Pediatric Intravenous Anesthesia in Japan-Where Are Anesthesiologists?

Most pediatric intravenous anesthesia in Japan is performed outside the operating theatre by non-anesthetists. The 2020 revision increased reimbursement for long-term intravenous anesthesia (Category 3) by anesthesiologists, but its impact on practice behavior is unknown. We analyzed the annual number of calculations for each category of intravenous anesthesia and their age distribution from the national reimbursement data for the three-year period fiscal years (FY) 2018-20 to elucidate trends in the pediatric age group. Regional disparities of calculation rate of pediatric addition per capita were examined. According to FY 2019 statistics, 5,774 outpatient intravenous anesthesia and 50,686 inpatient intravenous anesthesia procedures were performed annually in patients under 15 years of age. Of these, no case was complex anesthesia (Category 3) performed by a specialist anesthesiologist in outpatient settings and 1,162(3.9%) in inpatient settings. Category 3 occupancy was slightly higher in infants and decreased with age. (P < 0.01) In FY 2020 data, 41(0.7%) new Category 3 procedure were calculated in outpatient cases. The share of Category 3 in inpatient cases decreased to 2.0%. There was no decrease in the number of overall venous anesthesia due to COVID-19 pandemic. Regional disparities in calculations were up to 20 times greater. Long-term total intravenous anesthesia by anesthesiologists is rarely performed in Japan. Improvements in reimbursement are not sufficient to enable total intravenous anesthesia by a specialized anesthesiologist. A system for safe intravenous anesthesia by non-anesthesiologists is needed.