Paediatric Anaesthesia

Pre-operative Preparation

  • Building Rapport:

    • Use familiar objects like stethoscopes and masks to engage the child and reduce fear.

    • Play with the child to assess their behavior and determine if pre-medication is needed.

    • Build trust with parents by explaining the process and addressing their concerns.

  • Pre-anesthetic Clinics:

    • Conduct clinics a few days before surgery to familiarize the child with the environment and equipment.

    • Use this time to assess the child’s medical history, allergies, and recent illnesses (e.g., upper respiratory tract infections).

  • Setting Expectations:

    • Explain the induction method (gas or IV) to parents and involve them in the decision-making process.

    • Ensure parents are calm and supportive, as their anxiety can transfer to the child.

  • Pre-medication:

    • Consider pre-meds for anxious children, those with behavioral issues (e.g., ADHD, autism), or those with a history of traumatic anesthesia experiences.

    • Options include oral midazolam, intranasal dexmedetomidine, or ketamine, depending on the child’s needs and the situation. 📃(Notes)

Inductio Methods

Gas Induction:

  • Commonly used in children due to its non-invasive nature.

  • Use flavored masks to make the experience more pleasant.

  • Suitable for younger children or those who may not tolerate IV induction.

IV Induction:

  • Suitable for older children who can tolerate IV access.

  • Apply amla cream to facilitate painless cannulation.

  • Ensure all emergency drugs are prepared and ready before induction.

Pre-medication Options:

  • Midazolam:

    • Oral or intranasal;

    • effective for reducing anxiety

    • can cause paradoxical reactions or respiratory depression.

  • Clonidine:

    • Provides sedation and analgesia;

    • slower onset but longer duration.

  • Ketamine:

    • Useful for very anxious or uncooperative children;

    • can cause salivation and requires atropine.

  • Dexmedetomidine:

    • Intranasal option with minimal respiratory depression

    • can cause prolonged sedation.

Emergence and Extubatio

Deep vs. Awake Extubation:

  • Deep Extubation:

    • Reduces coughing and spasm

    • requires careful monitoring to ensure the child is deep enough.

  • Awake Extubation:

    • Ensures the child is fully awake and able to protect their airway

    • may cause coughing and agitation.

  • Managing Laryngeal Spasm:

    • Use CPAP, jaw thrust, and 100% oxygen to break the spasm.

    • Have emergency drugs like suxamethonium and atropine ready if the spasm is severe.

  • Post-operative Positioning:

    • Place the child in the left lateral position to manage secretions and reduce the risk of aspiration.

    • Ensure the child is breathing spontaneously and has no signs of airway obstruction before transferring to recovery.

Managing Complications

Laryngeal Spasm:

  • Most common emergency in pediatric anesthesia.

  • Three P's (pressure, propofol and paralysis)

    • Break the spasm with CPAP, jaw thrust, and 100% oxygen.

    • Administer suxamethonium and atropine if the spasm persists.

Post-operative Care:

  • Monitor for signs of airway obstruction, bleeding, or respiratory distress.

  • Ensure the child is fully awake and stable before discharge.

  • Don't start the next case until happy with the last.

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