REVIEW ARTICLE Improved outcomes in paediatric anaesthesia: contributing factors Mostafa Somri • Arnold G. Coran • Christopher Hadjittofi • Constantinos A. Parisinos • Jorge G. Mogilner • Igor Sukhotnik • Luis Gaitini • Riad Tome • Ibrahim Matter Accepted: 24 April 2012 / Published online: 12 May 2012 Ó Springer-Verlag 2012 Abstract Purpose To discuss developments in paediatric anaes- thesia 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 anaes- thesia have been extensively debated over the past few dec- ades, 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 emer- gent 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 anaes- thesia play a vital role in driving this downward trend. Conclusion 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 anaes- thesia will most likely be influenced by much-needed large prospective studies, which can provide further insight into patient safety and service delivery. Keywords Anaesthesia Á Paediatric Á Surgery Á Outcome Á Mortality Á Risk Introduction Anaesthesia-related adverse outcomes have been exten- sively debated over the past few decades. Landmark papers and statements have applied critical incident analysis techniques, borrowed from fields such as aviation, in order to examine the causes and consider possible preventative strategies for such outcomes (also termed ‘‘preventable mishaps’’). By highlighting how imperfections in clinical practice could lead to errors and thus patient harm, these innovative analyses provided anaesthetists with new insights based on which they could act to promote anaes- thesia patient safety [1, 2]. Although this specific term was not used at the time, these analyses have brought signifi- cant changes in anaesthetic practice. The American Society of Anesthesiologists (ASA) was created in 1984, the Anesthesia Patient Safety Foundation M. Somri (&) Á L. Gaitini Á R. Tome 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 e-mail: somri_m@yahoo.com A. G. Coran Section of Pediatric Surgery, C.S. Mott Children’s Hospital, University of Michigan Medical School, ANN ARBOR, MI, USA C. Hadjittofi UCL Medical School, London, UK C. A. Parisinos Department of Acute Medicine, Royal Free Hospital, London, UK J. G. Mogilner Á I. Sukhotnik Á I. Matter Departments of General and Pediatric Surgery, Bnai Zion Medical Center, Technion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel 123 Pediatr Surg Int (2012) 28:553–561 DOI 10.1007/s00383-012-3101-y