Analysis of anesthesia related severe adverse events in congenital catheterization cases from a single institution.

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In conclusion, we applaud Simpao et al. for adding to the literature the association of preoperative fasting with intraoperative hypotension. However, the limitations of their exposure and outcome variables must be considered when interpreting the findings of their report.

Treating congenital heart disease is a high-risk, high-benefit scenario, be it in the operating rooms or in cardiac catheterization labs. Inherent to the high-risk nature of the disease, adverse events of varying severity can happen during cath or surgical intervention. These have been traditionally the ‘real’ clinical teaching for the physician. Simulation technology helps physicians to be trained stress-free in zero-risk environments, especially for the low-frequency, high-risk events. But as always, introduction of new technology faces barriers, so is the case with simulators. Anesthesiology proudly compares itself to the aviation industry, which had also ridiculed aviation simulators in the 1970s. Now they are mandated by all worldwide aviation training authorities. Maybe its time for the anesthesiologists to take the lead in simulation in the health care sector too.

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