Aim:To determine the main reasons for cancellation of elective cases on scheduled date of surgery in pediatric patients.Materials and Methods:The audit was conducted in a 216 beds tertiary care pediatric super-specialty hospital. Two operation theatres (OT) provide elective surgical services to pediatric surgery, orthopedics, ophthalmology and otorhinolaryngology. The audit included all those patients who were posted for elective surgery over a period of one year. Cancelled cases were identified from predesigned OT utilization formats and the reasons for cancellation were evaluated.Results:A total of 2473 cases were posted for the elective surgery in the year 2009 and 189 (7.64%) patients had their surgery cancelled. The main reasons for cancellation were upper respiratory infections (30.68%) and shortage of time (29%). Other reasons were medically unfit patients (15.34%), precedence of emergency cases (3.7%); non-availability of ventilator and intensive care bed (4.7%); no-show by patient (4.76%); non-availability of blood (4.2%); incomplete work up (2.64%); administrative reasons (1.58%); patient not fasting (1.58%) and unspecified reasons (2.1%). Overall, 38.6% causes were preventable.Conclusions:Elective surgery cancellation is a significant problem with multifactorial etiology. Most common reasons for cancellation of planned surgery were sudden onset of respiratory tract infection in the admitted patient and shortage of time. It suggests that on many occasions, surgeons take more time than anticipated for performing the procedure.

Summary Background Videolaryngoscopy has an established role in difficult airway management in adults. However, there is limited literature to support their efficacy in children. The Truview Picture Capture Device has shown promising results for endotracheal intubation in infants in the past. The CMAC videolaryngoscope has launched its novel infant Miller blade, but its performance has not been assessed clinically for routine intubation in infants and neonates. We hypothesized that the CMAC videolaryngoscope would reduce the total time to intubation as compared to the Truview Picture Capture Device in neonates and infants. Methods After parental informed consent, 80 prospective infants posted for surgical procedures under general anesthesia were randomized to undergo intubation with either of the two. The two videolaryngoscopes were also compared in terms of time required for glottis view and intubation (primary outcome), modified Cormack and Lehane grade, first attempt and overall success rate, ease of intubation, number of attempts, and any complications. Results The CMAC significantly reduced the time required for glottic view [8 s (5.25‐9) vs 9 s (6.5‐12); P = 0.02] and intubation [22 s (18‐26) vs 26 s (21.5‐32); P = 0.003]. The median difference (95% CI) for time to tracheal intubation and time to glottic view was 4 s (1‐7) and 1 (0‐4). It also improved the ease of intubation, the Cormack‐Lehane grades, and first attempt success rate. Intubation with the CMAC was possible in 100% cases, whereas only 92.5% of patients could be intubated with the Truview. The failed intubations with the Truview could be successfully intubated with the CMAC. Conclusion The CMAC Miller blade reduced the total time taken for tracheal intubation and intubation difficulty as compared to the Truview Picture Capture Device and may be a better tool for intubation in infants.

Osteogenesis imperfecta (OI) is a rare disabling genetic connective tissue disorder. General anesthesia in these patients is associated with increased risks. Regional anesthesia is favored wherever feasible, but there are limited reports of use of a sole regional technique in OI in pediatric patients. Moreover, combined spinal-epidural anesthesia has never been described previously. We are reporting the use of combined spinal-epidural anesthesia for a prolonged surgery (multiple osteotomies) of lower limbs in a 10-year-old wheelchair-bound child with OI type III. Preoperative counseling, ultrasonography guidance, titrated local anesthetic dosage, and dexmedetomidine sedation helped establish optimum surgical conditions.

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