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Bergh-Eklöf B, Stattin K, Modiri AR, Frithiof R, Frykholm P. Distribution and outcomes of paediatric anaesthesia services in Sweden: an epidemiological study. Br J Anaesth 2024; 133:804-809. [PMID: 39095238 PMCID: PMC11443129 DOI: 10.1016/j.bja.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/08/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Centralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden. METHODS In this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019-22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status. RESULTS Data from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30-39) compared with other university hospitals (95% CI 6.1-12), county (95% CI 1.9-4.8), district (95% CI 0.07-2.2), and smaller hospitals (95% CI 0.0-22). CONCLUSIONS Most procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants.
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Affiliation(s)
- Björn Bergh-Eklöf
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Karl Stattin
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ali-Reza Modiri
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden; Uppsala Centre for Paediatric Anaesthesia and Intensive Care Research, Uppsala University Hospital, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden; Uppsala Centre for Paediatric Anaesthesia and Intensive Care Research, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Frykholm
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden; Uppsala Centre for Paediatric Anaesthesia and Intensive Care Research, Uppsala University Hospital, Uppsala, Sweden.
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Uto A, Yamashita K, Yoshimine S, Uchino M, Kibe T, Sugimura M. Analysis of perioperative autonomic nervous system activity to visualize stress in pediatric patients undergoing alveolar bone graft surgery. J Clin Monit Comput 2024:10.1007/s10877-024-01210-w. [PMID: 39172322 DOI: 10.1007/s10877-024-01210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
Perioperative stress in pediatric patients is often difficult to assess via interviews; thus, an objective measure to assess perioperative stress is needed. To visualize perioperative stress, we observed autonomic nervous system (ANS) activity, circulatory dynamics, and psychological status in pediatric patients undergoing alveolar bone grafting under general anesthesia. This prospective observational study included 40 patients aged 8-12 years who were scheduled for alveolar bone grafting in our hospital. ANS activity was analyzed using heart rate variability the day before surgery, during general anesthesia, 2 h postoperatively, 24 h postoperatively, and the day before discharge. ANS assessment included LF/HF (sympathetic nervous system activity) and HF (parasympathetic nervous system activity). Additionally, heart rate (HR), systolic blood pressure (SBP), face scale (FS) score were recorded. Data from 31 patients, excluding dropouts, were analyzed. The ratio of change to the preoperative value was compared. After surgery, the LF/HF, HR, SBP, and FS score significantly increased (P < 0.01) and HF significantly decreased (2 h postoperatively: P < 0.05, 24 h postoperatively, before discharge: P < 0.01). SBP recovered to preoperative values 24 h postoperatively, and HR and FS scores recovered to preoperative values before discharge. However, even before discharge, LF/HF remained significantly higher than preoperative values, and HF remained significantly lower than preoperative values (P < 0.01). Conclusion We observed perioperative stress from multiple perspectives. Circulatory dynamics and psychological status recovered by the day before discharge; however, ANS activity did not. Therefore, evaluating ANS activity may be useful in visualizing potential perioperative stress in pediatric patients.
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Affiliation(s)
- Akari Uto
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Advanced Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kaoru Yamashita
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Advanced Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Shusei Yoshimine
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Advanced Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Minako Uchino
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Advanced Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Toshiro Kibe
- Department of Oral and Maxillofacial Surgery, Field of Oral and Maxillofacial Rehabilitation, Advanced Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsutaka Sugimura
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Advanced Therapeutics Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Machotta A, Hansen TG, Weiss M. Children's rights - the basis of quality in pediatric anesthesia. Curr Opin Anaesthesiol 2023; 36:295-300. [PMID: 36815521 DOI: 10.1097/aco.0000000000001256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW In 1989, the United Nations passed the 'Convention on the Rights of the Child' (UNCRC) and, among others claimed the highest attainable standard of health for children and consequently the highest level of safety and quality in paediatric anaesthesia. SAFETOTS (Safe Anesthesia For Every Tot, www.safetots.org ), an initiative of international active paediatric anaesthetists, has derived 10 rights, the '10 R' of children undergoing anaesthesia care, which are critical for the well being of the child. RECENT FINDINGS The current situation in paediatric anaesthesia care in Europe does not always meet the requirements demanded by the UNCRC. Anaesthesia-related complications in children are still persistent. Anaesthesiologists are frequently asked to provide care for newborns, infants and small children without having sufficient child-specific expertise, resulting in an increased morbidity and mortality. SUMMARY This article will explain these statutes of children's rights and their implications for everyday paediatric anaesthesia. Furthermore, it will also express the institutional and political changes that are needed to guarantee children their right to enjoy the highest attainable standard of health.
