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The mask or the needle? Which induction should we go for?

Sommerfield, Davida,b; von Ungern-Sternberg, Britta S.a,b,c

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 377–383
doi: 10.1097/ACO.0000000000000729

Purpose of review This review summarizes the current evidence available to guide anaesthetists along the decision-making process between inhalational and intravenous anaesthesia when caring for paediatric patients.

Recent findings A recent large randomized controlled trial in children with risk factors demonstrated a significant benefit of intravenous induction over inhalational induction with regards to respiratory adverse events. This difference is particularly pronounced in those with respiratory symptoms.

Summary For children scheduled for elective surgery, intravenous induction has significant advantages with regards to reduced respiratory adverse events and for less postoperative behavioural disturbances, it may be associated with more anxiety at the time of induction. The anaesthetist in charge of the patient needs to weigh up the balance between the clinical risk of respiratory adverse events, the ‘veins on offer’, the level of anxiety and previous experiences of the child and his/her parents.

aDepartment of Anaesthesia and Pain Management, Perth Children's Hospital

bMedical School, The University of Western Australia

cTelethon Kids Institute, Perth, Australia

Correspondence to Britta S. von Ungern-Sternberg, Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia 6008, Australia. E-mail:

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