Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2022
Justification Of Empiric Methodology to Determine Dexmedetomidine Dose for the TREX Study.
Dexmedetomidine is the sedative agent administered in combination with remifentanil and low dose of sevoflurane in the interventional arm of the ongoing TREX trial (Trial Remifentanil DExmedetomidine). The TREX pilot study (published in Paediatr Anaesth 2019;29:59-67) established infusion rates higher than those initially proposed. This could be attributed to an inappropriate target concentration for sedation or incorrect initial pharmacokinetic parameter estimates. ⋯ This current PK analysis from the Italian arm of the TREX study confirms that plasma concentration of dexmedetomidine is predictable using known covariates such as age and size. The initial target concentration (0.6 μg.L-1 ) used to sedate children cared for in the intensive care after cardiac surgery was inadequate for infants in the current TREX study. A target concentration 1 mcg.L-1 , corresponding to a loading dose of 1 mcg.kg-1 followed by an infusion of 1 mcg.kg-1 .hour-1 , provided adequate sedation.
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Paediatric anaesthesia · Nov 2022
ReviewQuality improvement in New Zealand Pediatric Anesthesia; national quality direction, patient experience, equity, and collaboration.
The current priorities of the quality and safety of patient care in New Zealand at a central government level are described, with a focus on equity and patient experience. Priorities between stakeholders differ. We report the current quality activities of New Zealand pediatric anesthetists in relation to these governance aims, seeking gaps and suggesting future directions to align governance priorities and local activities. ⋯ Risk identification and critical event review contribute to local learnings in departments and institutions, and more widely to national and binational (with Australia) learnings. Several collaborative projects in Australia and New Zealand, whilst not primarily quality improvement projects, may improve pediatric anesthesia. These collaborations include a pediatric anesthesia professional network, a curriculum for a pediatric anesthetic fellowship, contributions to a document on standards for pediatric anesthesia, and a national quality group researching key performance indicators across New Zealand.
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Paediatric anaesthesia · Nov 2022
ReviewMaking quality improvement data more accessible and understandable: analyst, designer, and storyteller.
Making data more accessible and understandable in quality improvement requires a diversity of approaches beyond formal teaching in technical skills of measurement. Improvement practitioners might co-opt the wider skillset of analyst, designer, and storyteller in tailoring the team strategy needed to make best use of the data used to inform decision-making at the point of care. Data literacy levels, negative prior experiences, or limited access to technology might influence the ability of teams to engage in measurement. ⋯ Thoughtful data visualization takes account of the inherent perceptual challenges of comprehending data and complex images. Establishing a routine of simplification-removing redundant elements and distractions-and amplifying aspects that aid understanding can bring clarity to the important concepts within a chart. Story-telling techniques can help wider audiences engage with data by carefully shaping analytical and emotional content around a central narrative-always mindful of the limitations of working memory, and the emotional momentum needed to inspire change.
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Paediatric anaesthesia · Nov 2022
ReviewHow the Wake Up Safe Pediatric Anesthesia Collaborative Increased Quality Improvement Capability and Collaboration.
Wake Up Safe is a patient safety organization consisting of 40 institutions with a mission to improve the processes of care and outcomes for newborns, infants, and children having anesthesia for surgery and medical procedures. It was recognized that the level of quality improvement (QI), knowledge, and experience varied greatly between member institutions. In Fiscal Year 2015, the group's leadership created a subcommittee on QI and education in efforts to provide member institutions with the skills and resources to use QI methodology to improve care at their own institution. ⋯ This review describes the development and implementation of this initiative. As a result of this initiative, significant progress was made improving the QI capability of the collaborative over a two-year period. This educational and support program included workshops, an online discussion forum, site visits, and project presentations.