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Background: Children receiving proton therapy require repeated sedation. In this study, we aimed to investigate the utility of the perfusion index (PI) for evaluating consciousness level during repeated propofol sedation. Methods: In this prospective observational study, children aged from birth to 19 years old scheduled for proton therapy under repeated propofol sedation were enrolled. The primary outcome was the equivalence of PI values 5 min after anesthesia induction on consecutive sedation. Total consumption of propofol during sedation, time to reach the University of Michigan sedation scale (UMSS) score 1 after end of proton therapy, and duration of post‐anesthesia care unit (PACU) stay were recorded. Results: The PI values measured 5 min after induction of anesthesia were not equivalent to each other in consecutive sedation except for the second versus third (1st vs. 2nd: 97.5% CI: −1.34, 0.91; p = 0.206, 0.034; 2nd vs. 3rd: 97.5% CI: −0.87, 0.94; p = 0.023, 0.036 3rd vs. 4th: 97.5% CI: −2.08, −0.26; p < 0.99, <0.001; 4th vs. 5th: 97.5% CI: 0.21, 2.28; p < 0.001, >0.99; respectively). In consecutive sedation, there was not a significantly different difference in the time to reach UMSS score 1 (p > 0.99, all) for total consumption of propofol, time to reach UMSS score 1 after the end of proton therapy, and duration of PACU stay. Conclusions: During repeated propofol sedation in children, PI was insufficient to be used as an indicator of consciousness level assessment. However, we suggest that the information related to repeated sedation provided by this study may be helpful in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Ultrasound is not widely used to evaluate optimal supraglottic airway positioning even though it could potentially be used to identify and correct problem areas. Aims: We evaluated a new ultrasound scoring method to identify the position of the supraglottic airway and detect the location of air leaks during ventilation in pediatric patients. Methods: Using a prospective observational study design, we enrolled 90 pediatric patients of ASA physical status I–III scheduled for elective surgery under general anesthesia. After anesthesia induction, patients were assigned to a noncorrection group or a correction group after their first ultrasound evaluation. Noncorrection group comprised patients with tolerable I‐Gel positioning based on ultrasound evaluation and no problems with clinical parameters, while the correction group comprised patients with I‐Gel mispositioning based on ultrasound. Results: After the first ultrasound evaluation, 61 patients did not need I‐Gel correction (noncorrection group), while 29 patients needed I‐Gel correction (correction group) and underwent a second ultrasound evaluation. Airway sealing pressure and total ultrasound score showed a negative correlation (r = −.845, p <.001). The area under the receiver operating curve for total ultrasound score was 0.97 (95% confidence interval, 0.94–0.99; p <.001). In the correction group, ultrasound score and ventilation parameters improved after correction based on ultrasound evaluation. Conclusions: Ultrasound scores were negatively correlated with airway sealing pressure in pediatric patients. Ultrasound evaluation is useful for detecting misplacement of the I‐Gel and can be a useful tool for correction. [ABSTRACT FROM AUTHOR]