to identify complications in terms of frequency and outcomes.
  
  
  METHODS
  We defined acute severe complications as an unexpected perioperative event, which without intervention by the anesthesiologist within 30 min may lead to disability or death. A systematic search was performed using MEDLINE, EMBASE, and CINAHL. Screening and data extraction were performed independently. Assessment of bias was conducted using GRADE guidelines.
  
  
  RESULTS
  Of 3002 abstracts, 25 met all inclusion criteria. The most common acute severe complications in pediatric anesthesia are related to airway management and respiratory system, followed by cardiovascular events. There was a great variation in reporting the methods, particularly poor definitions of diagnostic criteria for complications. Data were heterogeneous and pooled estimates may not be generalizable. Some studies failed to define potential source of bias, explain how missing data were addressed, describe acute severe complications, and had incomplete postoperative follow-up.
  
  
  CONCLUSIONS
  The data on pediatric anesthesia acute severe complications are poorly defined with large variation in the specificity of diagnostic reporting even within studies. We suggest that it is vital for future studies in this area to be based on a standardized system of diagnostic reporting (possibly with a hierarchical system of coding) with adequate description of population details to describe heterogeneity of data.
authors.affiliation: Department of Anesthesiology, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Asadollah
authors.identifier: http://orcid.org/0000-0002-8810-0449
authors.initials: A
authors.lastname: Mir Ghassemi
authors.affiliation: Department of Anesthesiology, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Neira
authors.affiliation: Health Sciences Library, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Lee-Anne
authors.initials: LA
authors.lastname: Ufholz
authors.affiliation: Research Institute, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Barrowman
authors.affiliation: Department of Anesthesiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Jamila
authors.initials: J
authors.lastname: Mulla
authors.affiliation: Department of Anesthesiology, University Hospital, Coventry, UK.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Bradbury
authors.affiliation: Department of Anesthesiology, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Matthew Dylan
authors.initials: MD
authors.lastname: Bould
mesh_terms: D000208:Acute Disease; D000758:Anesthesia / Q000009:adverse effects* / Q000706:statistics & numerical data; D002648:Child; D006801:Humans; D010372:Pediatrics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000139:chemically induced*; D011184:Postoperative Period; D012720:Severity of Illness Index
keywords: anesthesia; child; complications; outcomes