Maintenance of physiological homeostasis is key for the Safe Conduct of Anesthesia in Children
The 10-N principles provide a simple matrix of clinical goals.
These principles apply to all pediatric anesthetic procedures from the ‘simple’ to the ‘complex specialist’.
- Provide suitable environments for the needs of children and parents
- Adopt appropriate and positive means of communication with parents and children
- Assist parents to prepare their child and themselves
- Strive to allow parents to be with their child during induction of anesthesia and as early as clinically possible in the post anesthesia care unit
- Avoid dehydration during the peri-operative period
- Minimize pre-operative fasting – Think Drink!
- Simplify your approach to peri-operative fluid therapy
- Use suitable pediatric equipment to accurately measure blood pressure
- Treat relevant hypotension without delay
- Monitor and teach the clinical assessment of volume status and tissue perfusion
Normal heart rate
- Use continuous heart rate monitoring (EKG) throughout
- Treat relevant bradycardia without delay
- Prevent hypoxia using established airway algorithms and protocols
- Monitor SpO2 throughout
- Titrate oxygen concentration according to the patients needs
- Use continuous monitoring of end-tidal carbon dioxide (capnography) and/or trans-cutaneous monitoring in neonates and premature children
- Verify capnography readings using capillary or arterial blood gas analysis
- Avoid hypo- and hyperventilation through adaptive ventilation strategies
- Use balanced electrolyte solutions as standard intravenous fluids
- Avoid hypotonic intravenous fluids
- Monitor plasma sodium concentrations during extended procedures and/or children with significant co-morbidity
- Avoid prolonged unnecessary fasting
- Monitor blood glucose concentrations during long fasting spells and/or patients with significant co-morbidity
- Provide carbohydrates to patients at risk of metabolic disturbances (neonates, premature children, patients with parenteral nutrition, metabolic diseases, burns)
- Monitor body temperature frequently or ideally continuously
- Avoid unintentional heat loss
- Use warming systems as a standard for every patient and every procedure
No Postoperative Discomfort: No Pain – No PONV – No Emergence Delirium
- Establish standards for the prevention, recognition and treatment of pain, postoperative nausea & vomiting (PONV) and emergence delirium
- Use a multi-modal approach to pain therapy: Local/regional anesthesia, simple analgesics, titration of opioids, use of adjuncts
Standardize your care
Development and implementation of effective Standard Operating Procedures is an ongoing process. However, commitment to a system of standards is immensely rewarding and leads to improved peri-operative care. This applies to any department – small or large, private, public or university. A shared approach to standard clinical problems creates a resilient and calm environment.
Build a healthy team
Clinical problem solving in the peri-operative period is a complex social process. Safe pediatric anesthesia requires a team built on mutual support, trust and purpose. A low hierarchical structure allows team members to speak up and ask for help. Interpersonal conflicts are detrimental to the patient and may lead to clinical errors and misjudgements.
Learn more about …
- causes of neuromorbidity
- how research is currently focused and how it could better help children
- the quality gap between ‘state of the art’ and clinical practice
- the “Big Five W” – What specialist care is about
- 10-N quality – A simple matrix for reviewing your care
- how to meet the concerns of parents
- Safetot’s story and mission
- our network and members
- the FAQ for practitioners
- the FAQ for parents
- our Publications
- Safetot’s sponsors
- Safetot’s supporting organisations
Weiss M. Concept of 10-N-Quality Pediatric Anesthesia . Cartoonist: Marco Brunori, Zurich (2014).
Weiss M, Vutskits L, Hansen TG, Engelhardt T. Safe Anesthesia For Every Tot – The SAFETOTS initiative. Curr Opin in Anaesthesiol. 2015; 28: 302-7.