Pediatric Perioperative Life Support

Abstract

Pediatric advanced life support training and guidelines are typically designed for first-responders and out-of-hospital resuscitation. Guidelines and scenarios that are more applicable to the perioperative environment would be beneficial for anesthesiologists. The goal of this article is to review resuscitation of pediatric patients during the perioperative period. We use a format that focuses on preresuscitation preparation, resuscitation techniques, and postresuscitation management in the perioperative period. In an effort to provide information of maximum benefit to anesthesiologists, we include common pediatric perioperative arrest scenarios with detailed description of their management. We also provide a section on postresuscitation management and review the techniques for maintaining the child's hemodynamic and metabolic stability. Finally, 3 appendices are included: an example of an intraoperative arrest record that provides feedback for interventions; a table of key medications for pediatric perioperative resuscitation; and a review of defibrillator use and simulation exercises to promote effective defibrillation.

Assessment Tools for Use During Anesthesia-Centric Pediatric Advanced Life Support Training and Evaluation

“…4,9,10 We established the content of the checklists through a detailed review of relevant literature to identify evidence-based practices and further refined them through a modified Delphi process. 2,9–14 We used the checklists to score several pilot scenarios (described below) and made iterative changes based on observations from these pilot simulations. The checklist items were modified to ensure that each item represented an observable, objective measure of performance.…”

“…1,2 The rarity of these events makes it difficult, if not impossible, for clinicians to develop the skills required for optimal management and for training programs to assess provider performance during actual resuscitation events, 3,4 leading some to propose resuscitation guidelines and curricula tailored to the perioperative environment and suggesting that clinicians receive more frequent resuscitation training with skills assessment. 2–6 The literature contains reports of several scoring instruments for assessing the resuscitation performance of providers in managing both adult and pediatric patients in a variety of settings 4,7–9 ; however, there are no valid published tools for the assessment of pediatric resuscitation skills in the perioperative setting with demonstrated reliability. Accordingly, we describe here our methods for developing a set of assessment tools for measuring participant competency during pediatric perioperative resuscitation scenarios and the process of assessing the reliability of scores produced by these tools.…”