P15

AIRWAY TOPICALISATION FOR PAEDIATRIC MICROLARYNGOBRONCHOSCOPY (MLB) AND OTHER AIRWAY PROCEDURES: REVIEW OF LOCAL PRACTICE AND CREATION OF NEW STANDARD OPERATING PROCEDURE (SOP)

K. Harvey-Kelly¹, D. Reichner¹, A. Miskovic¹, K. Brooks²

¹Great Ormond Street Hospital, London, UK

²Barts Health, UK

Background:

Airway topicalisation with local anaesthetic (LA) is common in paediatric anaesthesia to facilitate open airway procedures, reduce perioperative complications and provide analgesia. Topicalisation has a risk of LA toxicity and aspiration, however, guidance on LA dosing and fasting duration is limited. A review of literature and local practice was done to standardise nil-by-mouth time (NBM) and advise on LA dosing, via an SOP. The SOP aims to improve patient comfort, maintain safe practice in regards to aspiration risk and LA toxicity and provide clarity to trainees and recovery staff.

Methods:

Records of patients who underwent MLB at GOSH between September-December 2021 were reviewed. LA dose, fasting instructions, time nil-by-mouth and complications were recorded. A departmental survey was also undertaken to identify individual practice. Based on findings an SOP was introduced in November 2022 and a re-audit completed In July 2023.

Results:

224 records were reviewed, with no recorded episodes of LA toxicity, aspiration or intraoperative complications. 1% and or 4 % lidocaine were used in all cases with 2-3mg/kg (0.37-5.7) used in 72% of cases. Fasting instructions were undocumented in 23% of cases. Fasting times varied from 20 minutes-3h15, with 75% of children fasted over 1hr postoperatively. 25 doctors (92% Consultants) completed the survey. No experience of aspiration was recorded. 3mg/kg was the most commonly used LA dose (52%) and fasting times varied significantly.

Discussion:

Current literature supports the safe dose of 5mg/kg, with LA toxicity risk highest in neonates and infants. Aspiration risk is low and 1 hour fasting has been suggested following the biggest evidence review.

Conclusion:

An SOP was created to maintain safe practice, improve patient comfort by minimising fasting, and provide clarity to anaesthetists and recovery staff. Key points: children should be fasted for 1 hour post-topicalisation, a dose of 5mg/kg lidocaine is safe, volume and concentration of lidocaine is at the discretion of the anaesthetist. This has improved documentation and reduced the proportion of children fasted for over 1 hr.

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