Medication Errors in Pediatric Anesthesia

A Report From the Wake Up Safe Quality Improvement Initiative | Anesthesia & Analgesia

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Background: Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies.

Conclusions: Our findings characterize the most common types of medication errors in pediatric anesthesia practice and provide guidance on future preventative strategies. Many of these errors will be almost entirely preventable with the use of prefilled medication syringes to avoid accidental ampule swap, bar-coding at the point of medication administration to prevent syringe swap and to confirm the proper dose, and 2-person checking of medication infusions for accuracy.

Full reference: Lobaugh, L. et al. (2017) Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative. Anesthesia & Analgesia. Vol. 125 (Issue 3) pp. 936–942

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Movies could replace anaesthetic for child radiotherapy

Children with cancer could be spared dozens of doses of general anaesthesia by projecting a video directly on to the inside of a radiotherapy machine during treatment | OnMedica

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The new research was presented this week at the ESTRO 36 conference (European Society for Radiotherapy & Oncology), taking place in Vienna, Austria.

Catia Aguas, a radiation therapist and dosimetrist at the Cliniques Universitaires Saint Luc, Brussels, Belgium, told the conference that using video instead of general anaesthesia is less traumatic for children and their families, as well as making each treatment quicker and more cost effective.

The study included 12 children aged between one and a half and six years old who were treated with radiotherapy using a Tomotherapy® treatment unit at the university hospital. Six were treated before a video projector was installed in 2014 and six were treated after.

Before the video was available, general anaesthesia was needed for 83% of children’s treatments. Once the projector was installed, anaesthesia was only needed in 33% of treatments.

Read the full commentary here

Using Technology to Reduce Childrens’ Anxiety Throughout the Perioperative Period

Goldschmidt, K. & Woolley, A. Journal of Pediatric Nursing | Published online: 27 April 2017

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In the U.S. each year, approximately 5 million children undergo a surgical procedure (Perry, Hooper, & Masiongale, 2012). Surgery is one of the most stressful medical procedures that a child can experience. In fact, approximately 50% of children are reported to experience significant anxiety in the preoperative period (Perry et al., 2012). Pediatric nurses know the importance of incorporating parents into the child’s plan of care and understand that the child is comforted by the presence of someone that they know and love.

Read the abstract here

Parents’ reactions can lessen or worsen pain for injured kids

New research (yet to be published) has looked at family coping and distress during a dressing change following a burn injury in kids | The Conversation

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The 18-month study observed 92 families during their young child’s (one to six years) first burn dressing change at a Brisbane hospital.

Parents who reported they were more anxious or distressed were less able to support their child during the procedure. This decreased the child’s ability to cope and increased the child’s distress, which was measured by their ability to be distracted by toys and conversation, compared to crying or screaming during the dressing change.

Ratings of child anxiety and pain during the dressing change were also greater for children of parents who were less able to support their child during the dressing change.

Read the full blog post by  Erin Brown & Justin Kenardy here

Low Back Pain in Children and Adolescents

Moreno, M. (2017) JAMA Pediatrics. 171(3):312

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Image source: H – – J – Flickr // CC BY-NC-ND 2.0

Low back pain is often thought of as an adult condition. However, it is relatively common as children grow older.

At 7 years of age, about 1% of children will have experienced low back pain; at 10 years of age, about 6% of children will have experienced low back pain; and at 14 to 16 years of age, about 18% of adolescents will have experienced low back pain.

Unfortunately, having low back pain as a child or adolescent is a significant risk factor for having low back pain as an adult.

Read the full article here

Advantages and disadvantages of reducing local anesthetic requirements in children

Walker, B.J. (2017) Journal of Clinical Anesthesia. 38(5) pp. 158–159

Prior to the widespread use of ultrasound guidance in regional anesthesia, higher volumes of local anesthetic were often required to achieve reliable blockade with landmark and neurostimulation techniques.

The ability to clearly visualize neural structures with ultrasound guidance has resulted in more precise delivery of local anesthetic around the target nerve or plexus, which should theoretically reduce the risk of complications such as local anesthetic systemic toxicity (LAST) as well as tissue toxicity to nerves and surrounding muscle.

Read the abstract here

Smartphone-based behavioural intervention alleviates children’s anxiety during anaesthesia induction

Cumino, D. et al. European Journal of Anaesthesiology. Published online: 18 January 2017

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Background: Preoperative anxiety negatively influences children’s anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children’s anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial.

 

Conclusions: The behavioural distraction strategies using smartphones were effective in preventing an increase in children’s anxiety during anaesthesia induction.

Read the full abstract here