Search

Background: The NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE) prospective observational study reported critical events requiring intervention during 35.2% of 6542 anesthetic episodes in 5609 infants up to 60 weeks postmenstrual age. The United Kingdom (UK) was one of 31 participating countries. Methods: Subgroup analysis of UK NECTARINE cases (12.8% of cohort) to identify perioperative critical events that triggered medical interventions. Secondary aims were to describe UK practice, identify factors more commonly associated with critical events, and compare 30‐day morbidity and mortality between participating UK and nonUK centers. Results: Seventeen UK centers recruited 722 patients (68.7% male, 36.1% born preterm, and 48.1% congenital anomalies) undergoing anesthesia for 876 surgical or diagnostic procedures at 25–60 weeks postmenstrual age. Repeat anesthesia/surgery was common: 17.6% patients prior to and 14.4% during the recruitment period. Perioperative critical events triggered interventions in 300/876 (34.3%) cases. Cardiovascular instability (16.9% of cases) and/or reduced oxygenation (11.4%) were more common in younger patients and those with co‐morbidities or requiring preoperative intensive support. A higher proportion of UK than nonUK cases were graded as ASA‐Physical Status scores >2 or requiring urgent or emergency procedures, and 39% required postoperative intensive care. Thirty‐day morbidity (complications in 17.2%) and mortality (8/715, 1.1%) did not differ from nonUK participants. Conclusions: Perioperative critical events and co‐morbidities are common in neonates and young infants. Thirty‐day morbidity and mortality data did not demonstrate national differences in outcome. Identifying factors associated with increased risk informs preoperative assessment, resource allocation, and discussions between clinicians and families. [ABSTRACT FROM AUTHOR]

Background: Total intravenous anesthesia is used in less than 10% of operations in the UK. Many pediatric anesthetists in the UK and Ireland administer total intravenous anesthesia to children using a mixture of propofol and remifentanil in the same syringe. This unlicensed drug has not been studied clinically, because of lack of Medicines and Healthcare products Regulatory Agency (UK) or Food and Drug Administration (US) approval to undertake such studies. Aim: The aim of this service evaluation was to assess the safety profile and effectiveness of propofol‐remifentanil mixtures in the pediatric population undergoing a variety of surgical procedures. Methods: Pediatric Anesthetists in the UK and Ireland who regularly used propofol‐remifentanil mixtures for total intravenous anesthesia were invited to submit data. This data were analyzed to assess the effectiveness of anesthesia and the incidence and nature of any complications that occurred. Results: Usable data were collected from 873 patients. Mixtures were most commonly administered in gastroenterology and ear, nose, and throat procedures. Two‐thirds of patients were less than 10 years old, and their mean weight was 28.7 kg. Anesthesia using the mixture alone was successful in all but 3 patients. The commonest nonserious complication was coughing (4.6%), followed by movement (3.3%). The overall incidence of serious, related, unexpected adverse events requiring intervention was 1.7%. These included desaturation (5 patients), apnea (3), abdominal/chest rigidity (2), cough requiring paralysis (2), ventilatory problems (2), and hypotension (1). Most occurred at induction, were attributable to the properties of the drugs being administered and not directly related to the use of the mixture. No life‐threatening adverse events were recorded. Complications were less common if a ≤5 μg mL−1 concentration of remifentanil was used. Conclusion: These data demonstrate that effective anesthesia can be administered to pediatric patients undergoing a wide range of procedures using mixtures of propofol and remifentanil. Serious, related, unexpected adverse events requiring intervention had a low incidence and were largely due to predictable effects of the drugs being administered. A ≤5 μg mL−1 remifentanil concentration is associated with proportionately less complications. [ABSTRACT FROM AUTHOR]

