Cvetkovic Mirjana
Depertment of Critical Care, Theatres, Anaesthesia, Pain and Sleep, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Front Pediatr. 2018 Oct 29;6:254. doi: 10.3389/fped.2018.00254. eCollection 2018.
Approximately 90% of a million children worldwide born with congenital heart defect do not have an access to adequate pediatric cardiac care. The World Society for Pediatric and Congenital Heart Surgery, established in 2006 shifted the focus from providing individual pediatric cardiac care to developing global standards for the practice of pediatric cardiac surgery and professional education of the local teams. After recognizing the challenges of the local team regarding providing safe anesthesia and functioning as a broader team, we have focused our education on simplifying anesthetic procedures and advancing structured team approach. The appropriate selection of patients and simplifying anesthetic technique should be the standard of care. We introduced structured approach to daily education using just in time teaching, case based discussions and simple skill training simulation sessions. Furthermore, we enhanced team-training approach applying tools such as WHO surgical safety checklist and implementation manual, SAFE communication, introducing KDD with SMART aim, SCAMPs, advanced protocols of care and culture change tools. Following a significant number of short missions to developing centers we have, within NGO, succeeded to support building and maintaining several local pediatric cardiac centers with structured approach to anesthesia and team building. The appropriate selection of patients is one of the most important contributing factors for decreasing morbidity and mortality rate in pediatric cardiac surgery patients. The anesthesia technique for pediatric cardiac procedures should be aimed at fast-track surgery, with early extubation as a goal. Regional blocks such as paravertebral and caudal should be considered for perioperative pain control. By introducing structured approach to daily education and by enhancing team-training approach we have contributed evolving sustainable pediatric cardiac centers in developing countries.
全球约有100万先天性心脏病患儿中，约90%无法获得足够的小儿心脏护理。2006年成立的世界小儿及先天性心脏病外科学会将重点从提供个体小儿心脏护理转向制定小儿心脏手术实践的全球标准以及对当地团队进行专业教育。在认识到当地团队在提供安全麻醉以及作为一个更广泛的团队开展工作方面面临的挑战后，我们将教育重点放在简化麻醉程序和推进结构化团队方法上。患者的恰当选择和简化麻醉技术应成为护理标准。我们采用即时教学、基于病例的讨论和简单技能培训模拟课程等方式，引入了结构化的日常教育方法。此外，我们通过应用世界卫生组织手术安全检查表和实施手册、安全沟通、引入具有明确目标的关键决策图、外科手术改进项目、高级护理方案和文化变革工具等，加强了团队培训方法。在对多个发展中中心进行了大量短期任务访问后，我们在非政府组织内部成功地以结构化的麻醉和团队建设方法支持建立和维持了几个当地小儿心脏中心。患者的恰当选择是降低小儿心脏手术患者发病率和死亡率的最重要因素之一。小儿心脏手术的麻醉技术应以快速康复手术为目标，以早期拔管为目的。围手术期疼痛控制应考虑采用椎旁阻滞和骶管阻滞等区域阻滞方法。通过引入结构化的日常教育方法和加强团队培训方法，我们为发展中国家不断发展可持续的小儿心脏中心做出了贡献。
