Pediatric anaphylaxis in the operating room for anesthesia residents: a simulation study

Area of Science:

• Anesthesiology
• Pediatric Emergency Medicine
• Medical Simulation

Background:

• Pediatric intraoperative emergencies are rare, necessitating proficiency in management for anesthesia residents.
• Simulation offers a safe environment to practice rare events like anaphylaxis, improving skills and confidence.
• Standardized curricula are essential for consistent training in managing pediatric emergencies.

Purpose of the Study:

• To evaluate knowledge and performance gaps in anesthesia residents managing simulated pediatric intraoperative anaphylaxis.
• To compare the management skills of second-year (CA2) and third-year (CA3) residents in pediatric anaphylaxis and cardiopulmonary arrest.
• To identify specific areas for improvement in resident training for pediatric emergencies.

Main Methods:

• Anesthesia residents underwent a standardized simulation of pediatric intraoperative anaphylaxis during tonsillectomy/adenoidectomy.
• The simulation progressed to bradycardia and pulseless electrical activity if untreated, with key time points recorded.
• Post-simulation included a scripted debriefing and written evaluation to assess performance.

Main Results:

• Average diagnosis time for anaphylaxis was 7.6 minutes; epinephrine administration averaged 6.5 minutes.
• Only 35% of residents initiated an epinephrine infusion post-bolus; 65% experienced progression to pulseless electrical activity before treatment.
• Third-year residents (CA3) were faster at calling for help (2.5 min vs. 5 min for CA2) and considered a broader differential diagnosis.

Conclusions:

• Significant performance deficits exist in senior anesthesia residents managing pediatric intraoperative anaphylaxis.
• While CA3 residents showed better performance, notable gaps in recognizing anaphylaxis, pulseless electrical activity, and indications for chest compressions remain.
• Collaborative development of enhanced training is recommended for residents and programs to address these critical pediatric emergency management skills.