Vital signs changes in neonates during general anesthesia: an objective method to compare cases
General anesthesia in neonates has the potential to impair long term cognitive outcomes. However, given that anesthesia for urgent neonatal surgery cannot be avoided regardless of age, it is vitally important to understand the other factors that may contribute to poor long term outcomes. Attention is now directed to preventable factors such as changes in vital signs, which may have deleterious effects on cerebral perfusion in the neonatal brain. The goal of this research is to identify and prioritize rules for detecting vital sign deviations, and to develop a case severity score allowing comparison of cases with respect to the conduct of anesthesia. This tool will then be used to support future quality improvement projects and to facilitate future investigations into the conduct of neonatal anesthesia applied in multi-centre prospective studies.
Using thermoregulation metrics during scoliosis correction surgery as an example for team and individualized feedback mechanisms
Unless something is measured, practitioners don’t know how they are doing and where improvements are needed. Engaging high-performing individuals’ desire to do better is not always readily achieved by checklists, policies or guidelines. Continuous feedback of performance data can improve professional practice and outcomes. In this study, feedback of thermoregulation metrics is used as one strategy to continuously improve perioperative temperature management in our scoliosis patients. Individualized feedback, without changes in policy, is able to reduce monitoring delays significantly, and sustainably.
Automated intravenous anesthesia delivery to improve outcomes
As a highly experienced, interdisciplinary team of engineers and clinician-scientists, we have developed a system that automatically adjusts drug dosing. It does so by comparing feedback on anesthesia depth, using processed electrical activity from the patient's brain to a clinician-selected target. By administering the right amount of anesthesia drugs to patients, it minimizes side effects of these drugs, and allows clinicians to focus on optimizing patient safety through complex, high-level decision making. We are currently evaluating the performance of this system during general anesthesia for both adults and children. Future work includes expanding this work towards other users, such as nurses, and settings, such as intensive care unit sedation.