Update Paediatric Anaesthesia

This article describes the anaesthetic management of some of the commonly performed paediatric ENT procedures, including adenotonsillectomy, oesophagoscopy, and middle ear surgery.Anaesthesia for Paediatric ENT Surgery – June 1, 2008

In some places, by necessity, children undergo anaesthesia with inadequate facilities. Transport to another unit is frequently not an option and the following article describes a method to adapt the EMO system for use in children under 15kg. The technique requires anaesthesia training and should not be attempted by someone without the ability to intubate.Anaesthesia in Children using the EMO System – June 1, 1998

This presentation will consider the physiology of the neonate and the premature infant in an attempt to explain the particular vulnerability of neonates undergoing anaesthesia and surgery.Babies and Anaesthesia – June 1, 2005

This paper will attempt to show how a sound knowledge of anatomy, physiology, pharmacology and psychology of infants and children and how they differ from adults helps to improve their care during anaesthesia and the perioperative period.Basic Sciences and Practical Paediatric Anaesthesia – June 1, 2000

In all areas of anesthesia, safety and efficiency are valued goals, and in developing countries additional challenges due to shortages of anesthetic drugs, supplies and monitoring equipment may be present. Caudal epidural anesthesia in developing countries, can in combination with general anesthesia or alone provide safe, reliable and efficient analgesia and / or anesthesia for both high risk and general pediatric surgical patients.Caudal Epidural Anaesthesia for Paediatric Patients – December 1, 2003

Circumcision is a common procedure which can be carried out under local anaesthetic. The block is simple to perform and surgery causes little patient distress and has few complications.Circumcision under Local Anaesthetic – June 1, 2004

For surgical repair of clefts to be performed safely requires a team approach. The optimum anaesthetic management will depend on the age of the patient, the availability of intraoperative monitoring equipment, anaesthetic drugs and expertise, and the level of postoperative care that is available.Cleft Lip and Palate Surgery – June 1, 2002

In many countries, because of health service constraints, cleft lips and palates are not repaired as infants and many hospitals do not have oxygen and volatile anaesthetic agents. In these situations a very different approach to the anaesthetic management of these cases may be indicated. Airway management is of paramount importance and any surgical treatment requires an experienced surgeon and anaesthetist used to working in the local environment.
Cleft Palate Surgery in Less Affluent Hospitals – June 1, 2002

This is a case report of the anaesthetic management of a patient with severe neck contractures.Difficult Airway Management in an Infant – June 1, 2006

This article reviews the pathophysiology, diagnosis, terminology and anesthetic management of the compromised fetus.Foetal Compromise – June 1, 2006

Inhalation of a foreign body (FB) is a potentially life threatening event, with boys in the age range 1 to 3 years most at risk. Resistance to gas flow is related to the fourth power of the radius, so a small reduction in airway radius in a child will result in a large increase in resistance to airflow. Inhalation of an organic FB may result in airway hyper-reactivity and mucosal oedema. The occurrence of oedema in addition to the physical presence of the FB results in a rapid increase in airway resistance. Coupled with the high oxygen consumption of infants and small children, hypoxia may rapidly occur.Foreign Body in a Child – Anaesthesia for Bronchoscopy – December 1, 2003

In many countries children are the victims of war trauma, road traffic accidents or severe dehydration and need good intravenous access, this technique can be life-saving. In these situations peripheral venous access can be difficult to obtain and alternatives such as central venous access can be difficult and/or dangerous.
Intraosseous Infusion – December 1, 2000

The commonest cause of paediatric airway obstruction is still the child with depressed conscious level. There has been a marked reduction in the incidence of epiglottitis, with a relative predominance now of viral croup and bacterial tracheitis, usually caused by Staphylococcus aureus.Large Airway Obstruction in Children – June 1, 2004

This article outlines the essential principles of safe paediatric anaesthesia covering the basics of anatomy, physiology and pharmacology emphasising the differences which exist between adults and children. It is divided into three sections; physiology, pharmacology and practical considerations.Paediatric Anaesthesia Review – June 1, 1998

Caudal anaesthesia (CA) is epidural anaesthesia of the cauda equina roots in the sacral canal, accessed through the sacral hiatus. CA is a common paediatric regional technique that is quick to learn and easy to perform, with high success and low complication rates.Paediatric Caudal Anaesthesia – December 1, 2010

This article describes and explains the Resuscitation Council’s algorithms for basic life support in children. Note that these guidlines will be updated in late 2010Paediatric life support – December 1, 2009

Spinal anaesthesia provides a good alternative to general anaesthesia in newborns with increased anaesthesia-related risk, and for infants undergoing lower abdominal or lower extremity surgery during the first 6 months of life. It is most successful as a single shot technique, limited to surgery lasting less than ninety minutes.Paediatric Spinal Anaesthesia – June 1, 2009

Starvation, surgery and anaesthesia cause stress and alter physiology. Intravenous fluids are administered perioperatively to maintain homeostasis during this period. Water and electrolytes are required to correct deficits and ensure adequate intravascular volume, cardiac output and ultimately tissue oxygen delivery. Calories in the form of dextrose may be needed to prevent hypoglycaemia.Perioperative Fluids in Children (2004) – December 1, 2004

Day case surgery has grown to about 50% to 60% of paediatric surgery is performed as outpatients in most of the western countries like USA and UK. In India, the incidence of paediatric day case surgery is low (about 35%), because of illiteracy, lack of proper transport facilities and unhygienic conditions at home.Postoperative Analgesia in Paediatric Surgery – December 1, 2000

Routine sedative premedication is unnecessary for the majority of children, although a few patients will require this, often based around previous experience. Analgesia drugs are particularly useful when given preoperatively as the analgesic effect is present on awakening. Drugs to reduce the pain of venepuncture are commonly used.Premedication Drugs useful for Children – December 1, 2004

The Resuscitation Council’s guidelines on neonatal life support are presented and discussed.A floppy baby is unconscious – a baby with good tone is not. Good airway management and effective rescue breaths are key to achieving oxygenation of fluid-filled lungs. Chest compressions and drug administration are rarely needed.
Resuscitation at birth – December 1, 2009

For most newborn babies a clear airway and a warm environment are all that is required. However, 25% of all deliveries are at increased risk of requiring resuscitation, and a further number of babies require resuscitation after a normal birth with no apparent risk factors. For these babies effective and efficient basic and advanced life support must be readily available.Resuscitation of the Newborn – June 1, 1994

Gaining intravenous access is a common procedure but may be difficult in hypovolaemic patients or those with difficult veins. When direct cannulation of a vein cannot be performed or is taking too long, a venous cutdown or intraosseous infusion are alternative methods of access to the circulation. These two techniques are described here.Venous Cutdown and Intraosseous Infusion – June 1, 1995