Introduction

n children, mortality due to Anesthesia is significant, and its acute complications can change the lives of children in the future and have lifelong consequences for the child [1-5]. Identifying and evaluating side effects related to anesthesia, especially in children, can help prevent complications. It can also be effective in educational programs, reporting instructions and protocols, and helping parents. Studies have shown that children have higher critical incidents than adults, which can also affect the type and frequency [6-9]. One of the most commonly reported complications is respiratory, followed by cardiovascular. Reducing and limiting the complications of anesthesia in children is of great importance and is an endless challenge in this regard [10-14]. Existing anesthesia guidelines meet this challenge, but side effects, especially perioperative respiratory, haemodynamic, are common. Studies show that most complications are negligible, while some can lead to child mortality. Studies show that 15% of children under anesthesia have respiratory side effects [15-19]. The research was descriptive and the study population required hospitalized patients in need of blood and blood products in different wards of Namazi Hospital. This study included all patients requiring blood transfusions (emergency and non-emergency) [20-22]. Before blood transfusion, a questionnaire for each patient was completed by one of the above groups [23-26]. Questionnaire including patient name, age, sex, blood group, file number, ward, underlying disease, type of surgery, hemoglobin level and platelet count before treatment, type of injectable product (dense red blood cells, freshly frozen plasma, Platelet and Cryo) volume of injected product, history of blood transfusion, history of transplantation, history of complication of past blood transfusion, history of allergy, blood warming, heating device, number of injection needle heads and pressure injection [27-30]. Patients who during the injection or in the first 24 h after injection have symptoms such as needle pain, discomfort, chest pain, nausea, vomiting, shortness of breath, fever, hives, back pain, anuria, flushed face, generalized bleeding and in patients They had anesthesia, capillary bleeding, hypotension, and hematuria [31-35]. They were immediately re-sampled with EDTA blood and clotted and sent to the laboratory with blood bags and appendages. Depending on the type of complication, necessary tests were performed on samples before and after transfusion of patients (such as re-examination of ABO and Rh blood groups, crossmatch, blood culture, hot staining, peripheral blood smear, plasma dye for hemolysis, Coombs’s test and check the patient's details in the relevant notes in the patient's file and offices and their compliance with the blood bag label and patient ID card) [36-39]. At the same time, depending on the type of specific complication, additional questionnaires (specific to each of the acute blood complications) were completed, which indicated the clinical signs and tests requested [40-45].

A child's first visit to the dentist and the experience he or she gains have a significant impact on his or her future and health [46-49]. A good experience with the dentist, when Cook does not yet have acute dental problems, can build a good relationship between the child and the dentist and pave the way for the child to work together in the future [50-52]. Children who are referred to the dentist when they have a toothache and a problem usually have a fear of dental practice due to the unpleasant experience they have, and when they are treated and even examined, they cry out in fear and their hands and feet [53-55]. They shake themselves. This behavior of children in the dental office is not unusual [56-59]. Why are children afraid of dentistry? In answer to this question, it should be said that many factors such as information transmitted from parents and friends, bitter and painful previous experience of dental treatments, young age of the child and lack of rational approach to the problem during dental treatment, the child does not cooperate with Dentists have an impact on this pervasive fear [60-65]. Words like "needle" and "drill" that scare the child should not be used when preparing the child for a visit to the dentist. Substituting words like pinch, sleeping water, and gnashing of teeth is more acceptable to children and reduces their fear. What to do with a frightened child? Non-cooperation of the child reduces the quality and standard of medical services provided. In addition to reducing the accuracy and quality of work, physical intimidation and restraint can also produce pleasant psychological results in the child [66-69]. In many pediatric dental treatment centers, the dentist, with the help of his assistants and even the parents, has to keep the child immobile for a while so that a limited treatment can be performed in the shortest possible time [70-74]. An alternative solution to this problem is to provide medical treatment to this group of children under general anesthesia. This was first done by an American pediatric dentist in the early 1900s and is still not acceptable to many parents [75-79]. The younger the child is under anesthesia, or if the child has an underlying disease, the more difficult the anesthesia is and, naturally, the more complications it will have. Medications such as halothane, commonly used in adult anesthesia, are not recommended for pediatric anesthesia [80-84]. For this reason, it is necessary for parents to pay special attention to choosing medical centers and not to neglect pre-surgery anesthesia consultation. Benefits of anesthetizing the baby with anesthesia, the child loses consciousness and does not remember what happened during the operation. There is also complete pain for him and he will not move. This condition allows the therapist to proceed with complete calm and careful consideration of the necessary treatment [85-89]. Dental treatments under anesthesia compared to medical surgeries due to limited extent, low risk of postoperative bleeding, the possibility of controlling postoperative pain by prescribing oral analgesics and no need for intravenous drugs in the postoperative period, differences Therefore, the child can be hospitalized on the morning of the operation, and in one session, all the desired medical procedures can be performed as outpatient surgery, and the child can be discharged on the same day after a period of postoperative control [90-95]. About 50 years ago, the risks of anesthesia were very high, but today, due to the need to refer patients to equipped centers equipped with general anesthesia and the development of monitoring systems in the operating room, the risks and complications of anesthesia for patients are very low [96-99]. When the surgeon is operating, the anesthesiologist simultaneously monitors the patient's symptoms, including blood pressure and breathing, and keeps the condition under complete control. A common misconception among the general public is that anesthesia reduces the intelligence of children in adulthood, but this has not yet been scientifically proven [100-103]. Of course, there are still concerns about the side effects of repeated anesthesia. Some parents ask about the risk of death. Statistics show that the mortality rate due to anesthesia is 1 in 10,000 cases, which is also due to underlying diseases and the type of surgery [104-109].

