Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

https://rapm.bmj.com/content/rapm/40/5/401.full.pdf

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015

https://rapm.bmj.com/content/rapm/43/2/113.full.pdf

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017.

Editor’s PerspectiveWhat We Already Know about This TopicRegional anesthesia is associated with a low but poorly quantified incidence of complications.What This Article Tells Us That Is NewIn a prospective multicenter cohort of more than 100,000 blocks in children, there were no cases of permanent n

Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network.

Background Various beneficial effects derived from neuraxial blocks have been reported. However, it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications. Objectives Our primary objective was to summarize Cochrane systematic reviews that assess the effects of neuraxial blockade on perioperative rates of death, chest infection and myocardial infarction by integrating the evidence from all such reviews that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various populations. Our secondary objective was to summarize the evidence on adverse effects (an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility) of neuraxial blockade. Within the reviews, studies were selected using the same criteria. Methods A search was performed in the Cochrane Database of Systematic Reviews on July 13, 2012. We have (1) included all Cochrane systematic reviews that examined participants of any age undergoing any type of surgical (open or endoscopic) procedure, (2) compared neuraxial blockade versus general anaesthesia alone for surgical anaesthesia or neuraxial blockade plus general anaesthesia versus general anaesthesia alone for surgical anaesthesia and (3) included death, chest infection, myocardial infarction and/or serious adverse events as outcomes. Neuraxial blockade could consist of epidural, caudal, spinal or combined spinal-epidural techniques administered as a bolus or by continuous infusion. Studies included in these reviews were selected on the basis of the same criteria. Reviews and studies were selected independently by two review authors, who independently performed data extraction when data differed from one of the selected reviews. Data were analysed by using Review Manager Version 5.1 and Comprehensive Meta Analysis Version 2.2.044. Main results Nine Cochrane reviews were selected for this overview. Their scores on the Overview Quality Assessment Questionnaire varied from four to six of a maximal possible score of seven. Compared with general anaesthesia, neuraxial blockade reduced the zero to 30-day mortality (risk ratio [RR] 0.71, 95% confidence interval [CI] 0.53 to 0.94; I(2) = 0%) based on 20 studies that included 3006 participants. Neuraxial blockade also decreased the risk of pneumonia (RR 0.45, 95% CI 0.26 to 0.79; I(2) = 0%) based on five studies that included 400 participants. No difference was detected in the risk of myocardial infarction between the two techniques (RR 1.17, 95% CI 0.57 to 2.37; I(2) = 0%) based on six studies with 849 participants. Compared with general anaesthesia alone, the addition of a neuraxial block to general anaesthesia did not affect the zero to 30-day mortality (RR 1.07, 95% CI 0.76 to 1.51; I(2) = 0%) based on 18 studies with 3228 participants. No difference was detected in the risk of myocardial infarction between combined neuraxial blockade-general anaesthesia and general anaesthesia alone (RR 0.69, 95% CI 0.44 to 1.09; I(2) = 0%) based on eight studies that included 1580 participants. The addition of a neuraxial block to general anaesthesia reduced the risk of pneumonia (RR 0.69, 95% CI 0.49 to 0.98; I(2) = 9%) after adjustment for publication bias and based on nine studies that included 2433 participants. The quality of the evidence was judged as moderate for all six comparisons.No serious adverse events (seizure or cardiac arrest related to local anaesthetic toxicity, prolonged central or peripheral neurological injury lasting longer than one month or infection secondary to neuraxial blockade) were reported. The quality of the reporting score of complications related to neuraxial blocks was nine (four to 12 (median range)) of a possible maximum score of 14. Authors' conclusions Compared with general anaesthesia, a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk (level of evidence, moderate). Further research is required.

Neuraxial blockade for the prevention of postoperative mortality and major morbidity: an overview of Cochrane systematic reviews.

BACKGROUND: The French-Language Society of Paediatric Anaesthesiologists (ADARPEF) designed a 1-year prospective, multicenter and anonymous study to update both epidemiology and morbidity of regional anesthesia in children. METHODS: From November 2005 to October 2006, data from participating hospitals were recorded using an identification form, a data recording form, and a complication form. Information collected included the characteristics of the hospitals, the number and type of regional anesthetics (RA), the age of the involved children as well as the incidence, and type of complications. RESULTS: Data collected in 47 institutions included 104,612 pure general anesthesias (GAs), 29,870 GAs associated with regional blocks, and 1262 pure regional blocks. Central blocks accounted for 34% of all RA. Peripheral blocks (66%) were upper or lower limb blocks (29% of peripheral blocks), trunk blocks, and face blocks (71%). In children aged ≤3 years, the percentage of central blocks was similar to the peripheral ones (45% vs 55), while in older children, peripheral blocks were more than four times used than central ones. Complications (41 involving 40 patients) were rare and usually minor. They did not result in any sequelae. The study revealed an overall rate of complication of 0.12%; CI 95% [0.09-0.17], significantly six times higher for central than for peripheral blocks. CONCLUSIONS: As a result of the low rate of complications, RA techniques have a good safety profile and can be used to provide postoperative analgesia. In addition, the results should encourage anesthesiologists to continue to use peripheral instead of central (including caudal) blocks as often as possible when appropriate.

/pdf/epidemiology-and-morbidity-of-regional-anesthesia-in-neaodmltxn.pdf

Epidemiology and morbidity of regional anesthesia in children : a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF)

BACKGROUND: This survey aims to describe current practice in ambulatory care among pediatric anesthesiologists in France. METHODS: Members of the French-speaking Pediatric Anesthesiologists Association (ADARPEF) were sent a questionnaire examining the proportion of pediatric ambulatory anesthesia practiced by each responder, the level of adherence to pediatric ambulatory Anesthesia guidelines, and responder consensus in decision making when faced with common case scenarios in pediatric ambulatory anesthesia. For the latter, consensus was defined as a > 80% opinion. RESULTS: One hundred and forty-five pediatric anesthesiologists replied (43%). Ambulatory anesthesia appears underused in France. Recent French pediatric ambulatory anesthesia guidelines are being applied. Postoperative pain is poorly managed. The choice of scheduling children for ambulatory anesthesia appears to be more heavily influenced by practitioners' subjective evaluation than evidence from the literature. CONCLUSION: A better commitment for ambulatory care must be found among anesthesiologists. Further studies are required to improve coherence, safety, and efficiency of children selection for ambulatory anesthesia.

/pdf/french-current-practice-for-ambulatory-anesthesia-in-1dez2nzvbm.pdf

French current practice for ambulatory anesthesia in children: a survey among the French-speaking Pediatric Anesthesiologists Association (ADARPEF).

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Epidemiology and morbidity of regional anesthesia in children : a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF)

French current practice for ambulatory anesthesia in children: a survey among the French-speaking Pediatric Anesthesiologists Association (ADARPEF).