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George T Blike

Publications and source records attributed to George T Blike.

10 recordsLinked to original sources
PubMed2006

Pediatric anesthesia in the nonoperating room setting.

PURPOSE OF REVIEW: The paper will review the few studies that have been published recently on nonoperating room pediatric anesthesia/sedation. These studies target gaps in our understanding of critical factors associated with the provision of nonoperating room anesthesia safety and reliability in children. RECENT FINDINGS: More objective data regarding the safety and reliability of this practice have become available. Video can accurately capture a child's state and allow comparison of different sedation techniques more objectively than is possible with available literature. The use of standard simulated events allows rescue performance in actual care systems to be tested for their ability to manage a rare, but critical respiratory depression episode. Preliminary findings from a large multicenter study from the Pediatric Procedural Sedation Research Consortium suggests critical adverse events are rare (one cardiac arrest in over 30,000 sedation encounters), but that potentially critical events occur commonly (one in 400 procedures was associated with stridor, laryngospasm, wheezing or apnea). SUMMARY: Research into the critical factors that impact safety and reliability in the performance of nonoperating room anesthesia for children is providing objective observational techniques along with large outcomes databases that should enable targeted improvements in the safety and reliability of this growing practice.

Anesthesia↗
PubMed2006

Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium.

OBJECTIVE: We sought to use a large database of prospectively collected data on pediatric sedation and/or anesthesia for diagnostic and therapeutic procedures to delineate the nature and the frequency of adverse events that are associated with sedation/anesthesia care for procedures that are performed outside the operating room in children. METHODS: Data were collected by the Pediatric Sedation Research Consortium, a collaborative group of 35 institutions that are dedicated to improving sedation/anesthesia care for children internationally. Members prospectively enrolled consecutive patients who were receiving sedation or anesthesia for procedures. Data on demographics, primary illness, coexisting illness, procedure performed, medications used, outcomes, airway interventions, and adverse events were collected and reported on a Web-based data collection tool. RESULTS: A total of 26 institutions submitted data on 30,037 sedation/anesthesia encounters during the study period from July 1, 2004, to November 15, 2005. Serious adverse events were rare in the institutions involved in this study; there were no deaths. Cardiopulmonary resuscitation was required once. Less serious events were more common with O2 desaturation below 90% for > 30 seconds, occurring 157 times per 10000 sedations. Stridor and laryngospasm both occurred in 4.3 per 10,000 sedations. Unexpected apnea, excessive secretions, and vomiting had frequencies of 24, 41.6, and 47.2 per 10,000 encounters, respectively. CONCLUSIONS: Our data indicate that pediatric sedation/anesthesia for procedures outside the operating room is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation services. However, the safety of this practice depends on the systems' ability to manage less serious events.

Ambulatory Surgical Procedures↗
PubMed2005

Development and validation of the Dartmouth Operative Conditions Scale.

Studies of pediatric sedation practice have suffered from the lack of an objective scale that would allow for a comparison of the effectiveness and safety of sedation provided by various providers and techniques. We present the Dartmouth Operative Conditions Scale (DOCS), which is designed as a research tool to codify the appropriateness of the procedural conditions provided by various sedation interventions. To begin, human factors methodology was used to develop a model of the pediatric sedation process and to define the criteria for measuring a patient's condition during a procedure (DOCS). To accomplish validation, 70 video clips (30-s duration) were then selected from more than 300 h of procedural video tape for testing/grading purposes. Inter-rater reliability was tested by comparing the score for each video clip among 10 different raters. Intra-rater reliability was evaluated by retesting all of the raters 1 yr after their initial rating. Construct validity was confirmed by analyzing the change in DOCS score relative to the time that sedation intervention was undertaken. Criterion validity was tested by comparing the DOCS to a modified COMFORT score. The DOCS was completed with excellent inter-rater (kappa = 0.84) and intra-rater (kappa = 0.91) agreement by 10 health care providers with various backgrounds during the 1-yr study period. Criterion validity was supported by the close correlation between the DOCS and the modified COMFORT scores for 20 distinct video clips (Spearman correlation coefficient = 0.98; P <0.001). The distribution of DOCS scores 20 min after the anesthetic induction was significantly lower than the scores before initiation of sedation, and scores after emergence were consistently higher than those 20 min after sedation (P <0.001), thus confirming construct validity of the scale. The DOCS is a validated research tool when used with video data for comparing the effectiveness and safety of pediatric sedation service, regardless of technique used for decreasing anxiety or pain during a procedure.

Child↗
PubMed2005

A method for measuring system safety and latent errors associated with pediatric procedural sedation.

