New technologies in pediatric anesthesia

Holtby, Helen; Skowno, Justin; Kor, Daryl J.; Flick, Randall P.; Uezono, Shoichi

doi:10.1111/pan.12007

Cited by 32 publications

(36 citation statements)

References 64 publications

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“…This institutional resource captures data for all patients admitted to an acute care environment (e.g., operating room, intensive care unit, progressive care unit) at the study’s participating institution (23,24). In addition to information relating to the surgical encounter, this robust data warehouse contains information on baseline demographic and clinical characteristics and on fluid and transfusion therapies, as well as related information pertinent to perioperative course (e.g., medications, laboratory values, postoperative outcome, LOS).…”

Section: Methodsmentioning

confidence: 99%

Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: a single-institution propensity-adjusted cohort study

Jia

Brown

Clifford

et al. 2016

The Lancet Haematology

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Background Perioperative hemorrhage negatively impacts patient outcomes and results in substantial health care resource consumption. Plasma transfusions are frequently administered to address abnormal preoperative coagulation tests, with the hope of mitigating bleeding complications. This study aimed to evaluate the associations between preoperative plasma transfusion and bleeding complications in patients with elevated international normalized ratios undergoing noncardiac surgery. Methods An observational comparative effectiveness research study evaluating a consecutive sample of adult patients undergoing noncardiac surgery (N=14,743) with preoperative international normalized ratios ≥ 1.5 between January 1, 2008, and December 31, 2011. Among the patients, 1,234 (8.4%) had an international normalized ratio ≥ 1.5 and were included in this investigation. Exposure of interest was transfusion of preoperative plasma for an elevated international normalized ratio. Primary outcome was World Health Organization grade 3 bleeding in the early perioperative period. Secondary outcomes included blood loss, reoperation for bleeding, and additional patient-important outcomes including death and lengths of stay. Hypotheses were tested with univariate and propensity-matched analyses. Multiple sensitivity analyses were performed to further evaluate the robustness of study findings. Findings Of 1,234 study participants, 139 (11.3%) received a preoperative plasma transfusion. Those who received plasma had a higher rate of perioperative (52.5% vs 32.0%; P < .0001) and intraoperative (40.3% vs 24.5%; P < .0001) red blood cell transfusion, as well as an increased rate of reoperation for bleeding (11.5% vs 4.5%; P = .0005). The increased rate of perioperative red blood cell transfusion stayed in the propensity-matched analyses (OR, 1.75 [95% CI, 1.09–2.81]; P= .0210). Results from multiple sensitivity analyses were qualitatively similar. Interpretation Preoperative plasma transfusion for elevated international normalized ratios was associated with an increased rate of perioperative bleeding complications. Findings were robust in the sensitivity analyses, suggestive that more conservative management of abnormal preoperative international normalized ratios is warranted. Funding Department of Anesthesiology and Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester, Minnesota; National Institutes of Health, Grant Number: R01 HL121232-01.

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Section: Methodsmentioning

confidence: 99%

Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: a single-institution propensity-adjusted cohort study

Jia

Brown

Clifford

et al. 2016

The Lancet Haematology

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“…Evidence of outcome benefit for NIRS is currently lacking, but there is certainly potential for its use in goal-directed interventions to reduce organ hypoxia and ischaemia. 11,13 PAEDIATRIC ANAESTHESIA ANAESTHESIA AND INTENSIVE CARE MEDICINE --:-…”

Section: Monitoringmentioning

confidence: 99%

“…Additionally, the relative increased head size of children compared to adults results in a differing proportion of blood flow down the descending aorta, which may cause inaccuracy in interpretation. 11 Electrical methods: changes in thoracic electrical bioimpedance, as a result of changes in blood volume and flow, and blood cell orientation can be employed to provide continuous non-invasive assessment of cardiac output and other cardiac parameters. The ICON Ò (Cardiotronic/Osypka Medical, Inc., La Jolla, CA, USA) monitor is a portable, battery-operated, non-invasive cardiac output monitor that employs the principle of electrical velocimetry.…”

