Editorial
The new challenges in pediatric anesthesia in Colombia
Los nuevos retos de la Anestesia Pediátrica en Colombia
Piedad Cecilia Echeverry Marína,b,c,
Corresponding author
echeverrypiedad@gmail.com
Correspondence to: Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Cra. 15a # 120 – 74, Bogotá, Colombia.
Correspondence to: Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Cra. 15a # 120 – 74, Bogotá, Colombia.
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "5" "paginaFinal" => "7" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Piedad Cecilia Echeverry Marín" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Piedad Cecilia" "apellidos" => "Echeverry Marín" "email" => array:1 [ 0 => "echeverrypiedad@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Coordinator of the National Committee of Pediatric Anesthesia, Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Bogotá, DC, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Ortopedia Infantil Rooselvelt, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad de La Sabana – Chía, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Correspondence to</span>: Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), Cra. 15a # 120 – 74, Bogotá, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los nuevos retos de la Anestesia Pediátrica en Colombia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pediatric anesthesia is a branch of anesthesiology that has become increasingly relevant around the world during our professional practice of the last 50 years. In developed countries it is considered a supra-specialty, to the extent that in many healthcare systems in the developed world, pediatric patients under one year of age, or with complex pathologies, are exclusively being cared for in pediatric institutions by specialized anesthesiologists or with advanced training in pediatrics, accompanied by a physician, surgeon and paramedic with vast experience in comprehensive management of children.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,2</span></a> The end result is the optimization of an environment of safety and wellbeing, where children may receive multidisciplinary care that ensures prompt recovery and return to their regular school activities, in addition to a maximum reduction of adverse events or perioperative complications associated to poor care due to preventable human errors.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">When these considerations are expressed in terms of healthcare quality, important aspects such as clinical safety, effective healthcare, comprehensive patient-centered care, efficiency, equality, and prompt care shall be addressed. All these aspects highlight the importance of having specialized human resources for pediatric care, with clear competencies in this area and a perfectly synchronized team.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This kind of approach to pediatric anesthesia involves a constant evaluation of the clinical results in terms of patient and family satisfaction, the incidence of adverse events or complications, time of care, healthcare costs and team performance that finally are expressed as quality indicators. However, to reach this goal, highly skilled human resources are required who are specialized and constantly being trained through continued medical education for mastering psychomotor skills, promoting research in pediatric anesthesia and developing non-technical skills for team work.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The overall landscape in our country is grim due to a failure to establish pediatric anesthesiology as a subspecialty in Colombia and a formal university endorsed program, since the Colombian Ministry of Health and Social Protection considers it is not relevant, keeping in mind that there are no active programs in pediatric anesthesia in the country and that a professional graduated from an approved anesthesiology program may be prevented from practicing the competencies inherent to his/her specialty because of the establishment of new subspecialties.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> From this perspective, the challenges for the anesthesiologist managing pediatric patients are tougher. Consequently, since advanced training options for pediatric anesthesia are not available in the country, continuous education should be strengthened with the support of the scientific societies and universities or higher education institutions that enable the development of psychomotor skills, the development of new research projects, simulation workshops under high-fidelity clinical settings, and finally, the development of technical competencies and non-technical skills in supervised clinical practice.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Training the human resources that provide care to the pediatric population is essential for a positive impact on the outcomes and for improving the healthcare quality indicators.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The implementation and design of interventions aimed at reducing the number of adverse events in an institution demands a huge effort in training and education and a cultural change in order to accomplish the best clinical results in patients through an institutional continuous improvement model.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Integrating a quality improvement system into the practice of pediatric anesthesia is key to ensure patient safety. However, this integration entails a systematic exercise for the teams involved and encouraging the comprehensive examination of the care provided and the performance of each individual team member participating in children care to make our specialty as safe as possible.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Focusing on this objective, the National Committee of Pediatric Anesthesia developed a work plan to establish continuous education projects aimed at strengthening anesthesia training and knowledge in pediatric anesthesia of the anesthetists interested in this area of their practice. This project began with the publication of the Treaty on Pediatric Anesthesia in June 2015, in a multinational participation that brought together 95 authors from 8 different countries and with various medical specialties including anesthesiology, pediatrics, pediatric pulmonology, pediatric intensive care, pediatric surgery, inter alia. This project was followed by the organization of the First International Congress of the Surgical Neonate,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> held in partnership with the American Society of Pediatric Anesthesia (SPA), the Colombian Society of Neonatology, and the Colombian Society of Pediatric Surgery. This enabled the various medical specialties to share and broaden their knowledge since they all have a joint responsibility for the care, safety and wellbeing of our children.