Anesthesia Staff Research Articles

Patient handover from anaesthesia to postanaesthesia unit: An analysis of the current situation in three Swiss hospitals

Patient handover from anaesthesia to postanaesthesia unit: An analysis of the current situation in three Swiss hospitals Abstract: Background: Patient handovers carry a risk of inadequate or missing communication of important information that can jeopardize patient safety. To increase patient safety, protocols for processes and contents of a structured patient handover were created. Aim: To assess the current status of patient handovers from anaesthesia staff to recovery room nurses. Method: After a literature search an observation protocol for patient handovers according to the SBAR concept (von Dossow & Zwißler, 2016) was developed. Using this checklist, non-participant observations were conducted in three Swiss hospitals and evaluated with statistical analysis. Results: A total of 98 observations were made. The report receiving person felt integrated into the handover and received the necessary information. Deficiencies in patient identification and a joint control of lines after surgical interventions could be identified. The subjectively rated quality of patient handover did not differ between the three hospitals (X2(2)=,927, p=,629) and also not according to the time of day (X2(2)=3,604, p=,216). There was also no difference between the subjective quality of the handover and the delivering professional group (X2(3)=4,507, p=,212). Conclusions: The subjective quality of patient handover did not differ between the three hospitals. However, the patient handover protocols need to be adapted to ensure that patient identification and a joint assessment including control of lines and drains are performed.

Feasibility, implementation, and outcomes of in situ simulation-based curriculum to manage common emergencies in the pediatric post-anesthesia care unit

PurposeStudies have shown that most critical events that occur in the post-anesthesia care unit (PACU), including cardiac arrests, are preventable and respiratory in origin. Admission to the PACU necessitates transfer of care from anesthesiology staff to PACU nurses. The aim of the study is to assess a) feasibility in implementing an in-situ curriculum for PACU nurses to manage common pediatric emergencies, b) the effectiveness of the curriculum in improving self-confidence of the PACU nurses in performing essential skills c) nurses’' perception of such an offering. Design and methodsThis was a single center curricular evaluation study. Anonymous surveys were used to assess curriculum effectiveness by comparing self-reported confidence in the execution of key technical skills and application of knowledge in a real clinical environment at three time points: baseline, immediately post-simulation, and 3 months later. ResultsOf 50 PACU nurses, 80%, 98% and 58% responded to the targeted needs assessment, post-simulation and follow up (at 3 months) survey respectively. Self-reported confidence levels for most of the essential skills were significantly increased immediately after simulation and at 3 months. Most of the participants responded that the simulation training helped them improve care of hypoxic (83%) and hypotensive (62%) patients in the PACU. ConclusionImplementation of in situ curriculum for PACU nurses was feasible. The self-reported confidence in performing essential skills increased significantly and the nurses could apply these skills in real clinical environment. Practice implicationsInterprofessional simulation should be implemented in all high risk units to optimize safety of children.

Patient-Controlled Sedation by Non-Anaesthesiologists during Flexible Bronchoscopy: A One-Year Experience Regarding Safety, Feasibility and Costs

Background: Patient-controlled sedation (PCS) is an efficient and costsaving method for sedation during flexible bronchoscopy (FB) in the presence of anaesthetic staff, but no data is available for PCS in a non-anaesthesiologist environment. Methods: This descriptive study describes PCS with propofol in a non-anaesthesiologist setup during outpatient FB procedures, including transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy and/or multistation endobronchial ultrasound, and endoscopic ultrasound with bronchoscope. Results: 287 procedures were completed. The median (range) duration for the procedures was 45 (10-105) minutes. The median (range) total propofol dose administered was 201 (55-570) mg, and 61 procedures (21%) required bolus doses of alfentanil. Desaturation occurred during 21% of the procedures and was resolved spontaneously (59%) or by using a jaw thrust (41%). No evidence was found that alfentanil contributed to desaturation (p=0.081). Inconsistent results were shown regarding the impact of alfentanil on the reduction of cough. The post-procedural assessment revealed high score of satisfaction and feasibility. 3 (1%) procedures were cancelled due to insufficient sedation. No prolonged recovery with need of overnight stay was reported. The direct costs for sedation were 180 USD/procedure. Conclusion: PCS with propofol and the presence of trained nonanaesthesiologists during outpatient FB has shown to result in high procedure feasibility and satisfaction without compromising patient safety or increasing the risk for unhandled respiratory adverse events. The method reduces costs for sedation and offers the possibility to increase patient turn over due to no prolonged recovery.

