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Smith P.,Great Ormond Street Hospital NHS Foundation Trust | Bailey C.R.,Guys and St Thomas NHS Foundation Trust
Anaesthesia | Year: 2015

We performed a review of published literature comparing the i-gel™ with other supraglottic airway devices in children. Sixty-two articles were identified following a literature search; we included data from 14 randomised controlled trials and eight observational studies that compared i-gel sizes 1-2.5 with other commonly used, equivalently-sized, devices. The primary outcome in most studies was oropharyngeal leak pressure. In the 14 randomised trials the i-gel performed the same as the comparator device in five trials, significantly better in eight studies (p < 0.05) and significantly worse in one (p < 0.01). Seven studies assessed fibreoptic views of the larynx through the device; two found significantly better views through the i-gel. Three studies reported a shorter insertion time for the i-gel, whereas two reported a longer time. Insertion success rate, gastric tube placement and complications were similar for all the devices. Seven of the eight observational studies measured average oropharyngeal leak pressures of 20-27 cmH2O and all had first-time insertion success rates exceeding 90%. We conclude that the i-gel is at least equivalent to other supraglottic airway devices currently available for use in children, and may enable a higher oropharyngeal leak pressure and an improved fibreoptic view of the glottis. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Walker I.,Great Ormond Street Hospital NHS Foundation Trust
Update in Anaesthesia | Year: 2015

Children with congenital heart disease provide a challenge to the anaesthetist, but with careful planning, most can be anaesthetised safely. This article covers pathophysiology, recognition, and principles of anaesthesia for children with congenital heart disease, including anaesthesia for specific cardiac lesions. © 2015, Roayal Devon and Exeter Healthcare NHS Trust. All right reserved.

Walker I.A.,Great Ormond Street Hospital NHS Foundation Trust | Reshamwalla S.,Lifebox Foundation | Wilson I.H.,Royal Devon and Exeter NHS Foundation Trust
British Journal of Anaesthesia | Year: 2012

Summary The concept of using a checklist in surgical and anaesthetic practice was energized by publication of the WHO Surgical Safety Checklist in 2008. It was believed that by routinely checking common safety issues, and by better team communication and dynamics, perioperative morbidity and mortality could be improved. The magnitude of improvement demonstrated by the WHO pilot studies was surprising. These initial results have been confirmed by further detailed work demonstrating that surgical checklists, when properly implemented, can make a substantial difference to patient safety. However, introducing surgical checklists is not as straightforward as it seems, and requires leadership, flexibility, and teamwork in a different way to that which is currently practiced. Future work should be aimed at ensuring effective implementation of the WHO Surgical Safety Checklist, which will benefit our patients on a global scale. © The Author [2012].

Lachman P.,Great Ormond Street Hospital NHS Foundation Trust
Paediatrics and Child Health (United Kingdom) | Year: 2015

Clinicians often contend that there is insufficient time to meet the demands placed on them in their day-to-day work. This is true as every system is designed to get the results it achieves. If one reviews the way clinicians work and how we have designed our work patterns, it becomes apparent than most of what we do is wasteful, inefficient and not conducive to good time management. We need to place the patient at the centre and aim to decrease unnecessary waiting. This will require changes to traditional processes of working and use of modern technology. As we modernise the clinical micro-system, time will become available and we can deliver high quality care. © 2014 Elsevier Ltd.

Sury M.R.J.,Great Ormond Street Hospital NHS Foundation Trust | Sury M.R.J.,University College London
Paediatric Anaesthesia | Year: 2016

This educational review explores the current understanding of accidental awareness during general anesthesia (AAGA) in children. Estimates of incidence in children vary between 1 in 135 (determined by direct questioning) and 1 in 51 500 (determined from spontaneous reporting). The lessons from the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland show that the characteristics of spontaneous reports of AAGA are extremely variable and relate to the type of procedure and anesthetic technique rather than age group: approximately 50% of experiences were distressing; most lasted less than 5 min; neuromuscular blockade (NMB) combined with pain caused the most distress; most cases (approximately 70%) occur at induction or emergence. The value of depth of anesthesia monitoring in preventing AAGA is uncertain but is probably useful in patients having total intravenous anesthesia and NMB. Reports of AAGA by children should be received sympathetically and a generic protocol for managing distressed patients is presented. © 2016 John Wiley & Sons Ltd.

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