Paediatric anaesthesia最新文献

{"title":"Levobupivacaine plasma concentrations following repeat caudal anesthetics.","authors":"Geoff Frawley,&nbsp;Luis Ignacio Cortinez,&nbsp;Brian J Anderson,&nbsp;Andrew Bjorksten,&nbsp;Sebastian King","doi":"10.1111/pan.14556","DOIUrl":"https://doi.org/10.1111/pan.14556","url":null,"abstract":"<p><strong>Aim: </strong>A single caudal anesthetic at the start of lower abdominal surgery is unlikely to provide prolonged analgesia. A second caudal at the end of the procedure extends the analgesia duration but total plasma concentrations may be associated with toxicity. Our aim was to measure total plasma levobupivacaine concentrations after repeat caudal anesthesia in infants and to generate a pharmacokinetic model for prediction of plasma concentrations after repeat caudal anesthesia in neonates, infants and children.</p><p><strong>Methods: </strong>Infants undergoing definitive repair of anorectal malformations or Hirschsprung's disease received a second caudal anesthesia at the end of the procedure. Total levobupivacaine concentrations were assayed 3-4 times in the first 6 h after the initial caudal. These data were pooled with data from four studies describing plasma concentrations after levobupivacaine caudal or spinal anesthesia. Population pharmacokinetic parameters were estimated using nonlinear mixed-effects models. Covariates included postmenstrual age and body weight. Parameter estimates were used to simulate concentrations after a repeat levobupivacaine 2.5 mg kg^-1 caudal at 3 or 4 h following an initial levobupivacaine 2.5 mg kg^-1 caudal.</p><p><strong>Results: </strong>Twenty-one infants (postnatal age 11-32 weeks, gestation 37-39 weeks, weight 5.2-8.6 kg) were included. The measured peak plasma concentration after repeat caudal levobupivacaine 2.5 mg kg^-1 4 h after initial caudal was 1.38 mg L^-1 (95% prediction interval 0.60-2.6 mg L^-1 ) and 3 h after initial caudal was 1.46 mg L^-1 (0.60-2.80) mg L^-1 . Simulation of total plasma concentrations in neonates (7 kg, 57 weeks postmenstrual age) given caudal levobupivacaine 4 h after the initial caudal were 1.76 mg L^-1 (0.68-3.50) mg L^-1 if 2.5 mg kg^-1 levobupivacaine was used and 0.88 mg L^-1 (0.34-1.73) mg L^-1 if 1.25 mg kg^-1 of 0.125% levobupivacaine was used. In simulated older children (20 kg, 6 years), the mean maximum concentration was 1.43 mg L^-1 (0.60-2.70) mg L^-1 if 2.5 mg kg^-1 levobupivacaine was repeated at 3 h.</p><p><strong>Conclusion: </strong>Repeat caudal levobupivacaine 2.5 mg kg^-1 at 3 h after an initial 2.5 mg kg^-1 dose does not exceed the concentration associated with systemic local anesthetic toxicity. In 2.5% of simulated neonates (weight 3.8 kg, PMA 40 weeks), repeat caudal anesthesia demonstrates broaching of the lower concentration limit associated with toxicity at both 3 and 4 h after initial caudal.</p>","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1347-1354"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40358184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What every anesthesiologist should know about virtual reality.","authors":"Samuel Rodriguez,&nbsp;Thomas J Caruso","doi":"10.1111/pan.14464","DOIUrl":"https://doi.org/10.1111/pan.14464","url":null,"abstract":"in anyone who cares for kids, has kids, or just dislikes seeing kids suffer. As XR headsets continue to offer greater capabilities and ease of use at lower costs, many of the issues that have hampered implementation will be mitigated. For example, with newer AR headsets, children see holograms pro-jected on top of their actual surroundings. This technology stands to reduce the anxiety we sometimes see with completely immersive VR headsets. Also, the majority of VR headsets are now “all-in- one,” resulting in less wires, less calibration, and smaller device footprints. which be of","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1276-1277"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40689683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-factor prothrombin complex concentrate in pediatric cardiac surgery for children under 8 kg: A short report.","authors":"Gustavo A Cruz-Suárez,&nbsp;Laura Zamudio-Castilla,&nbsp;Akemi Arango,&nbsp;David A Pantoja,&nbsp;Philip E Leib,&nbsp;Antonio Suguimoto-Erasso,&nbsp;Fredy Ariza","doi":"10.1111/pan.14527","DOIUrl":"https://doi.org/10.1111/pan.14527","url":null,"abstract":"Cardiovascular surgery in pediatric patients is associated with a greater risk of bleeding and blood transfusions in approximately 79% of procedures. 