Transcript Improve outcomes - Life Support Foundation

Preparation for
Paediatric Anaesthesia
Dr Tim Baker
Stockholm, Sweden
[email protected]
SATA Conference, Tanzania, May 2016
Intro
Why do we need to prepare for
anaesthesia?
Which routines should we use?
Which checklists should we use?
Common fallacies
• ”I do not make mistakes”
• ”It was not my fault that the patient died”
• ”It is somebody else that is responsible for the equipment”
• ”I know the laryngoscope works because I used it earlier
• ”I am smarter than a piece of paper”
If something can go wrong,
it has gone wrong
Why do we need routines?
Anaesthesia
• is complicated
• can be standardised
• is time dependent
• can be dangerous
• has many people involved
Complications might happen fast so be
prepared to act!
Which routines should we use?
Pre-op visit
Check equipment
Check drugs
Patient pre-anaesthesia checklist
Surgery checklist
Post-op routines
Pre-op visit
Check equipment
Check drugs
Patient pre-anaesthesia checklist
Surgery checklist
Post-op routines
Pre-op visit
Aims
1. Assess illness severity - prioritisation
2. Find problems early
3. Optimise the patient
Improve outcomes
Pre-op form that can be used for all patients
Pre-op visit
Check equipment
Check drugs
Patient pre-anaesthesia checklist
Surgery checklist
Post-op routines
Check equipment
• Checklist for which equipment should ALWAYS be in
the operating theatre
• Checked that everything is present & working
everyday before every case
Check equipment
• A: Oropharyngeal airway, laryngoscope, suction,
Bougie, ETT different sizes
• B: Ambu-bag, Masks different sizes, anaesthesia
machine, pulse oximetry, paediatric Ambubag
• C: cannulae, syringes, giving sets, tilting of operation
table
Pre-op visit
Check equipment
Check drugs
Patient pre-anaesthesia checklist
Surgery checklist
Post-op routines
Check drugs
Adrenaline
Atropine
Ephedrine
Thiopentone
Ketamine
Suxamethonium
Coffee
R.L
N.S
Halothane
…..
Named person responsible for
emergency box daily /
before every case
Pre-op visit
Check equipment
Check drugs
Patient pre-anaesthesia checklist
Surgery checklist
Post-op routines
Patient pre-anaesthesia checklist
• Allergies?
• Fasting?
• Expected difficult airway?
• Possible complications
• Paediatric patient:
• Desaturate FAST
• Correct size equipment (and one size bigger, one size
smaller)
• Correct drug doses
How to remember
CHECK LISTS
Pre-op visit
Check equipment
Check drugs
Patient pre-anaesthesia checklist
Surgery checklist
Post-op routines
Participating Hospitals
Results
er
Pre-op visit
Check equipment
Check drugs
Patient pre-anaesthesia checklist
Surgery checklist
Post-op routines
Summary
• Be prepared for possible complications
• Emergency drugs & equipment always available in
the theatre
• Same preparations everytime. Use checklists.
Standardised preparations prevent
disaster when complications arise
[email protected]
www.lifesupportfoundation.org