Checking pregnancy status in adolescent girls before procedures under general anaesthesia.

OBJECTIVE: Surgery, ionising radiation and anaesthesia in the presence of an undetected pregnancy could be harmful. British guidelines state that female patients of 'childbearing age' should have their pregnancy status established before surgery. Approaching this topic with an adolescent girl can be challenging. DESIGN: The authors conducted an observational study and a survey in their institution and a national survey of Association of Paediatric Anaesthetists (APA) linkmen. SETTING: Local: Southampton. National: UK. RESULTS: Both surveys demonstrate widespread concerns about inconsistent and informal practices. Only 45% of respondents in the authors' institution stated they ask adolescent girls if they could be pregnant. 40% of APA linkmen were unaware of national guidelines. CONCLUSIONS: This work illustrates the need for consistent national guidance. We propose that all girls who have reached menarche should be routinely offered a urine pregnancy test before any procedure under general anaesthesia.

Effect of head posture on tracheal tube position in children.

Changes in the tracheal tube tip to carina distance were measured by radiographic screening following various head postures in 45 children undergoing cardiac catheterisation under general anaesthesia who were intubated via nasal and oral routes. Extension of the head moved the tracheal tube away from the carina and flexion moved it towards the carina in both routes. Endobronchial intubation was noted during neck flexion in a significant proportion of children intubated orally but none occurred during nasal intubation. Extension produced greater upward movement of the tracheal tube tip in the oral route than the nasal route. In contrast, flexion produced greater downward movement in the nasal route in some patients. The direction of movement with lateral rotation and use of a shoulder roll was inconsistent.

The recruitment of EEA and non-EEA doctors to Specialist Registrar posts in anaesthesia in the Wessex Region of the UK: a retrospective study of factors influencing successful appointment.

BACKGROUND AND OBJECTIVE: A retrospective analysis of applicants to Specialist Registrar training posts in anaesthesia in the Wessex Region of the UK was undertaken. METHODS: Applicants whose primary medical qualification was obtained in the European Economic Area were compared to applicants whose primary medical qualification was obtained outside it. The time since qualification, the time spent in anaesthesia, the time spent in other specialities, the post currently held and the success of the application were recorded. RESULTS: For doctors with a primary medical qualification from outside the European Economic Area, the median time since obtaining that qualification was 12.0 yr compared with 6.0 yr for doctors qualifying within it (P = 0.0001, U-test). Thirteen out of 89 (15%) doctors whose primary medical qualification was from outside the European Economic Area and 39 out of 61 (64%) doctors whose primary medical qualification was from within it were shortlisted for interview (P = 0.0001, chi2-test). Six out of 13 (46%) shortlisted doctors from outside the European Economic Area were appointed at interview compared with 24 out of 39 (62%) shortlisted doctors who qualified within it (P = 0.33, chi2-test). CONCLUSIONS: In the Wessex Region of the UK, applicants whose primary medical qualification is obtained within the European Economic Area are approximately four times as likely to be shortlisted than doctors qualifying outside it. However, after shortlisting, both categories are equally likely to be successful at interview.

Multiple-choice examinations: adopting an evidence-based approach to exam technique.

Negatively marked multiple-choice questions (MCQs) are part of the assessment process in both the Primary and Final examinations for the fellowship of the Royal College of Anaesthetists. It is said that candidates who guess will lose marks in the MCQ paper. We studied candidates attending a pre-examination revision course and have shown that an evaluation of examination technique is an important part of an individual's preparation. All candidates benefited substantially from backing their educated guesses while only 3 out of 27 lost marks from backing their wild guesses. Failure to appreciate the relationship between knowledge and technique may significantly affect a candidate's performance in the examination.

Parents in the anaesthetic room: a questionnaire survey of departments of anaesthesia.

Thirty departments of paediatric anaesthesia in the United Kingdom were sent a questionnaire about their policies and practices regarding parental presence in the anaesthetic room. Of 22 respondents, 100% left the decision about whether a parent should be present for induction of anaesthesia to the individual anaesthetist and only 14% had written policy guidelines. All departments permitted parental presence at induction for elective surgery, compared with 77% for emergency surgery and 55% for a rapid sequence induction. The minimum age of child below which parents were not allowed at induction varied between no age limit and one year.

Caudal blockade in the management of aortic thrombosis following umbilical artery catheterisation.

A neonate, with a postconceptual age of 29 weeks, suffered thrombosis of the aorta as a consequence of umbilical artery catheterisation. This resulted in ischaemic lesions of the lower limbs and buttocks. Part of the management consisted of the insertion of an extradural catheter, via the caudal route, which provided good pain relief and may have improved lower limb blood flow.

Parents in the anaesthetic room. A questionnaire survey of parents' reactions.

One hundred and forty-one parents were asked to complete a questionnaire about their reactions after accompanying their child during induction of anaesthesia. Of 139 respondents, 99% believed that their presence was of benefit to their child, and 95% believed that they helped the anaesthetist. The degree of anxiety experienced by the parent did not significantly affect this view, nor was the degree of anxiety affected by the method of induction chosen by the anaesthetist.

Life-threatening complications during anaesthesia in a patient with a ventriculo-atrial shunt and pulmonary hypertension.

A 6-year-old patient with hydrocephalus who underwent revision of a ventriculo-atrial shunt is described. Anaesthesia was complicated by the occurrence of systemic hypertension and arterial hypoxaemia. The patient was subsequently found to have pulmonary hypertension secondary to recurrent pulmonary thromboembolism. The pathophysiological mechanisms for the patient's deterioration are discussed and the anaesthetic management of children with pulmonary hypertension is outlined. It is concluded that patients with a ventriculo-atrial shunt who present for surgery should be screened carefully for the presence of pulmonary hypertension.