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Background Wake Up Safe, a Patient Safety Organization founded by the Society for Pediatric Anesthesia, collects data on serious adverse events along with demographic data from all pediatric patients receiving anesthesia care at participating institutions. This report reviews all events occurring between 2010 and 2015 and focuses on common adverse events that are anesthesia-related. Aims Determine which adverse events were most common from 2010 to 2015 among participating Wake Up Safe institutions. Determine how many anesthesia-related events were deemed to be preventable. Methods This is a descriptive report. The Wake Up Safe registry data were queried on September 29, 2017. Institutions were included if they had complete demographic data and at least 5 adverse events per year reported. At that time, 19 out of 29 institutions had complete demographic data for events from 2010 to 2015. This study describes demographic data and adverse events from these nineteen institutions. Descriptive data were extracted, and event rate was calculated for each adverse event category. In events that were assessed as primarily related to anesthesia, further detailed analysis was performed. Results Of all reported adverse events (2544 events), the most common were cardiac arrests (646, 31.6%), respiratory complications (598, 29.2%), and medication events (345, 16.9%). Of all anesthesia-related events (612 events), medication events were the most common (239, 31.9%), followed by respiratory complications (181, 24.1%), and cardiac arrests (139, 18.5%). Overall, 85% of anesthesia-related serious adverse events were deemed somewhat or almost certainly preventable. Conclusions The majority of anesthesia-related serious adverse events reported to the Wake Up Safe database are preventable. Medication events are the most common anesthesia-related adverse events. Innovations aimed at decreasing medication events may be the most impactful.

Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.

While shown to be safe for administration in pediatric patients, sugammadex has recently been associated with residual weakness or recurarization. We describe 4 additional cases of pediatric patients with residual or recurrent weakness following rocuronium reversal with sugammadex. Two infant patients developed postoperative ventilatory distress, which was possibly related to recurarization after sugammadex reversal. A third patient received sugammadex with apparent waning of clinical effect and subsequently required neostigmine reversal. A fourth patient was observed to have residual weakness, which led to prolonged intubation despite appropriate train-of-four results after reversal with sugammadex.

Objective To compare the incidence, severity, preventability, and contributing factors of non-routine events - deviations from optimal care based on the clinical situation - associated with team-based, nurse-to-nurse, and mixed handovers in a large cohort of surgical neonates. Study Design A prospective observational study and one-time cross-sectional provider survey were conducted at one urban academic children’s hospital. 130 non-cardiac surgical cases in 109 neonates who received pre- and post-operative NICU care. Results The incidence of clinician-reported NREs was high (101/130 cases, 78%) but did not differ significantly across acuity-tailored neonatal handover practices. National Surgical Quality Improvement – Pediatric occurrences of major morbidity were significantly higher (p

Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication.

Background and Objectives Epidural catheters placed for perioperative analgesia in young children confer clinical benefits but are technically challenging to insert. Approximations of the skin to epidural space depth in this population are limited to direct needle measurement and ultrasonography. Magnetic resonance imaging (MRI) is the most comprehensive imaging modality of the spine. This study aims to produce a more clinically useful formula from MRI data to estimate pediatric epidural depth. Methods Seventy children with normal lumbar spine MR images were enrolled. After determination of epidural depth, linear regression was used to estimate a weight-based formula. Analysis of variance and bootstrap methods were used to evaluate this formula against 4 commonly cited formulae. The quality of predictions was evaluated using the mean absolute prediction error. Results The estimated weight-based formula as derived by MRI data is given by: skin to epidural depth (mm) = 9.00 + 0.62 * weight in kilograms. The mean absolute prediction error was 2.56 mm (95% confidence interval [95% CI], 2.12–3.04) for the new formula. Additional derived formulae are skin to dorsal dura depth (mm) = 13.52 + 0.71 * weight in kilograms (mean absolute prediction error, 2.48 mm; 95% CI, 2.00–3.03) and skin to ventral dural depth (mm) = 23.08 + 0.86 * weight in kilograms (mean absolute prediction error, 2.50 mm; 95% CI, 2.04–3.06). Conclusions We provide the first predictive formulae, based on MRI data, for pediatric epidural depth estimation.

Introduction In 2013, our institution established a multidisciplinary pediatric neurovascular conference for coordination of care. Here, we review our initial experience. Methods Clinical and demographic data were obtained from medical records for patients presented to the pediatric neurovascular conference from April 2013 to July 2014. Patient descriptive characteristics were described by mean and standard deviation for continuous measures and by number and percent for categorical measures. Patients were secondarily stratified by lesion/disease type, and descriptive statistics were used to measure demographic and clinical variables. Results The pediatric neurovascular conference met 26 times in the study period. Overall, 75 children were presented to the conference over a 15-month period. The mean age was 9.8 (standard deviation, 6.3) years. There were 42 (56%) male patients. These 75 children were presented a total of 112 times. There were 28 (37%) patients with history of stroke. Complex vascular lesions were the most frequently discussed entity; of 62 children (83%) with a diagnosed vascular lesion, brain arteriovenous malformation (29%), cavernous malformation (15%), and moyamoya (11%) were most common. Most discussions were for review of imaging (35%), treatment plan formulation (27%), the need for additional imaging (25%), or diagnosis (13%). Standardized care protocols for arteriovenous malformation and moyamoya were developed. Conclusion A multidisciplinary conference among a diverse group of providers guides complex care decisions, helps standardize care protocols, promotes provider collaboration, and supports continuity of care in pediatric neurovascular disease.

HOLT-ORAM SYNDROME (HOS) is a rare congenital disorder associated with limb abnormalities, structural cardiac defects, and cardiac arrhythmias due to various abnormalities in TBX5, a member of the T-box gene family. Children with this disorder frequently present for orthopedic and congenital cardiac surgery. HOS may manifest with minor structural cardiac defects such as atrial septal defects or ventricular septal defects, though more complex defects such as hypoplastic left heart or truncus arteriosus have been reported. In addition, abnormal TBX5 gene products are implicated in the abnormal development of the cardiac conduction system, resulting in various cardiac arrhythmias. The genetic basis of the cardiac abnormalities associated with HOS is incompletely understood at present though abnormalities in ion conduction, particularly potassium conduction, may lead to atrial tachyarrhythmia. The authors present the case of an infant with HOS who underwent congenital cardiac surgery, developed intraoperative findings suspicious for malignant hyperthermia (MH), and responded favorably to standard MH treatment.