Parental Treatment Satisfaction Scores in a Day Care Pediatric Surgical Procedures

Objective: To determine the mean Parental treatment satisfaction scores in a day care pediatric surgical procedure. Method: A cross-sectional study was conducted at the department of Pediatric Surgery, Liaquat National Hospital, Karachi between September 2019 to March 2020. All children of age 1-15 years of either gender admitted in Day Care Surgery for undergoing any of the pediatric surgical procedures (Hernia surgery, circumcision surgery or cysts surgery) were included. Data regarding age of child, gender, educational status of mother and father and parental age was obtained and was noted. The questionnaire covered the following areas: surgical staff and general treatment satisfaction, nursing staff and general information satisfaction; and Anesthetic staff satisfaction. The total parenteral treatment satisfaction scores were calculated. Results: Age range of children in this study was from 1 to 15 years with mean age of 7.7 ± 5.5 years, mean age of mother was 35.1 ± 7.5, mean age of father was 39.7 ± 6.9, mean duration of surgery was 45 ± 13 and mean duration of anesthesia was 47 ± 5 in minutes. The mean Parental treatment satisfaction scores in a day care pediatric surgical procedure was 6.67 + 0.7. Conclusion: The satisfaction level of the parents was fair enough considering the units where pediatric sedation was administered. When the physical conditions and the communication with patients and their relatives are improved and the procedure schedule is followed strictly, there will be further improvement in positive clinical results. Keywords: Pediatric surgery, Parental, satisfaction score, Sedation

One-year Outcomes After Implementation Of A Ruptured Abdominal Aortic Aneurysm Protocol

OBJECTIVE Societal guidelines recommend protocol establishment for patients with ruptured abdominal aortic aneurysms (rAAA), but few reports exist. We describe 1-year outcomes after implementing a rAAA protocol and a survey of team member perceptions. METHODS This was a multi-hospital single healthcare network pre-post investigation (2017-2020) where a single quaternary university hospital (QUH) receives rAAA transfers. Protocol activation engages a multidisciplinary team including vascular surgery, anesthesia, operating room (OR) and emergency department (ED) staff, and was implemented in Feb 2020. Patients are routed from the helipad to the OR or ED for expedited management. Primary outcomes were time from QUH arrival to OR and 30-day mortality. Post-protocol outcomes were compared to historical controls (2017-2019). As a qualitative adjunct, we conducted a survey examining perceptions among participants at 1-year post implementation. Results: 88 patients with rAAA presented during our study period (42 pre; 46 post). Protocol activation occurred in 32 (70%) of post-protocol patients. Presenting characteristics were similar between groups (Table 1). QUH arrival time to OR was lower for the post protocol cohort compared to historical controls (pre 88.9±78.5; post 24.6±28.4 minutes; p<0.01). 30-day mortality did not differ significantly between groups (pre N=17(40%); post N=13(41%); P=.8). Most survey participants believed the protocol improved safety (65%) and care efficiency (63%). Almost all (89%) would want the protocol activated for a family member (Table 2). CONCLUSIONS rAAA protocol implementation reduced OR arrival time and improved patient safety and efficiency perspectives among staff. Protocol development should be considered at centers with high volumes of rAAA. Societal guidelines recommend protocol establishment for patients with ruptured abdominal aortic aneurysms (rAAA), but few reports exist. We describe 1-year outcomes after implementing a rAAA protocol and a survey of team member perceptions. This was a multi-hospital single healthcare network pre-post investigation (2017-2020) where a single quaternary university hospital (QUH) receives rAAA transfers. Protocol activation engages a multidisciplinary team including vascular surgery, anesthesia, operating room (OR) and emergency department (ED) staff, and was implemented in Feb 2020. Patients are routed from the helipad to the OR or ED for expedited management. Primary outcomes were time from QUH arrival to OR and 30-day mortality. Post-protocol outcomes were compared to historical controls (2017-2019). As a qualitative adjunct, we conducted a survey examining perceptions among participants at 1-year post implementation. Results: 88 patients with rAAA presented during our study period (42 pre; 46 post). Protocol activation occurred in 32 (70%) of post-protocol patients. Presenting characteristics were similar between groups (Table 1). QUH arrival time to OR was lower for the post protocol cohort compared to historical controls (pre 88.9±78.5; post 24.6±28.4 minutes; p<0.01). 30-day mortality did not differ significantly between groups (pre N=17(40%); post N=13(41%); P=.8). Most survey participants believed the protocol improved safety (65%) and care efficiency (63%). Almost all (89%) would want the protocol activated for a family member (Table 2). rAAA protocol implementation reduced OR arrival time and improved patient safety and efficiency perspectives among staff. Protocol development should be considered at centers with high volumes of rAAA.

