Training in pediatric anesthesia in Japan: how should we come along?
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EDITORIAL
Training in pediatric anesthesia in Japan: how should we come along? Soichiro Obara1,2 · Norifumi Kuratani2,3 Received: 2 August 2020 / Accepted: 19 September 2020 © Japanese Society of Anesthesiologists 2020
Keywords Pediatric anesthesia · Training · Caseload · Volume–outcome relationship · Simulation
Introduction The potential long-term impact of surgery and anesthesia has been progressing over the past 20 years with a significant interest and academically challenging research activity on the several aspects of neurodevelopment [1, 2]. Although anesthesiologists are currently facing the likelihood that detectable developmental anesthetic neurotoxicity may not exist in a single and short exposure to general anesthesia in early life [3–6], they have not yet been able to prove or disprove this nonexistence [7]. In addition to long-term neurodevelopmental outcome, anesthesiologists still need to pay sufficient attention to immediate perioperative risks. Pediatric anesthesia-related mortality has decreased to approximately 1 out of 10,000 children who receive anesthetics (0.01%) in high-income countries [8–13]. However, the rates of pediatric anesthesiarelated severe adverse events remaining approximately 2–8% even in high-income countries [12–16]. A recent prospective cohort study, the Anesthesia Practice in Children Observational Trial (APRICOT), revealed a relatively high overall incidence (5.2%) of perioperative severe adverse events with large variability in anesthetic practices across 33 European countries [17]. Subsequently, there are rising trends of minimally invasive surgeries including robotic surgery [18] and sedation or anesthesia outside the operating room [19–21]. Although * Soichiro Obara [email protected] 1
Department of Anesthesia, Tokyo Metropolitan Ohtsuka Hospital, 2‑8‑1, Minami‑ohtsuka, Toshima‑ku, Tokyo 170‑8476, Japan
2
Teikyo University Graduate School of Public Health, Tokyo, Japan
3
Department of Anesthesia, Saitama Children’s Medical Center, Saitama, Japan
these practices are not different in pediatric and adult patients, they may offer unique challenges, requiring the anesthesiologists’ scrupulous knowledge and comprehension on the associated anatomical and physiological considerations in pediatric patients [22]. Given the challenges observed in studies related to anesthetic impact on neurodevelopment, children offer unique opportunities for anesthesiologists to consider lifelong consequences of any early intervention. Pediatric perioperative issues are facing challenges which require sustained efforts from anesthesiologists. However, training in pediatric anesthesia is reaching a turning point in Japan.
Volume–outcome association in pediatric anesthesia Training in the field of anesthesia is generally implemented, which comprises direct teaching, targeted supervision, and overall acquisition of knowledge, skills, and attitudes essential to the safe and effective delivery of anesthesia [23]. Basically, the more you are trained, the more you can advance
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