Download PDF
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(07/08): 513-523
DOI: 10.1055/s-0042-118829
Topthema
Georg Thieme Verlag KG Stuttgart · New York

Anästhesie und Outcome: Einfluss bei Kindern

The Influence of Anesthesia On Perioperative Outcome in Children – Institutional and Individual Factors
Frank Fideler
,
Christian Grasshoff
Further Information

Publication History

Publication Date:
25 July 2017 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Die operative Versorgung von Kindern birgt ein erhöhtes Risiko schwerer perioperativer Komplikationen und stellt hohe Anforderungen an die beteiligten Berufsgruppen. Um das perioperative Outcome von Kindern vonseiten der Anästhesie positiv zu beeinflussen, sind neben der Optimierung institutioneller Faktoren individuelle Möglichkeiten innerhalb der intraoperativen Phase der Narkoseeinleitung und -aufrechterhaltung bedeutend, insbesondere die Einstellung des adäquaten Blutdrucks.

Abstract

The perioperative care of children is challenging for health care providers. Since anesthetists cannot affect the nature of the disease and have hardly an impact on the decision for surgery we summarized in this review individual and institutional factors for improving perioperative outcome by anesthetists. Individual factors include the level of education and the professional experience of the anesthetist as well as an anesthetic management that is focused on the maintenance of an adequate cerebral perfusion. Besides individual factors this review emphasizes the importance of institutional factors as measures to reduce anxiety and insecurity of the parents which result in less distress and coping of the children in the postanesthesia care unit as well as less need for pain medication, less emergence delirium and less sleep disorders. A behaviorally oriented preoperative preparation of parents and children also affects the postoperative course of the pediatric patients positively as well as institutional concepts for the reduction of perioperative medication errors and adverse drug events. We believe that perspectively pediatric surgery will be increasingly performed in high volume hospitals which are able to guarantee beneficial institutional structures as well as a high educational level and high professional experience of the employed anesthetists.

Kernaussagen

  • Eine verhaltensorientierte präoperative Vorbereitung von Eltern und Kindern wirkt sich positiv auf den postoperativen Verlauf der Kinder aus.

  • Maßnahmen zur Reduktion von Angst und Unsicherheit der Eltern sind im postoperativen Verlauf verbunden mit geringerem Schmerzmittelbedarf, weniger Emergence Delir und weniger Schlafstörungen.

  • Ein hohes Fallaufkommen und die Erfahrung des Anästhesisten wirken sich positiv aus hinsichtlich der Anzahl intraoperativer Herzstillstände, Vermeidung von Atemwegskomplikationen sowie der Häufigkeit postoperativer Komplikationen.

  • Institutionelle Konzepte zur Reduktion von Medikationsfehlern beeinflussen das Behandlungsergebnis positiv.

  • Zur Aufrechterhaltung einer ausreichenden zerebralen Perfusion sollen Hypotensionen vor allem in Verbindung mit paCO2- und Hb-Abfällen vermieden werden.

  • „Failure to Rescue“ ist abhängig vom Fallaufkommen der Klinik. Hohe Fallzahlen wirken sich positiv aus.

  • Zwischenergebnisse von GAS- und PANDA-Studie zeigen, dass die einmalige kurze Exposition gegenüber Anästhetika nicht zu einer Verschlechterung der neurologischen Entwicklung führt.

  • Das Verzögern einer klar indizierten chirurgischen oder diagnostischen Prozedur in Allgemeinanästhesie bei Kindern ist nach aktueller Datenlage nicht zu rechtfertigen

Schlüsselwörter

Kinderanästhesie - Outcome - Eltern - Neurotoxizität - Anästhetika - Hypotension - Hypokapnie - institutionelle Faktoren

Key words

pediatric anesthesia - outcome - parents - neurotoxicity - anesthetics - hypotension - hypocapnia - institutional factors
 

