Department of Paediatric Anaesthesia, Starship Children's Hospital, Auckland, New Zealand.
Department of Anaesthesia and Acute Pain Medicine, Royal Adelaide Hospital, Adelaide, Australia.
Anaesth Intensive Care. 2023 Nov;51(6):408-421. doi: 10.1177/0310057X231198255. Epub 2023 Oct 2.
Regional anaesthesia is an essential tool in the armamentarium for paediatric anaesthesia. While largely safe and effective, a range of serious yet preventable adverse events can occur. Incidence and risk factors have been described, but few detailed case series exist relating to paediatric regional anaesthesia. Across Australia and New Zealand, a web-based anaesthesia incident reporting system enables voluntary reporting of detailed anaesthesia-related events in adults and children. From this database, all reports involving paediatric regional anaesthesia (age less than 17 years) were retrieved. Perioperative events and their outcomes were reviewed and analysed. When offered, the reported contributing or alleviating factors relating to the case and its management were noted. This paper provides a summary of these reports alongside an evidence review to support safe practice. Of 8000 reported incidents, 26 related to paediatric regional anaesthesia were identified. There were no deaths or reports of permanent harm. Nine reports of local anaesthetic systemic toxicity were included, seven equipment and technical issues, six errors in which regional anaesthesia made an indirect contribution and four logistical and communication issues. Most incidents involved single-shot techniques or a neuraxial approach. Common themes included variable local anaesthetic dosing, cognitive overload, inadequate preparation and communication breakdown. Neonates, infants and medically complex children were disproportionately represented, highlighting their inherent risk profile. A range of preventable incidents are reported relating to patient, systems and human factors, demonstrating several areas for improvement. Risk stratification, application of existing dosing and administration guidelines, and effective teamwork and communication are encouraged to ensure safe regional anaesthesia in the paediatric population.
区域麻醉是小儿麻醉的重要工具。虽然它在很大程度上是安全有效的，但仍会发生一系列严重但可预防的不良事件。已经描述了发病率和危险因素，但很少有详细的关于小儿区域麻醉的病例系列存在。在澳大利亚和新西兰，一个基于网络的麻醉事故报告系统允许自愿报告成人和儿童的详细麻醉相关事件。从这个数据库中，检索到所有涉及小儿区域麻醉（年龄小于 17 岁）的报告。审查并分析了围手术期事件及其结果。当提供时，记录了与案例及其管理相关的报告的促成或缓解因素。本文提供了这些报告的摘要以及证据综述，以支持安全实践。在 8000 份报告的事件中，确定了 26 份与小儿区域麻醉相关的报告。没有死亡或永久性伤害的报告。包括 9 份局部麻醉全身毒性报告，7 份设备和技术问题报告，6 份区域麻醉间接贡献的错误报告，4 份后勤和沟通问题报告。大多数事件涉及单次注射技术或神经轴方法。常见的主题包括局部麻醉剂量的变化、认知负荷过重、准备不足和沟通中断。新生儿、婴儿和复杂的儿科患者不成比例地受到影响，突出了他们固有的风险状况。报告了一系列与患者、系统和人为因素相关的可预防事件，表明了几个需要改进的领域。鼓励进行风险分层、应用现有的剂量和管理指南以及有效的团队合作和沟通，以确保儿科人群的安全区域麻醉。
