Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2022
ReviewImplementation of an electroencephalogram-guided propofol anesthesia education program in an academic pediatric anesthesia practice.
Propofol total intravenous anesthesia (TIVA) is increasingly popular in pediatric anesthesia, but education on its use is variable and over-dosage adverse events are not uncommon. Recent work suggests that electroencephalogram (EEG) parameters can guide propofol dosing in the pediatric population. This education quality improvement project aimed to implement a standardized EEG TIVA training program over 12 months in a large pediatric anesthesia division. ⋯ This quality improvement education project successfully trained pediatric anesthesia faculty, staff, residents, and fellows in EEG-guided TIVA. The training program was effective, scalable, and sustainable over time for newly hired faculty staff and rotating fellows and residents.
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Paediatric anaesthesia · Nov 2022
Editorial ReviewUsing Kotter's 8 Steps of Change to Tackle Over-fasting of children attending day surgery.
Over-fasting before surgery can lead to dehydration, irritability, lethargy, nausea, hypoglycemia, tricky intravenous cannulation, and decreased patient satisfaction (Newton et al., Pediatr Anesth, 2017, 27, 793). We used "Kotter's 8 steps for change" as an approach to tackling the problem of over-fasting in our day surgery unit (Kotter, Leading Change, Harvard Business School Press, 1996). Using a video of a patient's experience with overfasting, we created a sense of urgency and need for change (Step1: create urgency). ⋯ Our change ideas were divided into "short-term wins," "intermediate term goals," and "longer term goals." We focussed on creating short-term wins (Step6: create quick wins) and celebrated successes along the way to create initial momentum. We did this in parallel with working on longer term changes. We continued to work on cementing these new ideas (Step7: build on the changes), so that transformation in the day surgery would persist before using the same system to spread the change to the rest of the hospital (Step8: making it stick).
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Paediatric anaesthesia · Nov 2022
ReviewQuality improvement and patient safety in China, present and future.
With continued political support and increased health financing, China has achieved great progress in medical and health quality during the two decades. The strategy to improve health in China is built on reliable cross-sectoral information and data sharing along with quality improvement science and safety analytics balancing equitability, accessibility, quality outcomes, and safety in healthcare for everyone. As part of the healthcare system, pediatric anesthesiology has made great efforts to align with the China healthcare strategy to achieve quality outcomes, accessibility, and patient safety, but it still faces many problems such as unbalanced regional development, lack of awareness and relevant knowledge, and increased workload due to insufficient number of anesthesiologists. ⋯ In turn, the major centers educate and collaborate with the district hospitals to empower local improvements in safety and quality. Since the science in QI and patient safety is relatively new to anesthesiology in China, such collaborations must be greatly scaled up to reach the large geography and patient population in China. While the future is promising, there is still a long way to go.
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Paediatric anaesthesia · Nov 2022
ReviewPositive approaches to safety: Learning from what we do well.
Historical and current methodologies in patient safety are based on a deficit-based model, defining safety as the absence of harm. This model is aligned with the human innate negativity bias and the general philosophy of health care: to diagnose and cure illness and to relieve suffering. While this approach has underpinned measurable progress in healthcare outcomes, a common narrative in the healthcare literature indicates that this progress is stalling or slowing. ⋯ More overtly positive approaches are available, specifically focusing on success-both outstanding success and everyday success-including exnovation, appreciative inquiry, learning from excellence and positive deviance. These approaches are not mutually exclusive. The new methods described in this article are not intended as replacements of the current methods, rather they are presented as complementary tools, designed to allow the reader to take a balanced and holistic view of patient safety.
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Paediatric anaesthesia · Oct 2022
ReviewInduction of anesthesia with sevoflurane in children: curiosities & controversies.
Inhalational inductions with sevoflurane (up to 8% inspired concentration) have been the standard for inducing anesthesia in children for over three decades. However, when sevoflurane was first introduced, clinicians reported isolated cases of unexpected myoclonic jerking movements during the induction in children without epilepsy. ⋯ More recently, a shift away from the use of nitrous oxide has prompted some to question whether sevoflurane has a role as an induction agent in children. The preponderance of evidence supports the practice of safely inducing anesthesia with 8% sevoflurane with or without nitrous oxide in children but recommended strategies to mitigate against epileptiform discharges may be more harmful than beneficial.