  • Literatur

  • 1 Habre W, Disma N, Virag K. et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med 2017; 5: 412-425
    CrossrefPubMedGoogle Scholar
  • 2 McCann ME, Schouten AN. Beyond survival; influences of blood pressure, cerebral perfusion and anesthesia on neurodevelopment. Paediatr Anaesth 2014; 24: 68-73
    CrossrefPubMedGoogle Scholar
  • 3 Jimenez F. Vollnarkose verschlechtert dauerhaft das Gedächtnis. Im Internet: http://www.welt.de/gesundheit/article128867496/Vollnarkose-verschlechtert-dauerhaft-das-Gedaechtnis.html Stand: 27.06.2017
    PubMedGoogle Scholar
  • 4 Flick RP, Sprung J, Harrison TE. et al. Perioperative cardiac arrests in children between 1988 and 2005 at a tertiary referral center: a study of 92,881 patients. Anesthesiology 2007; 106: 226-237
    CrossrefPubMedGoogle Scholar
  • 5 Litman RS, Berger AA, Chhibber A. An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery. Paediatr Anaesth 1996; 6: 443-447
    CrossrefPubMedGoogle Scholar
  • 6 Chorney JM, Tan ET, Kain ZN. Adult-child interactions in the postanesthesia care unit: behavior matters. Anesthesiology 2013; 118: 834-841
    CrossrefPubMedGoogle Scholar
  • 7 Kain ZN, Mayes LC, Caldwell-Andrews AA. et al. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics 2006; 118: 651-658
    CrossrefPubMedGoogle Scholar
  • 8 Sanders jr. RC, Nett ST, Davis KF. et al. Family presence during pediatric tracheal intubations. JAMA Pediatr 2016; 170: e154627
    CrossrefPubMedGoogle Scholar
  • 9 Kain ZN, Caldwell-Andrews AA, Mayes LC. et al. Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial. Anesthesiology 2007; 106: 65-74
    CrossrefPubMedGoogle Scholar
  • 10 Martin SR, Chorney JM, Tan ET. et al. Changing healthcare providersʼ behavior during pediatric inductions with an empirically based intervention. Anesthesiology 2011; 115: 18-27
    CrossrefPubMedGoogle Scholar
  • 11 Mudumbai SC, Honkanen A, Chan J. et al. Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis. Paediatr Anaesth 2014; 24: 1295-1301
    CrossrefPubMedGoogle Scholar
  • 12 Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009; 361: 1368-1375
    CrossrefPubMedGoogle Scholar
  • 13 Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care 2011; 49: 1076-1081
    CrossrefPubMedGoogle Scholar
  • 14 Keenan RL, Shapiro JH, Dawson K. Frequency of anesthetic cardiac arrests in infants: effect of pediatric anesthesiologists. J Clin Anesth 1991; 3: 433-437
    CrossrefPubMedGoogle Scholar
  • 15 Auroy Y, Ecoffey C, Messiah A. et al. Relationship between complications of pediatric anesthesia and volume of pediatric anesthetics. Anesth Analg 1997; 84: 234-235
    CrossrefPubMedGoogle Scholar
  • 16 von Ungern-Sternberg BS, Boda K, Chambers NA. et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet 2010; 376(9743): 773-783
    CrossrefPubMedGoogle Scholar
  • 17 Nanji KC, Patel A, Shaik S. et al. Evaluation of Perioperative Medication Errors and Adverse Drug Events. Anesthesiology 2016; 124: 25-34
    CrossrefPubMedGoogle Scholar
  • 18 Merry AF, Anderson BJ. Medication errors – new approaches to prevention. Paediatr Anaesth 2011; 21: 743-753
    CrossrefPubMedGoogle Scholar
  • 19 Llewellyn RL, Gordon PC, Wheatcroft D. et al. Drug administration errors: a prospective survey from three South African teaching hospitals. Anaesth Intensive Care 2009; 37: 93-98
    PubMedGoogle Scholar
  • 20 Kozer E, Seto W, Verjee Z. et al. Prospective observational study on the incidence of medication errors during simulated resuscitation in a paediatric emergency department. BMJ 2004; 329(7478): 1321-1321
    CrossrefPubMedGoogle Scholar
  • 21 Clark JA, Lieh-Lai MW, Samaik A, Mattoo TK. Discrepancies between direct and indirect blood pressure measurements using various recommendations for arm cuff selection. Pediatrics 2002; 110: 920-923
    CrossrefPubMedGoogle Scholar
  • 22 McCann ME, Schouten AN, Dobija N. et al. Infantile postoperative encephalopathy: perioperative factors as a cause for concern. Pediatrics 2014; 133: e751-e757
