Medication Errors in Pediatric Anesthesia

A Report From the Wake Up Safe Quality Improvement Initiative | Anesthesia & Analgesia

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Background: Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies.

Conclusions: Our findings characterize the most common types of medication errors in pediatric anesthesia practice and provide guidance on future preventative strategies. Many of these errors will be almost entirely preventable with the use of prefilled medication syringes to avoid accidental ampule swap, bar-coding at the point of medication administration to prevent syringe swap and to confirm the proper dose, and 2-person checking of medication infusions for accuracy.

Full reference: Lobaugh, L. et al. (2017) Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative. Anesthesia & Analgesia. Vol. 125 (Issue 3) pp. 936–942

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Choice of Anesthesia for Cesarean Delivery

Neuraxial anesthesia use in cesarean deliveries (CDs) has been rising since the 1980s, whereas general anesthesia (GA) use has been declining | Anesthesia & Analgesia

In this brief report we analyzed recent obstetric anesthesia practice patterns using National Anesthesiology Clinical Outcomes Registry data. Approximately 218,285 CD cases were identified between 2010 and 2015. GA was used in 5.8% of all CDs and 14.6% of emergent CDs. Higher rates of GA use were observed in CDs performed in university hospitals, after hours and on weekends, and on patients who were American Society of Anesthesiologists class III or higher and 18 years of age or younger.

Full reference: Juang, J. et al. (2017) Choice of Anesthesia for Cesarean Delivery: An Analysis of the National Anesthesia Clinical Outcomes Registry. Anesthesia & Analgesia. 124 (6) pp. 1914–1917

Movies could replace anaesthetic for child radiotherapy

Children with cancer could be spared dozens of doses of general anaesthesia by projecting a video directly on to the inside of a radiotherapy machine during treatment | OnMedica

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The new research was presented this week at the ESTRO 36 conference (European Society for Radiotherapy & Oncology), taking place in Vienna, Austria.

Catia Aguas, a radiation therapist and dosimetrist at the Cliniques Universitaires Saint Luc, Brussels, Belgium, told the conference that using video instead of general anaesthesia is less traumatic for children and their families, as well as making each treatment quicker and more cost effective.

The study included 12 children aged between one and a half and six years old who were treated with radiotherapy using a Tomotherapy® treatment unit at the university hospital. Six were treated before a video projector was installed in 2014 and six were treated after.

Before the video was available, general anaesthesia was needed for 83% of children’s treatments. Once the projector was installed, anaesthesia was only needed in 33% of treatments.

Read the full commentary here

Advantages and disadvantages of reducing local anesthetic requirements in children

Walker, B.J. (2017) Journal of Clinical Anesthesia. 38(5) pp. 158–159

Prior to the widespread use of ultrasound guidance in regional anesthesia, higher volumes of local anesthetic were often required to achieve reliable blockade with landmark and neurostimulation techniques.

The ability to clearly visualize neural structures with ultrasound guidance has resulted in more precise delivery of local anesthetic around the target nerve or plexus, which should theoretically reduce the risk of complications such as local anesthetic systemic toxicity (LAST) as well as tissue toxicity to nerves and surrounding muscle.

Read the abstract here

Smartphone-based behavioural intervention alleviates children’s anxiety during anaesthesia induction

Cumino, D. et al. European Journal of Anaesthesiology. Published online: 18 January 2017

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Background: Preoperative anxiety negatively influences children’s anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children’s anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial.

Conclusions: The behavioural distraction strategies using smartphones were effective in preventing an increase in children’s anxiety during anaesthesia induction.

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Adaptation for life after birth: a review of neonatal physiology

Riviere, D. et al. Anaesthesia and Intensive Care Medicine. Published online: January 5 2017

Life as a fetus is very different from life after birth. The neonatal period (first 28 days of life or 44 weeks postconception age) is a period of dramatic and rapid physiological changes. These vary from the immediate adaptations to extrauterine life to a consequent gradual maturation of organ function. Questions still exist around this transition concerning the optimal oxygen concentration during resuscitation, methods of respiratory support, facilitation of cardiovascular changes, identification of at-risk infants for problems such as hypoglycaemia and hypothermia, and the role of therapeutic hypothermia. This article combines well established and contemporary information to summarize a systems-based approach to traditional neonatal physiology.

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A survey of the dose of inhalational agents used to maintain anaesthesia in infants

Brinkman, E.N. et al. European Journal of Anaesthesiology. Published online: November 10 2016

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Image source: Bill McConkey – Wellcome Images // CC BY-NC-ND 4.0

Background: Various animal studies suggest that currently used anaesthetics are toxic to the developing brain. Many reviews advise that the total anaesthetic drug exposure should be reduced but the dose usually used in clinical practice has not been clearly elucidated.

Conclusion: The concentration of inhalational anaesthetics in %MAC increased with age and was lowest in neonates. Most young infants received inhalational anaesthetics at a concentration below 1 MAC, which accords with current guidance to minimise anaesthetic drug exposure but may have unintended consequences.

Read the abstract here