Pediatric clinical challenges

  • Lucinda L. Everett
  • Gennadiy Fuzaylov


Pediatric patients present for a wide variety of ambulatory surgical procedures. In general, children are good candidates for ambulatory surgery, but the patient screening and selection process needs to ensure that significant associated conditions are avoided, particularly in the freestanding ambulatory setting. General patient selection concepts and overall risk information for the pediatric patient are presented. Specific clinical challenges presented by pediatric patients are summarized in this chapter, including respiratory issues such as respiratory infection and sleep apnea, gastrointestinal reflux, congenital heart disease, Down syndrome, neuromuscular disorders, and children with hematologic disorders and cancer.


Obstructive Sleep Apnea Sleep Apnea Congenital Heart Disease Down Syndrome Sickle Cell Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Meneghini L, Zadra N, Zanette G, et al. The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children. Paediatr Anaesth. 1998;8:11–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Patel RI, Hannallah RS. Preoperative screening for pediatric ambulatory surgery: evaluation of a telephone questionnaire method. Anesth Analg. 1992;75:258–261.PubMedGoogle Scholar
  3. 3.
    Murat I, Constant I, Maud’huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period. Paediatr Anaesth. 2004;14: 158–166.CrossRefPubMedGoogle Scholar
  4. 4.
    Patel RI, Hannallah RS. Anesthetic complications following pediatric ambulatory surgery: a 3-yr study. Anesthesiology. 1988;69:1009–1012.PubMedCrossRefGoogle Scholar
  5. 5.
    Hoffmann KK, Thompson GK, Burke BL, et al. Anesthetic complications of tympanostomy tube placement in children. Arch Otolaryngol Head Neck Surg. 2002;128:1040–1043.PubMedGoogle Scholar
  6. 6.
    Tiret L, Nivoche Y, Hatton F, et al. Complications related to anaesthesia in infants and children. Br J Anaesth. 1988;61:263–269.CrossRefPubMedGoogle Scholar
  7. 7.
    Morray JP, Geiduschek J, Ramamoorthy C, et al. Anesthesia-related cardiac arrest in children: initial findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology. 2000;93:6–14.CrossRefPubMedGoogle Scholar
  8. 8.
    Morray JP, Geiduschek JM, Caplan RA, et al. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology. 1993;78:461–467.CrossRefPubMedGoogle Scholar
  9. 9.
    Bhananker SM, Ramamoorthy C, Geiduschek JM, et al. Anesthesia-related cardiac arrest in children; update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg. 2007;105:344–350.CrossRefPubMedGoogle Scholar
  10. 10.
    Tiret L, Nivoche Y, Hatton F, et al. Complications related to anaesthesia in infants and children. A prospective survey of 40,240 anaesthetics. Br J Anaesth. 1988;61:263–269.CrossRefPubMedGoogle Scholar
  11. 11.
    Tay CL, Tan GM, Ng SB. Critical incidents in paediatric anaesthesia: an audit of 10,000 anaesthetics in Singapore. Paediatr Anaesth. 2001;11:711–718.CrossRefPubMedGoogle Scholar
  12. 12.
    Bordet F, Allaouchiche B, Lansiaux S, et al. Risk factors for airway complications during general anaesthesia in paediatric patients. Paediatr Anaesth. 2002;12:762–769.CrossRefPubMedGoogle Scholar
  13. 13.
    Mamie C, Habre W, Delhumeau C, et al. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Paediatr Anaesth. 2004;14:218–224.CrossRefPubMedGoogle Scholar
  14. 14.
    Coté CJ, Zaslavsky A, Downes JJ, et al. Postoperative apnea in former preterm infants after inguinal herniorrhaphy. Anesthesiology. 1995;82:809–821.CrossRefPubMedGoogle Scholar
  15. 15.
    Welborn LG, Rice LJ, Hannallah RS, et al. Postoperative apnea in former preterm infants: prospective comparison of spinal and general anesthesia. Anesthesiology. 1990;72:838–842.CrossRefPubMedGoogle Scholar
  16. 16.
    Henderson-Smart DJ, Steer P. Prophylactic caffeine to prevent postoperative apnea following general anesthesia in preterm infants. Cochrane Database Syst Rev. 2001;4:CD000048.PubMedGoogle Scholar
  17. 17.
    Williams JM, Stoddart PA, Williams SAR, et al. Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia. Br J Anaesth. 2001;86:366–371.CrossRefPubMedGoogle Scholar
  18. 18.
    Tait AR, Malviya S. Anesthesia for the child with an upper respiratory tract infection: still a dilemma? Anesth Analg. 2005;100:59–65.CrossRefPubMedGoogle Scholar
  19. 19.
    Schreiner MS, O’Hara I, Markakis DA, et al. Do children who experience laryngospasm have an increased risk of upper respiratory tract infection? Anesthesiology. 1996;85:475–480.CrossRefPubMedGoogle Scholar
  20. 20.
