Building the Case for Quality Improvement.

Great improvements have been made by quality improvement teams. National trends towards using quality and value metrics in reimbursement suggest that physicians and advanced practitioners caring for children and adolescents will benefit from knowing and using quality improvement methods. These methods will also help as transparency of quality data becomes more commonplace.

Etiology of postanesthetic and postsedation events on the inpatient ward: data from a rapid response team at a tertiary care children's hospital.

Introduction: The goal of this study was to identify the etiology of events and demographics of patients that experience complications requiring activation of the Rapid Response Team (RRT) during the first 24 h following anesthetic care.

Methods: We performed a retrospective review of the Quality Improvement database from the Department of Anesthesiology & Pain Medicine at Nationwide Children's Hospital. The database was searched to identify those patients who had a RRT evaluation activated within 24 h of receiving anesthesia or procedural sedation.

A comparison of functional magnetic resonance imaging findings in children with and without a history of early exposure to general anesthesia.

Background: Functional magnetic resonance imaging (fMRI) has been used to evaluate the long-term consequences of early exposure to neurotoxic agents. fMRI shows that different patterns of brain activation occur in ethanol-exposed subjects performing a go/no-go response inhibition task. Pharmacologically, ethanol and general anesthetics have similar receptor-level activity in the brain.

Current practices regarding codeine administration among pediatricians and pediatric subspecialists.

Pharmacogenomic studies have revealed a wide variation in the metabolism of codeine to its active metabolite, morphine. A particular subset of patients, known as ultrarapid metabolizers, possesses multiple copies of the CYP2D6 gene responsible for codeine metabolism. This has been linked to serious morbidity and mortality in pediatric patients leading to considerable debate regarding the use of codeine for analgesia in the pediatric population.

Perioperative hypothermia in the pediatric population: a quality improvement project.

There are limited data in the pediatric population regarding the incidence of, risk factors for, and means to prevent perioperative hypothermia. The Institute for Healthcare Improvement Model for quality improvement (QI) methodology was used to bundle the most effective techniques to prevent hypothermia. A multidisciplinary QI team was assembled with the goal to decrease the incidence of perioperative hypothermia by 50%.

Severe intraoperative hypertension after induction of anesthesia in a child with a neuroblastoma.

Neuroblastomas are the most common, non-central nervous system tumor of childhood. Similar to pheochromocytomas, they are derived from neural crest cells and therefore retain the potential to synthesize catecholamines. Unlike pheochromocytomas, however, perioperative issues related to blood pressure instability with hypertension are uncommon.

A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans.

Objectives: We compared three primary outcomes of pausing the magnetic resonance imaging (MRI) scan, emergence quality and respiratory complications.

Aim: To measure and compare the quality between sevoflurane and propofol in children undergoing MRI scans.

Background: No randomized controlled trial exists comparing the quality between sevoflurane and propofol for MRI.