Kommentar 2: Gibt es einen rationalen Grund, sich nicht um die stete Verbesserung von Sicherheit und Qualität in der Kinderanästhesie zu bemühen?

Am 28. März 2017 wurden die mit Spannung erwarteten Ergebnisse der europäischen APRICOT-Studie veröffentlicht, an der sich auch 29 Einrichtungen aus Deutschland mit insgesamt 2232 Kindernarkosen beteiligt hatten (entsprechend 7,2% aller eingeschlossenen Fälle) [1]. Erwartungsgemäß kam es stante pede zu lebhaften Kontroversen darüber, wie diese Ergebnisse zu werten seien und welche Konsequenzen man daraus ziehen sollte – oder nicht. Wie bei vielen kinderanästhesiologischen Themen der vergangenen Jahre gingen auch hier die Emotionen hoch. Was also war passiert?

• Literatur

• 1 Habre W, Disma N, Virag K. et al. APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med 2017; 5: 412-425
• 2 Keenan RL, Shapiro JH, Kane FR. et al. Bradycardia during anesthesia in infants. An epidemiologic study. Anesthesiology 1994; 80: 976-982
• 3 Morray JP, Geiduschek JM, Ramamoorthy C. et al. Anesthesia-related cardiac arrest in children: initial findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology 2000; 93: 6-14
• 4 Murat I, Constant I, Maudʼhuy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth 2004; 14: 158-166
• 5 von Ungern-Sternberg BS, Boda K, Chambers NA. et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet 2010; 376: 773-783
• 6 Auroy Y, Ecoffey C, Messiah A. et al. Relationship between complications of pediatric anesthesia and volume of pediatric anesthetics. Anesth Analg 1997; 84: 234-235
• 7 Walker RW. Pulmonary aspiration in pediatric anesthetic practice in the UK: a prospective survey of specialist pediatric centers over a one-year period. Pediatr Anesth 2013; 23: 702-711
• 8 Weiss M, Vutskits L, Hansen TG. et al. Safe Anesthesia For Every Tot - The SAFETOTS initiative. Curr Opin Anaesthesiol 2015; 28: 302-307
• 9 de Leval MR, Carthey J, Wright DJ. et al. Human factors and cardiac surgery: a multicenter study. J Thorac Cardiovasc Surg 2000; 119: 661-672
• 10 Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care 2011; 49: 1076-1081
• 11 Mamie C, Habre W, Delhumeau C. et al. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Paediatr Anaesth 2004; 14: 218-224
• 12 Cravero JP. Risk and safety of pediatric sedation/anesthesia for procedures outside the operating room. Curr Opin Anaesthesiol 2009; 22: 509-513
• 13 de Graaff JC, Sarfo MC, van Wolfswinkel L. et al. Anesthesia-related critical incidents in the perioperative period in children; a proposal for an anesthesia-related reporting system for critical incidents in children. Paediatr Anaesth 2015; 25: 621-629
• 14 van der Griend BF, Lister NA, McKenzie IM. et al. Postoperative mortality in children after 101,885 anesthetics at a tertiary pediatric hospital. Anesth Analg 2011; 112: 1440-1447
• 15 Kurth CD, Tyler D, Heitmiller E. et al. National pediatric anesthesia safety quality improvement program in the United States. Anesth Analg 2014; 119: 112-121
• 16 Lee JH, Kim EK, Song IK. et al. Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching childrenʼs hospital. Paediatr Anaesth 2016; 26: 409-417
• 17 Weiss M, Hansen TG, Engelhardt T. Ensuring safe anaesthesia for neonates, infants and young children: what really matters. Arch Dis Child 2016; 101: 650-652
• 18 Astuto M, Lauretta D, Minardi C. et al. Does the Italian pediatric anesthesia training program adequately prepare residents for future clinical practice? What should be done?. Paediatr Anaesth 2008; 18: 172-175
• 19 Benzon HA, De Oliveira jr. GS, Hardy CA. et al. Status of pediatric anesthesiology fellowship research education in the United States: a survey of fellowship program directors. Paediatr Anaesth 2014; 24: 327-331
• 20 Lauritsen T. Educational Meeting of the Scandianavian Society of Anaesthesiology and Intensive Care (SSAI). Copenhagen, March 2017.
• 21 Lerman J. Time for a paradigm shift in paediatric anaesthesia in Europe. Lancet Respir Med 2017; 5: 365-367
• 22 Becke K. et al. Choosing wisely in pediatric anesthesia – an interpretation of the German Scientific Working Group on Pediatric Anesthesia (WAKKA). Paediatr Anaesth (submitted).
• 23 Steurer MA, Adams M, Bacchetti P. et al. Swiss medical centres vary significantly when it comes to outcomes of neonates with a very low gestational age. Acta Paediatr 2015; 104: 872-879