Section: Monitoringmentioning

confidence: 99%

“…The MostCare Ò Pressure Recording Analytical Method (PRAM) (Vytech Health, Padona, Italy), however, has been validated against echocardiography in children older than 1 month. 11 Although, it could be argued that the majority of children undergoing operations involving significant cardiac output changes will have an arterial cannula, the necessity for one to allow cardiac output monitoring is a potential drawback of these methods. A…”

mentioning

confidence: 99%

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Equipment and monitoring for paediatric anaesthesia

Leslie¹,

Froom²,

Gildersleve³

2015

Anaesthesia & Intensive Care Medicine

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There have been considerable developments in the equipment and monitoring available for paediatric anaesthesia over the past 3 years. Advances in airway management have come about primarily through the increased use of videolaryngoscopes. Numerous second-generation supraglottic airway devices are also now available with features aimed at improving both their safety profile and utility during difficult airway management. Concerns surrounding the endocrine effects of phthalates have led to the introduction of phthalate-free airway devices. The role of ultrasound continues to expand, with good evidence for its use where vascular access is challenging, while evidence in favour of alternative vascular access aids remains sparse. Smartphones and tablets have become an almost ubiquitous part of the paediatric anaesthetist's armoury, functioning as distraction devices for children and providing a wealth of useful information through applications. A number of cardiac output monitors are now available for use in paediatric anaesthesia and, with the advent of enhanced recovery programmes after surgery, it is likely that their use will increase in the future. This review will discuss a number of these devices and provide insight into the rationale for their use, focusing on those for which the best evidence is available.

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“…Although gaining popularity in the perioperative setting, the potential functions and advantages of AIMS may not yet be fully appreciated. 5 As with other EHR systems, the poorly planned installation of AIMS itself without active physician involvement in implementation strategies, design around workflow, and staff ''buy-in'' may lead to failed implementation and lack of acceptance of the system. 6 Without real-time clinical decision support systems (CDSS) or further data analysis, AIMS may not necessarily improve quality or safety.…”

Section: Introduction and Purposementioning

confidence: 99%

Review article: The evolving role of information technology in perioperative patient safety

Stabile

Cooper

2012

Can J Anesth/J Can Anesth

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Purpose The adoption of new technologies in medicine is frequently met with both enthusiasm and resistance. The universal adoption of health information technology (IT) and anesthesia information management systems (AIMS) remains low despite the potential benefits. Electronic medical records, and hence AIMS, are at the intersection of patient safety. This article highlights advantages and barriers to adoption and implementation of IT in general and AIMS in particular, with a focus on clinical decision support systems (CDSS) and computerized physician order entry (CPOE) as hallmarks that may lead to improvement in patient safety and quality in the perioperative setting. Principal findings The advantages of health IT and AIMS include improved legibility of documentation; the ability to integrate new scientific evidence into practice; enhanced management and exchange of complex health information; the ability to standardize order sets, incorporate computerized physician order entry, and provide clinical decision support; and the ability to capture data for management, research, and quality monitoring and reporting. While not foolproof, AIMS have been shown to improve safety, quality, and patient outcomes. Barriers to the adoption of health IT and AIMS include costs, lack of truly interoperable AIMS components in health-system IT solutions, and lack of clinician involvement in implementation, planning, design, and installation of many IT or AIMS products. Conclusions Health IT and AIMS are at the intersection of patient safety and technology. Anesthesiologists are perfectly positioned to be the physician leaders of adoption, design, implementation, and integration, not only for AIMS but also for health-system IT solutions in general.

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New technologies in pediatric anesthesia

Cited by 32 publications

References 64 publications

Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: a single-institution propensity-adjusted cohort study

Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: a single-institution propensity-adjusted cohort study

Equipment and monitoring for paediatric anaesthesia

Review article: The evolving role of information technology in perioperative patient safety

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