The first annual NEPAN educational meeting was held on the 14th November 2013. One of the most successful components of the meeting was the Clinical Conundrums discussion. In this two, expert paediatric anaesthetists discussed their suggested management of a series of paediatric anaesthetic scenarios.
The new BTS guidelines mandate two group & save samples taken at separate times before cross-matched blood can be issued. How would the panel suggest this should be tackled for paediatric practice?
A 3kg 23 day old baby presents to A&E; in a DGH with a history and examination findings suggestive of bronchiolitis. She is having hypoxic episodes with frequent apnoeas and bradycardic episodes. Following review by the Consultants in Paediatrics, Anaesthesia and Intensive Care, a decision is made that she requires intubation and respiratory support. She is transferred to theatres where she is anaesthetised. The three Consultants present are unable to intubate her but are, with difficulty, able to oxygenate her with a Mapleson F system and facemask with an oropharyngeal airway. What should be the next steps in her management plan?
A 6 year old boy presents on a Saturday afternoon to A&E; at a remote DGH (which has A&E; facilities and inpatient Paediatrics, but no out-of-hours / emergency operating). He has a painful, swollen hemi-scrotum and a presumed diagnosis of testicular torsion is made. The local surgeon and anaesthetist are willing to undertake the procedure. The nearest hospital with emergency surgical provision is 40 minutes away, and their CEPOD list is busy. What should happen to this child? Should he be transferred or treated locally?
My hospital has a large, rural catchment area. Should we be imposing maximum travel times or distances when agreeing to day-case surgery for children? Should we consider this for certain age-groups, perhaps under-1s or under-5s?