1. Preparation for Paediatric Anaesthesia Dr Tim Baker Stockholm, Sweden tim@lifesupportfoundation.org SATA Conference, Tanzania, May 2016

2. Intro Why do we need to prepare for anaesthesia? Which routines should we use? Which checklists should we use?

3. Common fallacies ”I do not make mistakes” ”It was not my fault that the patient died” ”It is somebody else that is responsible for the equipment” ”I know the laryngoscope works because I used it earlier ”I am smarter than a piece of paper” If something can go wrong, it has gone wrong

4. Why do we need routines? Anaesthesia is complicated can be standardised is time dependent can be dangerous has many people involved Complications might happen fast so be prepared to act!

5. Which routines should we use? Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines

6. Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines

7. Aims 1. Assess illness severity - prioritisation 2. Find problems early 3. Optimise the patient Improve outcomes Pre-op form that can be used for all patients Pre-op visit

8. Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines

9. Checklist for which equipment should ALWAYS be in the operating theatre Checked that everything is present & working everyday before every case Check equipment

10. A: Oropharyngeal airway, laryngoscope, suction, Bougie, ETT different sizes B: Ambu-bag, Masks different sizes, anaesthesia machine, pulse oximetry, paediatric Ambubag C: cannulae, syringes, giving sets, tilting of operation table Check equipment

11. Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines

12. Adrenaline Atropine Ephedrine Thiopentone Ketamine Suxamethonium Coffee R.L N.S Halothane ….. Named person responsible for emergency box daily / before every case Check drugs

13. Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines

14. Allergies? Fasting? Expected difficult airway? Possible complications Paediatric patient: Desaturate FAST Correct size equipment (and one size bigger, one size smaller) Correct drug doses Patient pre-anaesthesia checklist

15. How to remember CHECK LISTS

20. Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines

26. Participating Hospitals

27. Results er

28. Pre-op visit Check equipment Check drugs Patient pre-anaesthesia checklist Surgery checklist Post-op routines

30. Summary Same preparations everytime. Use checklists. Be prepared for possible complications Emergency drugs & equipment always available in the theatre Standardised preparations prevent disaster when complications arise

31. tim@lifesupportfoundation.org www.lifesupportfoundation.org