• Judith A Ten Barge, ZwiersAlexandra J MAJMDepartment of Anesthesiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands., Marijn J Vermeulen, Keyzer-DekkerClaudia M GCMGDepartment of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands., SimonsSinno H PSHPDepartment of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands., Lonneke M Staals, and Gerbrich E van den Bosch.
• Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands. Electronic address: j.tenbarge@erasmusmc.nl.
• J Clin Anesth. 2024 Oct 1; 97: 111508111508.

Study ObjectiveNecrotizing enterocolitis (NEC) is a life-threatening intestinal illness mostly affecting preterm infants, which commonly requires surgery. Anesthetic care for these patients is challenging, due to their prematurity and critical illness with hemodynamic instability. Currently, there are no guidelines for anesthetic care for these vulnerable patients. Therefore, this study aimed to describe current anesthesia practices across Europe for infants undergoing surgery for NEC.DesignCross-sectional survey study.ParticipantsAnesthesiologists working in centers where surgery for NEC is performed across Europe.MeasurementsA 46-item questionnaire assessing protocols for anesthesia practice, preoperative care, intraoperative care, postoperative care, and the respondent's opinion on the adequacy of anesthetic care for patients with NEC in their center.Main ResultsOut of the 173 responding anesthesiologists from 31 countries, approximately a third had a written standard protocol for anesthetic care in infants. Three quarters of the respondents screened all patients with NEC preoperatively, and a third structurally performed preoperative multidisciplinary consultation. For induction of general anesthesia, most respondents opted for intravenous anesthesia (n = 73, 43%) or a combination of intravenous and inhalation anesthesia (n = 57, 33%). For intravenous induction, they mostly used propofol (n = 58, 44%), followed by midazolam (n = 43, 33%) and esketamine (n = 42, 32%). For maintenance of anesthesia, inhalation anesthetic agents were more commonly used (solely: n = 71, 41%; in combination: n = 37, 22%), almost exclusively with sevoflurane. Postoperative analgesics mainly included paracetamol and/or morphine. Sixty percent of the respondents (n = 104) considered their anesthetic care for patients with NEC adequate. Suggestions for further improvement mainly revolved around monitoring, protocols, and collaboration.ConclusionsAnesthesia practice for infants undergoing surgery for NEC was highly variable. Most respondents considered the provided anesthetic care for patients with NEC adequate, but also recognized opportunities for further improvement, especially with regards to monitoring, protocols, and interdisciplinary collaboration.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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