Editorial introductions.

Editorial introductions.

Acupuncture and Global Health: Providing Medical Acupuncture Education and Service in Georgetown, Guyana.

Objective: Guyana is located on the north coast of the South American continent and is a middle-income developing country in the Caribbean. There is little educational opportunity for individuals interested in medical acupuncture. The aim of this project was to develop an introductory medical acupuncture curriculum for perioperative use. Materials and Methods: Through a carefully coordinated teaching-and-care plan, with support from physicians and various medical organizations, an educational opportunity in medical acupuncture was established at the Georgetown Public Hospital Corporation, a medical university teaching hospital in Georgetown, Guyana. The project involved development of a medical acupuncture curriculum, as well as teaching and patient care. Anesthesia staff members, resident trainees, and perioperative and pain-clinic patients participated. Results: Medical acupuncture-trained physicians were able to provide medical acupuncture education and services in a third-world country because of this project. Conclusion: This project is an ideal example of utilizing medical acupuncture for promoting global heath.

Impact of foeto-maternal resuscitation and perimortem caesarean section simulation training: An opinion survey of healthcare participants

Background: The incidence of maternal cardiac arrest is rising in recent years. Medical staff generally lack the experience of performing resuscitation on pregnant patients. Maternal cardiac arrest and perimortem caesarean section simulation training was newly introduced in the Advanced Life Support in Obstetrics provider courses in Hong Kong since April 2021. Objective: To evaluate the course participants’ opinions on maternal cardiac arrest simulation training. Methods: A questionnaire survey was conducted for all participants in the Advanced Life Support in Obstetrics provider course in April 2021 to assess their opinions on the usefulness of this training. Results: There were four Advanced Life Support in Obstetrics provider courses in April 2021 with 36 participants in each course, and 137 questionnaires were received at the end of the course. The response rate was 137/144 (95.1%). After excluding the questionnaires with incomplete information, 134 questionnaires were included for final analysis. Almost all of the participants agreed that the maternal cardiac arrest simulation training could help them in their work (97.8%), could improve their knowledge and skill (98.5%) and could improve team training and co-ordination (97.0%). The majority of them (97.0%) felt more confident in managing maternal cardiac arrest after the training, and 97.8% of participants felt that the perimortem caesarean section model was useful for training. Around 80% of the participants would recommend this course to their colleagues. There were no significant differences in opinions on the usefulness of this training among participants with regard to their specialty, whether they were doctors or nurses, their years of experience and the specific hospital settings. Conclusions: Maternal cardiac arrest simulation training was highly valued by all levels of obstetric, emergency medicine and anaesthesia staff in both public and private hospitals.

Normothermic regional perfusion surgical technique for the procurement of cardiac donors after circulatory death.

Normothermic regional perfusion surgical technique for the procurement of cardiac donors after circulatory death.

Evaluation of a new laryngoscope blade (Manipal throat packing blade) for throat pack insertion.

