Preparation for Paediatric Anaesthesia Dr Tim Baker Stockholm
Preparation for Paediatric Anaesthesia Dr Tim Baker Stockholm, Sweden tim@lifesupportfoundation. org SATA Conference, Tanzania, May 2016
Intro Why do we need to prepare for anaesthesia? Which routines should we use? Which checklists should we use?
Common fallacies • ”I do not make mistakes” • ”It was not my fault that the patient died” • ”It is somebody else that is responsible for the equipment” • ”I know the laryngoscope works because I used it earlier • ”I am smarter than a piece of paper” If something can go wrong, it has gone wrong
Why do we need routines? Anaesthesia • is complicated • can be standardised • is time dependent • can be dangerous • has many people involved Complications might happen fast so be prepared to act!
Which routines should we use? Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines
Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines
Pre-op visit Aims 1. Assess illness severity - prioritisation 2. Find problems early 3. Optimise the patient Improve outcomes Pre-op form that can be used for all patients
Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines
Check equipment • Checklist for which equipment should ALWAYS be in the operating theatre • Checked that everything is present & working everyday before every case
Check equipment • A: Oropharyngeal airway, laryngoscope, suction, Bougie, ETT different sizes • B: Ambu-bag, Masks different sizes, anaesthesia machine, pulse oximetry, paediatric Ambubag • C: cannulae, syringes, giving sets, tilting of operation table
Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines
Check drugs Adrenaline Atropine Ephedrine Thiopentone Ketamine Suxamethonium Coffee R. L N. S Halothane …. . Named person responsible for emergency box daily / before every case
Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines
Patient pre-anaesthesia checklist • Allergies? • Fasting? • Expected difficult airway? • Possible complications • Paediatric patient: • Desaturate FAST • Correct size equipment (and one size bigger, one size smaller) • Correct drug doses
How to remember CHECK LISTS
Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines
Participating Hospitals
Results er
Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines
Summary • Be prepared for possible complications • Emergency drugs & equipment always available in theatre • Same preparations everytime. Use checklists. Standardised preparations prevent disaster when complications arise
tim@lifesupportfoundation. org www. lifesupportfoundation. org
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