Green Mask: The Pediatric Anesthesia Podcast

2. EN - Neuromuscular blocking agents in neonates

Paralysis or not? The NMBA dilemma in neonates and infants. In this episode, we dive into the latest ESAIC pediatric guidelines and examine two complementary studies that help us understand the physiological rationale and safety implications behind airway management in this population. References: 1. Veyckemans F, Debouche S, Kaufmann J, et al. 2025 ESAIC and ESPA Guidelines on neuromuscular block in anaesthetised children: Indications, monitoring and reversal. Eur J Anaesthesiol. 2026;43(4):295-323. 2. Saldien V, Veyckemans F, Hansen TG. Development of the neuromuscular junction and neuromuscular blocking agents in neonates, infants and children: A narrative review. Eur J Anaesthesiol. 2026;43(4):324-334. 3. Christensen MI, Creutzburg A, Vested M, Nørskov AK, Lundstrøm LH, Afshari A. Effects of avoidance versus use of neuromuscular blocking agents for facilitation of tracheal intubation in children and infants: A systematic review with meta-analysis and trial sequential analysis. Eur J Anaesthesiol. 2026;43(4):335-348.

1. EN - Environmental Sustainability in Pediatric Anesthesia: why should we care?

Toward a Greener Future in Pediatric Anesthesia Why should pediatric anesthesiologists care about climate change? Because the operating room is one of healthcare’s biggest polluters—and anesthesia plays a key role. This podcast episode unpacks why rethinking pediatric anesthesia is not only an environmental imperative but also a clinical opportunity. Based on the latest evidence—including research up to 2025—the discussion explores how volatile anesthetic gases like desflurane and nitrous oxide contribute disproportionately to global warming. In response, the episode highlights superior, patient-centered alternatives such as total intravenous anesthesia (TIVA) and EEG-guided monitoring, which reduce emissions while improving outcomes like less respiratory complications and improved postoperative recovery. Listeners will also hear practical strategies: from switching to reusable materials to optimizing fresh gas flows—all aimed at making sustainability a new standard for safety and quality in pediatric care. Yet, meaningful change requires more than knowledge—it demands shifts in behavior, institutional commitment, and overcoming implementation barriers within clinical practice. Main references used in this podcast for discussion: 1.   IPCC Sixth Assessment Report: Metrics 2. Sulbaek Andersen MP et al. Assessingthe potential climate impact of anaesthetic gases. Lancet Planet Health. 2023;7(7):e622-e629. doi:10.1016/S2542-5196(23)00084-0 3. Shen F, et al. Effect ofIntravenous, Inhalational, or Combined Anesthesia Maintenance on PostoperativeRespiratory Adverse Events in Children Undergoing Adenotonsillectomy (AmPRAEC): A Multicenter Randomized Clinical Trial. Anesthesiology.doi:10.1097/ALN.0000000000005707 4. Karam C et al. Respiratory adverse events after LMA® mask removal in children: A randomized trial comparing propofol to sevoflurane. Anesth Analg. 2023;136(1):25–33. doi:10.1213/ANE.0000000000005945 5. Miyasaka KW et al.EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium: A Randomized Clinical Trial. JAMA Pediatr. Published online April 21, 2025. doi:10.1001/jamapediatrics.2025.0517 6. de Heer IJ et al. The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial. Paediatr Anaesth. 2025;35(4):287-293. doi:10.1111/pan.15065 7. Kalmar AF, et al. Environmental impact of propofol: A critical review of ecotoxicity and greenhouse effects. Best Pract Res Clin Anaesthesiol. 2025.10.1016/j.bpa.2024.12.003 8. Waspe J, Orr T. Environmental risk assessment of propofol inwastewater: a narrative review of regulatory perspectives. Anaesthesia. 2023;78:337–342. doi:10.1111/anae.15941 9. Karlsson SL, et al. Bacterial contamination and greenhouse gas emissions: reuse versus single-use infusion-set components for intravenous anesthesia. Eur J Anaesthesiol. 2024;41:910–920. 10. Kampman JM et al. The optimal mode of anaesthesia: are we ready for an evidence-based recommendation? Br J Anaesth. 2025. doi:10.1016/j.bja.2025.03.005 11. Kampman JM et al. Influence of nitrous oxide added to general anaesthesia on postoperative mortality and morbidity: a systematic review and meta-analysis. Br J Anaesth. 2024;133(6):1419–1426. doi:10.1016/j.bja.2024.02.011 12. Buhre W et al. The Glasgow Declaration on sustainability in Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2023;40(7):461–464. doi:10.1097/EJA.0000000000001862 13. Gonzalez-Pizarro P et al. European Society of Anaesthesiology and Intensive Care consensus on sustainability: Four scopes to achieve a more sustainable practice. Eur J Anaesthesiol. 2024;41(4):260–277. doi:10.1097/EJA.0000000000001942 14. van Nieuwenhuizen KE et al. Evidence-Based Integration of Environmental Sustainability into Clinical Guidelines for Operating Rooms: A Systematic Review. Ann Surg. Published online May 21, 2025.