Background and aims:Insertion of a throat pack using a Macintosh laryngoscope after placing an oral Ring, Adair and Elwyn (RAE) tube fixed to the lower lip in the midline invariably results in the lateral movement of the tongue or the tube requiring repositioning. The aim was to design a laryngoscope blade that would produce minimal movement of the endotracheal tube or the tongue during the insertion of throat pack and compare it with the Macintosh laryngoscope blade.Material and Methods:A laryngoscope blade similar to the Doughty’s blade of Boyle Davis mouth gag with a groove in the center of the blade was initially designed. This was made of polyvinyl chloride to enable 3-D printing. Specifications given were modified after trial and error including addition of a flange. A bench study was then done to compare the Macintosh blade with the Manipal blade with and without flange. Forty anesthesia postgraduates and staff familiar with airway management inserted throat pack with each blade in random order in a manikin already intubated with an oral RAE tube and their impressions were noted.Results:The RAE tube remained in the midline after throat packing in 97.5 and 95% with Manipal blade with and without flange as compared to 52.5% with Macintosh blade. Ease of use was affected by the lack of sturdiness of the new blades. The light was good. Most people found both blades better or the same as the Macintosh blade.Conclusion:The Manipal laryngoscope blade with and without flange are both associated with the minimal lateral movement of the endotracheal tube and are easy to use. Their sturdiness must be improved.

How Does Tube Size Affect Patients' Experiences of Postoperative Sore Throat and Hoarseness? A Randomised Controlled Blinded Study.

Sore throat (POST) and hoarseness (PH) are common complaints after endotracheal intubation (EI). The aim of this study was to investigate whether tube size impacts the experiences of POST and PH after EI in patients undergoing elective surgery, as well as to document a possible role of gender. This randomised, controlled, blinded study was conducted at Aalborg University Hospital, Thisted, Denmark or North Denmark Regional Hospital, Denmark. A total of 236 patients (53.4% female, mean age 50.9 years (SD 14.0)) were enrolled from the departments of gynaecology, parenchyma and orthopaedics. The patients were randomised to a tube size of 8.0 or 7.0 for males and 7.0 or 6.0 for females. Tube sizes were known to the anaesthesia staff but blinded for patients, researchers and staff at the postoperative care unit. POST and/or PH was reported 30–60 min before anaesthesia, at 30 min and at 2, 5, 12, 24, 48, 72 and 96 h after anaesthesia. Both female and male patients experienced significantly lower levels of POST and PH after intubation with the smallest tube size. This study demonstrates that a smaller size of tube results in a reduction in POST and PH after EI for both male and female patients.

COVID-19 implications for pediatric anesthesia: Lessons learnt and how to prepare for the next pandemic.

COVID-19 is mainly considered an "adult pandemic," but it also has strong implications for children and consequently for pediatric anesthesia. Despite the lethality of SARS-CoV-2 infection being directly correlated with age, children have equally experienced the negative impacts of this pandemic. In fact, the spectrum of COVID-19symptoms among children ranges from very mild to those resembling adults, but may also present as a multisystemic inflammatory syndrome. Moreover, the vast majority of children might be affected by asymptomatic or pauci-symptomatic infection making them the "perfect" carriers for spreading the disease in the community. Beyond the clinical manifestations of SARS-CoV-2 infection, the COVID-19 pandemic may ultimately have catastrophic health and socioeconomic consequences for children and adolescents, which are yet to be defined. The aim of this narrative review is to highlight how COVID-19 pandemic has affected and changed the pediatric anesthesia practice and which lessons are to be learned in case of a future "pandemic." In particular, the rapid evolution and dissemination of research and clinical findings have forced the scientific community to adapt and alter clinical practice on an unseen and pragmatic manner. Equally, implementation of new platforms, techniques, and devices together with artificial intelligence and large-scale collaborative efforts may present a giant step for mankind. The valuable lessons of this pandemic will ultimately translate into new treatments modalities for various diseases but will also have the potential for safety improvement and better quality of care. However, this pandemic has revealed the vulnerability and deficiencies of our health-care system. If not addressed properly, we may end up with a tsunami of burnout and compassionate fatigue among health-care professionals. Pediatric anesthesia and critical care staff are no exceptions.

