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Paediatric Day Case Anaesthesia — FRCA Final MCQ

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EasyDay SurgeryPaediatric Day Case AnaesthesiaFRCA Final

A healthy, appropriately fasted 5-year-old child weighing 20 kg is scheduled for bilateral myringotomy and grommet insertion as a day case. The child has no symptoms of an upper respiratory tract infection, no increased aspiration risk and no intravenous cannula in situ, and is very anxious about needles. Which is the most appropriate anaesthetic technique?

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Correct answer: B — Sevoflurane inhalational induction, supraglottic airway and spontaneous ventilation

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

Option A is the best technique. Grommet insertion is a brief, minimally painful day-case procedure in a child who is fasted and has no aspiration or respiratory risk factors. Sevoflurane permits a needle-free induction, while a supraglottic airway provides a secure, minimally stimulating airway without routine neuromuscular blockade or tracheal intubation. Spontaneous ventilation is suitable for such a short procedure, provided ventilation and end-tidal carbon dioxide are monitored and breathing is assisted if required. Options B and D impose unnecessary tracheal instrumentation and controlled ventilation; they would be reasonable only if patient or procedural factors required them. Ketamine sedation does not reliably provide the immobility and controlled conditions required for bilateral ear surgery. Local anaesthesia alone is generally unsuitable for a 5-year-old child.

Reference: Comparison of laryngeal mask airway and endotracheal tube in general anesthesia in children, systematic review and meta-analysis, 2023. https://pubmed.ncbi.nlm.nih.gov/37941592/