The state of UK pediatric anesthesia: a survey of National Health Service activity

Abstract

This secondary analysis of the 2013 United Kingdom National Health Service (NHS) Anaesthesia Activity Survey of the Fifth National Audit Project (of the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland) shows pediatric anesthesia activity in detail. A local coordinator (LC) in every NHS hospital collected data on patients undergoing any procedure managed by an anesthetist. Questionnaires had 30 question categories. Each LC was randomized to a 2-day period. The pediatric age groups were infants, (<1 year), preschool age (1-5 year), and school age children (6-15 year). The median questionnaire return rate was 98%. The annual caseload was estimated to be 486 900 children: 36 500 infants, 184 700 preschool age, and 265 800 school age children. Almost 90% of children (1-15 year) were ASA 1 or 2 and the substantial majority underwent routine nonurgent ear nose and throat, dental, orthopaedics, or general surgery procedures; 65% were 'day cases'. One in six children were managed outside operating theater sites compared with one in 12 adults. Forty one per cent was in district general hospitals. Almost all ASA 4 and 5 children (89%) and infants (92%) were managed in specialist hospitals. 'Awake' cases and sedation accounted for only 2% of cases. There were notable differences in demography and anesthetic care compared with adults and between different age groups of children. These data enable analysis of the current state of UK pediatric anesthetic practice and highlight differences between pediatric and adult services.

Incidence of severe critical events in paediatric anaesthesia in the United Kingdom: secondary analysis of the anaesthesia practice in children observational trial (APRICOT study)

“…In a recent large UK survey, 90% of children (1–15 years old) were ASA physical status 1 or 2 and 41% were managed in district general hospitals. Almost all (89%) were ASA physical status 4 and 5 children, and 92% of infants were managed in specialist hospitals . The majority (84.8%) of the APRICOT UK cohort were ASA physical status 1 or 2 and 18.3% were managed in district general hospitals .…”

“…However, the pre‐study survey of UK participating centres estimated an annual paediatric anaesthesia case‐load in 2012 of over 212,000 patients. In a secondary analysis of the 2013 UK National Health Service (NHS) Anaesthesia Activity Survey of the Fifth National Audit Project (of the Royal College of Anaesthetists), the annual paediatric case‐load was estimated to be 486,900 children . The APRICOT UK cohort of 7040 patients, if annualised to 183,040, represents 38% of this estimated annual caseload.…”

Accidental awareness during anesthesia in children

“…From the recent UK anesthesia activity survey, the estimated number of anesthetics administered to children in the National Health Service per year is 463 400 and, using this as the denominator, the annual incidence of spontaneous verifiable reports of AAGA was just 0.002% (or ~1 : 51 500) . For practical reasons, direct questioning of large numbers of children was not carried out by NAP5, but if it had, and if the true incidence of AAGA was 0.74%, there could have been ~ 3500 children per year in the UK with AAGA.…”

“…Few children managed by anesthetists receive sedation but, if it is considered, it should be appreciated that recall of events are common during sedation and may be distressing . NAP5 showed that a surprising number of sedated adults were distressed by their experiences, and this suggests that their expectations were not met and that there was a failure in communication and consent.…”

Inhalative und intravenöse Anästhesie bei Kindern

“…So werden in Großbritan-nien nur 13 % aller Anästhesien bei Kindern und nur 1 % bei Neugeborenen und Säuglingen durchgeführt [48]. Vielfach fehlt dem Anästhesisten die Vertrautheit mit einem Patienten der entsprechenden Altersklasse.…”