Background

The PARNet an ESAIC research group and represents a large collaborative European Pediatric Anesthesia research Network. Collaboration between ESAIC and ESPA is crucial for making the projects possible and successful. All centers running pediatric anesthesia and interested in being part of large collaborative projects are welcome to be part of the network. For this reason, multiple projects will be performed under the PARNet umbrella.

Chair

Prof. Nicola Disma, IRCCS Istituto Giannina Gaslini, Genova, Italy

Projects

CRICKET (Critical Events during tracheal intubation in kids)

A prospective observational study looking at major complications occurring during tracheal intubation in children undergoing general anaesthesia. Children from 0 to 16 years requiring tracheal intubation for general anaesthesia performed by the anaesthesia team are eligible for the study.

The aim is to include 100,000 patients within a period of 3 consecutive months, in 500 centres spread in all continents.

Status:

• Participation is open until the end of 2025

• • To register for the study please complete this short form below: https://redcap.link/CRICKETstudy

For further information contact the study coordinator at: CRICKET@insel.ch

Explore the website at: www.cricketstudy.eu

Principal investigators: Prof. Nicola Disma and Prof. Thomas Riva

The Big Apple Study

The topic is the current practice of ventilation strategies in children undergoing general anaesthesia and the occurrence post operative pulmonary complications. The study includes a 14-day inclusion period and is complemented by a pilot study taking place in Amsterdam UMC.

For further information contact : bigapple@amsterdamumc.nl

Explore the website at: https://icuresearch.nl/studies/big-apple

PI: Dr/Prof David van Meenen

PORPOISE study

The study focuses on planning physiological monitoring in the operating room and predicting outcomes using infra-red sensors. It is a feasibility study involving 500 children from 3-6 centers.

The ultimate aim is for this study to lead into a randomized controlled trial (RCT).

PI: Dr/Prof Peter Frykholm

POAKIDS

A European multicenter prospective study focusing on postoperative acute AKI in children undergoing non-cardiac surgery.  Secondary endpoints include markers from urine.

PI: Prof. Robert Frithiof

Sustainability

There is strong interest to collaborate with the sustainability committee, which is currently chaired by Dr. Patricio Gonzalez-Pizarro. PARNet is willing to support projects aimed at promoting sustainability and circular economy.

Postoperative Pain Management in Children: ESPA Pain Management Ladder Initiative

The aim of the ESPA Pain Committee is to improve the quality of pain management in children in Europe. The ESPA Pain Management Ladder Initiative was  launched during the ESPA-Congress in Prague in 2014.

Adequate postoperative pain management cannot be taken for granted. Even in institutions with existing postoperative pain management protocols, a high proportion of patients may request additional pain treatment because there are deficiencies in the assessment of pain and implementation of systems for ensuring optimal dosing of analgesics. Adequate postoperative pain management consists of patient-tailored and intervention-specific analgesic concepts. A number of existing guidelines on perioperative pain management give detailed recommendations for the use of analgesic drugs and methods based on the strength of evidence from research studies. These recommendations are supplemented by conclusions based on clinical experience and expert opinion but they usually do not provide detailed postoperative pain management guidance for specific procedures. The aim of the ESPA Pain Management Ladder Initiative is to fill this gap.

The ESPA Pain Management Ladder Initiative is a clinical practice advisory based upon expert consensus supported by the current literature to help to ensure the best possible perioperative pain management for all children.  In 2018 the perioperative pain management of six common pediatric surgical procedures (Inguinal hernia repair, Circumcision, Pyloromyotomy (open and laparoscopic), Adeno-tonsillectomy, Appendectomy (open and laparoscopic), Limb Fractures) was summarized and published. The second publication of Pain Management Ladders in 2024 focuses on five more complex pediatric surgical procedures (Hypospadia repair, Cleft lip and palate repair, Thoracotomy for non-cardiac surgery, Nissen fundoplication (open/endoskopic), Correction of congenital hip dislocation). The aim is to encourage best pain management practice across the diversity of clinical settings in Europe. These recommendations are intended for inpatients only.

The primary goal is to ensure a basic standard of perioperative pain management for all children even in settings with limited resources. Further steps on the ladder are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and suggests basic, intermediate, and advanced pain management methods. The primary aim is to attain at least the basic level of the ESPA Pain Management Ladder.  The basic level uses drugs and methods that are widely available, are proven to work, are safe, and do not require any complex monitoring. Oral and rectal administration of non-opioid drugs and regional anaesthesia play an important role since they are available in most places.  Intravenous opioids are recommended for intraoperative use and in the early postoperative period in settings where adequate monitoring is available.  The importance of timely and sufficient use of non-opioid analgesics and the additional use of co-analgesic drugs as well is emphasized. The secondary goal is to climb up the pain ladder as far as possible using all available resources suggested by the guidance for intermediate and advanced levels.

Education rather than new drugs or high-tech delivery systems is key to achieving successful pain management. Basic techniques can do a good job in many cases if physicians and nurses are trained to take responsibility for providing pain control. Furthermore all staff involved in paediatric postoperative pain management must give pain assessment and pain management a high priority and should be aware that acceptable standards of pain management have to be provided and resourced before surgery in infants and children is undertaken.

The purpose of the ESPA Pain Management Ladder Initiative is to support institutions to create their own pain management protocols according to their financial and personal resources and to encourage physicians to implement the best possible analgesic treatment for all children in order to comply with the principles of the UN Convention on the Rights of the Child.

ESPA Pain Committee