RESUMO
INTRODUCTION: Quality improvement in health care entails the design of reliable processes which prevent and mitigate medical errors. Checklists are cognitive tools which reduce such errors. The primary objective of this study was to design an anesthetic checklist in Pediatrics to be implemented in our hospital. METHODS: Delphi technique was used, with 3 rounds of questionnaire surveys: a generic questionnaire to obtain dimensions and items; and 2 specific ones to score individual items and obtain an overall rating for the checklist (median), and to measure the level of consensus (relative interquartile range) and internal reliability (Wilcoxon signed-rank test). RESULTS: Final version of the checklist obtained a high overall score (Med 9) with a very high consensus (RIR 5%). Internal consensus was reached on all items (RIR ≤ 30%). Wilcoxon signed-rank test found no statistically significant differences, demonstrating reliability or consistency of responses between consecutive rounds. CONCLUSION: The Anesthetic checklist in Pediatrics has been methodically designed for implementation and use in our hospital.
Assuntos
Anestesia/normas , Lista de Checagem/normas , Erros Médicos/prevenção & controle , Pediatria/normas , Melhoria de Qualidade , Lista de Checagem/métodos , Consenso , Técnica Delphi , Retroalimentação , Pesquisas sobre Atenção à Saúde/normas , Humanos , Segurança do Paciente , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Inquéritos e Questionários/normasRESUMO
Pediatric neuraxial anesthesia is an effective tool that can be used as a supplement or alternative to general anesthesia. However, there have always been doubts about its usefulness and risk-benefit ratio. The purpose of this review is to describe the current role of central blockades in pediatric patients, upgrade practical and safety aspects, and review the latest technological advances applied to this procedure.
Assuntos
Anestesia Geral , Anestesia por Condução , Criança , Humanos , Medição de RiscoRESUMO
The criteria for preoperative use of pacemakers are not unanimously agreed upon. Certain cases require careful assessment to weigh potential benefits against inherent risks in placing the device. Although external transcutaneous pacemakers, whose use circumvents the risks of transvenous insertion, have been available for years, such devices are not always appropriate, depending on the flow disorder involved or the type of surgery that will be performed. We report the case of a 75-year-old woman who was a candidate for surgery requiring general anesthesia (lumboperitoneal shunt due to chronic adult hydrocephaly). Although her condition did not initially call for prophylactic use of a pacemaker before surgery, changes soon developed that necessitated insertion of a temporary transvenous device for surgery and insertion of a permanent pacemaker the day after surgery.