Best practice & research clinical anesthesiology: Safety and quality in perioperative anesthesia care. Update on safety in pediatric anesthesia.

Jurgen C De Graaff,Martinus Hensgens,Thomas Engelhardt,Mathias Fuglsang Johansen

doi:10.1016/j.bpa.2020.12.007

Abstract

Pediatric anesthesia is large part of anesthesia clinical practice. Children, parents and anesthesiologists fear anesthesia because of the risk of acute morbidity and mortality. Modern anesthesia in otherwise healthy children above 1 year of age in developed countries has become very safe due to recent advance in pharmacology, intensive education, and training as well as centralization of care. In contrast, anesthesia in these children in low-income countries is associated with a high risk of mortality due to lack of basic resources and adequate training of health care providers. Anesthesia for neonates and toddlers is associated with significant morbidity and mortality. Anesthesia-related (near) critical incidents occur in 5% of anesthetic procedures and are largely dependent on the skills and up-to-date knowledge of the whole perioperative team in the specific needs for children. An investment in continuous medical education of the perioperative staff is required and international standard operating protocols for common procedures and critical situations should be defined.

Highlights

Anesthesia in children is a common and a large part of daily clinical practice of the general anesthesiologist with almost 30% of all general anesthesia procedures provided in children less than 15 years of age [1]
In children less than 8 years, most anesthetics are performed in American Society of Anesthesiologists (ASA)-physical status (PS) classes I (56%) and II (30%) patients, and are performed in a community hospital (57%) and surgical centers (22%) [4]
This study showed eight cases with perioperative cardiac arrest (POCA), of which five children died (Table 1)

Summary

Introduction

Anesthesia in children is a common and a large part of daily clinical practice of the general anesthesiologist with almost 30% of all general anesthesia procedures provided in children less than 15 years of age [1]. The continued decline in perioperative and anesthesia-related morbidity and mortality over the subsequent decades was achieved primarily by implementation of technological improvements and the introduction of standards for basic patient monitoring and widespread use of sevoflurane, propofol and sugammadex [9e11]. Database studies in tertiary referral centers in Australia and the Netherlands showed a similar incidence of approximately 1 case per 10,000 anesthetics in which anesthesia contributed partly to the death of the patients (Table 1) [12,13].

Results

Conclusion