PEACH in Asia: PEriAnesthetic morbidity in CHildren in Asia: A prospective multinational multicenter observational study to investigate epidemiology of severe critical events in pediatric anesthesia in Asia

BackgroundDespite significant advancements in pediatric anesthesia training and guidelines, the incidence of severe critical events in children undergoing anesthesia in Asia remains under-researched. This knowledge gap is particularly pressing given the rare but life-threatening nature of such complications. While studies from high-income countries report a decline in pediatric anesthesia-related mortality, similar data from developing regions, including Asia, are sparse and suggest higher risks. ObjectiveThe Peri-anesthetic Morbidity in Children in Asia (PEACH in Asia) study aims to provide a comprehensive assessment of the incidence and risk factors associated with severe critical events in pediatric anesthesia across Asia. This multinational, multicenter, prospective observational study seeks to enhance understanding of pediatric anesthesia-related risks and variability in practices within the region. MethodsThe study will enroll children aged birth to 15 years undergoing elective or urgent diagnostic or surgical procedures requiring sedation or general anesthesia, with or without regional analgesia. Data collection will focus on severe critical events occurring during and up to 60 minutes post-anesthesia, including laryngospasm, bronchospasm, pulmonary aspiration, drug errors, anaphylaxis, cardiovascular instability, neurological damage, cardiac arrest, and post-anesthetic stridor. The study will also capture patient demographics, medical history, and procedural details to identify potential risk factors. ResultsThe pilot phase of the PEACH in Asia study, conducted from May to June 2023, included 330 patients from ten institutions across nine countries. Preliminary findings revealed a severe critical event incidence rate of 12.4% [95% CI: 9.2-16.4]. Based on these results, the main study plans to recruit approximately 10,958 children across 15 to 30 Asian countries to achieve robust statistical power and refine risk factor identification. ConclusionThe PEACH in Asia study represents a critical step towards understanding and mitigating the risks associated with pediatric anesthesia in Asia. By providing data-driven insights into the incidence of severe critical events and regional variations in anesthesia practices, this study aims to inform and improve pediatric anesthesia protocols across the continent.