Children anesthetized with sevoflurane exhibit more immediate postoperative distress than those anesthetized with halothane. This difference is not carried over into the longer posthospital period. Negative behavioral changes occur more frequently with decreasing age.

The Pediatric Perioperative Outcomes Group (PPOG) is an international collaborative of clinical investigators and clinicians within the subspecialty of pediatric anesthesiology and perioperative care which aims to use COMET (Core Outcomes Measures in Effectiveness Trials) methodology to develop core outcome sets for infants, children, and young people that are tailored to the priorities of the pediatric surgical population. Focusing on four age-dependent patient subpopulations determined a priori for core outcome set development: (a) neonates and former preterm infants (up to 60 weeks postmenstrual age); (b) infants (>60 weeks postmenstrual age-<1 year); (c) toddlers and school age children (>1-<13 years); and (d) adolescents (>13-<18 years), we conducted a systematic review of outcomes reported in perioperative studies that include participants within age-dependent pediatric subpopulations. Our review of pediatric perioperative controlled trials published from 2008 to 2018 identified 724 articles reporting 3192 outcome measures. The proportion of published trials and the most frequently reported outcomes varied across predetermined age-groups. Outcomes related to patient comfort, particularly pain and analgesic requirement, were the most frequent domain for infants, children, and adolescents. Clinical indicators, particularly cardiorespiratory or medication-related adverse events, were the most common outcomes for neonates and infants <60 weeks and were the second most frequent domain at all other ages. Neonates and infants <60 weeks of age were significantly under-represented in perioperative trials. Patient-centered outcomes, healthcare utilization, and bleeding/transfusion-related outcomes were less often reported. In most studies, outcomes were measured in the immediate perioperative period, with the duration often restricted to the postanesthesia care unit or the first 24 postoperative hours. The outcomes identified with this systematic review will be combined with patient-centered outcomes identified through a subsequent stakeholder engagement study to arrive at a core outcome set for each age-specific group.

Fifty-one patients were divided randomly into four groups: halothane in oxygen; fentanyl plus nitrous oxide in oxygen; enflurane in oxygen; or isoflurane in oxygen. Standardized bleeding time was measured using a Simplate II bleeding device before and at least 40 min after the induction of anaesthesia. Arterial pressure was maintained at +/- 20% of control values and temperature was kept at 35-37 degrees C. The bleeding time was prolonged by 33% in the halothane group (P less than 0.01) and by 20% in the nitrous oxide-fentanyl group (n.s.). There was essentially no change in bleeding time in the groups receiving enflurane or isoflurane, although there was considerable variability within each group, which did not seem to be related to differences in sex, age, type of surgery, concentration of agent used or surgical procedure.

AimsTo meet the emotional and psychological needs of the child and the family admitted to hospital, as well as their medical needs.MethodFrom October 2014, each child admitted to the Paediatric Intensive Care Unit (PICU) had a specially designed laminated “What Matters to Me (WM2M)” card displayed at the bedside, completed by both the parents and (where possible) the child. This was a simple way to formally transfer more personal information, including likes and dislikes, from one member of staff to another. On the reverse, there was a feedback questionnaire to grade the use of the cards from “very good” to “very poor”, as well as an area for any other comments.ResultsAcross the initial 18 weeks of use, 85.7% of patients received a WM2M card. Feedback was taken from parents, patients and nursing staff. 54.8% of the WM2M cards had feedback completed. A total of 39.5% found the cards “very good” (26.3% of these were parents/patients and 13.2% nursing staff). 60.5% found the cards “good” (28.9% of these were parents/patients and 31.6% nursing staff). No one selected “poor” or “very poor”.Other wards began to take on the project after hearing staff and families commenting on the cards. This also included patients going to theatre. Furthermore, The Institute for Healthcare Improvement (IHI) presented a short presentation on the project after they heard about the cards, during a keynote speech at their 26th Annual National Forum in Orlando Florida.ConclusionsInstead of asking our patients “What’s the matter with you?” we also ask them “What matters to you?” This is what the IHI call “flipping healthcare”. Children are to be recognised as NHS consumers in their own rights. There should be less barriers to accessing their views and experiences1 of which we hope our WM2M cards have help to do.