Solution to the challenging part of the Shamrock method during lumbar plexus block.

gence agitation, UK-based anaesthetists (58%) preferred propofolandopioids forprevention andwouldwait for spontaneous resolution (54.4%). Parental presence for treatment of emergence agitation was allowed in more than 60% in UK responses and more than 40% in Italian responses. The majority of Italian respondents (66%) discuss before operation the possible presentation of emergence agitation, while the majority of UK-based respondents would do so once delirium presents (46%). More than half of UK respondents identified sevoflurane as the primary cause of emergence agitation followed by pain, preschool age, and stormy mask induction, while the majority of Italian respondents gave pain as primary cause followed by sevoflurane, stormy mask induction, and the child’s temper. Prolonged crying and thrashing were considered the most important features for the diagnosis of emergence agitation in both countries. The current survey reveals differences among European countries regarding the attitude towards, and management of, emergence agitation. However, the composition of the two paediatric societies, reflecting the degree of experience in the field of paediatric anaesthesia, makes a direct comparison difficult and any conclusions must, therefore, be drawn with great care. The role of midazolam for emergence agitation remains controversial. While several studies report a reduced incidence of emergence agitation after midazolam premedication, others report no effect or an even increased incidence and longer lasting agitation. 7 Treatment of emergence agitation depends also on the healthcare provider who assists the child during emergence from anaesthesia. Anaesthetists might be more prone to a pharmacological, rapid solution, while postoperative recovery nurses may choose to comfort and use parental presence to calm the child with emergence agitation. The third principal difference between respondents from the UK and Italy is timing of information given to parents. The amount of information given beforehand to the patient might dependon legal aspectsofconsent.Furthermore, the increasing numbers of civil claims may lead the Italian anaesthetist to a more cautious approach. Is emergence agitation to be considered as a complication of anaesthesia requiring preoperative discussion? This question and the role of midazolam (if any) for emergence agitation have to be addressed in the future.