Paediatric Major General, Abdominal and Uro-Oncological Surgery — WACS Viva & Clinical Scenarios (Paediatrics & Day Care)

Exam-style paediatric major general, abdominal and uro-oncological surgery viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 3-year-old child weighing 13 kg presents with a huge, painless left flank mass diagnosed as a Wilms tumour. Preoperative CT demonstrates displacement of the aorta and extensive thrombus within the inferior vena cava extending to the retrohepatic segment. Outline your preoperative evaluation, vascular access strategy, invasive monitoring choices, and intraoperative plan for emergency IVC cross-clamping or sudden massive haemorrhage.
• SCENARIO 2: A 2-year-old child is scheduled for excision of a large abdominal neuroblastoma. Preoperative workup reveals hypertension (blood pressure 130/85 mmHg) and elevated urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA). Detail your anaesthetic management, covering preoperative alpha-blockade, induction technique, hemodynamic control during surgical dissection, and postoperative management.
• SCENARIO 3: A 6-week-old infant weighing 3.8 kg with progressive cholestatic jaundice and pale stools is scheduled for a Kasai portoenterostomy. Outline your anaesthetic considerations, focusing on hepatic drug clearance, management of underlying coagulopathy, fluid balance, intraoperative hypothermia prevention, and postoperative pain control.
• SCENARIO 4: A 4-year-old child is undergoing elective diagnostic and operative laparoscopy for an impalpable undescended testis. Five minutes after carbon dioxide insufflation at an intra-abdominal pressure of 14 mmHg in the steep Trendelenburg position, peak inspiratory pressure increases from 18 cmH₂O to 32 cmH₂O, EtCO₂ rises to 58 mmHg, and heart rate drops from 120 bpm to 65 bpm. How do you evaluate and treat this intraoperative deterioration?