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Clinical Outcomes For KKH Paediatric Anaesthesia

Paediatric anaesthesia department in KKH started in May 1997. Our anaesthesiologists specialise in care of children of all ages from newborns to young adults and administer anaesthesia to about 8000 cases per year.

The department provides anaesthetic services for a full range of disciplines which include:

  • General surgery
  • Ears, Nose and Throat (ENT)
  • Cardiothoracic
  • Ophthalmology
  • Orthopaedics
  • Cardiology
  • Gastroenterology

Complex cases are also managed such as neonatal surgery, surgery for premature infants, cardiac surgery and neurosurgery. Furthermore, the department also provides procedural sedation services within the hospital and pain service specifically for children with and chronic pain problems.

Critical incident reporting

As part of our hospital’s quality assurance programme, our department has an audit for every patient under our care and reports critical incidents that occur. This database serves as a quality indicator as well as a valuable source of learning to continually improve patient care and safety.

Our data has shown that the safety of our anaesthetic service is equivalent or even exceeds standards of international children centres. For example, regional anaesthesia has been gaining popularity as a supplement to general anaesthesia. From 2000-2010, we did a total of 36,471 regional anaesthetics. Only 34 (0.09%) critical incidents reported were directly due to regional anaesthesia and none had serious sequelae. Our rates are lower than some reported in the literature1, with rates reported as high as 0.12%.

We attribute our low incidence to strict departmental guidelines on regional techniques and dose of local anaesthesia. The use of ultrasound guided regional anaesthesia also helps in improving safety.

Aspiration is a rare but potentially fatal complication of anaesthesia. There were a total of 22 (0.029%) cases reported from 2000-2010 which is lower than some published rates of between 0.1 – 0.47% 2. None had any major sequelae such as unplanned ICU admission.

Dental injuries are also one of the most commonly reported adverse events associated with anaesthesia. The risk is higher in children as they have a higher incidence of loose and easily dislodged primary teeth.

A retrospective study done from 2000 to June 2011 found a total of 42 incidence of dental injury out of 80811 anaesthetics (0.05%). Studies have reported incidence from 0.05% to as high as 12%. Our low incidence of dental injury could be attributed to a high index of suspicion, accurate history and precise knowledge of patient’s dentition. We also have multiple levels of dental screening and diagrams to accurately detail loose teeth and gaps.


  1. Giaufre ES, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective sursvey of the French-Language Society of Pediatric Anesthesiologists. Anest Analg 1996; 83:904-912
  2. Borland LM, Sereika SM, Woelfel SK et al. Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome. J Clin Anesth 1998; 10:95-102.
  3. Warner ME, Benenfield SM, Warner MA, et al. Perianaesthetic dental injuries: frequency, outcomes and risk factors. Anesthesiology 1999;90: 1302–1305