Author: Flora Liu, MD
IARS 2026 Annual Meeting coverage
Pediatric anesthesia faces major challenges involving workforce shortages, unequal access to safe care, inconsistent implementation of clinical guidelines, and uncertainty about which risk-assessment tools provide meaningful clinical value. At the 2026 IARS and SOCCA Annual Meeting, experts discussed how pediatric anesthesia can remain safe, equitable, and evidence based across widely different health care environments.
Faye Evans, MD, described the worldwide shortage of pediatric anesthesiologists and other qualified anesthesia professionals. Seventy-six countries remain below the World Federation of Societies of Anesthesiologists’ recommended minimum of five anesthesia providers per 100,000 people, with particularly severe shortages in Africa and Southeast Asia.
Areas with the lowest anesthesia workforce density experience substantially higher postoperative complication and hospital mortality rates. These risks are worsened by basic infrastructure limitations, including unreliable electricity and inadequate access to oxygen.
Dr. Evans emphasized that pediatric anesthesia fellowships should serve as more than pathways for producing subspecialists. Effective programs should also:
- Train general anesthesia providers
- Develop local clinical leaders
- Establish sustainable pediatric care systems
- Promote quality improvement
- Expand access to safer anesthesia services
The Paediatric Anaesthesia Training in Africa program, founded in 2020 and led by African pediatric anesthesiologists, has established fellowship sites in Kenya, Uganda, Nigeria, Zambia, Ethiopia, and Ghana. The program trained 32 pediatric anesthesiologists between 2022 and 2025 and achieved nearly complete retention within participating regions.
The ultimate objective is not for every child to receive care directly from a fellowship-trained pediatric anesthesiologist. It is to ensure that every child is treated by a provider with sufficient training, resources, and support to deliver safe care.
Thomas Engelhardt, MD, discussed the benefits and limitations of pediatric anesthesia guidelines. Guidelines are especially useful during emergencies, rare events, and unfamiliar clinical situations. However, the existence of a guideline does not guarantee that clinicians will follow it.
Although more than 250,000 clinical guidelines have been published since 1947, average adherence across medical specialties remains approximately 40%. Common barriers include:
- Weak or incomplete supporting evidence
- Poor guideline quality
- Failure to include important stakeholders
- Conflicts of interest
- Limited relevance to local practice
- Inadequate implementation planning
When assessed using the AGREE II evaluation instrument, only a small percentage of published guidelines met high-quality standards.
Pediatric fasting recommendations illustrate both the value and difficulty of guideline implementation. Evidence supports allowing clear liquids until one hour before anesthesia without increasing adverse respiratory events. Although several international organizations have endorsed this approach, recommendations and clinical practices remain inconsistent.
Guideline implementation should be considered during development rather than after publication. Transparent methods, broad stakeholder involvement, implementation specialists, and resources such as Guidelines for Guidelines and GUIDE-M may improve adoption.
Walid Habre, MD, PhD, reviewed pediatric anesthesia scoring systems. He distinguished scales that merely describe the presence or severity of a condition from risk-prediction tools that can guide clinical decisions.
Potentially useful scores include:
- STBUR for identifying children at risk from sleep-disordered breathing
- Pediatric postoperative nausea and vomiting risk scores
- PRAm for respiratory assessment
- Pediatric adaptations of the ASA Physical Status classification
Validated and clinically actionable scores should be incorporated into electronic medical records and decision-support systems whenever possible. However, scoring systems should supplement rather than replace individualized clinical judgment.
Artificial intelligence and machine-learning systems may eventually improve pediatric risk prediction by combining existing scores with patient characteristics, procedural information, and real-time clinical data.
The session also addressed reports of serious neurologic complications after general anesthesia in previously healthy patients of Venezuelan ancestry carrying a maternally inherited MT-ND4 mitochondrial variant.
Current ASA guidance should be reviewed when caring for potentially affected patients. Considerations may include ancestry screening, genetic consultation, avoidance of volatile anesthetics, use of regional anesthesia or total intravenous anesthesia, processed EEG monitoring to avoid burst suppression, extended postoperative neurologic and acid-base monitoring, and reporting suspected events to the Anesthesia Incident Reporting System.
Key Takeaways
Improving pediatric anesthesia globally requires more than increasing the number of subspecialists. Workforce development must be accompanied by reliable oxygen, electricity, equipment, education, and locally sustainable systems.
Clinical guidelines are valuable only when they are evidence based, relevant, transparent, and realistically implemented.
Risk scores can improve consistency and identify vulnerable children, but they should be integrated with clinical assessment rather than used in isolation.
New genetic and neurologic safety concerns demonstrate the importance of regularly reviewing current professional guidance and adjusting anesthetic plans for potentially susceptible pediatric patients.
Thank you to IARS for allowing us to summarize this important coverage from the 2026 Annual Meeting.