INTRODUCTION: The anesthetic management for pediatric patients undergoing direct laryngoscopy and/or bronchoscopy (DLB) is administered based on the anesthesiologist’s preference. Objectives: The preliminary analysis of this study aims to identify variables that decrease surgical end-to-transport (SET) time and directly impacts patient outcomes. SET time is defined as the time of surgery end to the time of patient exit from the operating room. METHODS: After IRB approval, all DLBs performed at Boston Children’s Hospital (Boston, MA) by the Otolaryngology Department from June 2012 to December 2014 (n= 2419) were obtained from the Anesthesia Information Management System. With a 0.05 level of significance, a multivariate logistic regression was performed in SAS v9.3 with SET time as the dependent variable and surgery duration, age, gender, ASA status, airway device and extubation status as the independent variables. Airway device and extubation status were found to be moderately predictable of each other, so separate models were conducted. Spearman correlation testing was performed to evaluate the relationship between SET time and post-anesthesia care unit (PACU) duration. RESULTS: We excluded cases having ASA classification >2, age >21 years, regional nerve blocks, tracheostomy, nasal cannula, or unknown airway or extubation status. Remaining cases (n = 967) were arranged by SET times and dichotomized by the median value (14 minutes) into two groups (≤14 minutes and >14 minutes). After adjusting for other variables, we found that patients with an endotracheal tube (ETT) were 4.85 times more likely to have a SET time higher than the median, as compared with to those having with a laryngeal mask airway (LMA) (p = 0.0023, 95% CI: 1.76, 13.33). We also found that patients with an ETT were 2.89 times more likely to have a SET time higher than the median compared with those having a mask airway device. (p < 0.0001, 95% CI: 2.09, 3.98). In addition, there was a weak positive correlation between SET time and PACU duration (r = 0.09406, p = 0.0069). DISCUSSION: Preliminary analysis indicates that airway management has a significant impact on SET time after adjusting for surgery duration, age, gender, and ASA status. The use of either a mask or an LMA resulted in a lower SET time than the use of an ETT. The correlation of SET time and PACU duration suggests that reducing SET time does not negatively impact post-operative outcomes and may even be positively, though weakly, correlated. This study is limited by its retrospective nature. Future analysis will include the evaluation of commonly used perioperative anesthetics with dosage and timing variables and their correlation with SET time and patient outcomes.

The primary aim of the thesis was to describe current awareness system of pediatric patients and their parents before anaesthesia and whether and to what extent the two groups are informed about anaesthesia. Furthermore, the thesis presents actual opinions of both responding groups on the current state of clinical practice and suggestions for its improvement. In accordance with available sources, so far no similar research has been carried out in the Czech Republic. A total number of 215 respondents at two biggest teaching hospitals in the Czech Republic have been addressed (Teaching Hospital Motol, Prague and Teaching Hospital Brno), the survey was finished by 131 people (60.93 %). Consequently, the questionnaire output was statistacally processed. The findings demonstrate a need of an improved anaesthesia awareness of pediatric patients and parents before the surgery. Obviously, both parents and children require printed information materials, although parents still tend to prefer rather the oral form - the anaesthesia interview. Keywords Anaesthesia, pediatric anaesthesiology, awareness, education, children, parents