Physically restraining children for induction of general anaesthesia: survey of consultant paediatric anaesthetists.
Résumé
Objectives: To discover whether any consensus exists among Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) members regarding use and acceptability (or otherwise) of physical restraint. Background: Despite growing recognition of children's right to be consulted regarding their healthcare, the issue of how to proceed when faced with a child unwilling to undergo induction of general anaesthesia remains relatively unaddressed. Methods: APA members were surveyed regarding their use or avoidance of physical restraint and alternate techniques to facilitate induction; factors affecting choice of technique; and extent of preoperative discussion. The anonymous online survey used both structured and free-text responses. Results: Of 596 surveys, 310 were returned, a 52% response rate. Use of physical restraint and extent of restraint employed declines with increasing child age. Distraction techniques are frequently employed for children under 6 years old, with use of sedative premedication increasing as child age increases. Urgency of procedure, developmental delay, and preoperative discussion all have an affect. Comments demonstrated a wide range of views and lack of consensus on what constitutes physical restraint, and what degree of restraint, if any, is acceptable. Conclusion: Our results are similar to US Society of Pediatric Anesthesia members, suggesting this remains an issue internationally. Consideration of practices in other specialties give some guidance. Our survey shows a range of views as to what physical restraint is or involves, and what constitutes acceptable practice regarding use or avoidance of physical restraint. We were unable to demonstrate consensus.
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