Paediatric sedation in Rigshospitalet (Royal Hospital of Copenhagen) is based on the respect of children’s rights
Dr Torsten Lauritsen is Head of Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen.
He has more than 15 years of experience within the fields of paediatrics, neonatology, paediatric intensive care medicine and paediatric anaesthesiology.
He is an experienced teacher and has been involved in teaching resuscitation and paediatric anaesthesia for more than two decades, and in developing new international guidelines within the field. He has held numerous national and international honorary posts such as chair of the steering committee for the Scandinavian Fellowship in paediatric anaesthesia, president of the Danish Resuscitation Council, board member of the Danish society for Anaesthesiology and Intensive Care Medicine and medical advisor for the Danish Red Cross.
Dr Lauritsen’s research involves developing new educational tools in paediatric anaesthesia and paediatric emergency medicine such as The European Paediatric Anaesthesia e-Learning Platform (EPAP).
He’s supervising a project testing an emergency paediatric e-learning and training course for medical students at the University of Copenhagen and projects studying the effect of e-learning and dyad training on resuscitation skills for lay people. He is doing clinical trials including The Prevent Agitation trial on pain and PONV, projects on distraction using apps and feedback sensors as well as pre-clinical trials in an animal model of NEC.
Paediatric sedation in Rigshospitalet (Royal Hospital of Copenhagen) is based on the respect of children’s rights.
Head clinician Torsten Lauritsen tells us about the world of child anaesthesia that he is directing at the teaching hospital, Rigshospitalet, in Copenhagen.
– We have tremendous respect for the individual rights of a child. That is not just mere words; our daily practical work is done in accordance with the spirit of the UN Child Convention. Physical restraint of a child in connection with treatments of different kinds is therefore unacceptable and must not take place.
– In June 2019 I participated in a child anaesthesia meeting in Vienna where I gave a talk titled: “The Seriously Ill Child in the Emergency Setting”. This is how I would summarize the message:
“Treatment of procedural pain and anxiety in children in the emergency setting is a daily challenge in every emergency unit. Nevertheless, the discomfort can be minimized for the child, the parents and the caregiver:
- Good and safe procedural pain and anxiety control is achievable even for sick children.
- Implementing a protocol for sedation and pain relief in every situation.
- Restraining a child is never acceptable and should not occur.
- Training and education of staff will be a first step to change the culture.
- Non-pharmacological as well as pharmacological methods are effective.
- Even an ill or injured child needs pain and anxiety relief.”
Following the UN Child Convention has meant that
“Every human being under 18 is recognized as a child”
This is how it is defined in the Danish hospital system.
Paediatric anaesthesia is a large and complex speciality. The patients can weigh between 400 grams and up to about 100 kilo. It can be difficult to control and decide the level of anaesthesia especially among the smallest.
– A child is not a small adult. Children have completely different metabolism, their organs are undeveloped and they have different pharmacodynamics from adults. To initiate anaesthesia and control the level of anaesthesia we have a list of parameters to weigh, such as age, body weight, height, blood pressure, heart frequency, blood pH, breathing frequency, skin colour, muscular blockade and others. They are valuable control tools but as an anaesthesiologist I am not merely data driven. A computer cannot replace me; I am also a craftsman who is adding his experience, clinical vision and knowledge.
– It is important to maintain the homeostasis of the patient, a stable and constant condition towards the exterior. Important homeostatic mechanisms are besides circulation and breathing, thermoregulation, osmotic regulation and regulation of blood sugar levels.
– I am active in the organisation Safetots, an international cooperation for safer child anaesthesia. Safetots is about making anaesthetists more focused on safe child anaesthesia. It is about having the right organisational structures, a focus on a number of basic physiological and psychological parameters in children in the perioperative process, having a focus on training of persons who are anaesthetising children and to respect children’s rights.
Read more on www.safetots.org. Safe Anaesthesia for Every Child.
Torsten Lauritsen is of the opinion, that it is required, before anything else that everyone who works within health care knows about performing resuscitation,
– We continuously offer courses in resuscitation also for the general public and have published our experiences in relation to training of ordinary people in the resuscitation of children.
Finally, how do you want the anaesthetic drugs of the future to be?
– Quickly in, quickly out. No or few side effects.