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Affiliation(s)
- Andreas Machotta
- Department of Anaesthesiology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Tom G Hansen
- Department of Anaesthesiology and Intensive Care, Division of Surgery, Akershus University Hospital Oslo, Norway and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital, Zürich, Switzerland
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Rai S, Bendale MC, Hanwate M, Reddy D, Gandotra A. Possibility of Avoiding Anesthesia in the Reduction of Greenstick and Angulated Forearm and Distal-End Radius Fractures in Children: A Comparative Study. Cureus 2023; 15:e38966. [PMID: 37313105 PMCID: PMC10259629 DOI: 10.7759/cureus.38966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction Greenstick and angulated forearm bone fractures are the most common fractures in children and invariably require closed reduction under anesthesia. However, pediatric anesthesia is somewhat risky and not always available in developing countries like India. Therefore, this study aimed to evaluate the standard (quality) of closed reduction without anesthesia in children and to determine satisfaction among parents. Materials and methods The present study included 163 children with closed angulated fractures of the distal radius and fracture shafts of both forearm bones, who were treated by closed reduction. One hundred and thirteen were treated without any anesthesia (study group) on an outpatient department (OPD) basis, whereas 50 children of similar age and fracture type underwent reduction with anesthesia (control group). After reduction by both methods check X-ray was done to evaluate the quality of the reduction. Results The average age of the 113 children in the present study was 9.5 years (range: 3.5-16.2 years), of which 82 children had radius or ulna fractures, and 31 had isolated distal radius fractures. In 96.8% of children, ≤10° of residual angulation was achieved. Furthermore, 11 children (12.4%) used paracetamol or ibuprofen for pain control in the study group. Moreover, 97.3% of parents stated that they would like their children to be treated without anesthesia if any fracture occurred again. Conclusions Closed reduction of greenstick angulated forearm and distal-end radius fracture in children in the OPD without anesthesia achieved satisfactory reduction and high parent satisfaction while reducing the risks of pediatric anesthesia and its associated complications.
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Affiliation(s)
- Sanjay Rai
- Orthopaedics, Military Hospital, Ambala, IND
| | | | - Mohit Hanwate
- Orthopaedics, SMBT (Smt Mathurabai Bhausaheb Thorat) Institute of Medical Sciences and Research Centre, Nashik, IND
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Hannan MJ, Parveen MK, Nandy A, Hasan MS. Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series. JMIRX MED 2021; 2:e25204. [PMID: 37725540 PMCID: PMC10414511 DOI: 10.2196/25204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/04/2021] [Accepted: 03/25/2021] [Indexed: 09/21/2023]
Abstract
BACKGROUND Owing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatric patients is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness, and success. OBJECTIVE The objective of this study is to compare postoperative patient comfort, length of hospital stay, and cost-effectiveness of pediatric laparoscopic appendectomies performed under spinal and general anesthesia with the usual standard-of-care procedures employed in the hospital. METHODS This is a case series of 77 consecutive pediatric laparoscopic appendectomies (involving 5-8-year-old children) that took place in a hospital in Chittagong, Bangladesh, in 2019. A total of 40 patients underwent spinal anesthesia and 37 patients underwent general anesthesia. Variables such as surgery and operation theater times, pain score, incidence of postsurgery vomiting, analgesic usage, discharge times, and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of anesthesia type. RESULTS The probability of vomiting when using spinal compared to general anesthesia was lower within the first 5 hours (P<.001) and 6 hours (P=.008) postoperation. A significant difference (P<.001) was observed between the total costs of the two procedures, with spinal anesthesia being less expensive. Patients were more likely to be discharged the same day of the procedure when spinal anesthesia was used (P=.008). CONCLUSIONS Spinal anesthesia has many advantages compared to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved due to a significant decrease in vomiting. This allows for more rapid hospital discharges and substantial cost savings, without compromising the outcome of the procedure.