Problem-Based Learning Discussion to Introduce Quality Improvement to Residents in the Perioperative Setting.

IntroductionQuality improvement (QI) is a growing and critical part of perioperative medical practice. However, there are few examples of educational tools to introduce new learners from anesthesiology to QI. This may contribute to a lack of enthusiasm to learn about and apply these concepts.MethodsThis problem-based learning discussion (PBLD) was designed to teach anesthesiology residents about QI in a way allowing for the application of core concepts in a group setting. We created this PBLD using available literature on QI in the perioperative setting. Basic concepts and terminology necessary for new learners to communicate about QI were specifically addressed. Feedback from staff anesthesiologists and resident participants in the PBLD was used to tailor it to the needs of the target learners and to reach the educational objectives.ResultsWe delivered this PBLD in two separate learning sessions both to board-certified anesthesiologists (N = 10) and to resident anesthesiologists (N = 19) at our institution. The exercise was reviewed anonymously, and qualitative feedback was used to improve updated versions. Respondents felt that the PBLD would be improved by avoiding jargon-based humor, considering the systemic implications of QI, and limiting the overall length of the learning tool. The PBLD has been adopted as a starting point for discussions about QI in our training program.DiscussionWe feel this PBLD can introduce new learners to the learning objectives. This tool has provided an alternative to lectures or computer-based modules for teaching QI.

The practice of regional anesthesia during the COVID-19 pandemic: an international survey of members of three regional anesthesia societies.

PurposeTo determine the preferences and attitudes of members of regional anesthesia societies during the COVID-19 pandemic.MethodsWe distributed an electronic survey to members of the American Society of Regional Anesthesia and Pain Medicine, Regional Anaesthesia-UK, and the European Society of Regional Anaesthesia & Pain Therapy. A questionnaire consisting of 19 questions was developed by a panel of experienced regional anesthesiologists and distributed by email to the participants. The survey covered the following domains: participant information, practice settings, preference for the type of anesthetic technique, the use of personal protective equipment, and oxygen therapy.ResultsThe survey was completed by 729 participants from 73 different countries, with a response rate of 20.1% (729/3,630) for the number of emails opened and 8.5% (729/8,572) for the number of emails sent. Most respondents (87.7%) identified as anesthesia staff (faculty or consultant) and practiced obstetric and non-obstetric anesthesia (55.3%). The practice of regional anesthesia either expanded or remained the same, with only 2% of respondents decreasing their use compared with the pre-pandemic period. The top reasons for an increase in the use of regional anesthesia was to reduce the need for an aerosol-generating medical procedure and to reduce the risk of possible complications to patients. The most common reason for decreased use of regional anesthesia was the risk of urgent conversion to general anesthesia. Approximately 70% of the responders used airborne precautions when providing care to a patient under regional anesthesia. The most common oxygen delivery method was nasal prongs (cannula) with a surgical mask layered over it (61%).ConclusionsGiven the perceived benefits of regional over general anesthesia, approximately half of the members of three regional anesthesia societies seem to have expanded their use of regional anesthesia techniques during the initial surge of the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-021-02150-8.

Investigating Barriers to Completion of Postpartum Tubal Ligation: A Retrospective Chart Review.

To identify the completion rate for postpartum tubal ligation (PPTL) and predictors of noncompletion of PPTL in a central New Jersey population. We conducted a retrospective chart review at a tertiary care center in New Jersey for patients delivering during an 18-month period. We used the electronic medical record to identify all of the patients who had documented desire for a PPTL at the time of admission. We calculated the rate of PPTL completion and identified predictors of completion and risk factors for noncompletion. We recorded any documented reasons for cancellation and choice of contraception after noncompletion. Of 626 women who requested PPTL on admission, 508 (81.2%) procedures were performed. The most common reasons for noncompletion were patient changing her mind (38.1%) and unknown/not documented (22.9%). Cesarean delivery was the strongest predictor of completion, with 93.4% completion among cesarean deliveries compared with 65.6% among vaginal deliveries (P < 0.01). Lack of insurance also was associated with noncompletion (P < 0.01). There was no difference in body mass index (P = 0.75), gravidity (P = 0.99), parity (P = 0.72), or high-risk status (P = 0.47) between completed and noncompleted PPTL. Cesarean delivery is a strong predictor of PPTL completion, most likely because of easier availability of the operating room, anesthesia, and ancillary staff. Body mass index, gravidity, and parity are not associated with PPTL completion. Future research should focus on exploring whether this association is system, provider, or patient dependent.

