Ten years of simulation-based training in pediatric anesthesia: The inception, evolution, and dissemination of the Managing Emergencies in Pediatric Anesthesia (MEPA) course.

2016 marked the 10-year anniversary of the inception of the Managing Emergencies in Paediatric Anaesthesia (MEPA) course. This simulation-based program was originally created to allow trainees in pediatric anesthesia to experience operating room emergencies which although infrequent, would be considered key competencies for any practicing anesthetist with responsibility for providing care to children. Since its original manifestation, the course has evolved in content, scope, and worldwide availability, such that it is now available at over 60 locations on five continents. The content has been modified for different learner groups and translated into several languages. This article describes the history, evolution, and dissemination of the MEPA course to share lessons learnt with educators considering the launch of similar initiatives in their field.

A systematic review and meta-analysis of acute severe complications of pediatric anesthesia.

BACKGROUND: Quantification of acute severe complications of pediatric anesthesia is essential to plan clinical guidelines and educational curricula. AIM: Our aim was to identify complications in terms of frequency and outcomes. METHODS: We defined acute severe complications as an unexpected perioperative event, which without intervention by the anesthesiologist within 30 min may lead to disability or death. A systematic search was performed using MEDLINE, EMBASE, and CINAHL. Screening and data extraction were performed independently. Assessment of bias was conducted using GRADE guidelines. RESULTS: Of 3002 abstracts, 25 met all inclusion criteria. The most common acute severe complications in pediatric anesthesia are related to airway management and respiratory system, followed by cardiovascular events. There was a great variation in reporting the methods, particularly poor definitions of diagnostic criteria for complications. Data were heterogeneous and pooled estimates may not be generalizable. Some studies failed to define potential source of bias, explain how missing data were addressed, describe acute severe complications, and had incomplete postoperative follow-up. CONCLUSION: The data on pediatric anesthesia acute severe complications are poorly defined with large variation in the specificity of diagnostic reporting even within studies. We suggest that it is vital for future studies in this area to be based on a standardized system of diagnostic reporting (possibly with a hierarchical system of coding) with adequate description of population details to describe heterogeneity of data.