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1. Provisional unicentric experience with an electronic incident reporting form in pediatric anesthesia.

Author

Montobbio G, Pini-Prato A, Guida E, Disma N, Mameli L, Avanzini S, Scali R, Tuo P, Jasonni V, and Mattioli G

Subjects
Adolescent, Adult, Age Distribution, Child, Child, Preschool, Female, Humans, Infant, Male, Prospective Studies, Young Adult, Anesthesia adverse effects, Risk Management statistics & numerical data
Abstract

Objective: To present and compare with literature our experience with an electronic anesthesia-related incident reporting form as a quality control measure at Gaslini Children's Hospital over a 19-month period., Methods: All events that occurred between March 2009 and September 2010 were recorded. We adopted an electronic reporting form included in the online recording process of every anesthetic procedure. Events were divided into near misses and adverse events. Adverse events were further divided into incidents, minor events, and major events. Patients were divided into three age-groups: <1, between 1 and 3, and >3 years., Results: A total of 12,850 anesthetics were performed. Eight (0.06%) near misses and 108 (0.8%) adverse events were reported. Adverse events occurred more frequently in infants. Of 108 events, 35 (32.4%), 61 (56.5%), and 12 (11.1%) were classified as incidents, minor, and major events, respectively. Of all the adverse events, 66 (61%) were respiratory, 27 (25%) organizational, six (5%) drug-related, four (4%) cardiocirculatory, and five (5%) miscellaneous., Conclusions: Infants were at the highest risk to experience adverse events. Although experimental electronic incident reporting proved to be feasible, there is reason to suspect that there was underreporting of near misses. Overreporting of near miss events may be enhanced by easier and more straightforward reporting forms as well as by better education for anesthetic providers about the importance of recognizing and reporting near misses., (© 2012 Blackwell Publishing Ltd.)

Published
2012
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2. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

Author

Davidson, Andrew J., Morton, Neil S., Arnup, Sarah J., De Graaff, Jurgen C., Disma, Nicola, Withington, Davinia E., Frawley, Geoff, Hunt, Rodney W., Hardy, Pollyanna, Khotcholava, Magda, Von Ungern Sternberg, Britta S., Wilton, Niall, Tuo, Pietro, Salvo, Ida, Ormond, Gillian, Stargatt, Robyn, Locatelli, Bruno Guido, McCann, Mary Ellen, Lee, Katherine, Sheppard, Suzette, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern-Sternberg, Britta S., Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Wolfler, Andrea, Izzo, Francesca, Sonzogni, Valter, Van Gool, Jose T D G, Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H M, Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Bellinger, David, Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Szmuk, Peter, Steiner, Jeffery, Kravitz, Brian, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Bagshaw, Oliver, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, McIntosh, Neil, Carlin, John, Leslie, Kate, De Lima, Jonathan, Hammer, Greg, Field, David, Gebski, Val, and Tibboel, Dick

Subjects
Male, Internationality, Spinal, Apnea, Research Support, U.S. Gov't, P.H.S, Child Development, Postoperative Complications, Research Support, N.I.H., Extramural, Risk Factors, Journal Article, Humans, Comparative Study, Anesthesia, Wakefulness, General, Anesthesia, General, Anesthesia, Spinal, Female, Follow-Up Studies, Infant, Infant, Newborn, Treatment Outcome, Anesthesiology and Pain Medicine, Research Support, Non-U.S. Gov't, Newborn, Multicenter Study, Randomized Controlled Trial
Abstract

Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods: Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Results: Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. Conclusions: RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

Published
2015

3. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

Author

Frawley, Geoff, Bell, Graham, Disma, NICOLA MASSIMO, Withington, Davinia E., De Graaff, Jurgen C., Morton, Neil S., Mccann, Mary Ellen, Arnup, Sarah J., Bagshaw, Oliver, Wolfler, Andrea, Bellinger, David, Davidson, Andrew J., Hardy, Pollyanna, Hunt, Rodney W., Stargatt, Robyn, Ormond, Gillian, Hartmann, Penelope, Ragg, Philip, Backstrom, Marie, Costi, David, Von Ungern Sternberg, Britta S., Wilton, Niall, Knottenbelt, Graham, Montobbio, Giovanni, Mameli, Leila, Tuo, Pietro, Giribaldi, Gaia, Prato, Alessio Pini, Mattioli, Girolamo, Izzo, Francesca, Salvo, Ida, Sonzogni, Valter, Locatelli, Bruno Guido, Khotcholava, Magda, Van Gool, Jose T. D. G., Numan, Sandra C., Kalkman, Cor J., Hagenaars, J. H. M., Absalom, Anthony R., Hoekstra, Frouckje M., Volkers, Martin J., Furue, Koto, Gaudreault, Josee, Berde, Charles, Soriano, Sulpicio, Young, Vanessa, Sethna, Navil, Kovatsis, Pete, Cravero, Joseph P., Marmor, Jacki, Lynn, Anne, Ivanova, Iskra, Hunyady, Agnes, Verma, Shilpa, Polaner, David, Thomas, Joss, Meuller, Martin, Haret, Denisa, Suresh, Santhanam, Hays, Stephen R., Taenzer, Andreas H., Maxwell, Lynne G., Williams, Robert K., Bell, Graham T., Dorris, Liam, Adey, Claire, Chisakuta, Anthony, Eissa, Ayman, Stoddart, Peter, Davis, Annette, Myles, Paul, Wolf, Andy, Carlin, John, Leslie, Kate, De Lima, Jonathan, Field, David, Gebski, Val, Tibboel, Dick, Szmuk, Peter, Steiner, Jeffery, and Kravitz, Brian

Subjects
Male, Hernia, Internationality, Spinal, Apnea, Hernia, Inguinal, Anesthesia, Conduction, Anesthesia, General, Anesthesia, Spinal, Child Development, Cohort Studies, Female, Humans, Infant, Infant, Newborn, Predictive Value of Tests, Prospective Studies, Single-Blind Method, Treatment Failure, Treatment Outcome, Anesthesiology and Pain Medicine, Conduction, Article, Anesthesia, General, Newborn, Inguinal
Abstract

Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure.This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic.RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46).The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.

Published
2015

4. Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children.

Author

Disma, Nicola, Frawley, Geoff, Mameli, Leila, Pistorio, Angela, Alberighi, Ornella D. Casa, Montobbio, Giovanni, and Tuo, Pietro

Subjects
CLONIDINE, ANESTHESIA, ANALGESIA, ABDOMINAL surgery, POSTOPERATIVE care
Abstract

Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose-response trial. A group of 120 children aged <6 years of age received caudal anesthesia with levobupivacaine and 1, 2, or 3 μg·kg of clonidine. The MLAC was determined according to a Dixon-Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. The MLAC of caudal levobupivacaine was 0.106%, 0.077%, and 0.035% with 1, 2, and 3 μg·kg of clonidine, respectively. There were significant dose-dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 μg·kg of clonidine group. Clonidine produces a local anesthetic sparing effect with a dose-dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose-dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 μg·kg of clonidine provides the optimum balance between improved analgesia and minimal side effects. [ABSTRACT FROM AUTHOR]

Published
2011
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