Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2011
ReviewOutcome for the extremely premature neonate: how far do we push the edge?
Significant advances in perinatal and neonatal medicine over the last 20 years and the recent emergence of fetal surgery has resulted in anesthesia providers caring for a growing number of infants born at the margin of viability. Anesthetic management in this patient population has to take into consideration the immature function of many vital organ systems as well as the effects of the underlying disease processes, which can frequently lead to severe physiological derangements. ⋯ However, even with advanced anesthetic and surgical management and optimal intensive care, extremely premature infants face substantial postoperative morbidity and mortality, as well as prolonged hospital courses. In this article, we will discuss the following questions: How far have we come in improving outcomes of extreme prematurity? And what will the future medical and societal challenges be, as we continue to redefine the limits of viability?
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Paediatric anaesthesia · Jul 2011
ReviewCardiac arrest in anesthetized children: recent advances and challenges for the future.
Over the past 50 years the incidence of anesthesia-related cardiac arrest has declined, despite increased patient co-morbidities, the most significant determinant of anesthetic risk. Multiple factors have contributed to this improvement including safer anesthetic agents, better monitoring devices and the development of a specialized pediatric environment. Provider skill has benefitted from improved training and recognition of high-risk situations. Further improvements will depend on international, multispecialty efforts to standardize terminology and analyze large numbers of these infrequent adverse events.
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Paediatric anaesthesia · Jul 2011
Design and implementation of a near-miss reporting system at a large, academic pediatric anesthesia department.
Current incident reporting systems encourage retrospective reporting of morbidity and mortality and have low participation rates. A near miss is an event that did not cause patient harm, but had the potential to. By tracking and analyzing near misses, systems improvements can be targeted appropriately, and future errors may be prevented. ⋯ An anesthesia-specific anonymous near-miss reporting system, which eases and facilitates data entry and can prospectively identify processes and practices that place patients at risk, was implemented at a large, academic, freestanding children's hospital. This resulted in a dramatic increase in reported events and provided data to target and drive quality and process improvement.
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Paediatric anaesthesia · Jul 2011
Improving surgical safety globally: pulse oximetry and the WHO Guidelines for Safe Surgery.
Access to safe surgery should be considered as part of the basic human right for health, but unfortunately, this ideal is far from being reached in many low-income countries. Pulse oximetry is recommended as a minimum standard of monitoring by all anesthesia organizations that have set standards, yet around 78,000 operating theaters worldwide lack this essential monitor. The WHO Safe Surgery Saves Lives Program has identified evidence-based guidelines for safe surgery that are applicable in any setting, and the Global Pulse Oximetry Program will help improve access to pulse oximetry in countries where it is not available. However, these initiatives are just a start; capacity, infrastructure, trained healthcare providers and access to essential drugs, and equipment for anesthesia and surgery need to become a public health priority in many low-income countries.