Pediatric Airway Course
1st Hands-on Paediatric airway surgery course
In an effort to provide continuous medical education, Ganeshman Singh Memorial Academy of ENT-Head and Neck Studies, Tribhuvan University Teaching Hospital, has been conducting various workshops on a regular basis for the past few years. These workshops have been quite successful as they have been able to attract participants not only from Nepal but also from foreign countries like India, Pakistan and Sudan. To add a feather to the cap, the first hands-on paediatric airway surgery was recently organised in Ganeshman Singh Building, TUTH on 24th and 25th May 2014.
Airway related problem is quite challenging, more so in children. Quite a few paediatric patients with such problems have been regular visitors in our ENT OPD. Paediatric airway management, being a highly specialised branch of otolaryngology, is relatively not well developed in our setup and in other institutions in Nepal. So, an urge to conduct such a course covering this aspect was felt in order to learn the basics, to start with, of paediatric airway management. This actually was the brainchild of Prof. Rajendra Guragain, the head of department of GMSM Academy of ENT-Head and Neck Studies and also the chief of paediatric unit of the department.
Finding an expert on the subject was not so difficult since Prof. Ajoy Mathew Varghese from Christian Medical College, Vellore, who specialises in paediatric airway, kindly accepted our invitation to be our external faculty for the workshop. He along with his junior colleague, Dr. Syeed Kamran Asif were our esteemed external faculties. The workshop was scheduled to be a two-day program with cadaveric dissection on the first day and live surgery on the next day. However, Prof. Ajoy showed his eagerness to come a few days earlier in order to make sure he assessed not only the patients but our setup also so that he could familiarise himself with whatever was available at our institute before the workshop officially started. The patients, listed for the workshop, were assessed in the OPD and under general anaesthesia in the operation theatre next day for those deemed necessary. Assessment of airway under general anaesthesia proved to be very helpful especially in a child, who initially thought to have anterior laryngeal web, turned out to have juvenile respiratory papillomatosis.
The workshop started off on 24th April with with a lecture on paediatric tracheostomy by Prof. Ajoy Mathew Varghese. Following the lecture was cadaveric dissection demonstration of tracheostomy, anterior posterior cricoid split and cartilage interposition, partial cricotracheal resection, tracheal resection and anastomosis. Hands-on cadaveric dissection for the participants was in the afternoon where they carried out the procedures demonstrated in morning, under the supervision of the external faculties and faculties from the institute. There were 16 participants – 14 dissectors and 2 observers. The participants included 8 from Institute of Medicine, 2 from Kathmandu Medical College and Patan Academy of Health Sciences, 1 each from Civil Hospital, Kathmandu, Universal College of Medical Sciences, Bhairahawa, Manipal College of Medical Sciences, Pokhara and National Medical College, Birgunj.
On 25th April, the second day, there was a lecture on evaluation of stridulous child. This followed a full day of live surgeries namely endoscopic release of acquired anterior glottic web and excision of suprastomal granulations, endoscopic excision of RRP using microdebrider, cricofissure and posterior cricoid split with coastal cartilage grafting for bilateral abductor paralysis. The day ended with certificate distribution and banquet dinner at Hotel Radisson.
All in all, the workshop went smoothly. The external faculties were very approachable and eager to impart their knowledge, which made the workshop all the more interactive and academic. This was completely a new experience and exposure since workshop focussing on paediatric airway had never been done before. Most importantly, those who participated in the workshop had a lot to gain in terms of the knowhow of paediatric airway.
Making this workshop a success involved contributions from different sources. First and the foremost, the forensic department needs a mention for providing the cadavers, without which hands-on cadaveric dissection wouldn’t have been possible. The support from faculties, residents, the nursing staff and supporting staff of ENT department was noteworthy. The dean’s office and pharmaceutical companies like Magnus Pharma Ltd, Asian Pharmaceuticals, Nepal Pharmaceuticals Ltd and Quest Pharmaceuticals relieved the organising committee of a big chunk of financial burden. With a team effort, the workshop proved to be a mission accomplished.
Dr Urmila Gurung
1st Hands-on Paediatric airway surgery course