1,2 4- factor prothrombin complex concentrate (4F- PCC) is increasingly used in complex cardiovascular surgery as it contains factors II, VII, IX, and X in a proportion 25 times higher than plasma. This report aims to describe the clinical results of using 4F- PCC in children under 8 kg who underwent cardiac surgery (CC) with cardiopulmonary bypass (CPB) and life- threatening bleeding (defined as bleeding ≥50 ml/min associated with hemo-dynamic instability despite multiple blood transfusions). This preliminary report included pediatric patients ≤8 kg who underwent cardiac surgery with CPB, required at least one dose of 4F-PCC intraoperatively due to uncontrolled bleeding despite","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1372-1373"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40664095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response of internal carotid artery blood flow velocity to fluid challenge under general anesthesia in pediatric patients with moyamoya disease: A prospective observational study.","authors":"Eun-Hee Kim,&nbsp;Jung-Bin Park,&nbsp;Pyoyoon Kang,&nbsp;Sang-Hwan Ji,&nbsp;Young-Eun Jang,&nbsp;Ji-Hyun Lee,&nbsp;Jin-Tae Kim,&nbsp;Hee-Soo Kim","doi":"10.1111/pan.14558","DOIUrl":"https://doi.org/10.1111/pan.14558","url":null,"abstract":"<p><strong>Background: </strong>Maintaining cerebral blood flow is important in intraoperative management of moyamoya disease patients.</p><p><strong>Aims: </strong>To access changes in the carotid artery blood flow velocity in response to fluid challenge, blood pressure, and cardiac output under general anesthesia in pediatric patients with moyamoya disease.</p><p><strong>Methods: </strong>This observational study included pediatric patients with moyamoya disease undergoing general anesthesia for encephaloduroarteriosynangiosis. Each patient underwent an ultrasound assessment thrice as follows: after anesthetic induction (T1), after fluid challenge (10 ml/kg, T2), and at the end of surgery (T3). The primary outcome was the change in the internal carotid artery blood flow velocity after fluid challenge and was assessed using a paired t-test. The secondary outcomes comprised changes in the internal, external, and common carotid artery blood flow peak velocities after fluid challenge and the factors influencing these changes.</p><p><strong>Results: </strong>We enrolled and analyzed 30 patients with a mean age of 7.2 years. After fluid challenge, the systolic (p = .003) and mean blood pressure (p = .017), stroke volume index (p = .008), and cardiac index (p = .140) were higher than those at T1. However, both internal carotid artery blood flow velocities did not change after fluid challenge (p = .798, mean difference and 95% confidence interval [CI], -1.1 and -10.3 to 8.0 for right, p = .164, mean difference and 95% CI, -5.2 and -12.7 to 2.2 for left). The internal carotid artery blood flow velocity was correlated with the cardiac index, stroke volume index, and mean and diastolic blood pressure, with low significance.</p><p><strong>Conclusions: </strong>The internal carotid artery blood flow velocity did not increase in pediatric patients with moyamoya disease under general anesthesia, despite fluid challenge and corresponding changes in the blood pressure and cardiac output. Intraoperative hemodynamic management to improve the cerebral blood flow in these patients requires further investigation.</p>","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1330-1338"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40377472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of general endotracheal anesthesia versus sedation without endotracheal intubation during initial percutaneous endoscopic gastrostomy insertion for infants: A retrospective cohort study.","authors":"Jacquelin Peck,&nbsp;Jerry Brown,&nbsp;Jamie L Fierstein,&nbsp;Anh Thy H Nguyen,&nbsp;Ernest K Amankwah,&nbsp;Mohamed Rehman,&nbsp;Michael Wilsey","doi":"10.1111/pan.14539","DOIUrl":"https://doi.org/10.1111/pan.14539","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Critical airway incidents are a major cause of morbidity and mortality during anesthesia. Delayed management of airway obstruction quickly leads to severe complications due to the reduced apnea tolerance in infants and neonates. The decision of whether to intubate the trachea during anesthesia is therefore of great importance, particularly as an increasing number of procedures are performed outside of the operating room.