Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2019
Practice GuidelineSociety for the Advancement of Blood Management Administrative and Clinical Standards for Patient Blood Management Programs. 4th Edition (Pediatric Version).
Patient Blood Management is the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Conceptually similar to a "bundle" strategy, it is designed to improve clinical care using comprehensive evidence-based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal-directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. ⋯ While every hospital may not be equipped to have a dedicated Pediatric Patient Blood Management program, this document highlights important universal clinical strategies that can be implemented to optimize pediatric bleeding management and minimize allogeneic blood product exposure through the use of multi-modal therapeutic strategies that have their central emphasis on the patient rather than the transfusion. Important strategies include: treatment of preoperative anemia, standardized transfusion algorithms, the use of restrictive transfusion thresholds, goal-directed therapy based on point of care and viscoelastic testing, antifibrinolytics, and avoidance of hemodilution and hypothermia as supported by evidence. For the full version, please go to https://www.sabm.org/publications.
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Paediatric anaesthesia · Mar 2019
Single injection ultrasound-guided rectus sheath blocks for children: Distribution of injected anesthetic.
Single injection ultrasound-guided rectus sheath blocks are used for postoperative analgesia after midline abdominal incisions, but the ultrasonographic spread of medication posterior to the rectus muscle has not been investigated. ⋯ After single injection ultrasound-guided rectus sheath blocks, incomplete cephalocaudal medication spread can be expected within the posterior rectus sheath.
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Paediatric anaesthesia · Mar 2019
Observational StudyFeasibility and Indicator Outcomes Using Computerized Clinical Decision Support in Pediatric Traumatic Brain Injury Anesthesia Care.
Traumatic brain injury anesthesia care is complex. The use of clinical decision support to improve pediatric trauma care has not been examined. ⋯ Use of clinical decision support in pediatric traumatic brain injury anesthesia care is feasible, reliable, and may have the potential to improve key performance indicator outcomes. This observational study suggests the possibility of clinical decision support as a strategy to reduce second insults and improve traumatic brain injury guideline adherence during pediatric anesthesia care.
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Paediatric anaesthesia · Mar 2019
ReviewResilience in children and their parents enduring pediatric medical traumatic stress.
Due to the general lack of familiarity with the concept in the medical field, resilience is rarely considered in pediatric medical traumas. Resilience is an ability that enables recovery after adversities such as traumas, surgeries, serious health problems, or social issues. Stress from medical traumas encompasses both the psychological and physical responses of children and their families. ⋯ Findings from the stress scale and screened risks could indicate the need for additional psychosocial support at the time of diagnosis of a serious illness, soon after injuries, and before and after operations. Such interventions can include decreasing distress, counseling children and their parents, and enabling strong connections to health care providers. Health care providers can help parents to minimize distress and adjust to their child's illness, thereby supporting the child's resilience, adjustment, and recovery.
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Paediatric anaesthesia · Mar 2019
Increasing Compliance of Safe Medication Administration in Pediatric Anesthesia by use of a standardized checklist.
Medication errors pose a significant risk perioperatively. In the perioperative environment, common medication administration processes are not typically performed. Given the common administration of potentially harmful medications and the potential for medication errors, patient risk is substantial. Specifically, intravenous acetaminophen has been used more frequently in the perioperative period which yielded an increase in medication administration errors reported. ⋯ Application of quality improvement methods, specifically a safety checklist, were utilized to improve the safe administration of acetaminophen during the perioperative period. Increasing reliability of accurate delivery and administration of medication to patients are crucial in optimizing patient safety. Use of a medication safety checklist may be beneficial in reducing potential administration errors, specifically for high-risk medications.