BackgroundChildren with hypertrophic cardiomyopathy (HCM) have historically been considered to be high-risk candidates for general anaesthesia (GA), but there is currently a paucity of evidence regarding the safety of anaesthesia and perioperative outcomes in this population.MethodsClinical features and outcomes of all paediatric patients (<18 years) with HCM undergoing GA between 2000 and 2016 were reviewed.Results86 patients (median 12.4 years (IQR 6.5, 14.9)) underwent 164 separate GA procedures. Aetiology included non-syndromic disease (n=44, 56%), malformation syndromes (n=22, 26%), inborn error of metabolism (n=10, 12%) and neuromuscular disease (n=4, 5%). At the time of GA, mean maximal wall thickness (MWT) on echocardiography was 19 mm (SD±8 mm), 23 (14%) patients had severe left ventricular hypertrophy (MWT>30 mm) and 35 (21%) patients had a haemodynamically significant left ventricular outflow tract (LVOT) gradient (>50 mm Hg). The majority (n=143, 87%) had no perioperative complications. 20 (12%) patients had minor perioperative complications: bradycardia (n=4), hypotension (n=15) or transient ST segment changes (n=1). One (0.6% of GA procedures) patient experienced a cardiac arrest during anaesthetic induction with death occurring 3 days later. Clinical parameters (including age, MWT, LVOT gradient, systolic and diastolic dysfunction) were not associated with an increased risk of complicationsConclusionsThis is the largest published series to date of paediatric patients with HCM undergoing GA, which demonstrates that, in an expert centre, patients can be anaesthetised with a relatively low perianaesthetic mortality (0.6%) and prevalence of minor complications (12%). Future studies are required to systematically identify clinical features that may predict anaesthetic risk.

Background: Craniocervical immobilization using halo body orthoses may be required in the management of children with craniocervical junction pathology. To date, the effect of such immobilization on perioperative anesthetic management has not been addressed in large series. Aims:The aim of this study was to review the airway management of children requiring halo body orthoses undergoing general anesthesia. Methods:The study was a retrospective case note review from a single institution.The neurosurgical database was interrogated to identify all patients less than 16 years of age that required a halo body orthosis from 1996 to 2015. We used the electronic patient record to identify all procedures performed under general anesthesia for these patients, either for halo application, or with the halo in situ. Details of techniques used for airway management were recorded, and paired data between individuals pre-and post-halo application were compared. Demographic data, diagnosis, and perioperative complications were also recorded. Results:We identified 90 children that underwent placement of a halo body orthosis. A total of 269 anesthetic records from these patients were analyzed and classified as pre-halo application, or halo in situ. Facemask ventilation was achieved in all patients, though some required simple airway adjuncts and may have been more difficult in the presence of the halo. Supraglottic airways were used successfully in many patients. There was a significant increase in the number of patients classed as Cormack and Lehane grades 3 or 4 on direct laryngoscopy with the halo in situ compared with before the halo was applied. The incidence of intubation using fiberoptic or videolaryngoscopy was higher with the halo in situ. Multiple intubation attempts were required in 3.4% (1/29) of patients undergoing anesthesia for halo placement compared with 15.1% (11/73) undergoing anesthesia with a halo in situ. Conclusion:Airway management in children with cervical spine pathology should be anticipated to be more difficult than the general pediatric population. This is likely to be due to co-existing pathology associated with cervical spine disease in children, limitation of neck movement to prevent further neurological injury, and the halo itself limiting access to the head. We recommend advanced preparation, and ensuring the immediate availability of an anesthetist with skills in managing the pediatric difficult airway to avoid complications in this patient population.

Objectives & BackgroundComputed tomography (CT) is becoming increasingly popular as a primary imaging modality in adult trauma patients. This study aims to examine the added value of thoracic CT (TCT) in the context of paediatric trauma.MethodsRetrospective review of the case notes of 182 consecutive paediatric trauma patients aged 16 and younger who received a chest X-ray (CXR) prior to TCT between January 2010 and April 2012 at a large tertiary paediatric trauma centre in East London.ResultsThe main mechanisms of injury involved were road traffic accidents (50%), stab injuries (31%), and falls (14%). One hundred and twenty one patients (66%) underwent a TCT scan following a normal CXR. Of these, thirty four (28%) patients had new injuries detected. These included lung contusions (n=20), small pneumothoraces (n=5) and rib fractures (n=3). Of the 61 (34%) patients that had a TCT scan following an abnormal CXR, 26 (43%) had additional injuries detected. These included lung contusions (n=8), fractured ribs (n=6) and small pneumothoraces (n=6). The additional information from the TCT did not alter clinical management in any of the above cases.ConclusionThis study indicates a need for a comprehensive guideline for imaging in paediatric trauma, where the use of TCT is limited to specific patients, especially in view of the health implications that CT poses and source of financial burden for the NHS.

Adequate skills and knowledge is necessary in pediatric cardiopulmonary resuscitation. We conducted a study to evaluate the current status of resuscitation knowledge and skills among the pediatric medical and nursing staff at the Royal London Hospital, London.