title: Successful and safe delivery of anesthesia and perioperative care for children with complex special health care needs.
abstract: OBJECTIVE
  To determine the utilization of anesthesia resources by children with complex special health care needs.
  
  
  METHODS
  Observational, inception cohort study of medical records.
  
  
  METHODS
  Urban, pediatric, tertiary-care hospital.
  
  
  METHODS
  All general anesthetic cases were screened for preexisting complex special health care needs. Medical records were reviewed for demographic, clinical, and outcome data.
  
  
  RESULTS
  435 children with complex special health care needs accounted for 479 delivered general anesthetic cases. This figure represented 14% of the total 3,437 cases presenting during the study period. It also represented 22% (49 of 224) of all cancellations. Down syndrome was the most identifiable developmental disorder (n = 43, 9%). Another 143 (30%) cases showed preexisting technology dependence. Scheduled surgical procedures (n = 425, 89%) comprised the majority of cases. Intraoperative and recovery room complications occurred in 6 (1%) and 133 (28%) cases, respectively. Eleven (2.3%) cases required unplanned post-anesthetic hospital ward or pediatric intensive care unit admission. Documentation of health care proxy or resuscitation status was not identified in any child under 18 years, and in only 4 of 33 children older than 18 years.
  
  
  CONCLUSIONS
  Children with complex special health care needs represented one out of 7 of all pediatric general anesthetic cases at a tertiary-care, academic center.
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, MA 02115-5724, USA. Robert.Graham@childrens.harvard.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Graham
authors.forename: Maria T
authors.initials: MT
authors.lastname: Wachendorf
authors.forename: Jeffery P
authors.initials: JP
authors.lastname: Burns
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Mancuso
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D018681:Anesthetics, General / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000150:complications; D004314:Down Syndrome / Q000150:complications; D005260:Female; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology
chemical_list: D018681:Anesthetics, General