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Survey of Paediatric Intubations and Grade of Anaesthetist

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Title: Survey of Paediatric Intubations and Grade of Anaesthetist


1
Survey of Paediatric Intubations and Grade of
Anaesthetist
  • M. C. Dale 1 , C. Cumming 2
  • 1 Specialty Trainee, Ninewells Hospital, Dundee
  • 2 Consultant Anaesthetist, Ninewells Hospital,
    Dundee
  • Contributions from C. Lee3, J. Hardy3, A. Kamat3
  • 3Senior Registrar, Ninewells Hospital, Dundee

2
Why do this survey?
  • Some would say tracheal intubation Gold
    standard of airway protection.

3
Background1
  • Tracheal intubation is a core skill
  • Necessary for patients of all ages.
  • Skills need to be maintained once competency is
    achieved.
  • Use of the Laryngeal Mask Airway and reduction of
    working hours have reduced trainees exposure to
    paediatric intubation.
  • 1. Yarrow S, Hare J, Robinson KN. Recent trends
    in tracheal intubation a retrospective analysis
    of 97 904 cases. Anaesthesia 200358 1019-1022.

4
Method
  • A retrospective analysis of paediatric
    anaesthetic data at Ninewells Hospital was
    collated for the period 03/01/2007 - 31/12/2008.

5
  • We looked at the following parameters
  • Total number of cases aged 0 13 years
  • Number of intubated vs. laryngeal masks vs.
    facemask cases
  • Age distribution of intubated cases
  • Time of day of intubations
  • Grade of anaesthetist performing intubation
  • Number of intubations per grade of anaesthetist
    for year

6
Shortcomings
  • Retrospective
  • Missing data 139 cases in 2007
  • 161 cases in 2008
  • Trainee supervised by consultant assume
    intubation done by trainee

7
Results
2007 2008
Total no. cases 2421 2267
Intubated patients 436 375
Laryngeal mask 1255 1375
Face mask 591 517
8
Airway management
9
Age distribution of intubated cases
10
2007
Time Consultant Trainee (direct supervision) Trainee (distant supervision) Total intubations
08h00-18h00 127 (38) 163 (49) 44 (13) 334
18h00-00h00 11 (13.5) 4 (5) 66 (81.5) 81
00h00-08h00 1 (5) 3 (14) 17 (81) 21
Total intubations 139 (31.9) 170 (39) 127 (29.1) 436
11
2008
Time Consultant Trainee (direct supervision) Trainee (distant supervision) Total intubations
08h00- 18h00 114 (39.9) 144 (50.3) 28 (9.8) 286
18h00- 00h00 8 (12.7) 4 (6.3) 51 (81) 63
00h00- 08h00 0 2 (7.7) 24 (92.3) 26
Total intubations 122 (32.5) 150 (40) 103 (27.5) 375
12
Neonatal Intubations
  • A consultant was always present in the
    anaesthetic room and theatre for paediatric cases
    aged below 1 year.
  • Neonates 4 in 2007
  • 7 in 2008

13
Average intubations/yr/grade of anaesthetist
2007 2008
Consultants 14.3 4-32 12.5 4-25
Trainees 7.7 1-24 6.5 1-26
14
Out of interest...
Trainee 1 5 Yrs _at_ N/W Trainee 2 4/12 _at_ RHSCE Trainee 3 4/12 _at_ RHSCE
Total cases 305 219 246
Intubated cases 64 74 110
Laryngeal mask 103 130 115
Face mask 138 15 21
15
CCT Documents
  • CCT documents II-IV Basic, intermediate and
    higher training.
  • Intermediate training (ST 34)
  • Strategies and practice for the management of
    paediatric emergencies in children loss of
    airway...

16
  • .....leading to this situation.

17
(No Transcript)
18
Conclusion
  • The numbers of intubated cases in the 0-13 yr age
    group is low 436 in 2007 and 375 in 2008.
  • Only 20.8 (n91) in 2007 and 26 (n98) in 2008
    of intubated children were aged 3 years or less.
  • In some areas of Scotland, within the adult
    population, new trainees carry out 50 intubations
    before providing anaesthesia without direct
    supervision3. Perhaps similar recommendations
    should be set for trainees delivering paediatric
    anaesthesia.

19
References
  1. Yarrow S, Hare J, Robinson KN. Recent trends in
    tracheal intubation a retrospective analysis of
    97 904 cases. Anaesthesia 200358 1019-1022.
  2. Tomlinson A. Effects of the EWTD on anaesthetic
    training in the UK. Anaesthesia 2005 60 96-97.
  3. Whymark C, Moores A, Macleod AD. A Scottish
    National Prospective Study of airway management
    skills in new-start SHOs. British Journal of
    Anaesthesia 2006 97 473-475.
  4. CCT in Anaesthesia II Competency Based Basic
    Level (ST 1 and 2) Training and Assessment. A
    Manual for Trainees and Trainers. Royal College
    of Anaesthetists, 2007.
  5. CCT in Anaesthesia III Competency Based
    Intermediate Level (ST 3 and 4) Training and
    Assessment. A Manual for Trainees and Trainers.
    Royal College of Anaesthetists, 2007.
  6. CCT in Anaesthesia IV Competency Based higher
    and Advanced Level (ST 5, 6 7 ) Training and
    Assessment. A Manual for Trainees and Trainers.
    Royal College of Anaesthetists, 2007.
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