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

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Why do this survey?

• Some would say tracheal intubation Gold
  standard of airway protection.

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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.

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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

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Shortcomings

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

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Results
2007 2008
Total no. cases 2421 2267
Intubated patients 436 375
Laryngeal mask 1255 1375
Face mask 591 517
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Airway management
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Age distribution of intubated cases
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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
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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

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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
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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
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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...

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• .....leading to this situation.

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(No Transcript)
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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.

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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.