‘State of the art’
‘State of the art’ in pediatric anesthesia is frequently defined and propagated at scientific meetings, congresses and in the literature in the form of expert lectures, opinions and reviews.
However, economic pressures, lack of trained staff and pediatric resources lead to situations where low-risk anesthesia rapidly turns into high-risk anesthesia.
Standards of peri-operative care differ
It is of note that in some European countries (Denmark, Netherlands, UK and Switzerland) require 2 adequately qualified persons for induction and emergence of general anesthesia in children. This is in stark contrast to daily clinical practice in many other countries. In addition, anesthesia residents and fellows are frequently not supervised on a one-to-one basis or do not receive structured pediatric training and education. This results in ‘survival’ medicine rather than quality-focused peri-operative pediatric anesthesia care. Exemplary programs are, however, available. (The Scandinavian Society of Anesthesiology and Intensive Care Medicine, UK Royal College of Anaesthetists)
Pediatric anesthesia is not financially lucrative
Health care payments for pediatric anesthesia are very unattractive in some countries resulting in cost cutting exercises by some independent anesthesia practitioners. These ‘cost-savings’ affect, but are not limited to, the provision of anesthetic assistants, equipment and medications. Children are often also scheduled together with adults on operating lists in larger hospitals and university centers, where professors and heads of surgical sub-specialties dictate the scheduling. The principle of a dedicated pediatric unit is that the surgeon follows the child and not vice versa. This mixed scheduling also leads to dilution of experience and expertise even though the caseload (experience) of the anesthesiologist is well known to be one of the most critical factors in outcome.
Regular pediatric anesthesia practice improves outcomes
A recommended minimum yearly caseload for a pediatric anesthesiologist consists of 300 children up to ten years and 12 infants up to 6 months of age.1 It is, therefore, not surprising that an annual case load of 0.7 general anesthetics in small children/per anesthesiologist leads to severe complications in 17%.2 It is, however, surprising that anesthesia departments with less than 100-200 anesthetics in children per year ‘provide’ anesthesia in pre-term neonates and extensive surgical procedures driven by secondary motives. Clear strategies and recommendations for a best standard of clinical care are required. The ‘Who’, ’Where’, ‘When’, ‘What’ and ‘How’ need to be identified to achieve an optimal outcome for vulnerable children.3,4
Learn more about …
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