A concept mobility device with multi-positional configurations and child-kind restraint for safe perioperative transfer and induction of anaesthesia in children with autistic spectrum disorder - a cross sectional study.

BACKGROUND: Transfer into the operating room, onto the operating table and mask induction of anaesthesia are major challenges faced by children with Autistic Spectrum Disorder (ASD). In a pilot study, parents observed that perioperative transfer becomes unsafe and difficult when children with ASD becomes uncooperative. METHOD: A CHILD-KIND CONCEPT mobility system comprising of multi-positioning seat configurations and restraining module was developed with inputs from multi-disciplinary healthcare professionals and parents with children with ASD. To appeal to children and motivate child-machine interaction, the seat configurations and restraining module are designed to take the form of child-friendly, non-threatening, fun and familiar items. The sitting configuration, sitting to supine transformation, the restraint modules resemble racing-car seat, reclining motion of a home massage chair, safety restraints found in airplanes and amusement rides respectively. Healthcare professionals (HCPs) involved in the perioperative patient care, parents of ASD children and children (neurotypical and ASD) experience the use of the system in a non-clinical environment and participated in a survey study. The acceptance of its functionality (HCPs, parents) for perioperative transfer and induction of anaesthesia, rating of the user experience and likes and dislikes of (parents and children) were obtained. RESULTS: Thirty-two HCPs, 30 parents and 23 children participated. Majority of parents and HCPs opined the use of the system enables improvement in the management of perioperative movement (90.0% parents, 100% HCPs), safe perioperative movement (86.7% parents, 96.9% HCPs) and promotes ease of anaesthesia induction (76.7% parents, 90.6% HCPs) for uncooperative combative ASD children. Overall, 93.8% HCPs and 86.7% parents would recommend its frequent use in their own practice and their ASD children respectively. Attractiveness and multi-functionality are attributes endorsed by parents and children. Children endorse its use for induction of anaesthesia (73.9%), dental chair (82.6%), intra-hospital transfer (95.7%). CONCLUSION: A child-kind mobility device that integrates appeal with functionality of restraint and multi-positional transformation has a potential to promote safe perioperative movement and ease of induction of anaesthesia in anxious uncooperative ASD children.

Perioperative Temperature Management in Children: What Matters?

Inadvertent perioperative hypothermia is common and associated with increased risk of perioperative complications. Adult data drives most guidelines for pediatric perioperative temperature management and does not consistently demonstrate effectiveness in children. This study aims to identify risk factors for hypothermia and determine the effectiveness of current interventions in the pediatric population. METHODS: We carried out a prospective observational study in children undergoing anesthesia in our tertiary pediatric unit. We included 869 patients (<16 y) undergoing emergency/elective surgeries over 2 months. Our team recorded the incidence of hypothermia (tympanic core temperature < 36°C) within 15 minutes of arrival to the postanesthetic care unit. We collected data such as patient demographic, surgical, anesthetic (including monitoring and warming measures used), and operating theater (OT) temperature. We performed statistical analysis to identify risk factors associated with hypothermia. RESULTS: Postoperative hypothermia incidence was 12.3% (107/869). The mean core temperature on arrival to the postanesthetic care unit was 36.6°C (+SD 0.45) in normothermic patients versus 35.6°C (+SD 0.34) in hypothermic patients. Multivariable analysis identified starting ambient OT temperature [odds ratio (OR) = 0.83, confidence interval (CI): 0.71-0.96; P = 0.010], intraoperative temperature monitoring (OR = 0.49, CI: 0.28-085; P = 0.011), use of occlusive dressing (OR = 0.35, CI: 0.15-0.85; P = 0.020), and active forced-air warming (OR = 0.42, CI: 0.25-0.70; P = 0.001) as factors independently protective of postoperative hypothermia. Hypothermia occurred less frequently with emergency vs. elective procedures (OR 0.43, CI: 0.21-0.91; P = 0.026). CONCLUSIONS: Routine core temperature monitoring and active forced-air warming are useful measures to prevent hypothermia. Additionally, occlusive covers and controlling ambient OT temperature are cost-effective and safe methods to reduce inadvertent hypothermia.

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetics.

INTRODUCTION: This study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore. METHODS: Data pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter. RESULTS: A total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children. CONCLUSION: Critical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.

The use of auricular examination for screening hepatic disorders.

Researches on auricular acupuncture (AA) have examined mainly its treatment effects. This study aimed to investigate the accuracy and precision of using auricular examination (AE) as a complementary diagnostic tool for screening hepatic disorders. Twenty patients suffering from liver dysfunction and 25 controls aged 18-60 years were recruited from an acute hospital. Participants were examined using three AE methods including visual inspection, electrical skin resistance measurement, and tenderness testing on the liver AA zone of both ears. Significant differences were found in visual inspection and electrical skin resistance on the AA zones between the two groups. Patients suffering from liver dysfunction tended to have at least one abnormality in skin color, appearance, presence of papules, abundance of capillary and desquamation on the ear (Relative Risk-Right ear: RR = 2.9, 95% confidence interval (CI) 1.4, 6.2; Left: RR = 1.8, 95% CI, 1.01, 3.1). The sensitivity for visual inspection was 0.7 for both ears; specificity was 0.76 for the (R) and 0.6 for the (L) ear. The mean difference in electrical skin resistance was 4.3 MOmega (95% CI, 1.7, 6.9) for the (L) ear; 4.5 MOmega (95% CI, 1.5, 7.6) for the (R) ear. Our results suggest that malfunction of the liver appeared to be reflected by the presence of morphological changes on the liver AA zone. Visual inspection and electrical skin resistance on the liver AA zone are potentially sensitive to screen hepatic disorders.