Paediatric anaesthesia
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This educational review explores the current understanding of accidental awareness during general anesthesia (AAGA) in children. Estimates of incidence in children vary between 1 in 135 (determined by direct questioning) and 1 in 51,500 (determined from spontaneous reporting). ⋯ The value of depth of anesthesia monitoring in preventing AAGA is uncertain but is probably useful in patients having total intravenous anesthesia and NMB. Reports of AAGA by children should be received sympathetically and a generic protocol for managing distressed patients is presented.
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Paediatric anaesthesia · May 2016
Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.
Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied. ⋯ We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery.
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Paediatric anaesthesia · May 2016
Observational StudyAudit of anesthetic trainees' 'hands-on' operating room experience in an Australian tertiary children's hospital.
There are no internationally accepted guidelines about what constitutes adequate clinical exposure during pediatric anesthetic training. In Australia, no data have been published on the level of experience obtained by anesthetic trainees in pediatric anesthesia. There is, however, a new ANZCA (Australian and New Zealand College of Anaesthetists) curriculum that quantifies new training requirements. ⋯ Experience gained at our hospital easily meets the new College requirements. Experience of fiber-optic intubation and regional blocks would appear insufficient to develop sufficient skills or confidence. The study provides other institutions with information to benchmark against their own trainee experience.
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Paediatric anaesthesia · May 2016
Etiology of postanesthetic and postsedation events on the inpatient ward: data from a rapid response team at a tertiary care children's hospital.
The goal of this study was to identify the etiology of events and demographics of patients that experience complications requiring activation of the Rapid Response Team (RRT) during the first 24 h following anesthetic care. ⋯ RRT calls were most common for respiratory concerns. High ASA status, general anesthesia administration, and the presence of acute or chronic conditions prior to anesthetic administration predispose a patient to perioperative complications resulting in the need for an RRT call.