M. C. Dale 1, C. Cumming 2 1 Specialty Trainee, Ninewells Hospital, Dundee 2 Consultant Anaesthetist, Ninewells Hospital, Dundee Contributions from: C.

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Presentation transcript:

M. C. Dale 1, C. Cumming 2 1 Specialty Trainee, Ninewells Hospital, Dundee 2 Consultant Anaesthetist, Ninewells Hospital, Dundee Contributions from: C. Lee 3, J. Hardy 3, A. Kamat 3 3 Senior Registrar, Ninewells Hospital, Dundee

Why do this survey? Some would say tracheal intubation = ‘Gold standard’ of airway protection.

Background 1 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 cases. Anaesthesia 2003;58:

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

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

Shortcomings Retrospective Missing data:139 cases in cases in 2008 Trainee supervised by consultant: assume intubation done by trainee

Results Total no. cases Intubated patients Laryngeal mask Face mask591517

Airway management

Age distribution of intubated cases

2007 TimeConsultantTrainee (direct supervision) Trainee (distant supervision) Total intubations 08h00- 18h (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

2008 TimeConsultantTrainee (direct supervision ) Trainee (distant supervision) Total intubations 08h00- 18h (39.9%)144 (50.3%)28 (9.8%)286 18h00- 00h00 8 (12.7%)4 (6.3%)51 (81%)63 00h00- 08h (7.7%)24 (92.3%)26 Total intubations 122 (32.5%)150 (40%)103 (27.5%)375

Neonatal Intubations A consultant was always present in the anaesthetic room and theatre for paediatric cases aged below 1 year. Neonates:4 in in 2008

Average intubations/yr/grade of anaesthetist Consultants14.3 [4-32]12.5 [4-25] Trainees7.7 [1-24]6.5 [1-26]

Out of interest... Trainee 1 5 N/W Trainee 2 RHSCE Trainee 3 RHSCE Total cases Intubated cases Laryngeal mask Face mask

CCT Documents: CCT documents II-IV: Basic, intermediate and higher training. Intermediate training (ST 3&4): Strategies and practice for the management of paediatric emergencies in children: loss of airway...

.....leading to this situation.

Conclusion The numbers of intubated cases in the 0-13 yr age group is low: 436 in 2007 and 375 in Only 20.8% (n=91) in 2007 and 26% (n=98) 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 supervision 3. Perhaps similar recommendations should be set for trainees delivering paediatric anaesthesia.

References 1.Yarrow S, Hare J, Robinson KN. Recent trends in tracheal intubation: a retrospective analysis of cases. Anaesthesia 2003;58: Tomlinson A. Effects of the EWTD on anaesthetic training in the UK. Anaesthesia 2005; 60: 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: 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, 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, 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.