ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2020 March;86(3):295-303

DOI: 10.23736/S0375-9393.19.14126-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Pediatric anesthesia practice in Italy: a multicenter national prospective observational study derived from the APRICOT Trial

Andrea WOLFLER ¹ ✉, Annalisa DE SILVESTRI ², Anna CAMPORESI ¹, Giorgio IVANI ³, Alessandro VITTORI ⁴, Nicola ZADRA ⁵, Lorena PASINI ⁶, Marinella ASTUTO ⁷, Bruno LOCATELLI ⁸, Andrea CORTEGIANI ⁹, Nicola DISMA ¹⁰ on behalf of the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI)

¹ Division of Anesthesia and Intensive Care, Department of Pediatrics, Children’s Hospital V. Buzzi, Milan, Italy; ² Clinical Epidemiology and Biometric Unit, San Matteo Foundation IRCCS, Pavia, Italy; ³ Department of Anesthesia and Intensive Care, Children’s Hospital Regina Margherita, Turin, Italy; ⁴ Department of Anesthesia and Critical Care, ARCO, Bambino Gesù Children Hospital IRCCS, Rome, Italy; ⁵ Department of Anesthesia and Intensive Care, University Hospital, Padua, Italy; ⁶ Department of Pediatric Anesthesia and Intensive Care, Sant’Orsola Malpighi Polyclinic, Bologna, Italy; ⁷ Department of Anesthesia, Vittorio Emanuele Polyclinic, Catania, Italy; ⁸ Department of Pediatric Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy; ⁹ Section of Anesthesia, Analgesia, Intensive Care and Emergency, Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Paolo Giaccone Polyclinic, University of Palermo, Palermo, Italy; ¹⁰ Department of Anesthesia, Giannina Gaslini Institute, Genoa, Italy

BACKGROUND: Pediatric anesthesia nowadays requires specific knowledge and expertise. The Anesthesia PRactice In Children Observational Trial (APRICOT) was a European multicenter study designed for the identification of perioperative severe critical events and management. We aimed at analyzing the Italian database in an attempt to determine the practice of anesthesia and the incidence of severe critical events in Italy.
METHODS: Secondary analyses of the database consisted in extracting the raw data from the 25 Italian centers that participated to APRICOT. Descriptive statistics and comparison with the reference data were made for all the variables collected.
RESULTS: The study analyzed 2087 children. The Italian cohort represents 6.7% of the overall study population. Most of the children were ASA 1-2 (90.6%) and underwent a surgical procedure (62.8%). In more than 84% of the cases, anesthesia management was performed by an expert with main or frequent activity in pediatric anesthesia with on an average 15 years of experience. The overall incidence of severe critical events was 3% (95% CI: 2.2-3.8). The most frequently reported severe critical incidents were of respiratory (2%; CI: 1.4-2.6) and cardiovascular origin (0.7%; CI. 0.3-1), while drug error, anaphylaxis and bronchial aspiration were very rare. There were no reports of perioperative cardiac arrest or patients with neurological damage.
CONCLUSIONS: This secondary analysis demonstrates that the incidence of severe critical incidence was lower in Italy in comparison to that reported for Europe. This low rate of critical events may be related to the high expertise and experience of the anesthesiologists in charge of the children in the Italian centres that participated to APRICOT.

KEY WORDS: Anesthesia; Child; Adverse effects; Airway management