Paediatric Regional Anaesthesia, Pain Management, and Sedation — WACS Viva & Clinical Scenarios (Paediatrics & Day Care)

Exam-style paediatric regional anaesthesia, pain management, and sedation viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 2-year-old boy weighing 12 kg is scheduled for repair of a large right-sided inguinoscrotal hernia. You plan a caudal epidural block under general anaesthesia. Describe your exact technique for landmark identification, needle advancement, prevention of intravascular/intrathecal injection, volume and concentration of local anaesthetic chosen, and adjuvant selection.
• SCENARIO 2: A 3-month-old infant born at 30 weeks post-menstrual age (current post-conceptual age 42 weeks, weight 3.2 kg) requires emergency right incarcerated inguinal hernia reduction and herniotomy. The neonatologist expresses grave concern regarding general anaesthesia-induced apnoea. How do you plan, position, dose, and execute awake spinal anaesthesia for this high-risk infant?
• SCENARIO 3: Immediately following the completion of a caudal epidural block with 0.25% bupivacaine in an anesthetized 4-year-old child (15 kg), the ECG shows sudden widening of the QRS complex, ventricular tachycardia, and severe hypotension. Detail your step-by-step management of this suspected Local Anaesthetic Systemic Toxicity (LAST) event, including resuscitation protocols and lipid emulsion therapy.
• SCENARIO 4: A 6-year-old child undergoing major open supraumbilical and infraumbilical laparotomy for choledochal cyst excision requires multimodal analgesia. Compare the utility, anatomy, and technique of bilateral ultrasound-guided TAP blocks versus rectus sheath blocks versus continuous thoracic epidural analgesia in this setting.