• Mostafa Somri, Arnold G Coran, Christopher Hadjittofi, Constantinos A Parisinos, Jorge G Mogilner, Igor Sukhotnik, Luis Gaitini, Riad Tome, and Ibrahim Matter.
• 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. somri_m@yahoo.com
• Pediatr. Surg. Int. 2012 Jun 1;28(6):553-61.

PurposeTo discuss developments in paediatric anaesthesia and explore the factors which have contributed to improved anaesthetic-related patient outcomes.MethodsNarrative review of findings in the literature retrieved from MEDLINE/Pubmed and manual search.ResultsAdverse perioperative outcomes related to anaesthesia have been extensively debated over the past few decades, 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 emergent 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 anaesthesia play a vital role in driving this downward trend.ConclusionDespite 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 anaesthesia will most likely be influenced by much-needed large prospective studies, which can provide further insight into patient safety and service delivery.

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