TP9.2.14A novel 'one stop' service for Gallstone (GS) disease utilizing Emergency General Surgery (EGS) ambulatory clinic (AC) and dedicated expedited theater lists for early Cholecystectomy

Abstract Introduction GS related disease account for almost 1/3rd admissions and referrals in EGS 1. Rate of early cholecystectomy, as mandated by NICE guidelines, in a recent RCS annual report was only 0-30% of eligible patients.2 Aims The aim was to determine if an improved rate of acute cholecystectomy (AC) had been achieved by; increasing elective capacity for emergency general surgeons (EGS), ring fencing hot lists for AC, increased use of NCEPOD list and campaign of awareness among theatre and anaesthetic staff. Material and Methods A retrospective study of rates of AC before and after implementation of changes in working practice was conducted using hospital episode data. All patients eligible for early cholecystectomy were included. AC rate, Intra and post -operative complications, length of stay and number of referrals to the elective upper gastrointestinal (UGI) service were determined. Results Conclusion Acute cholecystectomy during acute admission by emergency surgical had been significantly improved. It is safe and does not increase post-operative LOS.

SP2.2.10Barriers to Compliance of the WHO Safe Surgical Checklist in an Ethiopian Tertiary Referral Centre

Abstract Aims Ethiopia is the world’s 12th most populous country, with a health care system currently undergoing significant development. Current data shows perioperative mortality at 7%, compared to the 0.4– 0.8% reported in more economically developed countries. In 2008 the WHO created the Safe Surgical Checklist (SSC), globally shown to dramatically improve perioperative mortality and used throughout Ethiopia since 2010. The author aimed to review compliance to this checklist within emergency theatres in Ethiopia and assess potential barriers to its use. Methods A prospective observational study was undertaken at Felege Hiwot Referral Hospital, a tertiary referral hospital in Northwest Ethiopia, over a six-week period. 70 emergency operations were directly observed. Results The SSC was used in 0 out of 70 cases, no surgical pauses were observed and during each operation, a member of the anaesthetic team was observed to tick each box incorrectly as completed while finalising paperwork at the end of the case. Interviews with surgical and anaesthetic staff members revealed poor compliance to be secondary to a lack of knowledge of the benefits of the checklist and no training in its use. Conclusions After its introduction in 2008 compliance with SSC was poor globally, with the published data revealing this to be secondary to poor initial implementation from senior hospital staff and a lack of staff training. While compliance has improved in more economically developed countries, the same barriers are still faced in Ethiopia. These barriers must be targeted in order to improve perioperative outcomes.

The Efficacy of Single-Dose Aescin in Preventing Postoperative Sore Throat Compared to Placebos: A Double-Blinded, Randomized Controlled Trial

