General anesthesia without intravenous access in children--a survey of current practice among members of the APAGBI and UK regional representatives of the APAGBI and the AAGBI.

BACKGROUND: The establishment of intravenous (IV) access should be considered for all adults and children undergoing general anesthesia. Inhalational induction prior to the establishment of IV access remains a popular technique in pediatric practice, and most practitioners will subsequently obtain IV access at the earliest opportunity. Previous surveys have indicated that some anesthetists may elect to omit IV access for the duration of anesthesia and surgery; however, the extent of this practice is unclear. A survey of pediatric anesthetists (members of the APAGBI and regional representatives of both the APAGBI and the AAGBI) was conducted to determine the prevalence of anesthesia without IV access in children, together with the circumstances in which this would be considered by practitioners. METHOD: A web-based survey was distributed via email to members of the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) and regional representatives of both the APAGBI and the Association of Anesthetists of Great Britain and Ireland (AAGBI). In total, 1419 invitations to complete the survey were sent. RESULTS: Seven hundred and twenty seven completed surveys were returned, indicating a response rate of 51%. Twenty-eight respondents reported that they did not anesthetize children age <16 years. Of the remaining 699 respondents, 295 (42%) described circumstances where intravenous access was omitted during general anesthesia. The vast majority (84.7%) indicated that this was a rare occurrence. Only 44 (6.3%) respondents indicated they would always or usually undertake procedures under general anesthesia in children without IV access. Respondents suggested that short procedures, including dental extractions and myringotomy, were circumstances in which this practice was acceptable. CONCLUSION: The majority of respondents to this survey reported that they would usually establish IV access in children undergoing general anesthesia except in specific circumstances.

Anatomy and assessment of the pediatric airway.

Airway and respiratory complications are the most common causes of morbidity during general anesthesia in children. The airway changes in size, shape and position throughout its development from the neonate to the adult (1). Knowledge of the functional anatomy of the airway in children forms the basis of understanding the pathological conditions that may occur. This in turn allows a comprehensive assessment of the pediatric airway to take place, including a detailed medical history, clinical examination and specific investigative procedures.