A Comparison of Pediatric and Adult Anesthesia Closed Malpractice Claims

Morray, Jeffrey P.; Geiduschek, Jeremy M.; Caplan, Robert A.; Posner, Karen L.; Gild, William M.; Cheney, F. W.

doi:10.1097/00000542-199303000-00009

Cited by 303 publications

(141 citation statements)

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“…(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) The average annual rate of critical incident reporting at our hospital is 3%-4% (Fig. 2), and this percentage has remained stable through the years despite an increase in patient numbers.…”

Section: Discussionmentioning

confidence: 97%

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetic

Wan¹,

Siow²,

Lee³

et al. 2013

SMedJ

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INTRODUCTIONThis study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore.METHODS Data pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter.RESULTS A total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children.CONCLUSION Critical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.

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Section: Discussionmentioning

confidence: 97%

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetic

Wan¹,

Siow²,

Lee³

et al. 2013

SMedJ

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“…However, exaggerated upper airway reflexes, particularly laryngospasm, have the potential to cause harm [1]. An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8].…”

Section: Discussionmentioning

confidence: 99%

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

et al. 2012

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SummaryWe studied the effect of intravenous lidocaine on laryngeal and respiratory reflex responses in children anaesthetised with sevoflurane. We tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is temporarily diminished after the administration of lidocaine. Forty children, aged between 25 and 84 months, were anaesthetised with sevoflurane and breathed spontaneously through a laryngeal mask airway. Respiratory reflex responses were elicited by spraying distilled water onto the laryngeal mucosa at three time intervals: (i) before lidocaine was administered (baseline); (ii) at 2 min and (iii) at 10 min following the intravenous administration of a bolus of lidocaine 2 mg.kg )1 . A blinded reviewer assessed the evoked responses. The incidence of laryngospasm was reduced from 38% at baseline to 15% 2 min after lidocaine administration (p < 0.02) and 18% 10 min after lidocaine administration (p = 0.10). We conclude that intravenous lidocaine significantly reduced the incidence of laryngospasm but that the effect was short-lived. Protecting the lungs from aspiration is vitally important and is largely regulated by laryngeal and respiratory reflexes such as coughing, laryngospasm, expiration reflex, spasmodic panting and apnoea. However, exaggerated upper airway reflexes, particularly laryngospasm, have the potential to cause harm [1]. An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8]. Uncertainty regarding its usefulness is partly explained by the fact that most clinical studies were underpowered to assess the relatively rare event of laryngospasm. Often more common adverse effects, such as stridor and the occurrence of hypoxaemia from whatever cause, were included in analyses assessing its incidence. Furthermore, studies examining the action of intravenous lidocaine on cough suppression during tracheal intubation revealed that the effect may only last a few minutes [9]. The potentially transient nature of this effect might make evaluation in the clinical setting difficult.

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“…Children undergoing anesthesia have an increased perioperative risk for morbidity and mortality compared with adults [20]. A minimum annual caseload of 200-300 children up to 10 years of age including 1 infant/per month/per anesthesiologist is recommended to keep complications low [15,21].…”

Section: The 'Who'mentioning

confidence: 99%

Safe Anesthesia For Every Tot – The SAFETOTS initiative

Weiß

Vutskits

Hansen

et al. 2015

Current Opinion in Anaesthesiology

114

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PURPOSE OF REVIEW The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS The Safe Anesthesia For Every Tot initiative (www.safetots.org) has been set up during the last year to focus on the safe conduct of pediatric anesthesia. This initiative aims to provide guidance on markers of quality anesthesia care. The introduction and implementation of national regulations of 'who, where, when and how' are required and will result in an improved perioperative outcome in vulnerable children. The improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the safetots.org initiative. SUMMARY This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps in regulations, teaching and research. Defining the 'who', 'where', 'when' and 'how' in this context provides the framework for the safe conduct of pediatric anesthesia.

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A Comparison of Pediatric and Adult Anesthesia Closed Malpractice Claims

Cited by 303 publications

References 0 publications

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetic

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetic

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

Safe Anesthesia For Every Tot – The SAFETOTS initiative

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