1. ESP - Sostenibilidad ambiental en anestesia pediátrica: ¿por qué debería importarnos?

Hacia un Futuro Más Sostenible en la Anestesia Pediátrica ¿Por qué deberían los anestesiólogos pediátricos preocuparse por el cambio climático? Porque el quirófano es uno de los mayores contaminantes en el ámbito sanitario, y la anestesia juega un papel clave. Este episodio del pódcast analiza por qué repensar la anestesia pediátrica no solo es una urgencia ambiental, sino también una oportunidad clínica. Basado en la evidencia más reciente —incluyendo investigaciones actualizadas hasta 2025— el episodio explora cómo los gases anestésicos volátiles como el desfluorano y el N2O contribuyen de manera desproporcionada al calentamiento global. Como respuesta, se destacan alternativas superiores y centradas en el paciente, como la TIVA y el monitoreo guiado por EEG, que no solo reducen las emisiones, sino que también mejoran los resultados clínicos al disminuir las complicaciones respiratorias y favorecer una mejor recuperación postoperatoria. Los oyentes también conocerán estrategias prácticas: desde el uso de materiales reutilizables hasta la optimización de los flujos de gases frescos, todo orientado a hacer de la sostenibilidad un nuevo estándar de seguridad y calidad en el cuidado pediátrico. Sin embargo, el cambio real requiere más que conocimiento: implica modificar comportamientos, compromiso institucional y superar barreras de implementación en la práctica clínica. Principales referencias utilizadas en este episodio: 1.   IPCC Sixth Assessment Report: Metrics 2. Sulbaek Andersen MP et al. Assessingthe potential climate impact of anaesthetic gases. Lancet Planet Health. 2023;7(7):e622-e629 3. Shen F, et al. Effect ofIntravenous, Inhalational, or Combined Anesthesia Maintenance on PostoperativeRespiratory Adverse Events in Children Undergoing Adenotonsillectomy (AmPRAEC): A Multicenter Randomized Clinical Trial. Anesthesiology.doi:10.1097/ALN.0000000000005707 4. Karam C et al. Respiratory adverse events after LMA® mask removal in children: A randomized trial comparing propofol to sevoflurane. Anesth Analg. 2023;136(1):25–33 5. Miyasaka KW et al.EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium: A Randomized Clinical Trial. JAMA Pediatr. Published online April 21, 2025. doi:10.1001/jamapediatrics.2025.0517 6. de Heer IJ et al. The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial. Paediatr Anaesth. 2025;35(4):287-293. doi:10.1111/pan.15065 7. Kalmar AF, et al. Environmental impact of propofol: A critical review of ecotoxicity and greenhouse effects. Best Pract Res Clin Anaesthesiol. 2025 8. Waspe J, Orr T. Environmental risk assessment of propofol inwastewater: a narrative review of regulatory perspectives. Anaesthesia. 2023;78:337–342 9. Karlsson SL, et al. Bacterial contamination and greenhouse gas emissions: reuse versus single-use infusion-set components for intravenous anesthesia. Eur J Anaesthesiol. 2024;41:910–920. 10. Kampman JM et al. The optimal mode of anaesthesia: are we ready for an evidence-based recommendation? Br J Anaesth. 2025. doi:10.1016/j.bja.2025.03.005 11. Kampman JM et al. Influence of nitrous oxide added to general anaesthesia on postoperative mortality and morbidity: a systematic review and meta-analysis. Br J Anaesth. 2024;133(6):1419–1426. 12. Buhre W et al. The Glasgow Declaration on sustainability in Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2023;40(7):461–464. doi:10.1097/EJA.0000000000001862 13. Gonzalez-Pizarro P et al. European Society of Anaesthesiology and Intensive Care consensus on sustainability: Four scopes to achieve a more sustainable practice. Eur J Anaesthesiol. 2024;41(4):260–277. doi:10.1097/EJA.0000000000001942 14. van Nieuwenhuizen KE et al. Evidence-Based Integration of Environmental Sustainability into Clinical Guidelines for Operating Rooms: A Systematic Review. Ann Surg. Published online May 21, 2025