For almost 60 years, the paediatric anaesthetic literature has witnessed multiple publications reviewing epidemiological data with regard to anaesthetic practice, including morbidity, mortality and risk. This edition of Anaesthesia contains the most recent of these, from Strøm et al. looking at the characteristics of those under two years of age undergoing anaesthesia [1]. However, after six decades where extraordinary improvements in information technology with regard to databases, processing data and the worldwide sharing of information have occurred, should we not be expecting more from such epidemiological surveys than just reaffirming what we already know, and should we be demanding more from our electronic information systems? Literature reviewThe earliest of these publications were retrospective studies that produced estimates of risk, but no assessment of risk factors [2][3][4][5]. The next 30 years saw the publication of five epidemiological studies [6-10], which Patterson and Waterhouse noted that, despite significant differences in the design of these studies, could be considered as a group because the risk profiles produced were nearly identical, (infants are at greater risk of complications, ASA physical status 3 or greater increases risk substantially) [11]. These studies are summarised in Table 1. Tiret et al. published the first prospective multicentre study quoting an anaesthetic mortality of 1:40,000, and with a significantly higher risk of incidents in infants than in children (1:250 vs. 1:2000, p < 0.001) which increased significantly with higher ASA physical status [6]. Tay et al. not only replicated these findings but also highlighted that respiratory events were the most frequent (77.4%), with laryngospasm accounting for 35.7% [7], while Murat et al. recorded an incidence of respiratory events of 53% [8]. Both acknowledged that their results were potentially affected by the underreporting that is endemic within a voluntary system. The first study investigating cardiac arrest in children (paediatric peri-operative cardiac arrest (POCA) registry) was published at the beginning of the millennium by Morray et al.; quoting a rate of 1.4:10,000 anaesthetics; over half of these occurred in infants and two-thirds occurred in ASA physical status 3 to 4 patients (accounting for 95% of deaths) [9]. Data for the following six years of the POCA registry were published in 2007 by Bhananker et al. and the main difference was a reduction in medication-related arrests, attributed predominantly to a reduction in halothane-induced cardiac arrest [10].Differences in the design of these studies and definitions of incidents might account for discrepancies between studies, and paradoxically, as practice becomes safer, the harder it becomes to demonstrate further improvements, particularly at any one institution [12]. Although beset with problems of under-reporting and how incidents were defined, the analysis of critical incidents can help to determine what improvements might be made. An analysis of critical incid...
BackgroundTrainees have adopted new learning styles, challenging educators to utilise digital mediums to augment the anaesthetic curriculum.1 The computing power of smartphones, place them at the forefront of this movement. Studies report that 91% of US doctors use mobile devices,2 accessing them on average 15 times/day.3 DesignWe have produced a smartphone medical app specific to paediatric anaesthesia. A pocket-book of clinical and drug-administration guidelines was published by the department in 1994. With increasing demand for a digital resource, the 12th edition was developed as an app. We worked with a medical app development company (UBQO) and developed the conceptual idea of the app as an electronic ‘anaesthetic assistant’. UBQO encouraged a high level of collaboration, allowing them to translate our medical knowledge and experience into a rapidly evolving set of iterations. Regular updates were installed on our devices to ensure our continued involvement in the design of the product.StrategyThe app eclipses and augments our paper guidelines and is a valuable resource for anyone with an interest in paediatric anaesthesia. The app contains a comprehensive list of drugs, equipment and physiological parameters. The user can individually tailor anaesthetics for entire lists. In emergency scenarios, the app rapidly provides age-appropriate charts for all necessary equipment and drugs. Interactive critical-incident and resuscitation workflows are useful for training and real-life events. These utilities elevate the device above more traditional paper-based tools.ConclusionThe future of medical education lies in such innovations. It enables a more efficient clinician, minimises drug errors and promotes up-to-date care. It can save time in an emergency and be used for training purposes. Continual communication between technology and medical stakeholders is key for successful outcomes. Research has shown, the use of mobile devices is now universal. The app is a natural fit for a modern medical world. References. Robin BR, McNeil SG, Cook DA, et al. Preparing for the changing role of instructional technologies in medical education. Acad Med 2011;86:435–9.. EPGmedia-Healthcare Professional Use Of Mobile Devices: A comparative study between Europe and US 2010–2012.. R Brady. MCHIEC: Jan2013 The Evolution of Medical Apps.
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