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;In this retrospective cohort study, we evaluated airway management for infants below 6 months of age undergoing percutaneous endoscopic gastrostomy insertion. We compared demographic, procedural, and health outcome-related data for infants undergoing percutaneous endoscopic gastrostomy insertion under general endotracheal anesthesia (n = 105) to those receiving monitored anesthesia care (n = 44) without endotracheal intubation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective chart review was completed for all infants &lt;6 months of age who underwent percutaneous endoscopic gastrostomy insertion in our institution's endoscopy suite between January 2002 and January 2017. Descriptive statistics summarized numeric variables using medians and corresponding ranges (minimum-maximum), and categorical variables using frequencies and percentages. Differences in study outcomes between patients undergoing general anesthesia or monitored anesthesia care were evaluated with univariate quantile or Firth logistic regression for numerical and categorical outcomes, respectively. Results are presented as β [95% confidence interval] or odds ratio [95% confidence interval] along with corresponding p-values.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both groups were similar in distribution of age, race, and gender. However, patients selected for general anesthesia had lower median body weights (3.9 kg [range: 2.0-6.7] vs. 4.4 kg [range: 2.6-6.9]), higher percentages of cardiac (95.2% vs. 84.1%), and/or neurologic comorbidities (74.3% vs. 56.8%) and were more frequently given American Society of Anesthesiologists level IV classifications (41.9% vs. 29.6%) indicating that these infants may have had more severe disease than patients selected for monitored anesthesia care. Three monitored-anesthesia-care patients required intraoperative conversion to general anesthesia. General anesthesia patients experienced greater odds of intraoperative hypoxemia (45.2% vs. 29.0%; odds ratio: 2.0 [0.9-4.3], p-value: .09) and required postoperative airway intervention more frequently than monitored-anesthesia-care patients (13.03% vs. 2.3%; odds ratio: 4.6 [0.8-25.6], p-value: .08). Procedure times were identical in both groups (6 min), but general anesthesia resulted in longer median anesthesia times (44 min [range: 22-292] vs. 12 min [range:19-136]; β:13 [95% 6.9-19.1], p-value: &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Study results suggest that providers selected general anesthesia over monitored anesthesia care for ","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1310-1319"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40583134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A standardized approach to airway management during Abbé flap reconstruction.","authors":"Colton Fernstrum,&nbsp;Paige Deichmann,&nbsp;Forrest Duncan,&nbsp;Laura Humphries,&nbsp;Ian Hoppe","doi":"10.1111/pan.14554","DOIUrl":"https://doi.org/10.1111/pan.14554","url":null,"abstract":"<p><strong>Background: </strong>The Abbé flap is a two-staged procedure to address upper lip tightness, creating a surgically closed mouth during the first stage. Airway manipulation and management in the setting of a surgically closed mouth presents a challenge from an anesthetic standpoint.</p><p><strong>Aims: </strong>This study aims to describe the authors' standardized approach to airway management in cleft lip patients undergoing Abbé flap reconstruction.</p><p><strong>Methods: </strong>A retrospective review was performed including consecutive patients who underwent Abbe flap reconstruction at a single institution from 2019 to 2021. Five patients were included, and information regarding airway, intubation sequence, and emergence was gathered.