ANALYSIS OF CRITICAL INCIDENTS IN PEDIATRIC ANAESTHESIA - A CLINICAL STUDY

Apply

ANALYSIS OF CRITICAL INCIDENTS IN PEDIATRIC ANAESTHESIA - A CLINICAL STUDY

Journal Title: Journal of Advanced Medical and Dental Sciences Research - Year 2017, Vol 5, Issue 1

Abstract

Background: Critical incident monitoring is important in quality improvement and patient safety as it identifies potential risks to patients by analyzing adverse events or near-misses. The present study was conducted to report the incidence of critical events occurring in the department of anesthesia during surgery in children. Materials & Methods: This study was conducted in the department of anesthesia in Jan 2015 to Dec 2015. It included 1050 children upto 15 years of age who underwent any procedure in pediatric surgery OT. Children undergoing Cardiac and ear, nose, throat (ENT) surgeries, thoracic, abdominal, genitourinary procedures, neurosurgeries and paediatric surgeries such as circumcision, examination and dressing under general anaesthesia, lymph node biopsy. Children having pre‑operative cardiovascular compromise (hypotension, hypertension, arrhythmias) were excluded from cardiovascular adverse events. Those having pre‑operative desaturation/hypercarbia (congenital diaphragmatic hernia [CDH], tracheoesophageal fistula) were excluded from respiratory adverse events. <94% Oxygen saturation was considered as desaturation and >50 mm Hg end‑tidal carbon dioxide (ETCO2) was considered as hypercarbia. For laparoscopies, ETCO2 values <60 mm Hg was not considered as a critical incident. Pre‑anaesthetic check (PAC), intraoperative and postoperative check was done in the post‑anaesthesia care unit (PACU). Electrocardiogram (ECG), and pulse rate, pulse oximetry, ETCO2, blood pressure and temperature was monitored. Results: Out of 1050 patients, 250 were neonates, 300 were infants, 340 were toddlers and 160 were other children. We found that 25 neonates, 33 infants, 44 toddlers and 24 other children had critical events. The incidence rate was 12%. Respiratory incidents reported were laryngospasm (20), SGD related incidents (12), inappropriate size ETT (3), difficult neonatal intubation (5), difficult mask ventilation (6), accidental extubation (8), upper airway obstruction (8), urgent reintubation (5), bronchospasm (7) and hypercarbia (6). Associated desaturation was seen in laryngospasm (11), SGD related incidents (3), inappropriate size ETT (2), difficult neonatal intubation (6), difficult mask ventilation (3), upper airway obstruction (6), urgent reintubation (2), bronchospasm (2) and hypercarbia (1). Cardiovascular incidents were bradycardia seen in 7 patients, inferior vena cava rupture in 3 patients and accidental carotid punctures in 2 patients. The degree of harm recorded was no harm in 8 patients, low harm (31), moderate harm (68), severe harm (18) and I case of reported death. Critical incidents occurred in less than 2 hours (68), 2-6 hours (44) and more than 6 hours (14). Conclusion: Critical incident reporting is useful in perioperative safety of children. The anaesthesiologists can play important role in recording critical incidents. There is need to established critical incident monitoring system.

Authors and Affiliations

Ashish Mittal, Mridula Agarwal

Keywords

EP ID EP553721
DOI -
Views 107
Downloads 0