Paediatric anaesthesia
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When a patient is injured or dies during anesthesia care, both the family of the patient and the health care providers suffer. The family needs to know what happened. The family can benefit from personal contact with the involved physicians. ⋯ The health care providers must report adverse events. Systematic review of adverse events can provide improved patient safety. Mechanisms exist to support the health care providers recovering from these potentially devastating experiences, but useful support is often not immediately available.
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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
ReviewTolerance and addiction; the patient, the parent or the clinician?
Tolerance has been recognized for some time where chronic exposure to certain drugs, particularly benzodiazepines and opioids, is associated with apparent tachyphylaxis. When these drugs are stopped or progressively reduced as in 'tapering', withdrawal symptoms may result. Tolerance and the flip side of the coin, withdrawal, are the determinants of addiction. ⋯ When these agents are withdrawn, the adaptive mechanisms, devoid of substrate, take time to diminish and produce symptoms recognizable under the term of 'withdrawal'. Children may be exposed to these agents in different ways; in utero, as a result of substances that the mother ingests by enteral, parenteral or inhalational means that are transmitted to the infant via the placenta; as a result of an anesthetic for surgery; or as a result of sedation and analgesia administered to offset the stresses and trauma inherent from intensive care treatment in the neonatal intensive care unit or pediatric intensive care unit. Additionally, anesthetic and intensive care staff are exposed to powerful and addictive drugs as part of everyday practice, not simply by overt access, but also by subliminal environmental exposure.
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Paediatric anaesthesia · Jul 2011
ReviewLessons for pediatric anesthesia from audit and incident reporting.
This review will attempt to put the various systems that allow clinicians to assess errors, omissions, or avoidable incidents into context and where possible, look for areas that deserve more or less attention and resource specifically for those of us who practice pediatric anesthesia. Different approaches will be contrasted with respect to their outputs in terms of positive impact on the practice of anesthesia. ⋯ Implementation strategies are considered alongside the reports as the reports cannot be considered end points themselves. Specific areas where pediatric anesthetics has failed to address recurring risk through any currently available tools will be highlighted.