Pediatric liver transplantation in Australia and New Zealand: The case for a collaborative anesthetic database.

BACKGROUND: Liver transplantation is conducted with strict oversight of organizational structure and clinical practice. However, specific regulations pertaining to the delivery of anesthetic services are lacking and consideration of departmental structure and mechanisms for quality control must occur at a local level. Busy centers collect and process sufficient data to guide this process but those with low case loads may not generate enough data for useful analysis. In Australia and New Zealand, pediatric liver transplants are performed at only four locations. As these operations are not equally distributed geographically or temporally there are periods of low activity at some centers. As anesthesia affects patient outcome, quality assurance activities are important in this setting. AIMS: Provide a global overview of the structure and function of liver transplantation networks. Identify issues related to provision of pediatric anesthetic services with specific reference to Australasia. Examine anesthetic data from a single pediatric center to illustrate benefits and limitations of such activity. METHODS: Pediatric liver transplant centers from Australia and New Zealand were surveyed to determine the organizational and logistical issues related to a liver transplant service. An audit of 15 years of liver transplants from a single center was conducted for benchmarking purposes and to identify changes in anesthetic practice over time. RESULTS: Pediatric liver transplants performed in Queensland from January 2005 to December 2019 were reviewed. Changes in transfusion practice reflected international trends. Morbidity and mortality were comparable to international data. Important complications such as hepatic artery and portal vein thrombosis were uncommon and did not generate enough data for further analysis. CONCLUSIONS: Combining the anesthetic liver transplant data from all sites in a single registry would expand data collection and generate broadly applicable findings. We propose the establishment of an Australasian pediatric anesthetic liver transplant database.

Evaluation of an enhanced pulse oximeter auditory display: a simulaion study.

BACKGROUND: We compared anaesthetists' ability to identify haemoglobin oxygen saturation (SpO2) levels using two auditory displays: one based on a standard pulse oximeter display (varying pitch plus alarm) and the other enhanced with additional sound properties (varying pitch plus tremolo and acoustic brightness) to differentiate SpO2 ranges. METHODS: In a counter-balanced crossover study in a simulator, 20 experienced anaesthetists supervised a junior colleague (an actor) managing two airway surgery scenarios: once while using the enhanced auditory display and once while using a standard auditory display. Participants were distracted with other tasks such as paperwork and workplace interruptions, but were required to identify when SpO2 transitioned between pre-set ranges (target, low, critical) and when other vital signs transitioned out of a target range. They also identified the range once a transition had occurred. Visual displays were available for all monitored vital signs, but the numerical value for SpO2 was excluded. RESULTS: Participants were more accurate and faster at detecting transitions to and from the target SpO2 range when using the enhanced display (100.0%, 3.3 s) than when using the standard display plus alarm (73.2%, 27.4 s) (P<0.001 and P=0.004, respectively). They were also more accurate at identifying the SpO2 range once a transition had occurred when using the enhanced display (100.0%) than when using the standard display plus alarm (57.1%; P<0.001). CONCLUSIONS: The enhanced auditory display helps anaesthetists judge SpO2 levels more effectively than current auditory displays and may facilitate 'eyes-free' monitoring.

Comparison of Standard and Enhanced Pulse Oximeter Auditory Displays of Oxygen Saturation: A Laboratory Study With Clinician and Nonclinician Participants.

BACKGROUND: When engaged in visually demanding tasks, anesthesiologists depend on the auditory display of the pulse oximeter (PO) to provide information about patients' oxygen saturation (SpO2). Current auditory displays are not always effective at providing SpO2 information. In this laboratory study, clinician and nonclinician participants identified SpO2 parameters using either a standard auditory display or an auditory display enhanced with additional acoustic properties while performing distractor tasks and in the presence of background noise. METHODS: In a counterbalanced crossover design, specialist or trainee anesthesiologists (n = 25) and nonclinician participants (n = 28) identified SpO2 parameters using standard and enhanced PO auditory displays. Participants performed 2 distractor tasks: (1) arithmetic verification and (2) keyword detection. Simulated background operating room noise played throughout the experiment. Primary outcomes were accuracies to (1) detect transitions to and from an SpO2 target range and (2) identify SpO2 range (target, low, or critical). Secondary outcomes included participants' latency to detect target transitions, accuracy to identify absolute SpO2 values, accuracy and latency of distractor tasks, and subjective judgments about tasks. RESULTS: Participants were more accurate at detecting target transitions using the enhanced display (87%) than the standard display (57%; odds ratio, 7.3 [95% confidence interval {CI}, 4.4-12.3]; P < .001). Participants were also more accurate at identifying SpO2 range using the enhanced display (86%) than the standard display (76%; odds ratio, 2.7 [95% CI, 1.6-4.6]; P < .001). Secondary outcome analyses indicated that there were no differences in performance between clinicians and nonclinicians for target transition detection accuracy and latency, SpO2 range identification accuracy, or absolute SpO2 value identification. CONCLUSIONS: The enhanced auditory display supports more accurate detection of target transitions and identification of SpO2 range for both clinicians and nonclinicians. Despite their previous experience using PO auditory displays, clinicians in this laboratory study were no more accurate in any SpO2 outcomes than nonclinician participants.