Risk in pediatric anesthesia

Abstract

Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co-morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk.

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

“…2,12,45 Since the first era, anaesthetic-related mortality has declined to approximately 1 in 10 000 anaesthetics. 12,13,46 Twenty-four hour perioperative mortality from any cause varies widely, and may relate to case mix.…”

“…28,[37][38][39] Valuable insight into trends and associations has been gained from these sources, and patient safety improved by routine respiratory monitoring and the reduction of preventable cardiac arrest from medication errors. 2,33,36,40 Selection and reporting bias can be overcome with the use of databases and anaesthetic information systems featuring nonvoluntary reporting. Large datasets with numerators and denominators for accurate incidence calculation are provided through such systems.…”

“…32 Comparative analysis is hampered with the use of a case mix and institutional audit with a small sample size. 2,27,28,41 Collaborative, prospective collection through paediatric-specific databases facilitates the accurate calculation of incidence, the elucidation of causality and the development of neonatal and paediatric perioperative risk models. 16,[41][42][43][44] …”

“…[1][2][3][4][5][6][7] The purpose of this review was to refocus on immediate clinical safety outcomes within 24 hours of anaesthesia ending. 8 There is a significant difference in outcome in developed and developing countries, and the contributory factors are highlighted in this regard.…”

“…[13][14][15][16] • High-risk patients are identified, which assists when making informed decisions on patient care. 2,17,18 • Informed consent is enhanced when immediate anaestheticrelated risk is accurately communicated to families and patients. 13 • System issues are identified which contribute to substandard anaesthetic care, especially in middle-and low-income countries.…”