Paediatric, Adolescent, and Reconstructive Gynaecological Anaesthesia — WACS Viva & Clinical Scenarios (Gynaecology)

Exam-style paediatric, adolescent, and reconstructive gynaecological anaesthesia viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 13-year-old girl presents with severe cyclical lower abdominal pain, a palpable lower abdominal mass, and inability to pass urine for 12 hours. Ultrasound confirms massive haematometrocolpos secondary to an imperforate hymen. Describe your anaesthetic management for emergency hymenotomy and evacuation.
• SCENARIO 2: A 4-year-old girl with 21-hydroxylase deficiency (Congenital Adrenal Hyperplasia) is scheduled for elective feminising genitoplasty and clitoroplasty. She is on maintenance oral hydrocortisone and fludrocortisone. Formulate your preoperative assessment, perioperative steroid supplementation, intraoperative fluid/electrolyte management, and regional analgesia plan.
• SCENARIO 3: A 9-year-old girl is brought to the emergency theatre with acute right iliac fossa pain, persistent vomiting, and an ultrasound diagnosis of acute ovarian torsion. She had a light meal 2 hours prior to presentation. Detail your induction technique, physiological considerations, and postoperative analgesia.
• SCENARIO 4: A 16-year-old girl with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is scheduled for an ileal vaginoplasty (creation of a neovagina using an isolated ileal loop). The procedure involves both abdominal and perineal surgical teams. Outline your comprehensive anaesthetic plan including airway, regional/neuraxial techniques, and postoperative recovery.