1. 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

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

3. 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 97 904 cases. Anaesthesia 2003;58: 1019- 1022.

4. 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

6. Shortcomings Retrospective Missing data:139 cases in 2007 161 cases in 2008 Trainee supervised by consultant: assume intubation done by trainee

7. Results 20072008 Total no. cases24212267 Intubated patients436375 Laryngeal mask12551375 Face mask591517

8. Airway management

9. Age distribution of intubated cases

10. 2007 TimeConsultantTrainee (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 TimeConsultantTrainee (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

12. 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

13. Average intubations/yr/grade of anaesthetist 20072008 Consultants14.3 [4-32]12.5 [4-25] Trainees7.7 [1-24]6.5 [1-26]

14. Out of interest... Trainee 1 5 Yrs @ N/W Trainee 2 4/12 @ RHSCE Trainee 3 4/12 @ RHSCE Total cases305219246 Intubated cases 6474110 Laryngeal mask 103130115 Face mask1381521

15. 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...

16. .....leading to this situation.

18. 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% (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.

19. References 1.Yarrow S, Hare J, Robinson KN. Recent trends in tracheal intubation: a retrospective analysis of 97 904 cases. Anaesthesia 2003;58: 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.