Outcomes after paediatric anaesthesia

Abstract

PURPOSE OF REVIEW To review the developments within paediatric anaesthesia and describe the various factors that have contributed to the improvements in anaesthesia-related outcomes in children. RECENT FINDINGS During the years substantial improvements in paediatric anaesthesiarelated outcomes has derived from safety advances in equipment, drugs, human factor analysis, professional standardization and organization, subspecialty care and regionalization. However, universally agreed outcome measures are lacking. SUMMARY Despite a steadily and significant improvement in paediatric anaesthesia-related outcomes over the years further and future improvements are still necessary in areas such as adverse-event reporting and long-term neurocognitive outcomes with much more focus on patient/family-centred outcomes. Clinical experts and stakeholders should meet and agree on a consensus to identify indicators that could act as outcome measures in future large-scale prospective observational studies and clinical trials. Such an approach will foster benchmarking and continuous quality assessment and improvement at individual, institutional, interinstitutional, regional, national and international levels and facilitate larger scale clinical research. Furthermore, it will attain a high public health importance and will facilitate comparisons between healthcare provision models leading to optimization of perioperative care delivery.

Beyond mortality: definitions and benchmarks of outcome standards in paediatric anaesthesiology

“…One of the most comprehensive studies done, the APRICOT study, found a 1% reduction in critical respiratory events per year of experience of the anesthetizing provider and that centres with higher paediatric volumes have a lower rate of serious adverse events [24]. Experts now recommend that children with a higher risk as well as those under the age of 3 years should be managed by individuals and institutions with greater expertise and clinical volumes [25,37–39,41 ▪▪ ,42]. The data we have in the published literature are not truly representative of reality.…”

“…Are there differences in outcomes based upon the experience, or lack thereof, of practitioners and centres caring for children? Although the evidence is not conclusive, several studies address the impact of experience and patient volume on outcomes, including the APRICOT study [20 ▪▪ ,25,34,35,36 ▪ ,37–40,41 ▪▪ ]. Nonpaediatric trained anaesthesiologists have higher rates of cardiac arrest versus paediatric anaesthesiologist [36 ▪ ], as well as an increased risk of bradycardia [34] and respiratory events [40].…”

After nectarine: how should we provide anesthesia for neonates?

“…Systolic and mean blood pressures intervention thresholds are commonly accepted as low as to 25 mmHg and 17 mmHg (equal to 2 standard deviations below the mean preanesthetic values) in pediatric anesthesia. Whether these ‘hard’ limits, based on ambulatory [17] or preanesthetic [18,19] references, are safe for each patient is unknown [20–23]. In addition, the accuracy of blood pressure measurements can differ between 15 and 30% depending on the methods used especially below 30 mmHg [16 ▪ ,24], further increasing the uncertainty.…”