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Affiliation(s)
- Md Jafrul Hannan
- Department of Pediatric Surgery, South Point Hospital, Chittagong, Bangladesh
| | | | - Alak Nandy
- Department of Anesthesiology, Chattagram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh
| | - Md Samiul Hasan
- Department of Pediatric Surgery, Dhaka Shishu Hospital, Dhaka, Bangladesh
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Becke-Jakob K, Eich C, Röher K. Präoperative Vorbereitung in der Kinderanästhesie. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01040-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shoham Y, Krieger Y, Rubin G, Koenigs I, Hartmann B, Sander F, Schulz A, David K, Rosenberg L, Silberstein E. Rapid enzymatic burn debridement: A review of the paediatric clinical trial experience. Int Wound J 2020; 17:1337-1345. [PMID: 32445271 DOI: 10.1111/iwj.13405] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/20/2020] [Accepted: 05/05/2020] [Indexed: 01/22/2023] Open
Abstract
NexoBrid (NXB) has been proven to be an effective selective enzymatic debridement agent in adults. This manuscript presents the combined clinical trial experience with NXB in children. Hundred and ten children aged 0.5 to 18 years suffering from deep thermal burns of up to 67% total body surface area were treated with NXB in three clinical trials. Seventy-seven children were treated with NXB in a phase I/II study, where 92.7% of the areas treated achieved complete eschar removal within 0.9 days from admission. Thirty-three children (17 NXB, 16 standard of care [SOC]) participated in a phase III randomized controlled trial. All wounds treated with NXB achieved complete eschar removal. Time to complete eschar removal (from informed consent) was 0.9 days for NXB vs 6.5 days for SOC (P < .001). The incidence of surgical excision was 7.9% for NXB vs 73.3% for SOC (P < .001). Seventeen of these children participated in a phase III-b follow-up study (9 NXB and 8 SOC). The average long-term modified Vancouver Scar Scale scores were 3.4 for NXB-treated wounds vs 4.4 for SOC-treated wounds (NS). There were no significant treatment-related adverse events. Additional studies are needed to strengthen these results.
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Affiliation(s)
- Yaron Shoham
- Plastic Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Yuval Krieger
- Plastic Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Guy Rubin
- Orthopaedic Department, Central Emek Hospital, Afula, Israel
| | - Ingo Koenigs
- Department of Pediatric Surgery, Pediatric Burn Unit, Plastic and Reconstructive Surgery in Children, Altonaer Kinderkrankenhaus & University Medical Center, Hamburg-Eppendorf, Germany
| | - Bernd Hartmann
- Burn Center with Plastic Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Frank Sander
- Burn Center with Plastic Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Alexandra Schulz
- Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
| | | | | | - Eldad Silberstein
- Plastic Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
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Breuer F, Beckers SK, Poloczek S. [Mass casualty incidents and attacks involving a multitude of children and adolescents-Overview of policy recommendations and challenges]. Anaesthesist 2019; 68:476-482. [PMID: 31297543 DOI: 10.1007/s00101-019-0626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fortunately, mass casualty incidents involving a large number of children and adolescents are rare and the experience in this field, both in terms of medical as well as psychosocial emergency care is comparatively low. Children represent a vulnerable group and have a particularly high risk of developing posttraumatic stress disorder in the aftermath of experiencing disasters. A selective literature search was carried out in Medline. The peculiarity of damaging events with a large number of children and adolescents affected is that in addition to emergency medical care, an early approach to psychosocial emergency care must be provided. Accordingly, it makes sense to integrate such structures into the respective deployment concepts. A specific screening algorithm for children could so far not prevail but due to the physiological and anatomical characteristics appropriate emergency medical care concepts should be provided. Furthermore, hospitals must adapt to this patient group in a suitable manner.
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Affiliation(s)
- F Breuer
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland.
| | - S K Beckers
- Ärztliche Leitung Rettungsdienst Stadt Aachen, Berufsfeuerwehr Aachen, Aachen, Deutschland.,Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - S Poloczek
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestr. 2, 10179, Berlin, Deutschland
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Ziegler B, Becke K, Weiss M. [Reduction the risk in pediatric anesthesia-what should we know-what should we do]. Wien Med Wochenschr 2018; 169:56-60. [PMID: 30229333 DOI: 10.1007/s10354-018-0651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/27/2018] [Indexed: 11/28/2022]
Abstract
Pediatric anesthesia has always been conjuncted with higher risk than anesthesia for adults (JP Morray; Pediatric Anesthesia 2011;21:722-9). Not only the imminent critical events, but also, caused by recently published data, the theoretical neurotoxicity of anesthetic agents and a potencial negative influence of anesthetics on braindevelopement, are in the spotlight.Concerns about the neurodevelopement and the general warnings from the U.S. Food and Drug Administration (FDA) for anesthesia in young children led to a worldwide discussion about safety in pediatric anesthesia (FDA Safety Anouncement 2017).Beside these theoretical risks, which are based only on animal research, we have to pay much more attention to the widely spread out poor quality of anesthesia in children.The following article should summarize the state of science about the risks and the opportunities to minimize them.
