Crises and Other Scenarios in Pediatric Anesthesia
Crisis management is an uncommon but essential component of pediatric anesthesia. Airway and respiratory complications are the commonest causes of crises during pediatric anesthesia, and inadequate depth of anesthesia is a common causative factor. Secure and appropriate airway patency as well as secure and appropriate intravenous access (‘a secure tube and reliable drip’) are basic yet essential components of anesthesia and should not be overlooked. Abrupt changes in patient condition announcing the start of a crisis can be attributed to surgical factors such as painful stimuli or hemorrhage, the pharmacological effects of drugs such as sympathetic block or anaphylaxis, and patient factors related to pre-existing conditions. Some crisis events end quickly and others take a more protracted course. Processes essential for initial patient care must occur promptly. These include calling for help, establishing a team framework, role allocation and working through an ‘ABCD’ resuscitation process. On many occasions, just systematically working through ‘ABCD’ will fix the problem. For more complicated and prolonged crises, establishing good management of the essentials allows the leader or leadership group to ‘step back’ and take a more considered approach to the problem and piece together the information available. The team can then work through a number of potential causes of the crisis. Efficient, effective patient care includes organization, clear communication and attention to ‘the basics’ whilst maintaining an ongoing vigilance for relevant differential diagnoses. Early requests for assistance and timely decision-making ensure harm mitigation in the stressful emergency scenario.