Sadacharam, Kesavan

Background: Immersive technologies (ImTs), including virtual, augmented, or mixed reality, are increasingly used to support periprocedural pediatric patients, but clinical adoption varies widely across children’s hospitals and specialties. Multiple determinants for the adoption of ImT in health care have been identified; however, these have not been well characterized in pediatric perioperative settings. Aims: Among Society for Pediatric Anesthesia Improvement Network (SPAIN) member institutions, we describe the current state of pediatric perioperative ImT use, identify barriers and facilitators to ImT adoption, and report perceived implementation-related factors. Methods: We conducted a multi-institutional cross-sectional survey of pediatric perioperative practices via key contacts from SPAIN. Survey responses underwent mixed-methods analyses informed by the Consolidated Framework for Implementation Research. Results: Among 27 eligible institutions, 24 (89%) provided responses, 13 of which reported ImT use. Of these, 8 (62%) reported existing institutional infrastructure or governance to support ImT. Use patterns were highly heterogeneous, but use was commonly paired with the presence of champions, technology expertise, and available resource support. Use cases included anxiety reduction, distraction, and procedural support. Barriers, facilitators, and potential strategies for successful implementation were highlighted. Conclusions: ImT is used variably across pediatric anesthesia practices affiliated with SPAIN. These findings provide a descriptive snapshot of current practice and highlight factors commonly associated with adoption. Further work is needed to more rigorously characterize the implementation processes and evaluate strategies that may support integration of ImT into routine care in diverse clinical settings.

AbstractBackgroundAdolescent Idiopathic Scoliosis (AIS) affects 2%–4% of the general pediatric population. While surgical correction remains one of the most common orthopedic procedures performed in pediatrics, limited consensus exists on the perioperative anesthetic management.AimsTo examine the current state of anesthetic management of typical AIS spine fusions at institutions which have a dedicated pediatric orthopedic spine surgeon.MethodsA web‐based survey was sent to all members of the North American Pediatric Spine Anesthesiologists (NAPSA) Collaborative. This group included 34 anesthesiologists at 19 different institutions, each of whom has a Harms Study Group surgeon performing spine fusions at their hospital.ResultsThirty‐one of 34 (91.2%) anesthesiologists completed the survey, with a missing response rate from 0% to 16.1% depending on the question. Most anesthesia practices (77.4%; 95% confidence interval [CI], 67.7–93.4) do not have patients come for a preoperative visit prior to the day of surgery. Intravenous induction was the preferred method (74.2%; 95% CI 61.3–89.9), with the majority utilizing two peripheral IVs (93.5%; 95% CI 90.3–100) and an arterial line (100%; 95% CI 88.8–100). Paralytic administration for intubation and/or exposure was divided (51.6% rocuronium/vecuronium, 45.2% no paralytic, and 3.2% succinylcholine) amongst respondents. While tranexamic acid was consistently utilized for reducing blood loss, dosing regimens varied. When faced with neuromonitoring signal issues, 67.7% employ a formal protocol. Most anesthesiologists (93.5%; 95% CI 78.6–99.2) extubate immediately postoperatively with patients admitted to an inpatient floor bed (77.4%; 95% CI 67.7–93.3).ConclusionMost anesthesiologists (87.1%; 95% CI 80.6–99.9) report the use of some form of an anesthesia‐based protocol for AIS fusions, but our survey results show there is considerable variation in all aspects of perioperative care. Areas of agreement on management comprise the typical vascular access required, utilization of tranexamic acid, immediate extubation, and disposition to a floor bed. By recognizing the diversity of anesthetic care, we can develop areas of research and improve the perioperative management of AIS.