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Aspiration and regurgitation prophylaxis in paediatric anaesthesia
T Engelhardt1, L Strachan, G Johnston
1Department of Anaesthesia and Intensive Care, Grampian University Hospital Trusts, Foresterhill, Aberdeen AB25 9ZD, UK.
Insights
Paediatric anaesthetists do not routinely use acid aspiration prophylaxis. Perceived risk factors for aspiration vary with anaesthetist experience, influencing practice for emergency and elective paediatric surgery.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Surgical Safety
Background:
- No existing surveys address aspiration prophylaxis in pediatric anesthesia.
- Practices regarding fasting times and risk factors are not well-documented.
Purpose of the Study:
- To survey current practices of aspiration prophylaxis among UK pediatric anesthesiologists.
- To identify perceived risk factors for aspiration in pediatric surgery.
- To explore the influence of experience on these practices.
Main Methods:
- A postal survey was distributed to members of the Association of Paediatric Anaesthetists (APA) in the UK.
- The survey assessed fasting guidelines, routine prophylaxis, and perceived risk factors for different age groups and surgical types.
- Respondents' years of experience in pediatric anesthesia were also recorded.
Main Results:
- A 55.1% response rate was achieved, with 88 valid replies.
- Fasting guidelines: ~4h solids/milk & 2h liquids for emergencies; 5-6h solids/milk & 2h liquids for elective surgery.
- Pharmacological prophylaxis is not used; mechanical methods (cricoid pressure, NG aspiration) are variably employed. Hiatus hernia, previous aspiration, difficult intubation, cerebral palsy, and sepsis are key perceived risks.
Conclusions:
- Perceived risk factors for aspiration differ based on anaesthetist experience.
- Less experienced practitioners prioritize previous aspiration and renal failure, while more experienced ones focus less on hiatus hernia, difficult intubation, and cerebral palsy.
Background:
Surveys of aspiration prophylaxis in paediatric anaesthesia do not exist.
Methods:
A postal survey was sent out to all UK members of the Association of Paediatric Anaesthetists (APA) to assess current practice. We asked about minimum fasting times for liquids and solids/milk, their routine acid aspiration prophylaxis and perceived risk factors for emergency and elective surgery in children those less than 1 year old and those aged 1-14 years. We also asked if the APA member had more than 10 years experience in paediatric anaesthesia.
Results:
One hundred and two (55.1%) APA members replied out of a total of 185 questionnaires sent. Eighty-eight (88/102) were considered valid. Fasting in emergencies is approximately 4 h for solids/milk and 2 h for clear liquids. Fasting for elective surgery is between 5 and 6 h for solids/milk and 2 h for clear liquids. Pharmacological methods to reduce the risk of aspiration are not used. Mechanical methods vary from 40-50% for cricoid pressure and 20-30% for nasogastric aspiration if a tube is present. The presence of a hiatus hernia is perceived by over 80% as a risk factor, previous aspiration by over 60%, difficult intubation, cerebral palsy and sepsis by 20-30%.
Conclusion:
Perceived risk factors vary with "experience": hiatus hernia, difficult intubation and cerebral palsy are less important whereas previous aspiration and renal failure appear to be more important for paediatric anaesthetists with less than 10 years in paediatric anaesthetic practice.