National Pediatric Anesthesia Safety Quality Improvement Program in the United States

Kurth, C. Dean; Tyler, D. D.; Heitmiller, Eugenie S.; Tosone, Steven R.; Martin, Lynn D.; Deshpande, Jayant K.

doi:10.1213/ane.0000000000000040

Cited by 89 publications

(68 citation statements)

References 22 publications

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“…However, overall the incidence of bedside intervention for postoperative apnea was appreciable by current standards of patient safety in pediatric anesthesia. 11–13 Infants in the GA arm also had lower minimum blood pressures intra-operatively. The strongest risk factor for apnea was prematurity.…”

Section: Discussionmentioning

confidence: 92%

“…This non-trivial event rate underscores the need for close monitoring in this population. 11–13 Another limitation to the trial was lack of blinding. It was impossible to blind nursing staff because an infant recovering from spinal would often have no lower limb motor function, in the GA arm the airway is often secured by tape that leaves a distinctive mark on the infant’s sensitive skin and in the RA arm a puncture site would be visible in the infant’s back.…”

Section: Discussionmentioning

confidence: 99%

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Apnea after Awake Regional and General Anesthesia in Infants

et al. 2015

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Background Post-operative apnea is a complication in young infants. Awake-regional anesthesia (RA) may reduce the risk; however the evidence is weak. The General Anesthesia compared to Spinal anesthesia (GAS) study is a randomized, controlled, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods Infants ≤ 60 weeks postmenstrual age scheduled for inguinal herniorraphy were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born < 26 weeks’ gestation. The primary outcome of this analysis was any observed apnea up to 12 hours post-operatively. Apnea assessment was unblinded. Results 363 patients were assigned to RA and 359 to GA. Overall the incidence of apnea (0 to 12 hours) was similar between arms (3% in RA and 4% in GA arms, Odds Ratio (OR) 0.63, 95% Confidence Intervals (CI): 0.31 to 1.30, P=0.2133), however the incidence of early apnea (0 to 30 minutes) was lower in the RA arm (1% versus 3%, OR 0.20, 95%CI: 0.05 to 0.91, P=0.0367). The incidence of late apnea (30 minutes to 12 hours) was 2% in both RA and GA arms (OR 1.17, 95%CI: 0.41 to 3.33, P=0.7688). The strongest predictor of apnea was prematurity (OR 21.87, 95% CI 4.38 to 109.24) and 96% of infants with apnea were premature. Conclusions RA in infants undergoing inguinal herniorraphy reduces apnea in the early post-operative period. Cardio-respiratory monitoring should be used for all ex-premature infants.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Apnea after Awake Regional and General Anesthesia in Infants

et al. 2015

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“…The reported incidence of serious adverse events in pediatric anesthesia varies between 0.14% (North American registry data) and 5.2% (prospective European multicenter study). A 30‐day inhospital mortality rate of 0.1% has been found in children undergoing anesthetic procedures .…”

Section: Introductionmentioning

confidence: 99%

“…A 30‐day inhospital mortality rate of 0.1% has been found in children undergoing anesthetic procedures . Respiratory complications are the most frequently reported adverse events . However, perioperative morbidity and mortality are dramatically higher among children with MPS/ML .…”

Section: Introductionmentioning

confidence: 99%

Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses: A retrospective cohort study

Dohrmann

Muschol

Sehner

et al. 2020

Pediatric Anesthesia

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Background Children suffering from mucopolysaccharidoses (subtypes I, II, III, IV, VI, and VII) or mucolipidoses often require anesthesia, but are at high risk for perioperative adverse events. However, the impact of the disease subtype and the standard of care for airway management are still unclear. Aims This study aimed to assess independent risk factors for perioperative adverse events in individuals with mucopolysaccharidoses/mucolipidoses and to analyze the interaction with the primary airway technique implemented. Methods This retrospective study included individuals with mucopolysaccharidoses/mucolipidoses who underwent anesthesia at two high‐volume centers from 2002 to 2016. The data were analyzed in a multivariate hierarchical model, accounting for repeated anesthesia procedures within the same patient and for multiple events within a single anesthesia. Results Of 141 identified inpatients, 67 (63 mucopolysaccharidoses and 4 mucolipidoses) underwent 269 anesthesia procedures (study cases) for 353 surgical or diagnostic interventions. At least one perioperative adverse event occurred in 25.6% of the cases. The risk for perioperative adverse events was higher in mucopolysaccharidoses type I (OR 8.0 [1.5‐42.7]; P = .014) or type II (OR 8.8 [1.3‐58.6]; P = .025) than in type III. Fiberoptic intubation through a supraglottic airway was associated with the lowest risk for perioperative adverse events and lowest conversion rate. Direct laryngoscopy was associated with a significantly higher risk for airway management problems than indirect techniques (estimated event rates 47.8% vs 10.1%, OR 24.05 [5.20‐111.24]; P < .001). The risk for respiratory adverse events was significantly higher for supraglottic airway (22.6%; OR 31.53 [2.79‐355.88]; P = .001) and direct laryngoscopy (14.8%; OR 14.70 [1.32‐163.44]; P = .029) than for fiberoptic intubation through a supraglottic airway (2.1%). Conclusions The disease subtype and primary airway technique were the most important independent risk factors for perioperative adverse events. Our findings indicate that in MPS/ML children with predicted difficult airway indirect techniques should be favored for the first tracheal intubation attempt.

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“…Clinical outcomes are measurable changes in health, function, or quality of life which, in conjunction with the structures (settings, qualifications of providers, administrative systems for care) and processes (components of care) surrounding care delivery, are important in evaluating the quality of health care in adults and children . However, clinical outcomes and related measurement tools need to be well‐defined, relevant, and valid to contribute to quality improvement and to enable comparative trials to assess the clinical efficacy of different interventions …”

Section: The Need For Core Outcome Sets For Pediatric Perioperative Carementioning

confidence: 99%

Pediatric perioperative outcomes: Protocol for a systematic literature review and identification of a core outcome set for infants, children, and young people requiring anesthesia and surgery

Razavi

Walker²,

Moonesinghe

et al. 2020

Pediatric Anesthesia

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Clinical outcomes are measurable changes in health, function, or quality of life that are important for evaluating the quality of care and comparing the efficacy of interventions. However, clinical outcomes and related measurement tools need to be well-defined, relevant, and valid. In adults, Core Outcome Measures in Effectiveness Trials (COMET) methodology has been used to develop core outcome sets for perioperative care. Systematic literature reviews identified standardized endpoints (StEP) and valid measurement tools, and consensus across a broader range of relevant stakeholders was achieved via a Delphi process to establish Core Outcome Measures

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National Pediatric Anesthesia Safety Quality Improvement Program in the United States

Abstract: WUS documented the incidence and types of SAE nationally in pediatric anesthesiology. Education and application of QI and SA in anesthesia departments are key strategies to improve perioperative safety by WUS.

Cited by 89 publications

References 22 publications

Apnea after Awake Regional and General Anesthesia in Infants

Apnea after Awake Regional and General Anesthesia in Infants

Airway management and perioperative adverse events in children with mucopolysaccharidoses and mucolipidoses: A retrospective cohort study

Pediatric perioperative outcomes: Protocol for a systematic literature review and identification of a core outcome set for infants, children, and young people requiring anesthesia and surgery

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