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Perioperative laryngospasm management in paediatrics: a high-fidelity simulation study
  1. Daphné Michelet1,2,
  2. Jennifer Truchot1,3,
  3. Marie-Aude Piot1,4,
  4. David Drummond1,5,
  5. Pierre-François Ceccaldi1,6,
  6. Patrick Plaisance1,3,
  7. Antoine Tesnière1,7,
  8. Souhayl Dahmani2,8
  1. 1Ilumens Simulation Department, University Paris Descartes, Paris, France
  2. 2Department of Anesthesia, Robert Debré Hospital, Paris, France
  3. 3Emergency Department, Lariboisière Hospital, Paris, France
  4. 4Psychiatry Department, Monsouris Mutualiste Institute, Paris, France
  5. 5Paediatric Pulmonology Department, Necker Hospital, Paris, France
  6. 6Gynecology and Obstetric Department, Beaujon Hospital, Clichy, France
  7. 7Department of Anaesthesia and Intensive Care, George Pompidou European Hospital, Paris, France
  8. 8INSERM U 1141, Robert Debré Hospital, Paris, France
  1. Correspondence to Dr Daphné Michelet, Department of Anaesthesia, Robert Debré Hospital, Paris 75019, France; daphne.michelet{at}aphp.fr

Abstract

Aim Paediatric anaesthesia is a very specialised domain lacking training during the traditional curriculum. The laryngospasm is a stressful and life-threatening event that requires immediate action. The main objective of this study was to assess the effect of knowledge of a simple algorithm on the management of laryngospasm by trainee anaesthetists and nurse anaesthetists during a high-fidelity simulation session.

Method Residents in paediatric anaesthesia and training nurse anaesthetists with similar curriculum were randomly allocated to undergo a simulation session of laryngospasm with the help of a simple algorithm administered to them 5 min before the simulation session (group A) or as taught in their curriculum (group C). The primary endpoint was the assessment score of laryngospasm management using 10 technical items (validated in experienced paediatric anaesthetists). Secondary endpoints were: the non-technical skills using the Anaesthetists' Non-Technical Skills (ANTS) score and timing of critical management steps. The correlation between the technical and non-technical scores was also studied. Data are expressed as median (range).

Results 72 participants (18 teams in each group) were included in this study. There was a statistically significant difference between group A and C on the primary endpoint: 8.5 (2–10) vs 5 (2–8), respectively (p<0.0001). There was also a significant difference between the two groups for the ANTS score 12 (7–16) vs 8 (6–12), respectively (p<0.0001). No difference in timing of management was observed. Finally, there was a strong correlation between the technical skills and all the non-technical skills categories in the A group.

Conclusion A simple algorithm improved the technical and non-technical skills of students during the management of a simulated laryngospasm.

  • laryngospasm
  • paediatric anaesthesia
  • High-fidelity simulation training

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Footnotes

  • Contributors DM: participated in study design, student recruitment, high-fidelity simulation sessions, video analysis, data analysis and interpretation, drafting and revising the manuscript and approved the final version. JT: participated in study design, high-fidelity simulation session, video analysis, data interpretation, drafting and revising the manuscript and approved the final version. M-AP, DD : participated in video analysis and approved the final version. P-FC, PP, AT: participated in data collection analysis and interpretation, drafting and revising the manuscript and approved the final version. SD: participated in study design, data collection analysis and interpretation, drafting and revising the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was approved by our institutional IRB (Comité d’Evaluation de l’Ethique des projets de Recherche Biomédicale de l’hôpital Robert Debré; # 2015/312(2)).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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