None listed
Conditions
Brief summary
Perioperative respiratory adverse events (PRAE) are one of the major causes of morbidity and mortality during paediatric anaesthesia. Three quarters of critical incidents and at least one third of peri-operative cardiac arrests are linked to adverse respiratory events. Fortunately most perioperative respiratory adverse events are easily managed with no postoperative sequelae but some can lead to life threatening hypoxemia. Various definitions of perioperative respiratory adverse events are in use, but they are commonly considered to be any adverse event impacting the respiratory system at the induction of anaesthesia, intraoperatively or early post operatively. This includes laryngospasm, bronchospasm, hypopnea or apnea, breath holding, hypoxemia or the prolonged need for supplemental oxygen, pulmonary aspiration, airway obstruction, severe cough, stridor or reintubation. These events can adversely affect perioperative outcomes, including increased resource utilization and costs. The induction of anaesthesia and the immediate post-operative periods are high risk times for PRAE. While multiple management strategies exist to prevent PRAE at these critical phases of patient care, there is a paucity of data on whether patient positioning on the surgical bed alters the incidence of PRAE. In this study we will investigate if positioning the patient’s head elevated at a 30- degree incline for induction and transfer to the operating room and again from the end of surgery through to fully awake in post anaesthesia care unit (PACU) results in a lower incidence of PRAE in children, as compared to flat positioning (0 degrees) throughout this period. Both patient positions are commonly used in routine clinical practice in our institution both in theatre and in PACU. There are no guidelines or evidence specifying the use of one over the other.
Interventions
This trial compares the incidence of perioperative respiratory adverse events between children with inclined head position (30 degrees) and those laid flat on their surgical bed from (1) induction and transfer to theatre and (2) from transfer at the end of surgery to trolley, to the post operative care unit (PACU), and until fully awake in PACU.
To clarify the intervention is the position of the surgical bed - either flat or at an angle of 30 degrees.
The timing of the intervention will be vari
This trial compares the incidence of perioperative respiratory adverse events between children with inclined head position (30 degrees) and those laid flat on their surgical bed from (1) induction and transfer to theatre and (2) from transfer at the end of surgery to trolley, to the post operative care unit (PACU), and until fully awake in PACU. To clarify the intervention is the position of the surgical bed - either flat or at an angle of 30 degrees. The timing of the intervention will be variable and totally depend each participant's anaesthesia experience. The length of time for the induction of anaesthesia and on the end of surgery and transfer to recovery will vary from patient to patient but is anticipated to be 10 to 45 minutes for induction of anaesthesia and for the end of surgery it is anticipated to be 20-60 minutes. The mechanical settings on the surgical beds will be used to achieve the angle required for the study. A case report form (CRF) will be completed for each patient and the anaesthetists will need to document if the intervention was adhered to or not. The surgical head position will be at the discretion of the anaesthetist in conjunction with the surgeon.
Sponsors
Perth Children's Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
0 to 18 Years
Healthy volunteers
No
Inclusion criteria
All children undergoing elective and emergency surgery under general anaesthesia in the operating theatres at Perth Children's Hospital who will be transferred to the post operative care unit (PACU) after surgery – between 8am and 6pm on weekdays.
Exclusion criteria
The following will be excluded from participation: Patients who have an inability to tolerate being flat pre-operatively e.g. heart failure/ aspiration risk etc., at the discretion of the treating anaesthetist Patients transferred from theatre straight to PICU or NICU
Outcome results
None listed