An Overview of Pediatric Anesthesia
Anesthesia in children is very safe. However, critical events do occur, with more than half of them involving the respiratory system and the airway. To maintain safety, surgery and anesthesia for children can only be performed in centers with the correct staff training, equipment and physical environment. Professional organizations have guidelines for these requirements. The law gives parents the right to decide about a child’s treatment, but consent and the right to refuse treatment becomes more complicated as the child’s age increases towards 16–18 years and the child is more likely to have Gillick competency. Although there is overlap between the anesthetic techniques used in adults and children, the techniques used in adults are not always appropriate in children—for example, IV induction is not always best, and the technique for adult rapid sequence induction requires modification to prevent complications in children. Children will not always keep their hand still for an IV insertion, and will not always simply accept a facemask. Techniques to assist with these common tasks are used in pediatric practice. After anesthesia, children are more likely than adults to wake unhappy and upset, and will not always suffer pain quietly. Emergence delirium is a common problem and can spoil an otherwise good anesthetic experience for the family. There are several effective strategies to prevent it.
KeywordsSafety of pediatric anesthesia Emergence delirium Inhalational induction Day surgery in children Post extubation stridor Pediatric anesthesia services
Anesthesia Risk and Provision of Services
- ANZCA Guideline PS29 Statement on anaesthesia care of children in healthcare facilities without dedicated paediatric facilities. http://www.anzca.edu.au/resources/professional-documents. Accessed Feb 2019.
- Guidelines for the provision of paediatric anaesthetic services. In: Guidelines for the provision of anaesthetic services 2019. Chapter 10. Royal College of Anaesthetists 2018. https://www.rcoa.ac.uk/gpas2019. Accessed July 2019.
- General Medical Council of UK Ethical Guidance for Doctors. 0-18 years. Updated 2018. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/0-18-years/appendix-1. Accessed July 2019.
- Hivey S, Pace N, Garside JP, Wolf AR. Religious practice, blood transfusion, and major medical procedures. Pediatr Anesth. 2009;19:934–46. A long and detailed discussion from medical and legal points of view. General issues in pediatric consent are covered as well as the specific issue of blood transfusion in Jehovah’s Witness patients.CrossRefGoogle Scholar
- RCOA Consent and Ethics; Children and young people. https://www.rcoa.ac.uk/consent-ethics/children-young-people. Accessed July 2019. This webpage from the Royal College includes links to various UK sites, and some very good scenario-based discussions about children refusing treatment.
Induction and Aspiration
- ANZCA Guideline PS4. Recommendations for the post-anaesthesia recovery room. 2006. http://www.anzca.edu.au/resources/professional-documents. Accessed Feb 2019.
- Costi D, et al. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst Rev. 2014;(9):CD007084. https://doi.org/10.1002/14651858.CD007084.pub2.
- Martin S, et al. Guidelines on the prevention of post-operative nausea and vomiting in children. Association Paediatric Anaesthetists Great Britain & Ireland; 2016. www.apagbi.org.uk.
- Morgan J, et al. On behalf of the Association of Paediatric Anaesthetists of Great Britain and Ireland Guidelines Working Group on Thromboprophylaxis in Children. Prevention of perioperative venous thromboembolism in paediatric patients: guidelines from the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). Pediatr Anesth. 2018;28:382–91.CrossRefGoogle Scholar
Vaccination During Anesthesia
- Currie J, et al. The timing of vaccination with respect to anaesthesia and surgery. Association of Paediatric Anaesthetists of Great Britain and Ireland. https://www.apagbi.org.uk/sites/default/files/inline-files/Final%20Immunisation%20apa.pdf. Accessed July 2019.