    CrossrefPubMedGoogle Scholar
  • 23 Michelet D, Arslan O, Hilly J. et al. Intraoperative changes in blood pressure associated with cerebral desaturation in infants. Paediatr Anaesth 2015; 25: 681-688
    CrossrefPubMedGoogle Scholar
  • 24 de Graaff JC, Pasma W, van Buuren S. et al. Reference Values for Noninvasive Blood Pressure in Children during Anesthesia: A Multicentered Retrospective Observational Cohort Study. Anesthesiology 2016; 125: 904-913
    CrossrefPubMedGoogle Scholar
  • 25 Williams M, Lee JK. Intraoperative blood pressure and cerebral perfusion: strategies to clarify hemodynamic goals. Paediatr Anaesth 2014; 24: 657-667
    CrossrefPubMedGoogle Scholar
  • 26 Nafiu OO, Voepel-Lewis T, Morris M. et al. How do pediatric anesthesiologists define intraoperative hypotension?. Paediatr Anaesth 2009; 19: 1048-1053
    CrossrefPubMedGoogle Scholar
  • 27 Simpao AF, Ahumada LM, Gálvez JA. et al. The timing and prevalence of intraoperative hypotension in infants undergoing laparoscopic pyloromyotomy at a tertiary pediatric hospital. Paediatr Anaesth 2017; 27: 66-76
    CrossrefPubMedGoogle Scholar
  • 28 Weber F, Honing GH, Scoones GP. Arterial blood pressure in anesthetized neonates and infants: a retrospective analysis of 1091 cases. Paediatr Anaesth 2016; 26: 815-822
    CrossrefPubMedGoogle Scholar
  • 29 Rhondali O, André C, Pouyau A. et al. Sevoflurane anesthesia and brain perfusion. Paediatr Anaesth 2015; 25: 180-185
    CrossrefPubMedGoogle Scholar
  • 30 Rhondali O, Juhel S, Mathews S. et al. Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years. Paediatr Anaesth 2014; 24: 734-740
    CrossrefPubMedGoogle Scholar
  • 31 Ringer SK, Ohlerth S, Carrera I. et al. Effects of hypotension and/or hypocapnia during sevoflurane anesthesia on perfusion and metabolites in the developing brain of piglets-a blinded randomized study. Paediatr Anaesth 2016; 26: 909-918
    CrossrefPubMedGoogle Scholar
  • 32 Davidson AJ. Neurotoxicity and the need for anesthesia in the newborn: does the emperor have no clothes?. Anesthesiology 2012; 116: 507-509
    CrossrefPubMedGoogle Scholar
  • 33 Sanders RD, Hassell J, Davidson AJ. et al. Impact of anaesthetics and surgery on neurodevelopment: an update. Br J Anaesth 2013; 110 (Suppl. 01) i53-i72
    CrossrefPubMedGoogle Scholar
  • 34 Davidson AJ, Disma N, de Graaff JC. et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet 2016; 387(10015): 239-250
    CrossrefPubMedGoogle Scholar
  • 35 Sun LS, Li G, Miller TL. et al. Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA 2016; 315: 2312-2320
    CrossrefPubMedGoogle Scholar
  • 36 Dobbing J, Sands J. Comparative aspects of the brain growth spurt. Early Hum Dev 1979; 3: 79-83
    CrossrefPubMedGoogle Scholar
  • 37 Huttenlocher PR, Dabholkar AS. Regional differences in synaptogenesis in human cerebral cortex. J Comp Neurol 1997; 387: 167-178
    CrossrefPubMedGoogle Scholar
  • 38 Glatz P, Sandin RH, Pedersen NL. et al. Association of anesthesia and surgery during childhood with long-term academic performance. JAMA Pediatr 2017; 171: e163470
    CrossrefPubMedGoogle Scholar
  • 39 FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women. Im Internet: https://wayback.archive-it.org/7993/20170111071047/http://www.fda.gov/Drugs/DrugSafety/ucm532356.htm Stand: 27.06.2017
    PubMedGoogle Scholar
  • 40 Andropoulos DB, Greene MF. Anesthesia and Developing Brains – Implications of the FDA Warning. N Engl J Med 2017; 376: 905-907
    CrossrefPubMedGoogle Scholar
  • 41 Becke K, Eich C, Höhne C. et al. Kinderanästhesie: Was wirklich wichtig ist. Dtsch Arztebl International 2017; 114: 166-169
    PubMedGoogle Scholar
  • 42 Im Internet: http://www.safetots.org Stand: 27.06.2017
    PubMed
  • 43 Weiss M, Vutskits L, Hansen TG, Engelhardt T. Safe Anesthesia For Every Tot – The SAFETOTS initiative. Curr Opin Anaesthesiol 2015; 28: 302-307
    CrossrefPubMedGoogle Scholar
  • 44 Haynes AB, Weiser TG, Berry WR. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360: 491-499
    CrossrefPubMedGoogle Scholar