Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2011
ReviewLessons for pediatric anesthesia from audit and incident reporting.
This review will attempt to put the various systems that allow clinicians to assess errors, omissions, or avoidable incidents into context and where possible, look for areas that deserve more or less attention and resource specifically for those of us who practice pediatric anesthesia. Different approaches will be contrasted with respect to their outputs in terms of positive impact on the practice of anesthesia. ⋯ Implementation strategies are considered alongside the reports as the reports cannot be considered end points themselves. Specific areas where pediatric anesthetics has failed to address recurring risk through any currently available tools will be highlighted.
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Paediatric anaesthesia · Jul 2011
ReviewEquipment and monitoring--what is in the future to improve safety?
There have been a number of recent developments in the practice of anesthesia and intensive care aimed at improving outcome in terms of reducing both morbidity and mortality, as well as other less-defined factors, such as quality of service provision. Significant advances have been made in airway devices such as pediatric tracheal tube designs, Microcuff(®) tracheal tubes, and new laryngoscopes. Noninvasive monitoring devices, including continuous hemoglobin analysis and near infrared spectrometry, are being increasingly used in pediatric anesthesia. Other, 'scaled-down' versions from adult anesthesia care, however, have not universally been shown to result in improved safety and outcomes in pediatric anesthesia.
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Paediatric anaesthesia · Jul 2011
ReviewOutcome for the extremely premature neonate: how far do we push the edge?
Significant advances in perinatal and neonatal medicine over the last 20 years and the recent emergence of fetal surgery has resulted in anesthesia providers caring for a growing number of infants born at the margin of viability. Anesthetic management in this patient population has to take into consideration the immature function of many vital organ systems as well as the effects of the underlying disease processes, which can frequently lead to severe physiological derangements. ⋯ However, even with advanced anesthetic and surgical management and optimal intensive care, extremely premature infants face substantial postoperative morbidity and mortality, as well as prolonged hospital courses. In this article, we will discuss the following questions: How far have we come in improving outcomes of extreme prematurity? And what will the future medical and societal challenges be, as we continue to redefine the limits of viability?
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Medication errors in pediatric anesthesia represent an important risk to children. Concerted action to reduce harm from this cause is overdue. An understanding of the genesis of avoidable adverse drug events may facilitate the development of effective countermeasures to the events or their effects. ⋯ Causes that should be addressed include a lack of pediatric formulations and/or presentations of medication that necessitates dilution before administration or the use of intravenous formulations for oral administration in children, a frequent failure to obtain accurate weights for patients and a paucity of pharmacokinetic and pharmacodynamic data. Technological innovations, including the use of bar codes and various cognitive aids, may facilitate compliance with these recommendations. Improved medication safety requires a system-wide strategy standardized at least to the level of the institution; it is the responsibility of institutional leadership to introduce such strategies and of individual practitioners to engage in them.