Qualität und sichere Anästhesie für alle Kinder

Zusammenfassung

Im Jahr 1989 haben die Vereinten Nationen die „United Nations Convention on the Rights of the Child“ (UNCRC) beschlossen und u. a. für Kinder der höchstmögliche Gesundheitsstandard gefordert. Safe Anaesthesia For Every Tot (SAFETOTS , www.safetots.org), eine Vereinigung von international tätigen Kinderanästhesist*innen, hat daraus 10 Rechte, die „10 R“ („10 Rights“) abgeleitet, die für die pädiatrisch-anästhesiologische Praxis von essenzieller Bedeutung sind. Das erste Recht (R1) postuliert: „Kinder haben das Recht, höchstmöglichen Gesundheitsstandard in Anspruch nehmen zu dürfen. Vor allem Kinder unter drei Lebensjahren sollen durch erfahrene Anästhesistinnen mit fundierter Ausbildung, kontinuierlicher Weiterbildung und regelmäßiger Tätigkeit in Kinderanästhesie betreut werden. Kinder mit signifikanter Komorbidität und diejenigen, welche hoch-spezialisierte oder große Eingriffe benötigen, profitieren von spezialisierter Kinderanästhesie in Kinderkliniken“. Die aktuelle Situation in der kinderanästhesiologischen Versorgung wird den Anforderungen, wie durch die UNCRC gefordert, nicht überall gerecht. Oft werden Ärztinnen in der Anästhesie ohne ausreichende kinderspezifische Expertise mit der anästhesiologischen Versorgung von Neugeborenen, Säuglingen und Kleinkindern beauftragt, was zu Morbidität und Letalität führt. Um Kindern zu ihrem verbrieften Recht auf bestmögliche Versorgung zu verhelfen, bedarf es Veränderungen. Es braucht Entscheidungsträger*innen, Politiker*innen und Standesvertreter*innen, die umdenken und bereit sind, die UNCRC umzusetzen.

Auf lokaler Ebene kann durch Reorganisation viel erreicht werden. Die Bündelung von operativen Eingriffen bei Kindern zusammen mit der Konzentration auf ein definiertes Team innerhalb einer Klinik führt bereits zu einer signifikanten Verbesserung.

Abstract

In 1989 the United Nations passed the “United Nations Convention on the Rights of the Child” (UNCRC) and, among others, demanded the highest attainable standard of health for children. Safe Anesthesia for Every Tot (SAFETOTS, www.safetots.org), an association of internationally active pediatric anesthetists, has derived 10 rights, the 10 R’s, which are of essential importance for the pediatric anesthetic practice. The first right (R1) postulates: “Children have the right to enjoy the highest possible standard of health. Children below the age of three years in particular should be treated by experienced anesthesiologists with profound and continuous training and regular activity in pediatric anesthesia. Children with significant comorbidities and those who need highly specialized or major interventions benefit from specialized pediatric anesthesia in pediatric centers”. The current situation in pediatric anesthesia care in Germany, Austria and Switzerland does not always meet the requirements demanded by the UNCRC. Anesthesia-related complications are approximately 10 times more frequent in children than in adults. In contrast to adults, children who are injured during anesthesia are often healthy. Severe complications in pediatric anesthesia have a mortality that is several times higher than in adult anesthesia. There are hardly any statistics on this for German-speaking countries but corresponding cases frequently occur in the context of expert opinions in liability litigation and in the press. Anesthesiologists are often charged with the anesthetic care of newborns, infants and small children without having sufficient child-specific expertise, which results in morbidity and mortality. In some places, only a few babies per year undergo general anesthesia in clinics without a specialized pediatric anesthesia team or a small number of infant anesthesia cases are divided among a large number of anesthesiologists. These case numbers are not even sufficient to maintain a single pediatric anesthesiologist in training in this age group.

Changes are needed to guarantee children the right to enjoy the highest attainable standard of health. We need decision-makers, politicians and professional representatives who rethink and who are willing to implement the UNCRC. This includes changing the current financing of hospitals in order that the quality actually provided is financed. The “pay for performance” must change to “pay for quality”. In addition to broad basic pediatric care, all complex forms of pediatric treatment must be carried out in specialized pediatric centers, particularly for small and severely ill children.

Significant improvement can be achieved at the local level by reorganization, bundling of pediatric surgical interventions within a clinical unit together with the concentration on a dedicated team.