Editor's Picks for the Pediatric Anesthesia Article of the Day: July 2025

Today's editor's picks for the Pediatric Anesthesia Article of the Day are the articles with the highest “opens” and the most reader responses in the month of July 2025. Enjoy! Title: Blood Transfusion and Pediatric Patient Blood Management: Unique Considerations. Links: https://ronlitman.substack.com/p/blood-transfusion, https://ronlitman.substack.com/p/pediatric-patient-blood-management. Original article: Nicholas, J., A. K. Panigrahi. Advances in Transfusion Medicine. ASA Monitor 89(6): 13–14, June 2025. DOI: 10.1097/01.ASM.0001118144.06446.c9. Dudaryk, R., J. Meizoso, and M. Schreiber, The New Old Solution: Whole Blood for Nontraumatic Hemorrhage. Anesthesia & Analgesia, 140(6): 1359–1362, 2025. DOI: 10.1213/ANE.0000000000007217. Original article: Murto, K., L. Downey, S. M. Goobie. Pediatric Patient Blood Management: Unique Considerations. ASA Monitor 89(6): 15–17, June 2025. DOI: 10.1097/01.ASM.0001118148.27159.c1. The June 2025 issue of the ASA Monitor has several terrific articles devoted to blood transfusion. We reviewed basic information on blood product safety and availability including the use of whole blood to simplify trauma resuscitation and decrease time to transfusion, cold storage of platelets which may offer improved hemostatic function, improved inventory management and reduced infection risk, and new fibrinogen replacement products that may improve accessibility while also decreasing product waste. Title: Pro-Con Debate: Air or Saline for Loss-of-Resistance Technique. Link: https://ronlitman.substack.com/p/pro-con-debate-air-or-saline-for. Original article: Hao D., K. Bonner, T. Burnham, M. P. Stojanovic. Pro-Con Debate: Air or Saline for Loss-of-Resistance Technique of Interlaminar Epidural Access with Fluoroscopy-Guided Pain Medicine Procedures. Anesth Analg. 2025 Jul 1; 141(1):103–108. DOI: 10.1213/ANE.0000000000007272. Epub 2024 Nov 13. PMID: 40493784. Editorial: Garcia-Tomas V., H. T. Benzon, F. M. Peralta. Air or Saline? Unlocking the Best Approach for Loss-of-Resistance During Epidural Space Access. Anesth Analg. 2025 Jul 1; 141(1):100–102. DOI: 10.1213/ANE.0000000000007484. Epub 2025 Mar 21. PMID: 40117206. Although the article is focused on adult OB and chronic pain practice, the discussion is applicable to pediatric anesthesia. Cutting to the chase: The existing literature does not support a claim that either air or saline LOR could increase success in identifying the lumbar epidural space (in patients who are in labor). Title: Rescuing Failed Direct Laryngoscopy in Children. Link: https://ronlitman.substack.com/p/rescuing-failed-direct-laryngoscopy. Original article: Stein M. L., J. H. Nagle, T. W. Templeton, S. J. Staffa, S. G. Flynn, M. Bordini, S. Nykiel-Bailey, A. G. Garcia-Marcinkiewicz, F. Padiyath, M. Matuszczak, A. C. Lee, J. M. Peyton, R. S. Park, B. S. von Ungern-Sternberg, P. N. Olomu, A. I. Hunyady, C. Matava, J. E. Fiadjoe, P. G. Kovatsis, PeDI Collaborative. Comparing Videolaryngoscopy and Flexible Bronchoscopy to Rescue Failed Direct Laryngoscopy in Children: A Propensity Score Matched Analysis of the Pediatric Difficult Intubation Registry. Anaesthesia. 2025 Jun; 80(6):625–635. DOI: 10.1111/anae.16576. Epub 2025 Mar 20. PMID: 40113331. Editorial: Evans M. A., T. J. Caruso. Rescuing Failed Direct Laryngoscopy in Children: One Size Does Not Fit All. Anaesthesia. 2025 Jun; 80(6):621–624. DOI: 10.1111/anae.16577. Epub 2025 Mar 21. PMID: 40114500. What works best when direct laryngoscopy fails—videolaryngoscopy (VL) or flexible bronchoscopy (FB)? In children under 5 kg, flexible bronchoscopy had a significantly higher eventual success rate than videolaryngoscopy (90% vs. 71%). First-pass success also trended higher (62% vs. 43%, p = 0.061). We think that VL and FB are not competitors—they are complementary tools. The real question is not which is better, but which is better for this patient, right now, in your hands, with your team. That's the art of pediatric anesthesiology. Stein et al. remind us that evidence matters. Evans and Caruso remind us that context matters. But we'll remind you that execution matters most. So stock your carts, drill your team, sharpen your technique, and never stop learning. Because one day—maybe today—that child who “can't be intubated” will be yours. Title: Pediatric Dental Anesthesia: The Need for National Standards and Reporting. Link: https://ronlitman.substack.com/p/pediatric-dental-anesthesia-the-need. Original article: Salik I., K. M.Chan, I. Pesola, A. E. Abramowicz. Death in the Dentist's Chair: The Urgent Need for Universal Pediatric Dental Sedation Standards. Anesth Analg. 2025 May 23. DOI: 10.1213/ANE.0000000000007578. Epub ahead of print. PMID: 40408278. Serious morbidity or mortality should be astonishingly rare in dental offices but isn't. Salik et al. have correctly highlighted the lack of uniformity in both regulation and reporting for pediatric dental office based anesthesia, which should help us to improve safety. Achieving true standardization and improving safeguards, however, will require consensus on definitions, regulatory frameworks, and data reporting mechanisms. The safety of our pediatric patients depends on the dental profession's willingness and our professional colleagues' buy-in to meet this challenge with urgency and cooperation. Title: Postoperative Apnea and Former Preterm Infant: Evolving Evidence for Management. Link: https://ronlitman.substack.com/p/postoperative-apnea-and-former-preterm. Original article: Ying E. L.-B., K. Rahul, G. D. Priti, J. C. Charles, Members of Wake Up Safe/Society of Pediatric Anesthesia Quality & Safety committee. Postoperative Apnea and Former Preterm Infant: Evolving Evidence for Management, Anesthesia Patient Safety Foundation, June 2025 https://www.apsf.org/article/postoperative-apnea-and-former-preterm-infant-evolving-evidence-for-management/?utm_source=APSF+Newsletter+Email+-+External&utm_medium=email&utm_campaign=EMAIL_CAMPAIGN_2025_06_01. The risk for postoperative apnea is inversely related to gestational age and increases with cardiac shunts, anemia, decreasing post conceptual age at the time of surgery, hypothermia, glucose and electrolyte disturbances, and a patent ductus arteriosus. How should these patients be monitored? The authors recommend: “Apnea and bradycardia monitoring, nursing observation, continuous pulse oximetry, and a respiratory monitor.” We would add that this is best accomplished in a high surveillance unit (ICU or PACU) and this monitoring should be used in transport from the OR to the PACU and when the patient is transferred to the wards. The authors have nothing to report.