Children's rights - the basis of quality in pediatric anesthesia.

Purpose Of Review: In 1989, the United Nations passed the 'Convention on the Rights of the Child' (UNCRC) and, among others claimed the highest attainable standard of health for children and consequently the highest level of safety and quality in paediatric anaesthesia. SAFETOTS (Safe Anesthesia For Every Tot, www.safetots.

[Quality and safe anesthesia for all children : That is their right!].

In 1989 the United Nations passed the "United Nations Convention on the Rights of the Child" (UNCRC) and, among others, demanded the highest attainable standard of health for children. Safe Anesthesia for Every Tot (SAFETOTS, www.safetots.

Prophylactic fibrinogen concentrate administration in surgical correction of paediatric craniosynostosis: A double-blind placebo-controlled trial.

Background: Surgical craniosynostosis repair in children is associated with massive blood loss and significant transfusion of blood products. Fibrinogen concentrate is claimed to be useful in reducing blood loss and transfusion requirements.

Objective: We investigated whether prophylactic administration of fibrinogen concentrate will reduce blood loss and transfusion requirements during paediatric craniofacial surgery.

Choosing Wisely in pediatric anesthesia: An interpretation from the German Scientific Working Group of Paediatric Anaesthesia (WAKKA).

Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics. (ii) In children without relevant preexisting illnesses (ie, ASA status I/II) who are scheduled for elective minor or medium-risk surgical procedures, no routine blood tests should be performed.

What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review.

Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare.

The quality of the evidence base for clinical pathway effectiveness: room for improvement in the design of evaluation trials.

Background: The purpose of this article is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs.

Methods: An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations.

Have we drawn the wrong conclusions about the value of care pathways? Is a Cochrane review appropriate? Response to the commentary article published by Kris Vanhaecht et al.

The commentary provided by Vanhaecht et al. from the European Pathways Association (EPA) questions whether conclusions derived from the review of effects of clinical pathways in hospitals are appropriate. They provide some methodological discussion that indicates a poor appreciation of the detailed content of the review as published in the Cochrane Library and a lack of understanding of the methodological requirements for complex interventions of the Cochrane Effective Practice and Organisation of Care (EPOC) group.

The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis.

This paper is a summary version of the previously published Cochrane review. It may increase the reach of the topic to health researchers and practitioners and encourage further discussion. The systematic review aims to summarize the evidence and assess the effect of clinical pathways on professional practice, patient outcomes, length of hospital stay, and hospital costs.

[Non cooperation and refusal during induction of anesthesia in children].

Induction of anesthesia can be very distressing for children. This may lead to a lack of cooperation and refusal. The knowledge about the reasons of this behaviour is important to develop strategies and techniques to minimize the preoperative stress.

Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs.

Background: Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes whilst maximising clinical efficiency.

Objectives: To assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs.

Intraoperative fresh-frozen plasma versus human albumin in craniofacial surgery--a pilot study comparing coagulation profiles in infants younger than 12 months.

The transfusion of fresh-frozen plasma (FFP) is suggested to minimize dilution coagulopathy when applied instead of colloids during paediatric craniofacial surgery (pCFS). We prospectively compared plasmatic haemostaseologic function between volume replacement with FFPs versus human albumin (HA) in a pilot study. Thirty infants with primary craniosynostosis were scheduled for pCFS.

Ultrasound-guided central venous cannulation in a very small preterm neonate.

Percutaneous central venous cannulation of small infants is a challenging procedure. The use of ultrasound guidance has been shown to increase the success rate generally in children and to decrease the incidence of associated complications. To demonstrate that this technique is also suitable in very small infants we describe the case of a preterm neonate of 850 g body weight (BW), in which percutaneous central venous cannulation was performed successfully using ultrasound imaging for guidance.

[Anesthetic management of pediatric cleft lip and cleft palate repair].

We have developed a modern strategy for the anesthetic management of pediatric cleft lip and cleft palate repair using anesthetic drugs such as sevoflurane, desflurane, acetaminophen, remifentanil, and pirtitramide together with new techniques. It provides best conditions for the surgeon and maximum safety for the pediatric patient. A team of pediatricians, neonatologists, pediatric surgeons, and pediatric anesthetists have tackled the problem of management of children with craniofacial abnormalities such as cleft lip and cleft palate.

How to enter the pediatric airway for bronchoscopy.

Background: Bronchoscopies are performed in childhood for diagnostic reasons (e.g. evaluation of stridor, unexplained cough, possible malformations) and therapeutic reasons (e.

Comparison between instillation of bupivacaine versus caudal analgesia for postoperative analgesia following inguinal herniotomy in children.

Background: In this study we compare the postoperative pain relief for inguinal herniotomy in children provided by instillation of bupivacaine into the wound with that provided by a caudal block.

Methods: Fifty-eight children aged 0-5 years having elective unilateral hernia repair were studied in this prospective, randomized, single-blind study. Anaesthesia was induced and maintained with oxygen, nitrous oxide, sevoflurane and propofol.