Characterization of neonatal anesthesia in Colombia from a multidisciplinary perspective. Observational study
Abstract
Introduction: The neonatal period, encompassing the first 28 days of life, is marked by low functional reserve and adaptation to extrauterine life. Neonates have higher postoperative morbidity and mortality compared to older pediatric patients. The anesthesiologist’s expertise significantly influences neonatal perioperative outcomes. In Colombia, disparities in healthcare access and education impact neonatal anesthesia training. However, there is limited information on neonatal anesthesia practice and training in the country.
Objective: To characterize neonatal anesthesia from the perspective of anesthesiologists, pediatric surgeons, neonatologists, and directors of specialization programs in anesthesiology in Colombia.
Methods: An observational, cross-sectional study was conducted. A survey was administered among practicing anesthesiologists, pediatric surgeons, neonatologists, and directors of anesthesiology programs in Colombia with regards to several aspects of neonatal anesthesia. An ad hoc questionnaire was designed including 5 domains: perception of professional practice, techniques used, technical and logistical resources of the institutions, training received during the anesthesiology residency, and curricular aspects of the anesthesiology postgraduate program in Colombia.
Results: According to the neonatologists, the anesthesia categories with the worst performance were thermoregulation (poorly managed 38.8% and very poorly managed 22.4%) and management of intravenous fluids (poorly managed 34.7% and very poorly managed 6.1%). With regards to the opinion of the pediatric surgeons, the categories with the lowest performance were thermoregulation (poorly managed 12.5%) and the use of vasoactive medications (poorly managed: 6.3% and very poorly managed 3.1%). 77.8% of the country's anesthesiology programs fail to include neonatal anesthesia as part of the syllabus. 61.5% of anesthesiologists considered their training inadequate to manage a surgical neonate and 89.6% believe that pediatric anesthesia should be a subspecialty in Colombia.
Conclusions: There is a discrepancy between anesthesiologists' self-perception of neonatal care and the views of neonatologists and pediatric surgeons. In Colombia, academic training in neonatal anesthesiology appears to be limited, reflecting gaps in the curricular content of training programs.
References
1. Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, et al. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth. 2024;94:111407. https://doi.org/10.1016/j.jclinane.2024.111407.
2. Disma N, Veyckemans F, Virag K, Hansen TG, Becke K, Harlet P, et al. Morbidity and mortality after anaesthesia in early life: results of the European prospective multicentre observational study, neonate and children audit of anaesthesia practice in Europe (NECTARINE). Br J Anaesth. 2021;126(6):1157-72. https://doi.org/10.1016/j.bja.2021.02.016.
3. Jansen G, Irmscher L, May TW, Borgstedt R, Popp J, Scholz SS, et al. Incidence, characteristics and risk factors for perioperative cardiac arrest and 30-day-mortality in preterm infants requiring non-cardiac surgery. Clin Anesth. 2021;73:110366. https://doi.org/10.1016/j.jclinane.2021.110366.
4. Bösenberg AT. Neonatal anesthesia with limited resources. Paediatr Anaesth. 2014;24(1):98-105. https://doi.org/10.1111/pan.12291.
5. Kuan CC, Shaw SJ. Anesthesia for major surgery in the neonate. Anesthesiol Clin. 2020;38(1):1-18. https://doi.org/10.1016/j.anclin.2019.10.001.
6. Trujillo A. Social determinants for health and neonatal anesthesia in Colombia. Colombian Journal of Anesthesioly. 2023:51(2):e1063. https://doi.org/10.5554/22562087.e1063
7. Gómez L, Gómez J, Sánchez N, González L, Naranjo L, Ríos F, et al. Documento marco del Plan de Estudios y Competencias para un Programa de Anestesiología en Colombia. Bogotá: Sociedad Colombiana de Anestesiología y Reanimación; 2017.
8. International Bank for Reconstruction and Development/World Bank. Building an equitable society in Colombia [internet]. 2021 [cited 5 Oct 2024]. Available at: https://documents1.worldbank.org/curated/en/686821635218586591/pdf/Main-Report.pdf
9. Sullivan A, Donovan B, Young BC, Cummings C. Collaboration between maternal-fetal medicine and neonatology when counseling at extreme prematurity. Neoreviews. 2023;24(3):e137-e143. https://doi.org/10.1542/neo.24-3-e137.
