Paediatric anaesthesia
-
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.
-
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.
-
Biomedical research has been struck with the problem of study findings that are not reproducible. With the advent of large databases and powerful statistical software, it has become easier to find associations and form conclusions from data without forming an a-priori hypothesis. This approach may yield associations without clinical relevance, false positive findings, or biased results due to "fishing" for the desired results. ⋯ Many leading journals also require the SAP as part of the submission package. The goal of this article and the companion article detailing the SAP of an actual research study is to provide a practical guide on writing an effective SAP. We describe the what, why, when, where, and who of a SAP, and highlight the key contents of the SAP.
-
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.
-
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.