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Anaesthesia for manipulation of forearm fractures in children: a survey of current practice
1University Department of Anaesthesia, Leicester Royal Infirmary, Infirmary Square,Leicester LE1 5WW, UK.
Insights
Pediatric anesthesiologists show varied preferences for rapid sequence induction (RSI) in children undergoing forearm fracture surgery. Many do not consistently apply RSI, even when guidelines suggest it for all emergency surgeries.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Trauma Care
Background:
- Current guidelines recommend treating all pediatric surgical emergencies as having a full stomach.
- A local audit revealed inconsistent anesthetic techniques for pediatric trauma patients.
Purpose of the Study:
- To assess anesthesiologists' preferred anesthetic techniques for pediatric forearm fracture manipulation.
- To evaluate adherence to full stomach precautions in pediatric emergency surgery.
Main Methods:
- A postal questionnaire was distributed to 500 anesthesiologists.
- Four clinical scenarios were presented involving a 6-year-old child with a forearm fracture, varying injury timing, fasting, and analgesia.
- Respondents indicated their preferred anesthetic technique, including rapid sequence induction and tracheal intubation.
Main Results:
- 83% of anesthesiologists preferred rapid sequence induction for same-day surgery if the child had eaten 2 hours prior and received opioids.
- Preference for rapid sequence induction was lower among experienced anesthesiologists compared to trainees (P < 0.05).
- Only 34.5% preferred rapid sequence induction for delayed surgery and 19.3% for same-day surgery after 6 hours of fasting.
Conclusions:
- Anesthesiologists' application of rapid sequence induction for pediatric forearm fractures varies significantly.
- Not all practitioners adhere to the recommendation for rapid sequence induction in all pediatric emergency surgical cases.
- Further education or guideline clarification may be needed to ensure consistent practice.
Abstract:
Despite recent recommendations that all children presenting for urgent or emergency surgery should be treated as though they have a full stomach, a local audit had shown a wide variation in technique used for anaesthesia in children after trauma. Therefore, a postal questionnaire was sent to 500 anaesthetists regarding their preferred anaesthetic technique for a 6-year-old child requiring manipulation of a forearm fracture. Four clinical situations were presented differing in the timing of surgery in relation to the injury, starvation times before injury and the administration of opioid analgesia. Rapid sequence induction and tracheal intubation was preferred by 83% of all anaesthetists for surgery on the day of injury if the child had eaten 2 h prior to injury and had received opioid analgesia, but the percentage was significantly lower in experienced anaesthetists (P < 0.05) compared with trainees, and was 34.5% overall if surgery was delayed until the following day. Only 19.3% would perform a rapid sequence induction for surgery on the day of injury if the child had not eaten for 6 h before the injury. We conclude that not all anaesthetists believe that rapid sequence induction is necessary for anaesthesia after forearm fractures, despite recent recommendations.
