Psychological Factors, Serum Trace Elements, and Clinical Features of Factitious Oral Ulcers in Children and Adolescents: A Cross-Sectional Study.

Total intravenous anesthesia (TIVA) has gained popularity among pediatric anesthesiologists [], at least partly due to its potential advantages over inhalational anesthesia []. Strictly, TIVA requires intravenous (IV) cannulation in an awake child to facilitate both an IV induction and IV maintenance of anesthesia. However, a common alternative consists of an inhalational induction followed by IV maintenance; this is sometimes considered sufficient to apply the label “TIVA” [], but may be more usefully characterized as mostly IV anesthesia (MIVA). While inhalational induction with oral sedative premedication remains the most commonly used mode of induction for pediatric anesthesia in North America and most of Europe [, ], IV induction is used frequently at BC Children's Hospital (BCCH), with 57% of patients having TIVA and a further 20% having MIVA []. BCCH has gained an international reputation for training, using, and advocating for this approach. In a 2019 study, interviews with anesthesiologists and procedural suite nurses identified success factors for IV induction of anesthesia in children, including effective distraction, family preparation, parental presence, support of the operating room team, effective use of local analgesic cream, adapting the approach to the individual child, and the anesthesiologist's efficiency in cannulation; barriers included needle phobia, uncooperative children, anxious parents, ineffective use of analgesic cream, and unfavorable anatomy [].