Summary: Background: Total intravenous anesthesia usage in children remains relatively unpopular in the UK and Ireland. A postal survey by Hill et al in 2008 indicated that only 26% of Consultants used a propofol infusion at least once a month. Aims: Following an increase in teaching and training opportunities in pediatric total intravenous anesthesia in the UK, we repeated the survey among Consultant members of Association of Paediatric Anaesthetists of Great Britain and Ireland and Society for Intravenous Anaesthesia, to see if this had affected total intravenous anesthesia usage in children and how practice may have changed. Methods: We used an anonymous online survey sent to Association of Paediatric Anaesthetists of Great Britain and Ireland and Society for Intravenous Anaesthesia members. Results: A total of 291 responses were analyzed. Total intravenous anesthesia was the default method of anesthesia in 8% of respondents and a further 46% used total intravenous anesthesia at least monthly. Overall total intravenous anesthesia usage had increased in the past year in 53%. The main indications were malignant hyperthermia susceptibility, and postoperative nausea and vomiting. Ear/nose/throat surgery was the most popular surgical specialty. The main reasons for not using total intravenous anesthesia were that it was too "fiddly" and lack of confidence in the user. Most respondents used propofol in combination with remifentanil. Over 80% used propofol target‐controlled infusion. The potential for propofol‐related infusion syndrome concerned many, with 74% limiting infusion duration as a result. Bispectral Index was not used routinely by the majority of anesthetists. Even though most anesthetists did not use total intravenous anesthesia routinely, 98% felt they would be confident to anesthetize an malignant hyperpyrexia‐positive patient using the technique. Conclusion: This survey has shown that although total intravenous anesthesia is not the default anesthetic technique for most anesthetists, overall usage in children has more than doubled in the past 10 years, with many happy to use it in a wide variety of patients and procedures. [ABSTRACT FROM AUTHOR]

Research summary: This paper posits adaptive capability as a mechanism through which a firm's prior growth influences the exhibition of future entrepreneurial action. Defined as the firm's proficiency in altering its understanding of market expectations, increased adaptive capability is a consequence of the new resource combinations that result from expanding organizational boundaries. Increased adaptive capability in turn corresponds to expansion of entrepreneurial activity, as firms increase their entrepreneurial orientation as the strategic mechanism to capitalize on their improved understanding of market conditions. We find support for our research model in a two-study series conducted in South Korea and the United Kingdom. Managerial summary: Most would agree that entrepreneurially oriented firms-being innovative, entering new markets, and taking risk-grow faster. But how a firm becomes entrepreneurial is a complicated question. In this study, we flipped the growth relationship around and found support for growth contributing to a firm's entrepreneurial orientation. But between growth and being more entrepreneurial is the firm's ability to recognize changes in market expectations. We argue that as a firm grows, it acquires new resources and new knowledge of how to use those resources. These new resource combinations increase its ability to recognize changes in market expectations-its adaptive capability. This capability uncovers new entrepreneurial opportunities for value creation. To capture this potential value, firms expand their entrepreneurial orientation. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Pulmonary aspiration of gastric contents is a potentially devastating complication of anesthesia. Aims This prospective multicenter survey of specialist pediatric centers in the UK set out to elucidate the incidence, risk factors, and the outcome of such events. The survey took place over a twelve-month period via a web-based secure reporting system. Results Over the twelve-month period, 24 cases of pulmonary aspiration were reported. Over that time period, there were 118 371 cases performed at the eleven pediatric centers. The overall incidence of pulmonary aspiration is therefore 1 in 4932 cases or 2 in 10 000 cases. Over that time period, there were 18 cases during elective surgery and six cases in nonelective/emergency surgery. The incidence of pulmonary aspiration in the elective situation is therefore 1 in 5076 cases or 2.0 per 10 000 cases. The incidence in emergency procedures is 1 in 4498 cases or 2.2 per 10 000 cases. The timing and severity of deterioration were recorded. In the study period, 8 of 24 cases did not deteriorate, 13 of 24 deteriorated with immediate effect, and the further 3 of 24 deteriorated within the next hour. The deterioration was mild in 11 patients requiring medical management only, and the deterioration was severe in five patients. Those five patients required ventilation for varying durations of time. All patients made a full recovery. Conclusions This multicenter survey of specialist pediatric centers in the UK over a one-year period reveals a low incidence of pulmonary aspiration in both elective and emergency cases. All patients made a full recovery. [ABSTRACT FROM AUTHOR]