Paediatric anaesthesia
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Wrong route medication errors due to tubing misconnections are potentially life-threatening complications that have been made possible by the universal use of the Luer connector. The new International Organization of Standardization standards for small bore connectors, ISO 80369 series, have been developed to reduce the risk of these types of erroneous connections. ⋯ However, design and manufacturing standards have progressed slowly, and clinical roll-outs have been delayed, despite the implementation of California laws to promote their use. We are currently in a state of transition where new connectors for enteral and neuraxial use will be entering the clinical market in the next few years, and increasing use will identify additional patient safety concerns.
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Paediatric anaesthesia · Jan 2018
Incidence and predictors of 30-day postoperative readmission in children.
Hospital readmissions are being used as a quality metric for hospital reimbursement without a clear understanding of the factors that contribute to readmission. ⋯ Children with congenital heart disease, high American Society of Anesthesiologist physical class, inpatient status, and at least 1 postoperative complication of any kind are at high risk for postsurgical readmissions. We provide an algorithm for quantifying this risk with the goal of reducing the number of readmissions, improving the care of patients with complex chronic illnesses, and reducing hospital costs.
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Paediatric anaesthesia · Jan 2018
Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children.
Children often starve for longer than recommended by current preoperative fasting guidelines. ⋯ The introduction and implementation of the 6-4-0 fasting regimen reduces median fluid fasting duration and the number of children subjected to extended fasting.
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Paediatric anaesthesia · Jan 2018
Ultrasound-guided pudendal nerve block in children: A new technique of ultrasound-guided transperineal approach.
Transperineal pudendal nerve block guided by nerve stimulator is used in pediatric anesthesia as an alternative to caudal analgesia in perineal surgery. The risk of rectal puncture or intravascular injection is inherent to this blinded technique. We described a new technique of transperineal pudendal nerve block, with ultrasound guidance, to improve safety of the technique. ⋯ The new technique of ultrasound-guided pudendal nerve block, described in this study, seems to be easy to perform with a good success rate, and probably improves safety of the puncture and of the injection by real-time visualization of anatomical structures and local anesthetic spread.
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Paediatric anaesthesia · Jan 2018
Comparative StudyPressure-flow characteristics of breathing systems and their components for pediatric and adult patients.
Breathing circuits connect the ventilator to the patients' respiratory system. Breathing tubes, connectors, and sensors contribute to artificial airway resistance to a varying extent. We hypothesized that the flow-dependent resistance is higher in pediatric breathing systems and their components compared to respective types for adults. ⋯ The resistances of pediatric breathing systems and their components result in pressure gradients exceeding those for adults several fold. Considering the resistance of individual components is crucial for composing a breathing system matching the patient's needs. Compensation of the additional resistance should be considered if a large composed resistance is unavoidable.