Implementation of an electroencephalogram‐guided propofol anesthesia practice in a large academic pediatric hospital: A quality improvement project

Background Propofol‐based total intravenous anesthesia is gaining popularity in pediatric anesthesia. Electroencephalogram can be used to guide propofol dosing to the individual patient to mitigate against overdosing and adverse events. However, electroencephalogram interpretation and propofol pharm...

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Bibliographic Details
Published in:Pediatric anesthesia 2024-02, Vol.34 (2), p.160-166
Main Authors: Jones Oguh, Sheri, Iyer, Rajeev S., Yuan, Ian, Missett, Richard, Daly Guris, Rodrigo J., Johnson, Gregory, Babus, Lenard W., Massa, Christopher B., McClung‐Pasqualino, Heather, Garcia‐Marcinkiewicz, Annery G., Sequera‐Ramos, Luis, Kurth, C. Dean
Format: Article
Language:English
Subjects:
Anesthesia, General - methods
Anesthesia, Intravenous - methods
Anesthetics, Intravenous
Child
Electroencephalography
Electronic health records
Hospitals, Pediatric
Humans
Pediatrics
Process controls
Propofol
Quality Improvement
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Summary:Background Propofol‐based total intravenous anesthesia is gaining popularity in pediatric anesthesia. Electroencephalogram can be used to guide propofol dosing to the individual patient to mitigate against overdosing and adverse events. However, electroencephalogram interpretation and propofol pharmacokinetics are not sufficiently taught in training programs to confidently deploy electroencephalogram‐guided total intravenous anesthesia. Aims We conducted a quality improvement project with the smart aim of increasing the percentage of electroencephalogram‐guided total intravenous anesthesia cases in our main operating room from 0% to 80% over 18 months. Balancing measures were number of total intravenous anesthesia cases, emergence times, and perioperative emergency activations. Methods The project key drivers were education, equipment, and electronic health record modifications. Plan‐Do‐Study‐Act cycles included: (1) providing journal articles, didactic lectures, intraoperative training, and teaching documents; (2) scheduling electroencephalogram‐guided total intravenous anesthesia teachers to train faculty, staff, and fellows for specific cases and to assess case‐based knowledge; (3) adding age‐based propofol dosing tables and electroencephalogram parameters to the electronic health record (EPIC co, Verona, WI); (4) procuring electroencephalogram monitors (Sedline, Masimo Inc). Electroencephalogram‐guided total intravenous anesthesia cases and balancing measures were identified from the electronic health record. The smart aim was evaluated by statistical process control chart. Results After the four Plan‐Do‐Study‐Act cycles, electroencephalogram‐guided total intravenous anesthesia increased from 5% to 75% and was sustained at 72% 9 months after project completion. Total intravenous anesthesia cases/mo and number of perioperative emergency activations did not change significantly from start to end of the project, while emergence time for electroencephalogram‐guided total intravenous anesthesia was greater statistically but not clinically (total intravenous anesthesia without electroencephalogram [16 ± 10 min], total intravenous anesthesia with electroencephalogram [18 ± 9 min], sevoflurane [17 ± 9 min] p 
ISSN:1155-5645
1460-9592
DOI:10.1111/pan.14791