Maria Matuszczak MD
Professor of Anesthesiology
Division Chief Pediatric Anesthesia
Nothing to disclose
Objectives
Part 1
The preoperative assessment
Preparation of the operating room
The checklist
Crisis management
Post anesthesia care
Importance of communication
Team building
Simulation
Objectives
Part 2
Neurotoxicity and developing brain
Wake-up safe
PRAN
Pediatric Difficult Airway Registry
The preoperative assessment
Preparation of the operating room
How safe is Healthcare
Deaths due to medical errors = 8th cause of death.
Deaths due to medical errors > motor vehicle accidents,
breast cancer or AIDS
Medication errors alone = 7,000 deaths annually
Healthcare-associated infections =100,000 deaths
Total national costs of preventable adverse events are
estimated to be between $17 - $29 billion
Patient safety topics on the WHO website
Patient safety resources are categorised using these topic headings:
Abuse/aggression and patient safety
Consent, communication, confidentiality
Documentation and patient safety (checklists/patient records)
Environment and patient safety (cleaning, PEAT)
Human factors and patient safety culture (Seven Steps, teamwork, staffing)
Medical devices/equipment
Medication safety
Patient accident (slips, trips and falls)
Patient admission, transfer, discharge (patient ID)
Patient assessment and diagnosis (tests, scans)
Patient treatment/procedure (nutrition)
Risk assessment and patient safety
The checklist
Gawande A. The checklist manifesto: how to get things right. New York: Metropolitan
Books, 2010.
The checklist
14 cases of wrong-side thoracenteses are identified.
Contributing factors:
failure to perform a time-out (n=12),
missing indication of laterality on the patient’s consent form (n=10),
absence of a site mark on the patient’s skin ,
absent verification of medical images (n=7).
Complications included:
pneumothoraces (n=4), hemorrhage (n=3), and death directly
attributable to the wrong-side thoracentesis (n=2).
Teamwork and communication failure, unawareness of existing policy,
and a deficit in training and education were the most common root
causes of wrong-side thoracentesis.
Crisis management
SPA’s Pediatric Critical Events Checklists are freely available on the SPA website at
http://www.pedsanesthesia.org/newnews/Critical_Event_Checklists.pdf.
Crisis management
Arriaga AF, Bader AM, Wong JM, et al.
Simulation-Based Trial of Surgical-Crisis
Checklists. N Engl J Med 2013; 368: 245-53.
Post-Anesthesia Care Unit
Importance of communication/handoffs
Culture of safety
Team building
Awareness
Simulation
Objectives
Part 2
Neurotoxicity and developing brain
Wake-up safe
PRAN
Pediatric Difficult Airway Registry
Neurotoxicity and developing brain
Consensus Statement on the Use of Anesthetics and Sedatives in Children
December 2012
Each year, millions of young children require surgery and other procedures for serious or life-threatening
medical conditions or to improve their quality of life. Anesthetic and sedative drugs are widely used to help
ensure the safety, health, and comfort of children undergoing these procedures. However, increasing
evidence from research studies suggests the benefits of these agents should be considered in the context of
their potential to cause harmful effects.
Previous research in young animals and children has raised concerns that exposure to commonly used
anesthetics may produce adverse neurobehavioral effects. However, these studies had limitations that
prevent experts from drawing conclusions on whether the harmful effects were due to the anesthesia or to
other factors, including surgery, hospitalization, or pre-existing conditions. Furthermore, the findings in
children have been mixed, with some studies of infants and young children undergoing anesthesia or
sedation finding long-term deficits in learning and behavior while others have not.
Clearly, additional research is urgently needed to identify any possible risks to young children. In the
absence of conclusive evidence, it would be unethical to withhold sedation and anesthesia when necessary.
Instead, healthcare providers should do the following:
Discuss with parents and other caretakers the risks and benefits of procedures requiring anesthetics or
sedatives, as well as the known health risks of not treating certain conditions
Stay informed of new developments in this area
Recognize that current anesthetics and sedatives are necessary for infants and children who require surgery
or other painful and stressful procedures
Wake-up safe
The Goals of Wake up Safe are:
To define quality in pediatric anesthesia care.
To develop ways of measuring quality in pediatric anesthesia care.
To develop robust Quality Improvement Systems within Departments of Pediatric
Anesthesia.
To provide data to allow research about adverse events in pediatric perioperative
care.
The Objectives of Wake up Safe are:
To develop a registry of adverse events in pediatric perioperative care.
To analyze adverse events and to determine common causes for these adverse
events.
To devise strategies to prevent adverse events.
To gather data to allow departments to compare their data with national norms.
PRAN
Pediatric regional anesthesia network
December 2012; 115(6) 1352-64
14,917 RA, performed on 13,725
patients, from April 1, 2007 through
March 31, 2010. No deaths or
complications with sequelae lasting >3
months (95% CI 0–2:10,000). 95% of
blocks placed while patients were
under GA. Widespread use of
ultrasound (83% of upper extremity
and 69% of lower extremity blocks).
Pediatric Difficult Airway Registry
Conclusion