Background: Postoperative sore throat (POST) is a common complication found in surgical patients undergoing general anesthesia with endotracheal tube (ETT). Its severity varies and may affect postoperative outcomes and patient satisfaction. Aescin is an extract from horse chestnut (Aesculus Hippocastanum) that possesses the anti-inflammatory, venous decongestion, and antiedema property with few side effects. Objective: To demonstrate the reduction of incidence and severity of POST in patients undergoing general anesthesia with ETT. Materials and Methods: One hundred and seventeen patients, ASA I and II undergoing general anesthesia with ETT with elective surgery (abdominal, breast, gynecological, orthopedics) in a university hospital were enrolled and allocated randomly to aescin (A) or placebo (P) group. Patients, investigators, and research assistants were blinded to the allocation. Patients in A group (n=58) received aescin (Reparil&reg;) 40 mg orally 2 to 6 hours prior to surgery and P group (n=59) received placebo. Anesthesia care was identical and under blinded staff anesthesiologist&rsquo;s discretion. The presence/absence of POST, numerical pain score of POST, adverse events and cumulative analgesics consumption were recorded postoperatively at 30, 60 minutes, 2, 4, and 24 hours. Results: Thirty-seven and 34 patients in A and P group, respectively, developed POST which was not different significantly at all time points. Numerical pain score at all time points did not differ between groups statistically. However, log-rank test analysis revealed that A group had a slightly more rapid recovery from POST than P group (0.0013 vs. 0.0007 case/person-minute, p=0.03). Side effects and analgesics consumption did not differ between groups. Conclusion: Single 40 mg oral dose of aescin preoperatively, compare to placebo, did not reduce the incidence or severity of POST in the first 24 postoperative hours. Aescin, however, hastened the speed of recovery of POST compare to placebo with statistical significance. Keywords: Aescin; Incidence; Postoperative sore throat; Reparil

The interplay between children, their parents and anaesthesia staff during the child's anaesthesia - An observational study.

To interpret and understand the interplay between children, their parents, and anaesthetic staff to gain a greater understanding of children being anaesthetised. Anaesthesia induction is a stressful procedure for the child and parents in the technologically advanced environment in the operating room (OR). Anaesthesia staff are a key resource for ensuring safety and interplays, but the meeting is often short, intensive, and can affect the child and the parent. A qualitative observational design with a hermeneutic approach. Twenty-seven non-participant observations were conducted and videotaped when children were being anaesthetised. The SRQR checklist was used. The result is presented as a theatre play with three headings; the scene, the actors, and the plot. The scene was not designed for the child or the parent's comfort and could lead to anxiety and insecurity. Four themes described the interplays: The need to be inviting and to be invited, The need for varying compliance, The need for mutual dependence, and The need to give and to receive emotional support. The plot could lead to uncertainty, and the interplay could change between being caring and uncaring depending on the actors. The technologically advanced environment in the OR constituted an emotional obstacle, but the anaesthesia staff themselves can be a powerful resource creating a caring environment. The outcome of the plot may depend on the anaesthesia staff's bearing. A caring approach in the OR requires a willingness from the anaesthesia staff to invite the child to participate and find a balance between helping the parents to find their place in the OR and support them in supporting their child. The findings can start reflections in the unit on how to create a more caring environment.

It's Not Over Till It's Over: A Prospective Cohort Study and Analysis of "Anesthesia Stat!" Emergency Calls in the Pediatric Post-Anesthesia Care Unit (PACU).

BackgroundEmergency "Anesthesia Stat!" (AS!) calls remain a common practice in medical centers even when advanced communication infrastructures are available. We hypothesize that the analysis of post-procedure "AS!" calls will lead to actionable insights which may enhance patient safety.MethodsAfter institutional review board approval, we prospectively collected data from April 2015 through May 2018 on "AS!" calls throughout the pediatric operating rooms (OR), off-site locations, and post-anesthesia care unit (PACU) at a tertiary university medical center. Data recorded included demographic information, location, time of the event, event duration, vital signs, medications, anesthesia staff, attending anesthesiologist, and staff responding to the call. A narrative account of the event was also documented.ResultsA total of 82 "AS!" calls occurred, with ages ranging from 11 days old to 17 years old. Forty-nine of the 82 calls (60%) occurred at emergence. Seventy-one of the 82 calls (87%) were solely respiratory-related. Thirty-five of 49 emergence calls (71%) occurred in the PACU. Further, 34 of 35 PACU calls (97%) were respiratory-related, with 30 of 35 PACU calls (86%) associated with desaturation requiring intervention by anesthesia staff. Finally, 31 of 35 PACU calls (89%) occurred within 30 minutes of patient arrival to PACU.ConclusionAnalysis of "AS!" events from our PACU continues to support the need for the prompt and continuous availability of at least one staff member with advanced airway management skills. Further, pediatric patients undergoing general anesthesia and surgery should likely be monitored for a minimum of 30 minutes following arrival in the PACU.