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In order to provide some continuity to this educational project, a compilation of recent publications in pediatrics was done with the exclusive purpose of preparing a pediatric anesthesia supplement with the participation of renowned international authors with vast experience and important publications in the world literature; i.e., Dr Lynn Martin, Dr. Anne Lynn and Dr. Nathalia Jiménez. Moreover, this project has been a platform to include new authors and researchers that with their effort and devotion have made valuable contributions to our knowledge and research in the area of pediatric anesthesia in our country, regarding relevant topics such as sedation outside the OR, regional anesthesia, neonatal surgery and ventilation perioperative management in children.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Center for Technological Development of the Colombian Society of Anesthesiology and Resuscitation – SCARE – has organized a team to carry out the editorial work and be able to publish this collective paper that comprises anesthesiologists experts in pediatric anesthesia, as well as other specialists interested in advancing and strengthening the continuous medical education program as a cornerstone for improving the quality of perioperative care of pediatric patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">These projects are just the beginning of an ambitious, more formal and structured continuous medical education program, that in the near future will involve virtual courses for the advancement of knowledge, practical workshops for the development of specific psychomotor skills, simulation workshops in high fidelity settings to ensure learning and integration of theoretical knowledge with psychomotor skills, without the exposure of patients to human errors from caregivers in the process of learning.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Further down these activities shall be integrated with the development of competencies in the supervised clinical area, within the framework of institutional protocols.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, the pediatric anesthesia supplement we herein submit, is the result of a continuous education project proposed by the National Committee of Pediatric Anesthesia, with a view to promote an updated knowledge in topics of interest relating to pediatric anesthesia, to encourage research and increase the number of new members participating in the Committee to publish their work and share their professional pediatric experience. Strengthening our human resources in the area of pediatric healthcare is essential to ensure safety and wellbeing, and to underpin all quality improvement programs.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author's own resources.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The author is the coordinator of the National Committee of Pediatric Anesthesia at S.C.A.R.E.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Echeverry Marín PC. Los nuevos retos de la Anestesia Pediátrica en Colombia. Rev Colomb Anestesiol. 2017;45:5–7.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the pediatric perioperative anesthesia environment. American Academy of Pediatrics. Section on Anesthesiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Hackel" 1 => "J.M. Badgwell" 2 => "R.R. Binding" 3 => "L.S. Dahm" 4 => "B.S. Dunbar" 5 => "C.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 9 | 2 | 11 |
| 2024 September | 7 | 2 | 9 |
| 2024 August | 13 | 2 | 15 |
| 2024 July | 12 | 10 | 22 |
| 2024 June | 8 | 7 | 15 |
| 2024 May | 14 | 4 | 18 |
| 2024 April | 12 | 4 | 16 |
| 2024 March | 26 | 8 | 34 |
| 2024 February | 16 | 6 | 22 |
| 2024 January | 12 | 4 | 16 |
| 2023 December | 11 | 2 | 13 |
| 2023 November | 9 | 11 | 20 |
| 2023 October | 28 | 8 | 36 |
| 2023 September | 11 | 2 | 13 |
| 2023 August | 11 | 6 | 17 |
| 2023 July | 14 | 4 | 18 |
| 2023 June | 8 | 2 | 10 |
| 2023 May | 8 | 2 | 10 |
| 2023 April | 8 | 1 | 9 |
| 2023 March | 4 | 1 | 5 |
| 2023 February | 5 | 4 | 9 |
| 2023 January | 7 | 5 | 12 |
| 2022 December | 11 | 7 | 18 |
| 2022 November | 14 | 17 | 31 |
| 2022 October | 6 | 5 | 11 |
| 2022 September | 6 | 8 | 14 |
| 2022 August | 7 | 7 | 14 |
| 2022 July | 4 | 7 | 11 |
| 2022 June | 8 | 13 | 21 |
| 2022 May | 11 | 9 | 20 |
| 2022 April | 9 | 8 | 17 |
| 2022 March | 11 | 6 | 17 |
| 2022 February | 4 | 7 | 11 |
| 2022 January | 6 | 6 | 12 |
| 2021 December | 9 | 7 | 16 |
| 2021 November | 3 | 6 | 9 |
| 2021 October | 11 | 9 | 20 |
| 2021 September | 5 | 6 | 11 |
| 2021 August | 11 | 5 | 16 |
| 2021 July | 4 | 7 | 11 |
| 2021 June | 14 | 3 | 17 |
| 2021 May | 12 | 5 | 17 |
| 2021 April | 11 | 15 | 26 |
| 2021 March | 10 | 9 | 19 |
| 2021 February | 5 | 9 | 14 |
| 2021 January | 9 | 7 | 16 |
| 2020 December | 6 | 6 | 12 |
| 2020 November | 3 | 0 | 3 |
| 2020 October | 10 | 1 | 11 |
| 2020 September | 2 | 10 | 12 |
| 2020 August | 11 | 7 | 18 |
| 2020 July | 6 | 8 | 14 |
| 2020 June | 5 | 6 | 11 |
| 2020 May | 7 | 4 | 11 |
| 2020 April | 2 | 4 | 6 |
| 2020 March | 5 | 4 | 9 |
| 2020 February | 3 | 2 | 5 |
| 2020 January | 6 | 9 | 15 |
| 2019 December | 3 | 4 | 7 |
| 2019 November | 3 | 3 | 6 |
| 2019 October | 3 | 1 | 4 |
| 2019 September | 4 | 2 | 6 |
| 2019 August | 6 | 2 | 8 |
| 2019 July | 5 | 7 | 12 |
| 2019 June | 1 | 1 | 2 |
| 2019 May | 5 | 16 | 21 |
| 2018 December | 1 | 0 | 1 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 42 | 7 | 49 |
| 2018 April | 39 | 10 | 49 |
| 2018 March | 36 | 13 | 49 |
| 2018 February | 26 | 8 | 34 |
| 2018 January | 42 | 9 | 51 |
| 2017 December | 32 | 9 | 41 |
| 2017 November | 27 | 6 | 33 |
| 2017 October | 29 | 14 | 43 |
| 2017 September | 28 | 9 | 37 |
| 2017 August | 27 | 7 | 34 |
| 2017 July | 28 | 9 | 37 |
| 2017 June | 29 | 12 | 41 |
| 2017 May | 33 | 13 | 46 |
| 2017 April | 68 | 14 | 82 |
| 2017 March | 55 | 16 | 71 |
| 2017 February | 35 | 5 | 40 |
| 2017 January | 44 | 13 | 57 |
| 2016 December | 7 | 11 | 18 |
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