Postal survey of paediatric practice and training among consultant anaesthetists in the UK

Abstract

A postal survey of previous paediatric anaesthetic training, current paediatric experience and management of an infant pyloromyotomy was undertaken among consultant anaesthetists in the UK. A total of 851 questionnaires were returned, giving a response rate of 31%; 352 (41%) consultants had at least one paediatric list each week, 180 (21%) anaesthetized more than one infant less than 6 months old each month and 373 (44%) had obtained more than 6 months' specialist training. Consultants trained most recently had received significantly longer (P < 0.001) specialist training than their senior colleagues: 558 (66%) consultants dealt with infants requiring a pyloromyotomy, 348 with one or two cases annually. Two-thirds preferred to use an i.v. induction technique and less than half used cricoid pressure. Choice of technique was related to the duration of specialist paediatric training and when it was received, but not to current paediatric anaesthetic experience. The results are discussed in relation to recently published recommendations on paediatric anaesthetic services.

Use of modified rapid sequence tracheal intubation in pediatric patients

“…[20] The results of surveys from the United Kingdom indicated that RSI was modified more frequently for infants. [21] Cricoid pressure would include hyperextension of the neck with placement of a hard neck rest beneath the cervical curve, which may not be applicable due to the small size of the child. In the literature, several publications refer to a MRSI with the use of inhalation induction[2223] and RSI after pre-loading with narcotics[2425] or without the use of muscle relaxants.-[26] In this survey, 33% of respondents would consider a MRSI without administration of muscle relaxant when concerned about a muscular pathology [Figure 4].…”

Improved outcomes in paediatric anaesthesia: contributing factors

“…Despite a clear inverse relationship between complications in paediatric anaesthesia and the number of anaesthetics administered, determining a minimum case volume is difficult. Nevertheless, Auroy et al [53,54] recommend a minimum of 200 cases annually.…”

Where should paediatric surgery be performed? Commentary Commentary Commentary

“…In 1997 Auroy et al showed that groups performing fewer than 100 paediatric anaesthetic procedures a year had a significantly increased complication rate compared with groups performing more than 200 procedures 17. Stoddart identified that a major problem of occasional paediatric anaesthetic practice is for the anaesthetist to remain up to date 18. There is broad agreement with this general philosophy19 20; however, it is not happening in practice as shown by the Digivote survey conducted by the Association of Anaesthetists Linkman Conference in 1996—only 60% of hospitals providing paediatric anaesthesia complied with the Royal College of Anaesthetists’ guidelines,21 22 and most disturbing of all only 62% of those present would be happy to allow their own children to be anaesthetised in their own hospital under its current arrangements 20…”

“…Training is also highlighted as a problem in other allied specialities such as paediatric intensive care40 and anaesthesia 18…”