Paediatric imaging under general anaesthetic
Paediatric imaging under general anaesthetic
This page is probably beyond the purview of the Final exam, but is included because of the below guideline from 2021 and its appearance in an (unofficial) past paper.
Resources
- Following the death of a child undergoing an MRI under GA, a new consensus statement on best practice for requesting, vetting and consenting for non-invasive diagnostic procedures under GA in paediatric patients was published
- Risk of death under anaesthesia is 1:100,000 - 1:1,000,000 for healthy children undergoing non-emergency procedures
- Higher in younger children
- Higher in non-healthy children, who are more likely to need anaesthetic support for imaging (esp. if <4yrs old)
- Therefore the MDT should only undertake essential imaging where the results will impact on care / deferral would be detrimental to the patient
- Should always consider alternatives to GA, including:
- Procedural sedation
- Play therapist involvement to facilitate awake scanning
- Deferral until child is older
- The requesting clinician should contextualise the risk and explain risks/benefits/side-effects to the patient's parents
- Written information about risks relating to anaesthesia should be provided to the patient's parents as early in the care pathway as possible
- It should always be emphasised that no anaesthetic is risk free
- The requesting clinician should document the anticipated benefits and consequent risks of the imaging, including use of structured request and consent forms
- Consent for anaesthesia does not require signatures but does require a record of the discussion which took place
- Best practice for consent for diagnostic procedures under GA, where the GA itself poses the greatest risk, involves:
- All children requiring imaging under GA should be reviewed at paediatric pre-assessment clinic
- If it is felt health conditions impact on a patient's risk, they should be referred to anaesthetic pre-assessment clinic
- Patients identified as being high risk should be provided with appropriate information resources
- Consent for imaging under GA should involve an individualised assessment of the risk of GA and communication thereof
- The same standards of care apply for urgent or emergent procedures too
- In accordance with GMC guidance, consent for imaging and anaesthesia should be reconfirmed on the day of the procedure
'Clear, unambiguous communication and documentation throughout the perioperative pathway'