Authors: Flora Liu, MD
IARS Daily Dose, May 3, 2026.
This report from the 2026 Annual Meeting presented by the International Anesthesia Research Society and Society of Critical Care Anesthesiologists focused on some of the most pressing global issues in pediatric anesthesia, including workforce shortages, implementation of evidence-based guidelines, and the evolving role of perioperative risk scoring systems.
Dr. Faye Evans opened the discussion by emphasizing the worldwide shortage of pediatric anesthesiologists, especially in low- and middle-income countries. According to data presented from the World Federation of Societies of Anaesthesiologists, 76 countries remain below the recommended minimum anesthesia provider density of five providers per 100,000 population. Areas with the most severe shortages experience markedly increased postoperative complication rates and dramatically higher in-hospital mortality. In some regions, even basic infrastructure remains unreliable, including electricity and oxygen availability.
A major focus was the role of pediatric anesthesia fellowships as “system-building” programs rather than simply subspecialty training pathways. The WFSA-supported Paediatric Anaesthesia Training in Africa (PATA) initiative, founded in 2020, was highlighted as a successful model. Fellowship programs across several African countries have already trained 32 pediatric anesthesiologists with nearly 100% retention, directly improving access to pediatric surgical care for an estimated 1.2 million children. The broader goal emphasized by the speakers was not universal access to subspecialists, but rather ensuring every child receives anesthesia care from adequately trained providers capable of safely managing pediatric patients.
Dr. Thomas Engelhardt then reviewed the challenges associated with implementing pediatric anesthesia guidelines into routine clinical practice. Despite over 250,000 published clinical practice guidelines since 1947, adherence rates across specialties remain approximately 40%, and fewer than half are consistently implemented. Common problems include inconsistent evidence quality, conflicts of interest, poor applicability, and lack of stakeholder involvement. When assessed using the AGREE II quality assessment tool, only 5% of published guidelines met high-quality standards.
Pediatric fasting guidelines served as a practical example of evidence-based evolution in perioperative care. More liberal fasting protocols allowing clear liquids up to one hour before anesthesia have not increased adverse respiratory events and have now been endorsed by several international societies, although global implementation remains inconsistent. The presentation emphasized that successful guideline adoption requires consideration of implementation strategies during development rather than after publication.
Dr. Walid Habre concluded the session with a review of perioperative risk scores in pediatric anesthesia. He distinguished between scoring systems designed merely to measure symptom severity and those capable of predicting perioperative complications and guiding management decisions. Scores such as STBUR, pediatric PONV risk tools, PRAm, and pediatric-adapted ASA Physical Status classifications were discussed as useful adjuncts that should ideally be integrated into electronic medical record systems. Although no currently available score has complete external validation, these tools remain clinically valuable when combined with physician judgment. Artificial intelligence and machine-learning systems may eventually improve predictive modeling and decision-support integration in pediatric anesthesia.
The session also addressed emerging concerns regarding severe neurologic complications after general anesthesia in previously healthy patients of Venezuelan ancestry carrying a maternally inherited MT-ND4 mitochondrial variant affecting complex I. Current recommendations include ancestry screening, consideration of genetic consultation, avoidance of volatile anesthetics when appropriate, use of regional anesthesia or total intravenous anesthesia, processed EEG monitoring to avoid burst suppression, and prolonged postoperative neurologic and metabolic monitoring. Clinicians were encouraged to report suspected cases to the Anesthesia Incident Reporting System.
Key Points
• Global shortages of pediatric anesthesia providers remain a major contributor to perioperative morbidity and mortality in children.
• The WFSA PATA fellowship initiative demonstrates that regional training programs can achieve excellent provider retention and improve pediatric surgical access.
• Clinical guideline implementation remains inconsistent despite strong evidence supporting many pediatric anesthesia practices.
• Liberalized pediatric fasting guidelines allowing clear fluids up to one hour before anesthesia continue to gain international acceptance.
• Pediatric perioperative risk scores may improve clinical decision-making when integrated into electronic medical records and combined with physician assessment.
• Artificial intelligence and machine-learning technologies may enhance future pediatric risk stratification systems.
• Anesthesia providers should remain aware of emerging mitochondrial-associated neurologic complications reported in patients with Venezuelan ancestry.
Thank you to the International Anesthesia Research Society Daily Dose for allowing us to summarize and share this article.