Enhancing the utility of virtual surgical pre-assessment.

During the COVID-19 pandemic, virtual pre-assessment was introduced for all elective and semi-urgent surgeries to maintain surgical clinical services in the authors' Trust. This mainly involved telephone pre-assessments, although occasionally video technology was used. This had to be managed and maintained at a distance with little or no training or established method. This article includes experiences of staff involved in a single tertiary centre, an assessment of the pros and cons of virtual pre-assessment and concludes with a set of recommendations to enhance the utility of the service for the future.

Morbidity after thoracoscopic resection of congenital pulmonary airway malformations (CPAM): single center experience over a decade.

PURPOSE: Video-assisted thoracoscopic (VATS) resection of CPAM in children is an established, albeit controversial strategy for its management. We report a 10-year single center experience. METHODS: All children underwent VATS (2008-2017) and their current status was reviewed. Patients were grouped: 'symptomatic-P' (if parents reported recurrent lower respiratory tract infections etc.) or 'symptomatic-S' (neonates presenting with respiratory distress/difficulty) or 'asymptomatic'. RESULTS: 73 children, aged 10 m (4d-14yrs) underwent VATS; a neonate as an emergency ('symptomatic-S') and all others electively. The lesion was unilateral in all but one case. Histologically none were malignant. Of the elective 72 cases, 7 (10%) required conversion to open thoracotomy. Twenty (27.7%) were 'symptomatic-P' and the duration of surgery when compared to 'asymptomatic' children was longer 269 (range 129-689) versus 178 (range 69-575) minutes (P = 0.01). Post operatively, 8 children (11%) had a grade III/IV (Clavien-Dindo) complication; persistent air leak/pneumothorax (n = 5), chylothorax (n = 1), pleural effusion (n = 1) and seizure/middle cerebral artery thrombosis (n = 1). There was no mortality. Twenty-four children (33.3%) were reported 'symptomatic-P' post-surgery after a median follow up of 2.18 years. The surgical intervention had no impact on 'symptomatic-P' status (P = 0.46). CONCLUSION: The risks of surgery may outweigh benefit in asymptomatic children. CLINICALTRIALS. GOV IDENTIFIER: NCT04449614.

Emergency anesthesia for evacuating a traumatic acute subdural hemorrhage in a child overdosed with hypertonic saline.

A previously healthy 1-year-old child with a traumatic acute subdural hemorrhage received 10 times higher dose of hypertonic saline inadvertently immediately before surgery. This case report describes deviations in fluid management needed to alleviate salt toxicity and its adverse effects during surgery under anesthesia perioperatively. The child made an uneventful recovery with no evident residual damage at follow-up.

Efficacy of paediatric anaesthetic trolleys: A call for a basic standard and layout.

BACKGROUND: Providing safe anaesthesia to children especially in emergency situations goes hand in hand with instant availability of appropriately sized equipment and monitoring. This is best achieved using a designated paediatric anaesthetic trolley containing essential equipment. Guidance for the contents of such trolleys is neither explicit nor standard. We used a survey and a qualitative enquiry to develop a checklist suitable for standardisation of contents and layout of paediatric anaesthetic trolleys. METHODS: We conducted an observational study of our current practice and paediatric anaesthetic trolleys in a tertiary care hospital. We also performed a qualitative enquiry from experienced paediatric anaesthetists and operating department practitioners.We developed an empirical checklist to ensure the minimum 'essential' equipment is available on these trolleys and implemented a standard layout to facilitate its use. RESULTS: We identified 11 areas in our hospital where anaesthesia is provided to children, each with a designated paediatric anaesthetic trolley. There were considerable deficiencies of items in all areas with no standard pattern or layout. Different types of trolleys contributed to the confusion. In addition, overstocking of inappropriate items hindered its efficient use. CONCLUSION: Standardising the contents and layout of the paediatric anaesthetic trolley is an essential pre-requisite for safer paediatric anaesthetic practice.