Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2022
Training Clinicians to become Leaders of Complex Change: Lessons from Scotland.
Clinicians are trained to diagnose disease and recommend treatments or procedures. This is the focus of much of undergraduate training, but delivery of healthcare depends on so much more than theoretical knowledge and technical skill. It is a complex environment where professionals from different backgrounds have to work together to deliver safe pathways of care to patients who have very varied backgrounds. ⋯ In turn, this can negatively impact on the experience of patients and staff. Attempting to change this complex environment requires a unique set of skills. This article describes an international fellowship that creates a network of individuals skilled in quality improvement, human factors, service design and leadership.
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We describe a two-year-old boy with Dravet syndrome, a severe genetic epilepsy, who developed a generalized tonic-clonic seizure immediately following an intravenous bolus of lidocaine given for propofol pain amelioration during induction of anesthesia for emergency gastroscopy. Although lidocaine has not specifically been reported as potentiating seizures in Dravet syndrome, it is well-established that sodium channel blockers can worsen seizures in this population.
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Paediatric anaesthesia · Oct 2022
Randomized Controlled TrialInvasive and non-invasive assessment of macro- and microcirculatory effects of vasopressors during sevoflurane anesthesia in a pediatric experimental model: a randomized trial.
While non-invasive assessment of macro- and micro-circulation has the promise to optimize anesthesia management, evidence is lacking for the relationship between invasive and non-invasive measurements of cardiac output and microcirculatory indices. ⋯ The results of this study suggest that non-invasive cardiac output measurements may not accurately reflect changes in macrocirculation after hemodynamic optimization by vasopressors. Due to the incoherence between macro- and micro-circulation, monitoring microcirculation is essential to guide patient management.