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.

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BackgroundInterprofessional simulation-based team training has been highlighted as a means to improve team performance,1 The Simulated interPRofessional Team training programme (SPRinT) has published data on the effectiveness of such programmes.2 We aimed to explore and understand participant perspectives on the value of the interprofessional aspects of simulation in our established programme.MethodologyParticipants attending SPRinT courses completed questionnaires on five common themes related to interprofessional simulation, indicating their level of agreement with statements. Results were analysed according to three general professional groups; nursing staff, medical staff and anaesthetists.ResultsData was collected from 64 staff during 10 consecutive courses (91% response rate). The professional groups comprised 10 anaesthetists, 26 nursing staff and 22 medical staff.Medical and nursing groups indicated most of their previous simulation experience was with participants from mixed professional backgrounds (82% and 85% respectively). Anaesthetists indicated most previous simulation training had been with their own profession only (70%).All groups indicated similar levels of agreement that simulation improved their awareness of other professional’s roles (All groups: 100% agreement), helped break down workplace barriers (anaesthetists: 100%, nurses: 94%, medical: 91%) and improved their interprofessional team-working ability (anaesthetists: 100%, nurses: 100%, medical: 96%).Anaesthetists indicated that their specific technical training needs may be better met in solo profession simulation. This trend was not seen in the other groups.There was no distinct agreement amongst any groups as to whether participants felt more comfortable participating in groups of the same or multi-professional backgrounds.ConclusionsOur results show all participants valued the opportunity for interprofessional simulation training, particularly in regards to increasing awareness of team members’ roles, breaking down barriers and improving working relationships.Anaesthetists highlighted the on-going need for single profession simulation when focusing on specialty-specific technical skills.Good team functioning has been demonstrated to improve patient outcome in critical incidents. Our results support the role for interprofessional simulation training in improving team cohesiveness.ReferencesA review of simulation-based interprofessional education. Clin Simulat Nurs 2011;7(4):117–126Stocker M, et al. Impact of an embedded simulation team training programme in a paediatric intensive care unit: a prospective, single centre, longitudinal study. Intensive Care Med 2012;38(1):99–104