</p><p><strong>Results: </strong>During the initial surgery, the airway was secured via nasotracheal intubation to allow for adequate surgical exposure. On emergence, with a newly constructed surgically closed mouth, the anesthesiologist forfeits the ability to reintubate should the patient fail extubation without the use of nasal fiberoptic guided intubation or flap deinset. In addition, any coughing or tension on the surgical site could cause inadvertent disruption to the integrity of the new flap. Dexmedetomidine titrated to effect was used to allow for smooth emergence, with the surgeon present. During the second stage, the patient was kept spontaneously breathing while local anesthetic and intravenous anxiolytic allowed for pedicle division. The patient was then orally intubated, and the flap was inset. All five patients had successful reconstruction with no airway concerns or events.</p><p><strong>Conclusions: </strong>The proposed standardized approach to airway management during Abbé flap reconstruction was safe and effective in this limited series of patients.</p>","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1305-1309"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33462251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of antifibrinolytics in 6583 pediatric patients having craniosynostosis surgery: A decade of data reported from the multicenter Pediatric Craniofacial Collaborative Group.","authors":"Michael R King,&nbsp;Steven J Staffa,&nbsp;Paul A Stricker,&nbsp;Carolina Pérez-Pradilla,&nbsp;Olivia Nelson,&nbsp;Hubert A Benzon,&nbsp;Susan M Goobie","doi":"10.1111/pan.14540","DOIUrl":"https://doi.org/10.1111/pan.14540","url":null,"abstract":"<p><strong>Background: </strong>Antifibrinolytics such as tranexamic acid and epsilon-aminocaproic acid are effective at reducing blood loss and transfusion in pediatric patients having craniofacial surgery. The Pediatric Craniofacial Collaborative Group has previously reported low rates of seizures and thromboembolic events (equal to no antifibrinolytic given) in open craniofacial surgery.</p><p><strong>Aims: </strong>To query the Pediatric Craniofacial Collaborative Group database to provide an updated antifibrinolytic safety profile in children given that antifibrinolytics have become recommended standard of care in this surgical population. Additionally, we include the population of younger infants having minimally invasive procedures.</p><p><strong>Methods: </strong>Patients in the Pediatric Craniofacial Collaborative Group registry between June 2012 and March 2021 having open craniofacial surgery (fronto-orbital advancement, mid and posterior vault, total cranial vault remodeling, intracranial LeFort III monobloc), endoscopic cranial suture release, and spring mediated cranioplasty were included. The primary outcome is the rate of postoperative complications possibly attributable to antifibrinolytic use (seizures, seizure-like activity, and thromboembolic events) in infants and children undergoing craniosynostosis surgery who did or did not receive antifibrinolytics.</p><p><strong>Results: </strong>Forty-five institutions reporting 6583 patients were included. The overall seizure rate was 0.24% (95% CI: 0.14, 0.39%), with 0.20% in the no Antifibrinolytic group and 0.26% in the combined Antifibrinolytic group, with no statistically reported difference. Comparing seizure rates between tranexamic acid (0.22%) and epsilon-aminocaproic acid (0.44%), there was no statistically significant difference (odds ratio = 2.0; 95% CI: 0.6, 6.7; p = .257). Seizure rate was higher in patients greater than 6 months (0.30% vs. 0.18%; p = .327), patients undergoing open procedures (0.30% vs. 0.06%; p = .141), and syndromic patients (0.70% vs. 0.19%; p = .009).</p><p><strong>Conclusions: </strong>This multicenter international experience of pediatric craniofacial surgery reports no increase in seizures or thromboembolic events in those that received antifibrinolytics (tranexamic acid and epsilon-aminocaproic acid) versus those that did not. This report provides further evidence of antifibrinolytic safety. We recommend following pharmacokinetic-based dosing guidelines for administration.