Discuss the unique considerations, challenges, and techniques involved in administering anaesthesia to children, including appropriate dosages, airway management, and monitoring in paediatric patients.
Paediatric Anaesthesia – Key Concepts & Practical Guide
| Aspect | Details |
|---|---|
| Definition | Administration of anaesthetic drugs and techniques to children (birth‑to‑18 yr) for surgery, diagnostics, or procedures. |
| Goals | • Provide analgesia, amnesia & immobility • Preserve physiologic stability (airway, ventilation, circulation, temperature, glucose) • Minimize peri‑operative stress and postoperative pain |
| Unique Challenges | • Anatomical & physiological differences from adults • Limited physiological reserve • Communication & cooperation issues • Drug dosing & pharmacokinetics variability |
| System | Pediatric Specifics | Clinical Implications |
|---|---|---|
| Airway | • Larger tongue relative to mouth • More cephalad, floppy epiglottis • Narrowest part at cricoid (circular) • Smaller functional residual capacity (FRC) |
• Rapid desaturation → need for pre‑oxygenation • Use appropriately sized cuffed or uncuffed tubes (size = (Age/4)+4) |
| Cardiovascular | • Higher baseline heart rate (HR) • Lower systemic vascular resistance • Limited ability to increase stroke volume |
• HR is primary determinant of cardiac output → avoid bradycardia • Fluid bolus may be needed before induction in hypovolemic infants |
| Respiratory | • Higher metabolic rate → ↑ O₂ consumption (6–8 ml kg⁻¹ min⁻¹) • Lower FRC, higher closing volume • More compliant chest wall |
• Faster fall in PaO₂ during apnea • Use gentle ventilation, avoid high peak pressures |
| Thermoregulation | • Large surface‑area‑to‑mass ratio • Limited brown‑fat stores & shivering response |
• Warm environment, active warming devices, fluid warming |
| Pharmacology | • Faster hepatic blood flow relative to size but immature enzyme systems • Larger volume of distribution for water‑soluble drugs • Higher clearance for some agents (e.g., propofol) |
• Dose by weight (mg kg⁻¹) with age‑adjusted limits • Titrate to effect, watch for prolonged recovery with certain drugs |
History
Physical Examination
Investigations (as indicated)
Risk Stratification