Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2019
ReviewGetting to know a familiar face: Current and emerging focused ultrasound applications for the perioperative setting.
Ultrasound technology is available in many pediatric perioperative settings. There is an increasing number of ultrasound applications for anesthesiologists which may enhance clinical performance, procedural safety, and patient outcomes. This review highlights the literature and experience supporting focused ultrasound applications in the pediatric perioperative setting across varied disciplines including anesthesiology. The review also suggests strategies for building educational and infrastructural systems to translate this technology into clinical practice.
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Paediatric anaesthesia · Jul 2019
A 4 year quality improvement initiative reducing post-operative nausea and vomiting in children undergoing strabismus surgery at a quaternary paediatric hospital.
Post-operative nausea and vomiting is a significant cause of morbidity in pediatric anesthesia. As well as patient discomfort, post-operative nausea and vomiting can also result in dehydration, delayed discharge and unplanned hospital admission. Children undergoing strabismus surgery are known to be a particularly high risk group for post-operative nausea and vomiting. ⋯ Using quality improvement methodology, we were able to sustainably reduce the incidence of post-operative nausea and vomiting for children undergoing strabismus repair. We demonstrated using an evidence based therapeutic bundle can reduce incidence of post-operative nausea and vomiting in the high risk surgical strabismus population to a level comparable to the average post-operative nausea and vomiting incidence in our post anesthetic care unit population.
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Paediatric anaesthesia · Jul 2019
Quality improvement project to reduce pediatric clear liquid fasting times prior to anesthesia.
Unnecessarily long preprocedural fasting can cause suffering and distress for children and their families. Institutional fasting policies are designed to consistently achieve minimum fasting times, often without regard to the extent to which actual fasting times exceed these minimums. Children at our hospital frequently experienced clear liquid fasting times far in excess of required minimums. ⋯ Using quality improvement methodology, we safely improved the duration of preoperative fasting experienced by our patients. Our results provide additional data supporting the safety of more permissive 1-hour clear liquid fasting minimums. We suggest other institutions pursue similar efforts to improve patient and family experience.
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Paediatric anaesthesia · Jul 2019
The effect of pediatric patient temperament on postoperative outcomes.
Research has improved practitioner awareness of the impact of individual characteristics on responses to painful procedures. However, there is little data relating preexisting temperament profiles and postsurgical/anesthesia outcomes in pediatric patients. In particular, it is not clear how best to identify which patients are at risk of poor postsurgical outcomes. ⋯ Our data indicate that preoperative temperament characteristics may differentially influence pediatric postoperative pain experience in children. Specifically, children with high levels of positive and negative emotionality may exhibit more postsurgical pain behaviors.