{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T18:11:03Z","timestamp":1771006263023,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,12,12]],"date-time":"2016-12-12T00:00:00Z","timestamp":1481500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pediatric intraoperative emergencies are rare but it is crucial for an anesthesia resident to be proficient in their management. Even the more common emergencies like anaphylaxis may not happen frequently for this proficiency to occur. Simulation increases exposure to these rare events in a safe learning environment to improve skills and build confidence while standardizing curriculum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Anesthesia residents participated in a simulated case of intraoperative pediatric anaphylaxis to evaluate knowledge and performance gaps. The study also sought to determine whether a difference exists between second\u2010 (<jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>2) and third\u2010year (<jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>3) anesthesia residents when managing pediatric anaphylaxis and cardiopulmonary arrest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Anesthesia residents completed a standardized programmed simulation of intraoperative anaphylaxis in a 5\u2010year old undergoing tonsillectomy and adenoidectomy. Anaphylaxis presented and progressed to bradycardia and pulseless electrical activity if anaphylaxis went unnoticed or untreated. Key time points were recorded. A scripted debriefing and written evaluation followed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Average time to diagnose anaphylaxis was 7.6\u00a0min, and time to give epinephrine was 6.5\u00a0min. Thirty\u2010five percent of residents started epinephrine infusion following initial bolus. Average time calling for help between <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>3 and <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>2 residents was 2.5\u00a0min vs 5\u00a0min (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.01). <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>3 residents verbalized a broader differential, including malignant hyperthermia and pneumothorax. Progression to pulseless electrical activity occurred in 65% of sessions prior to epinephrine being administered. No resident initiated chest compressions for bradycardia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Important performance deficits were seen in senior anesthesia residents during a simulated case of pediatric intraoperative anaphylaxis. Although <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>3 performed better, deficits still existed. Anesthesia residents and training programs should partner in developing additional training recognizing anaphylaxis, pulseless electrical activity, and indication for chest compressions in a child.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13052","type":"journal-article","created":{"date-parts":[[2016,12,13]],"date-time":"2016-12-13T04:32:43Z","timestamp":1481603563000},"page":"205-210","source":"Crossref","is-referenced-by-count":17,"title":["Pediatric anaphylaxis in the operating room for anesthesia residents: a simulation study"],"prefix":"10.1111","volume":"27","author":[{"given":"Emily B.","family":"Johnston","sequence":"first","affiliation":[{"name":"Department of Anesthesia Baptist Health Paducah Paducah KY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Collin","family":"King","sequence":"additional","affiliation":[{"name":"Department of Anesthesia University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A.","family":"Sloane","sequence":"additional","affiliation":[{"name":"School of Medicine University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerral W.","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Anesthesia University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber Q.","family":"Youngblood","sequence":"additional","affiliation":[{"name":"Pediatric Simulation Center, Children's of Alabama Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry","family":"Lynn Zinkan","sequence":"additional","affiliation":[{"name":"Pediatric Simulation Center, Children's of Alabama Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy M.","family":"Tofil","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,12,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200702000-00009"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1097\/ALN.0b013e318238bcf6","article-title":"Simulation\u2010based assessment of pediatric anesthesia skills","volume":"115","author":"Fehr JJ","year":"2011","journal-title":"Anesthesiology"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2003.11.033"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2004.069914"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000082993.84883.7D"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181bbd443"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2007.01347.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03017379"},{"key":"e_1_2_10_10_1","first-page":"837","article-title":"First\u2010aid treatment of anaphylaxis to food: focus on epinephrine","volume":"113","author":"Simons F","year":"2004","journal-title":"J Allergy Clin Immunol"},{"key":"e_1_2_10_11_1","unstructured":"Society of Pediatric Anesthesia PediCrisis Checklists.http:\/\/www.pedsanesthesia.org\/newnews\/Critical_Event_Checklists.pdf. 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