Dr Ekta Rai MRCAMD Department of Anesthesia Christian Medical College Vellore Background for the audit Observation in the hospital Global Awareness Impact of poor Quality of Induction ID: 935906
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Slide1
Quality of Anaesthesia Induction and anxiety levels among the children – An Audit
Dr. Ekta Rai. MRCA,MDDepartment of Anesthesia Christian Medical CollegeVellore
Slide2Background for the audit
Observation in the hospitalGlobal Awareness
Slide3Impact of poor Quality of Induction
Slide4Impact of poor quality of induction
Physiological Psychological
Slide5Aim
Incidence of poor quality of induction Factors associated with poor inductionBased on the finding take measures
Slide6WORK FLOW
IRB ApprovedProspective Observational Cohort StudyPeriod= 2 monthsInformed Consent from ParentsVerbal Assent taken as appropriate from the child.
Slide7Work Flow
Inclusion CriteriaElective surgeryIn patient2-15 yearsExclusion CriteriaNot willing to take part in the study
Major surgeries requiring morbidity, blood transfusion and ICU admission
Mental retardation, Autistic children
Slide8Work Flow
WardInterviewed- Primary Care giverSocio-economic statusChild illnessTemperament of childAnxiety among children and parent
Holding Bay ; Induction Room
Anxiety Scores
Slide9Outcome
ICC (Induction compliance checklist) Score > 4 – Poor InductionIncidence of poor induction 30.77 % (24/78)Reference: Kain
Z,Mayes
L, O’Connor TZ et al. Preoperative
anxietyin
children, predictor and
outcomes.Arch
Pediatr
Adolesc Med 1996;150:1238-1245
Slide10Results
Factors associated with poor induction
Age (2 to 4
yrs
)
White Coat Fear
5.6 times high ICC scores
Pre-medication
(94.9 %)Not associated with low ICC scores
Sedation 90% protection against high ICC scoresParental presenceComplex phenomenon
Childs acceptance for surgery12 times protective against high ICC scoresInhalational induction`High
ICC scores
Distraction techniques (less than 50% used)
Protective
Slide11Anxiety Levels
Pre-operative anxietyWard – 10.3%Holding bay- 6.5% (unmonitored sleeping children)Separation anxiety -20.5%Induction room – 25.6%
Slide12Steps Taken- 1.Kids Friendly atmosphere
Slide13Holding Bay
Slide14Friendly Anesthesia staff
Slide15Fasting Strategies
Strict Adherence to Fasting guidelinesUse of Lollipops( Infants)
Slide16Current statusAnesthetist Opinion
Smoother Induction- Relaxed Atmosphere Calm Parents HelpImproved Bonding
Premedication not always required
Technician play vital role
Improved Bonding
Slide17Opinions
SurgeonAlert ; Quiet; Playful even with Drip on..Comfortable and composed Older childrenImproved used of analgesic techniques
Slide18Nurse’sOpinion
Children walking to OTComfortable kids in recovery
Slide19Thank you