10. Habre W, Disma N, Virag K, Becke K, Hansen TG, Jöhr M, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med. 2017;5(5):412-25. https://doi.org/10.1016/S2213-2600(17)30116-9. Epub 2017 Mar 28. Erratum in: Lancet Respir Med. 2017 May;5(5):e19. Erratum in: Lancet Respir Med. 2017 Jun;5(6):e22. PMID: 28363725
11. Zielinska M, Piotrowski A, Vittinghoff M. Neonatal anaesthesia in Europe — Is it time to create standards? Anaesth Crit Care Pain Med. 2022;41(2):101044. https://doi.org/10.1016/j.accpm.2022.101044. Epub 2022 Feb 19. PMID: 35192949.
12. Shi F, Xiao Y, Xiong W, Zhou Q, Huang X. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis. J Anesth. 2016;30(1):3-11. https://doi.org/10.1007/s00540-015-2062-4.
13. Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, et al. Incidence of post-extubation stridor in infants with cuffed vs. uncuffed endotracheal tube: a retrospective cohort analysis. Front Pediatr. 202211;10:864766. https://doi.org/10.3389/fped.2022.864766.
14. Foster BA, Tom D, Hill V. Hypotonic versus isotonic fluids in hospitalized children: a systematic review and meta-analysis. J Pediatr. 2014;165(1):163-9.e2. https://doi.org/10.1016/j.jpeds.2014.01.040.
15. Lönnqvist PA. III. Fluid management in association with neonatal surgery: even tiny guys need their salt. Br J Anaesth. 2014;112(3):404-6. https://doi.org/10.1093/bja/aet436.
16. McAuliffe G, Bissonnette B, Boutin C. Should the routine use of atropine before succinylcholine in children be reconsidered? Can J Anaesth. 1995;42(8):724-9. https://doi.org/10.1007/BF03012672.
17. Parnis SJ, Van Der Walt JH. A National Survey of Atropine Use by Australian Anaesthetists. Anaesth Intensive Care. 1994;22(1):61-5. https://doi.org/10.1177/0310057X9402200110.
18. Durrmeyer X, Walter-Nicolet E, Chollat C, Chabernaud JL, Barois J, Chary Tardy AC, et al. Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN). Front Pediatr. 2023;10:1075184. https://doi.org/10.3389/fped.2022.1075184.
19. Baker S, Yogavijayan T, Kandasamy Y. Towards non-invasive and continuous blood pressure monitoring in neonatal intensive care using artificial intelligence: A narrative review. Healthcare (Basel). 2023;11(24):3107. https://doi.org/10.3390/healthcare11243107.
20. Disma N, Asai T, Cools E, Cronin A, Engelhardt T, Fiadjoe J, et al. Airway management in neonates and infants. Eur J Anaesthesiol. 2024;41(1):3-23. https://doi.org/10.1097/EJA.0000000000001928.
21. García H, Franco Gutiérrez M. Multidisciplinary management of patients with esophageal atresia. Bowl Med Hosp Infant Mex. 2011;68(6):467-75.
22. Schmedding A, Wittekindt B, Schloesser R, Hutter M, Rolle U. Outcome of esophageal atresia in Germany. Dis Esophagus. 2021;34(4):doaa093. https://doi.org/10.1093/dote/doaa093.
23. de Graaff JC, Frykholm P, Engelhardt T, Schindler E, Kovesi T, Simic D, et al. Pediatric anesthesia in Europe: Variations within uniformity. Paediatr Anaesth. 2024. https://doi.org/10.1111/pan.14873.
24. Echeverry Marín PC. The new challenges of pediatric anesthesia in Colombia. Colombian Journal of Anesthesiology. 2017;45(1):5-7. http://dx.doi.org/10.1016/j.rca.2016.10.003
Downloads
Copyright (c) 2023 Colombian Journal of Anesthesiology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
