{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:13:36Z","timestamp":1792066416162,"version":"4.4.0"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Propofol\u2010based total intravenous anesthesia is gaining popularity in pediatric anesthesia. Electroencephalogram can be used to guide propofol dosing to the individual patient to mitigate against overdosing and adverse events. However, electroencephalogram interpretation and propofol pharmacokinetics are not sufficiently taught in training programs to confidently deploy electroencephalogram\u2010guided total intravenous anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We conducted a quality improvement project with the smart aim of increasing the percentage of electroencephalogram\u2010guided total intravenous anesthesia cases in our main operating room from 0% to 80% over 18\u2009months. Balancing measures were number of total intravenous anesthesia cases, emergence times, and perioperative emergency activations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The project key drivers were education, equipment, and electronic health record modifications. Plan\u2010Do\u2010Study\u2010Act cycles included: (1) providing journal articles, didactic lectures, intraoperative training, and teaching documents; (2) scheduling electroencephalogram\u2010guided total intravenous anesthesia teachers to train faculty, staff, and fellows for specific cases and to assess case\u2010based knowledge; (3) adding age\u2010based propofol dosing tables and electroencephalogram parameters to the electronic health record (EPIC co, Verona, WI); (4) procuring electroencephalogram monitors (Sedline, Masimo Inc). Electroencephalogram\u2010guided total intravenous anesthesia cases and balancing measures were identified from the electronic health record. The smart aim was evaluated by statistical process control chart.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After the four Plan\u2010Do\u2010Study\u2010Act cycles, electroencephalogram\u2010guided total intravenous anesthesia increased from 5% to 75% and was sustained at 72% 9\u2009months after project completion. Total intravenous anesthesia cases\/mo and number of perioperative emergency activations did not change significantly from start to end of the project, while emergence time for electroencephalogram\u2010guided total intravenous anesthesia was greater statistically but not clinically (total intravenous anesthesia without electroencephalogram [16\u2009\u00b1\u200910\u2009min], total intravenous anesthesia with electroencephalogram [18\u2009\u00b1\u20099\u2009min], sevoflurane [17\u2009\u00b1\u20099\u2009min] <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Quality improvement methods may be deployed to adopt electroencephalogram\u2010guided total intravenous anesthesia in a large academic pediatric anesthesia practice. Keys to success include education, in operating room case training, scheduling teachers with learners, electronic health record modifications, and electroencephalogram devices and supplies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14791","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T16:11:07Z","timestamp":1699978267000},"page":"160-166","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Implementation of an electroencephalogram\u2010guided propofol anesthesia practice in a large academic pediatric hospital: A\u00a0quality improvement project"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4683-054X","authenticated-orcid":false,"given":"Sheri","family":"Jones\u00a0Oguh","sequence":"first","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4221-5790","authenticated-orcid":false,"given":"Rajeev S.","family":"Iyer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4821-0360","authenticated-orcid":false,"given":"Ian","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5800-8158","authenticated-orcid":false,"given":"Richard","family":"Missett","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8185-4926","authenticated-orcid":false,"given":"Rodrigo J.","family":"Daly\u00a0Guris","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenard W.","family":"Babus","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Massa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"McClung\u2010Pasqualino","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9163-9728","authenticated-orcid":false,"given":"Annery G.","family":"Garcia\u2010Marcinkiewicz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Sequera\u2010Ramos","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Dean","family":"Kurth","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Critical Care Medicine, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania  Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005945"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200512000-00007"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12090"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032196"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.04.022"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14021"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004262"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2020.06.007"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14520"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1062860615605176"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14176"},{"key":"e_1_2_10_13_1","volume-title":"Improving the Reliability of Health Care","author":"Nolan T","year":"2004"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2020-002303"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14480"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14791","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T04:14:44Z","timestamp":1705551284000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.14791"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,14]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1111\/pan.14791"],"URL":"https:\/\/doi.org\/10.1111\/pan.14791","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,14]]},"assertion":[{"value":"2023-06-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}