The results of several studies show that exposure to general anesthesia before the age of 4 increases the risk of cognitive problems and ADHD. Another study found that children who underwent two general anesthetics were 50 % more likely to have learning difficulties than other children [110-113]. To answer the question of how these drugs affect children's brains, British experts are conducting joint research [115]. Although surgery is inevitable for children in threatening cases, one of the goals of this joint study is to help parents in Especially the decision to delay surgery [13]. According to the results of one study, which has caused a great deal of concern, anesthesia before the age of 2 significantly increases the risk of developing ADHD [19]. On the other hand, general anesthesia before the age of 4 increases the probability of reading, writing and solving math problems by up to 50%. In this regard, the number of times of anesthesia and its time are also important, as it has been determined that surgery less than 2 h does not pose any risk [13]. But surgeries lasting more than 3 hours increase the likelihood of learning disabilities [15].

"The complications and consequences of anesthesia vary depending on the type and physical condition of the individual." Some of these complications show up quickly and by the end of the surgery time, and some complications occur in the long run. Anesthesia has the same potential risks for all people that are not related to their underlying diseases, and before the operation, the patient is informed by the legal

framework whether he or she will accept the risk of anesthesia or not. Dangerous

complications from anesthesia occur in less than one percent of people. Cross-sectional allergic reactions to the anesthetic and discharge into the lungs are possible side effects of anesthesia. Of course, in some people who have underlying diseases such as chronic hypertension, underlying heart disease, advanced heart failure, lung failure, brain damage, etc., anesthesia can have its own consequences.

Selection Criteria

Nausea and vomiting are the most common consequences of anesthesia. These side effects are caused by anesthesia, but at present, due to the use of the best anesthetics in the country, vomiting and nausea caused by anesthesia are greatly reduced. Some people think that anesthesia causes memory impairment and this concern is much more serious, especially for children and infants, but no scientific textbook mentions memory impairment or permanent brain damage as complications of anesthesia. The situation is slightly different for adults, and temporary forgetfulness may occur in adults after anesthesia. Spinal and local anesthesia also have their own consequences. Headache followed by low back pain is one of the most important complications of spinal anesthesia and in some rare cases it can cause other problems. Regarding how long a person can be anesthetized, it can be said that the patient's history should be considered for this purpose, whether the person is tolerant of receiving anesthesia or previous drugs, problems with the liver, kidneys or breathing. "They created it or not."

