M. C. Dale 1 , C. Cumming 2

1 Specialty Trainee, Ninewells Hospital, Dundee2 Consultant Anaesthetist, Ninewells Hospital, Dundee

Contributions from: C. Lee3, J. Hardy3, A. Kamat3

3Senior Registrar, Ninewells Hospital, Dundee

Why do this survey?

Some would say tracheal intubation = ‘Gold standard’ of airway protection.

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 2003;58: 1019-1022.

Method

A retrospective analysis of paediatric anaesthetic data at Ninewells Hospital was collated for the period 03/01/2007 - 31/12/2008.

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 2007

161 cases in 2008• Trainee supervised by consultant: assume

intubation done by trainee

Results

2007 2008Total no. cases 2421 2267

Intubated patients 436 375

Laryngeal mask 1255 1375

Face mask 591 517

Airway management

0%

10%

20%

30%

40%

50%

60%

70%

Intubated Laryngeal mask

Face mask

19%

55%

26%16.50%

60.70%

22.80% 2007

2008

6%n=25

15%n=66

15%n=6863.6%

n=277

2007<1 yr1-3 yrs4-5 yrs6-13 yrs

Age distribution of intubated cases

9.60%n=36

16.50%n=62

12.30%n=46

61.6%n=231

2008

< 1 yr

1-3 yrs

4-5 yrs

6-13 yrs

2007Time 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

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

Neonatal Intubations

• A consultant was always present in the anaesthetic room and theatre for paediatric cases aged below 1 year.

• Neonates: 4 in 20077 in 2008

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]

Out of interest...

Trainee 15 Yrs @ N/W

Trainee 24/12 @ RHSCE

Trainee 34/12 @ RHSCE

Total cases 305 219 246

Intubated cases

64 74 110

Laryngeal mask

103 130 115

Face mask 138 15 21

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 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 supervision3. 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 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.