</p>","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1339-1346"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40581145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Administration of sodium bicarbonate in pediatric liver transplantation can also confirm intravenous position of catheters.","authors":"Keisuke Yoshida,&nbsp;Keisuke Kuwana,&nbsp;Jun Honda,&nbsp;Satoki Inoue","doi":"10.1111/pan.14542","DOIUrl":"https://doi.org/10.1111/pan.14542","url":null,"abstract":"","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1374-1375"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40653671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of combined cerebral and somatic renal near infrared spectroscopy during noncardiac surgery in children: a proposed algorithm.","authors":"Stefania Franzini,&nbsp;Myriam Brebion,&nbsp;Ann-Marie Crowe,&nbsp;Stefania Querciagrossa,&nbsp;Melissa Ren,&nbsp;Ernesto Leva,&nbsp;Gilles Orliaguet","doi":"10.1111/pan.14552","DOIUrl":"https://doi.org/10.1111/pan.14552","url":null,"abstract":"<p><p>Cerebral near infrared spectroscopy (NIRS) monitoring has been extensively applied in neonatology and in cardiac surgery, becoming a standard in many pediatric cardiac centers. However, compensatory physiological mechanisms favor cerebral perfusion to the detriment of peripheral tissue oxygenation. Therefore, simultaneous measurement of cerebral and somatic oxygen saturation has been advocated to ease the differential diagnosis between central and peripheral sources of hypoperfusion, which may go undetected by standard monitoring and not mirrored by cerebral NIRS alone. A clinical algorithm already exists in cardiac surgery, aimed to correct intraoperative cerebral oxygen desaturations. A similar algorithm still lacks in noncardiac pediatric surgery. The goal of this paper is to propose a clinical algorithm for the combined use of cerebral and somatic NIRS monitoring during anesthesia in the pediatric population undergoing noncardiac surgery. A panel of experienced pediatric anesthetists developed the algorithm that is based on the clinical experience and intraoperative observations. It aims to lessen the current variability in interpreting NIRS measurement. Multisite NIRS monitoring was achieved applying one pediatric sensor to the forehead for cerebral tissue perfusion reading and a second one to the decumbent lumbar region for recording somatic renal tissue perfusion. The algorithm describes a sequence of acts aimed to identify the putative cause of intraoperative organ tissue desaturation and suggests clinical interventions expected to restore adequate tissue perfusion. It is composed of two arms: the main arm includes patients with an observed decrease in cerebral perfusion (CrO2), the second one includes those with a stable CrSO2 with declining RrSO2. Described also are five clinical cases of infants and neonates in whom pathological alterations of organ perfusion were detected using intraoperative multisite NIRS monitoring, portrayed in the accompanying figures (Annex).</p>","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1278-1284"},"PeriodicalIF":1.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40689684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training clinicians to become leaders of complex change: Lessons from Scotland.","authors":"Shobhan Thakore","doi":"10.1111/pan.14518","DOIUrl":"https://doi.org/10.1111/pan.14518","url":null,"abstract":"<p><p>Clinicians are trained to diagnose disease and recommend treatments or procedures. This is the focus of much of undergraduate training, but delivery of healthcare depends on so much more than theoretical knowledge and technical skill. It is a complex environment where professionals from different backgrounds have to work together to deliver safe pathways of care to patients who have very varied backgrounds. This can lead to inefficiency and variation in provision of care and clinical outcomes. In turn, this can negatively impact on the experience of patients and staff. Attempting to change this complex environment requires a unique set of skills. This article describes an international fellowship that creates a network of individuals skilled in quality improvement, human factors, service design and leadership.</p>","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":" ","pages":"1216-1222"},"PeriodicalIF":1.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40464507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}