Inclusion criteria

1. Randomized controlled trials studies, controlled clinical trials, prospective and retrospective cohort studies.

2.  Acute severe complications of anesthesia

3. Age < 16 years of age.

4. English language

Exclusion criteria

1. In vitro studies, reviews, animal studies and clinical studies

2. Incomplete or inconsistent data for the purpose of the present study.

3. Studies that referred to conscious sedation rather than general or regional anesthesia.

4. Excluded data on cardiac arrest

Surgery is painful and this pain must be eliminated in some way. Anesthesia has greatly contributed to the advancement of medical science by reducing the patient's pain during surgery and has enabled us to perform surgeries more easily [19]. However, anesthesia may be associated with problems for the patient [13]. These side effects may persist for hours or days after anesthesia and disappear in the vast majority of patients with medical care. Dr. Khosrow Farhadi, anesthesiologist and faculty member of Kermanshah University of Medical Sciences, stated in this regard: "Complications and consequences of anesthesia vary depending on the type and physical condition of individuals. What are the serious side effects of anesthesia? Some of these complications show up quickly and by the end of the surgery time, and some complications occur in the long run [18]. Anesthesia has the same set of potential risks for all people that are not related to their underlying diseases, and before the operation, the patient is informed by the legal framework whether or not he or she will accept the risk of anesthesia. Dangerous complications from anesthesia occur in less than one percent of people [51]. Cross-sectional allergic reactions to the anesthetic and discharge into the lungs are possible side effects of anesthesia. However, in some people who have underlying conditions such as chronic hypertension, underlying heart disease, advanced heart failure, lung failure, brain damage, etc., anesthesia can also have its own consequences. Some people think that anesthesia causes memory impairment. Memory impairment or permanent brain damage have not been mentioned in any scientific textbook as a complication of anesthesia [15]. Anesthesia is a targeted procedure performed by an anesthesiologist Nausea and vomiting are the most common consequences of anesthesia [156-159]. These side effects are caused by anesthesia, but at present, due to the use of the best anesthetics in the country, vomiting and nausea caused by anesthesia are greatly reduced. Some people think that anesthesia causes memory impairment and this concern is much more serious, especially for children and infants, but no scientific book mentions memory impairment or permanent brain damage as complications of anesthesia. Headache followed by low back pain is one of the most important complications of spinal anesthesia and in some rare cases it can cause other problems [16]. Regarding how long a person can be anesthetized, it can be said that the patient's history should be considered for this purpose, whether the person is tolerant of receiving anesthesia or previous drugs, problems with the liver, kidneys or breathing [16]. "They created it or not." Studies that did not meet the inclusion criteria were excluded from the study. In the second step, the full text of 9 studies was reviewed. Finally, three studies were selected (Figure 1) [13].

Problems with Anesthesia and Local Anesthesia

Nausea and vomiting: This problem exists in both anesthesia and anesthesia. Sore throat: In cases where the patient is under general anesthesia and is due to a tube that is inserted into the patient's trachea during anesthesia. This pain may last for hours to days. Feeling dizzy: Caused by low blood pressure or medications used. Shivering: due to anesthesia drugs or due to the patient staying cold during surgery. It is treated by warming the patient with an electric towel. Headache: Medications taken during surgery, lowering blood pressure, anxiety and other causes can cause headaches. Severe headaches are more common after anesthesia. Itching: It is caused due to the use of large amounts of narcotic analgesics or due to allergies to drugs. Low back pain: usually caused by lying on the operating table for a long time. Confusion and memory impairment: more common in the elderly after general anesthesia. Lung infection: more common in smokers. Not seen in anesthesia. Urinary disorders: In men it is more in the inability to urinate and in women it is urinary incontinence. It usually heals within a few hours after surgery. Seen in numbness. - Muscle pain: due to the use of some drugs during general anesthesia. Complications that are less common - Shortness of breath and slow breathing: caused by excessive use of drugs to reduce postoperative pain. Injuries to teeth, lips and tongue: These injuries are usually mild and are in the form of small hemorrhages and are due to the pressure of the respiratory tract that is used for the patient during general anesthesia. - Not being fully anesthetized and being aware of the surroundings during general anesthesia: This condition occurs in some cases and although the patient is not in pain, but during anesthesia is not completely asleep and is aware of what happens in the operating room.

Characteristics

Nine studies (three randomized controlled trial study and seven Cohort studies) have been included in present article. The Number of patients a total was 10244 with rang of age between 0-16) (Table1) [16].

Bias assessment

According to GRADE guidelines, all studies had low to moderate risk of bias.

Figure 1. Study Attrition

Table1. Studies selected for systematic review and meta-analysis

Perioperative Respiratory Adverse Event

Prevalence of perioperative respiratory adverse event in pediatric anesthesia was 10% (ES, 0.10 95% CI 0.01, 0.19) among nine studies and heterogeneity found (I2=0%; P =0.96). Heterogeneity between studies was very low and similar results have been reported in all studies (Figure 2).

Figure 2. Forest plot showed perioperative respiratory adverse event