81 - 85 SBAs for the Final FRCA
Question 81
A 4-year-old child with severe obstructive sleep apnoea is listed for adenotonsillectomy on your morning list. He has no allergies and no significant other medical history. He had a mild cold last week but has not had any symptoms for three days.
Which of the following is the most appropriate anaesthetic plan?
- Midazolam premedication followed by intravenous induction with propofol and fentanyl
- Cancel the case given his recent respiratory tract infection
- Intravenous induction with ketamine and fentanyl
- Rapid sequence induction with endotracheal intubation
- Gas induction with sevoflurane
Answer
- Gas induction with sevoflurane
A gas induction allows you to keep the child breathing and avoid muscle relaxation. The main benefit of this is that you have less risk of losing the airway and then struggling to find it again.
You want to avoid any unnecessary sedatives in kids with OSA as they're very sensitive.
A fasted child for elective surgery shouldn't require rapid sequence induction in the absence of other indications.
However attractive the thought of cancelling the case may seem, a mild cold with no symptoms for several days isn't really justifiable, especially given severe OSA makes cold and chest infections worse and more frequent.
You should also use short acting opioids for the procedure and employ a multimodal opioid sparing analgesic recipe in these kids.