Gamma Knife, Paediatrics And Anaesthesia: The Development Of A Safe Hospital Transport System

Keywords: gamma knife, anesthesia, children, pediatrics, technique

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     The provision of general anaesthesia for treatment of children during Gamma Knife surgery requires frequent intra- and inter-hospital transfers. Patient transfers are hazardous 1 and guidelines concerning the organization of the patient transfer have been developed 2. These guidelines have contributed to a reduction in adverse events 3 during patient transfer. A transfer system should be mobile, self-contained and capable of dealing with all critical events. .
     We describe the development of a patient transfer system for the treatment of the paediatric patient during stereotactic radiosurgery. We have audited the adverse incidents related to patient transfer over 12 months with reference to gamma knife units
     A modified Standard Critical Care Transfer trolley (CCT Six, Ferno UK) formed the basis for the transfer system. Complications related to paediatric transfer over a 12 month period were audited. 
     We contacted 71 international Gamma Knife treatment centres to establish the numbers of paediatric patients treated under general anaesthesia and any complications reported.
     The modified transfer trolley allowed 1) the delivery of intravenous sedation, 2) secure ventilator and oxygen supply, 3) patient warming device, 4) supports for the administration of IV fluid, 5) storage space for airway and cardiovascular resuscitation equipment. All staff were trained in Paediatric Life Support. No patient in our unit suffered a complication during transfer or treatment.
     This is a retrospective study.
     Transfer of the anaesthetised paediatric patient is a high risk procedure. The majority of adverse events during hospital transfer relate to equipment problems and patient management problems such as airway and vascular access difficulties 4. Other Gamma knife units have reported complications that require the support of the main hospital.
     Our low incidence of critical events since the introduction of the transfer system supports the concentration of expertise and the application of a transfer system. We commend all units treating patients under general anaesthesia consider specialist transfer system.


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