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Affiliation(s)
- Bernhard Ziegler
- Univ. Klinik f. Anästhesie, perioperative Medizin und allgemeine Intensivmedizin, Salzburger Landeskliniken, Paracelsus Medizinische Privatuniversität, Strubergasse 22, 5020, Salzburg, Österreich.
| | - Karin Becke
- Abteilung für Anästhesie und Intensivmedizin, Klinik Hallerwiese/Cnopf'sche Kinderklinik, Nürnberg, Deutschland
| | - Markus Weiss
- Anästhesieabteilung, Universitäts-Kinderspital Zürich, Zürich, Schweiz.,Extraordinarius für Kinderanästhesie, Universität Zürich, Zürich, Schweiz
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van Lindert EJ, Arts S, Blok LM, Hendriks MP, Tielens L, van Bilsen M, Delye H. Intraoperative complications in pediatric neurosurgery: review of 1807 cases. J Neurosurg Pediatr 2016; 18:363-71. [PMID: 27231823 DOI: 10.3171/2016.3.peds15679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.
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Affiliation(s)
| | - Sebastian Arts
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura M Blok
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mark P Hendriks
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luc Tielens
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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St Pierre M, Breuer G, Strembski D, Schmitt C, Lütcke B. [Briefing improves the management of a difficult mask ventilation in infants : Simulator study using Web-based decision support]. Anaesthesist 2016; 65:681-9. [PMID: 27565996 DOI: 10.1007/s00101-016-0213-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/17/2016] [Accepted: 07/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unanticipated airway problems in infants can rapidly develop into severe hypoxemia. Team members can provide support and suggest steps of action if a shared mental model of the next steps exists. Briefing prior to induction of anaesthesia may create such a shared mental model among all team members. OBJECTIVES The aim of the study was to assess whether a short briefing on the recommendations for an unexpected difficult airway, developed by the Working Group on Paediatric Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine, would influence the management of an unexpected difficult mask ventilation in an infant. The study also aims to assess whether a shared mental model would encourage the anaesthesia nurse to speak up and foster implicit coordination. METHODS Nineteen teams consisting of an anaesthesia resident and an anaesthesia nurse participated in a scenario of an urgent induction of anaesthesia in an infant. Teams were randomized to either conduct a briefing on the recommendations for an unexpected difficult airway prior to induction of anaesthesia or to have access to a Web-based cognitive aid with an emergency manual page containing the identical algorithm if needed. Induction of anaesthesia triggered upper airway obstruction and desaturation. The time course of desaturation followed published physiologic modelling. The time until the obstruction was relieved was recorded. Video recordings of the scenarios were analysed with respect to coordination patterns prior to induction as well as to coordination forms (implicit vs. explicit) during the emergency. At the end of the course, participants were asked to fill out a questionnaire. RESULTS Teams of both groups checked on the availability of airway equipment, but teams in the briefing group talked more often about treatment steps to relieve airway obstruction (p < 0.005). The time until the obstruction was relieved was significantly shorter in the briefing group (median: 80 s vs. 126 s; p < 0.005). In 45 % of the intervention scenarios the nurse suggested the solution to the airway problem whereas only 10 % of the nurses in the control group proposed a measure to relieve the obstruction (n.s.). Both groups showed no difference in the frequency of implicit vs. explicit coordination patterns. Nurses from the intervention group found the situation to be less an emergency and felt better prepared than nurses from the control group (p < 0.05). CONCLUSION Briefings prior to anaesthesia induction in paediatric anaesthesia should include management of unanticipated problems. In a simulation setting, a briefing on treatment steps for an unexpected difficult airway improves management of an upper airway obstruction. Explicit communication of intended actions by the anaesthesiologist may foster speaking up by team members.
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Affiliation(s)
- M St Pierre
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland.
| | - G Breuer
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - D Strembski
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - C Schmitt
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - B Lütcke
- Anästhesiologische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland
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