Error Traps in Developing a Pediatric Enhanced Recovery After Surgery (ERAS) Program.

Enhanced recovery after surgery (ERAS) pathways have been shown to improve patient outcomes, increase patient satisfaction, and decrease costs. First created and implemented in the adult population, these pathways are now commonplace and continue to expand in the pediatric realm. While there are many proven benefits to ERAS pathways, there continue to be challenges to their proper implementation and long-term success.

The implementation of a pectus bar insertion enhanced recovery after surgery pathway: A quality improvement initiative.

Background: Pectus excavatum repair is associated with significant discomfort, and pain is a primary contributor to postoperative hospital length of stay. Recent advances in postoperative pain control include the use of intercostal cryoablation techniques that may now make it possible to discharge patients on the day of surgery. Unnecessary variation in patient care and noncompliance with care bundles may be a factor in extended length of stay.

Vaping Associated Cardiac Arrest at School in a Teenager with Anomalous Left Coronary Artery.

The prevalence of electronic cigarette use is increasing at an astonishing pace, particularly in the teenage population. While at school, a healthy 13-year-old male experienced a sudden cardiac arrest after vaping multiple times throughout the day. Workup revealed an anomalous left coronary artery originating from the right sinus of Valsalva.

Trimmed central venous catheters in pediatric cardiac surgery: Does height or weight correlate with the amount trimmed?

Background: Due to excess catheter length, pediatric patients undergoing cardiac surgery frequently have the tip of the central venous catheter trimmed while on bypass to obtain optimal catheter positioning.

Aims: We sought to determine if there is a correlation between the patient's height or weight and the length of catheter removed. Our secondary aim compared the instances of central line-associated bloodstream infections and venous thromboembolisms between the trimmed and untrimmed catheters.

The implementation of low-flow anesthesia at a tertiary pediatric center: A quality improvement initiative.

Introduction: Anesthesia machines have evolved over the years to excel in delivering low-flow anesthesia (<1 L fresh gas flow) in a closed-circuit system, with the obvious benefits being decreased costs and reduced emissions of greenhouse gases. At a pediatric hospital that provides over 25 000 anesthetics a year, a quality improvement project was initiated with the aim of decreasing the amount of sevoflurane used per anesthetic by 20% over the course of a year.

Methods: Three Plan-Do-Study-Act cycles involving gathering comparative data, departmental education, improvement updates on our huddle board, and intraoperative confirmation rounds were completed.

Breathing circuit compliance and accuracy of displayed tidal volume during pressure-controlled ventilation of infants: A quality improvement project.

Introduction: Anesthesia machines have evolved to deliver desired tidal volumes more accurately by measuring breathing circuit compliance during a preuse self-test and then incorporating the compliance value when calculating expired tidal volume. The initial compliance value is utilized in tidal volume calculation regardless of whether the actual compliance of the breathing circuit changes during a case, as happens when corrugated circuit tubing is manually expanded after the preuse self-test but before patient use. We noticed that the anesthesia machine preuse self-test was usually performed on nonexpanded pediatric circuit tubing, and then the breathing circuit was subsequently expanded for clinical use.