The practice of sedating patients in the hospital for diagnostic and therapeutic procedures may be associated with life-threatening respiratory depression. We describe a method that uses a simulated event to identify latent system failures. A simulated scenario was developed that was reproducible with realistic physiology that degraded over time if no interventions occurred and improved when treated appropriately. Management of the scenario was observed in an ideal setting, a radiology department, and an emergency department. Event management was videotaped. The simulator's physiological data were saved automatically at 5-s intervals. Deviations from "best practice" were measured by using a set of video markers for event detection, diagnosis, and treatment. The simulator data files were used to calculate time out of range for critical variables. Hypoxia and hypotension lasted 4.5 and 5.5 min in the radiology and emergency departments, respectively, compared with 0 min in the gold standard setting. Many latent failures were identified by reviewing the video. This study supports the feasibility of using available human simulation as a crash-test dummy to more objectively quantify rescue system performance in actual sedation care settings. This method revealed vulnerabilities in personnel and in care systems even though sedation care regulatory requirements were met.

Anesthesiology↗
PubMed2004

Pediatric sedation.

PURPOSE OF REVIEW: Pediatric sedation continues to evolve. It is an area of practice that involves a variety of pediatric subspecialties, the practitioners of many of which are not fully aware of what is being done by others involved in this care. The purpose of this review is to consider the current status of pediatric sedation in general and to discuss the most recent literature concerning this practice. Specifically we will discuss the use of new medications for pediatric sedation, issues concerning fasting status, issues surrounding the effectiveness of sedation, and discharge criteria after sedation. RECENT FINDINGS: Propofol sedation is growing rapidly outside of the operating room environment. Emergency-medicine and intensive-care providers are regularly employing propofol for procedural sedation and reporting its effective use in their hands. Also in the emergency-medicine field, evidence is emerging that fasting status is not a particularly important factor in the genesis of critical events during sedation. Anesthesiologists are evaluating the use of dexmedetomidine for sedation of children and new reports describe the advantages of deep sedation and anesthesia over moderate sedation for painful procedures. Finally an important study shows that a patient's condition on discharge after sedation can be improved through the implementation of specific criteria using objective scoring techniques. SUMMARY: Anesthesiologists and those outside of anesthesiology are employing new potent sedative hypnotic agents to accomplish effective pediatric sedation. At the same time, the consensus-generated sedation guidelines--particularly with respect to fasting guidelines--are being questioned. All of this is occurring in the face of mounting evidence that sedation depth needs to be adequate to provide optimal operating conditions and patient satisfaction. Regardless of sedation method used, recovery criteria need to be carefully considered in order to optimize patient safety.

Journal Article↗
PubMed2004

Review of pediatric sedation.

Sedating children for diagnostic and therapeutic procedures remains an area of rapid change and considerable controversy. Exploration of this topic is made difficult by the fact that the reports of techniques and outcomes for pediatric sedation appear in a wide range of subspecialty publications and rarely undergo comprehensive examination. In this review article, we will touch on many aspects of the topic of pediatric sedation from the perspective of the anesthesiologist. We begin with a review of the historical role of anesthesiologists in the development of the current standards for pediatric sedation. We also examine the current status of pediatric sedation as reflected in published studies and reports. A specific review of the issues surrounding safety of sedation services is included. Current trends in sedation practice, including the expanding role of potent sedative hypnotic drugs outside the field of anesthesiology, are noted. Finally, we suggest future areas for research and clinical improvement for sedation providers.

Anesthesia↗
PubMed2003

Microsystems in health care: Part 6. Designing patient safety into the microsystem.

BACKGROUND: This article explores patient safety from a microsystems perspective and from an injury epidemiological perspective and shows how to embed safety into a microsystem's operations. MICROSYSTEMS PATIENT SAFETY SCENARIO: Allison, a 5-year-old preschooler with a history of "wheezy colds," and her mother interacted with several microsystems as they navigated the health care system. At various points, the system failed to address Allison's needs. The Haddon matrix provides a useful framework for analyzing medical failures in patient safety, setting the stage for developing countermeasures. CASE STUDY: The case study shows the types of failures that can occur in complex medical care settings such as those associated with pediatric procedural sedation. Six patient safety principles, such as "design systems to identify, prevent, absorb, and mitigate errors," can be applied in a clinical setting. In response to this particular case, its subsequent analysis, and the application of microsystems thinking, the anesthesiology department of the Children's Hospital at Dartmouth developed the PainFree Program to provide optimal safety for sedated patients. CONCLUSION: Safety is a property of a microsystem and it can be achieved only through thoughtful and systematic application of a broad array of process, equipment, organization, supervision, training, simulation, and team-work changes.

Academic Medical Centers↗