    Tait AR, Reynolds PI, Gutstein HB. Factors that influence an anesthesiologist’s decision to cancel elective surgery for the child with an upper respiratory tract infection. J Clin Anesth. 1995;7:491–499.CrossRefPubMedGoogle Scholar
  21. 21.
    Levy L, Pandit UA, Randel GI, et al. Upper respiratory tract infections and general anaesthesia in children. Peri-operative complications and oxygen saturation. Anaesthesia. 1992;47:678–682.CrossRefPubMedGoogle Scholar
  22. 22.
    Tait AR, Malviya S, Voepel-Lewis T, et al. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001;95:299–306.CrossRefPubMedGoogle Scholar
  23. 23.
    Tait AR, Pandit UA, Voepel-Lewis T, et al. Use of the laryngeal mask airway in children with upper respiratory tract infections: a comparison with endotracheal intubation. Anesth Analg. 1998;86:706–711.CrossRefPubMedGoogle Scholar
  24. 24.
    Jacoby DB, Hirshman CA. General anesthesia in patients with viral respiratory infections: an unsound sleep? Anesthesiology. 1991;74:969–972.CrossRefPubMedGoogle Scholar
  25. 25.
    Gross JB, Bachenberg KL, Benumof JL, et al. Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea. American Society of Anesthesiologists. Available at: pdf. Accessed July 5, 2007.Google Scholar
  26. 26.
    Blum RH, McGowan FX Jr. Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthetic implications. Paediatr Anaesth. 2004;14:75–83.CrossRefPubMedGoogle Scholar
  27. 27.
    Wilson K, Lakheeram I, Morielli A, et al. Can assessment for obstructive sleep apnea help predict postadenotonsillectomy respiratory complications? Anesthesiology. 2002;96:313–322.CrossRefPubMedGoogle Scholar
  28. 28.
    Strauss SG, Lynn AM, Bratton SL, et al. Ventilatory response to CO2 in children with obstructive sleep apnea from adenotonsillar hypertrophy. Anesth Analg. 1999;89:328–332.CrossRefPubMedGoogle Scholar
  29. 29.
    Brown KA, Laferriere A, Moss IR. Recurrent hypoxemia in young children with obstructive sleep apnea is associated with reduced opioid requirement for analgesia. Anesthesiology. 2004;100:806–810.CrossRefPubMedGoogle Scholar
  30. 30.
    Schwartz DA, Connelly NR, Theroux CA, et al. Gastric contents in children presenting for upper endoscopy. Anesth Analg. 1998;87:757–760.CrossRefPubMedGoogle Scholar
  31. 31.
    Warner MA, Warner ME, Warner DO, et al. Perioperative pulmonary aspiration in infants and children. Anesthesiology. 1999;90:66–71.CrossRefPubMedGoogle Scholar
  32. 32.
    Morris CD, Menashe VD. 25-year mortality after surgical repair of congenital heart defect in childhood. A population-based cohort study. JAMA. 1991;266:3447–3452.CrossRefPubMedGoogle Scholar
  33. 33.
    Warner MA, Lunn RJ, O’Leary PW, et al. Outcomes of noncardiac surgical procedures in children and adults with congenital heart disease. Mayo Clin Proc. 1998;73:728–734.CrossRefPubMedGoogle Scholar
  34. 34.
    Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis—Guidelines from the American Heart Association. Circulation (online publication); April 19, 2007 found at: 106.183095.Google Scholar
  35. 35.
    Kanamori G, Witter M, Brown J, Williams-Smith L. Otolaryngologic manifestations of Down syndrome. Otolaryngol Clin North Am. 2000;33:1285–1292.CrossRefPubMedGoogle Scholar
  36. 36.
    Brockmeyer D. Down syndrome and craniovertebral instability. Topic review and treatment recommendations. Pediatr Neurosurg. 1999;31:71–77.CrossRefPubMedGoogle Scholar
  37. 37.
    Sei Y, Sambuughin NN, Davis EJ, et al. Malignant hyperthermia in North America: genetic screening of the three hot spots in the type I ryanodine receptor gene. Anesthesiology. 2004;101:824–830.CrossRefPubMedGoogle Scholar
  38. 38.
    Yemen TA, McClain C. Muscular dystrophy, anesthesia and the safety of inhalational agents revisited; again. Paediatr Anaesth. 2006;16:105–108.CrossRefPubMedGoogle Scholar
  39. 39.
    Girshin M, Mukherjee J, Clowney R. The postoperative cardiovascular arrest of a 5-year-old male: an initial presentation of Duchenne’s muscular dystrophy. Paediatr Anaesth. 2006;16:170–173.CrossRefPubMedGoogle Scholar
  40. 40.
    Martyn JAJ, Richtsfeld M. Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology. 2006;104:158–169.CrossRefPubMedGoogle Scholar
  41. 41.
    Ames WA, Hayes JA, Crawford MW. The role of corticosteroids in Duchenne muscular dystrophy: a review for the anesthetist. Paediatr Anaesth. 2005;15:3–8.CrossRefPubMedGoogle Scholar
  42. 42.
    White RJ, Bass SP. Myotonic dystrophy and paediatric anaesthesia. Paediatr Anaesth. 2003;13:94–102.CrossRefPubMedGoogle Scholar
  43. 43.
    Wongprasartsuk P, Stevens J. Cerebral palsy and anaesthesia. Paediatr Anaesth. 2002;12:296–303.CrossRefPubMedGoogle Scholar
  44. 44.
    Shipton EA, Prosser DO. Mitochondrial myopathies and anaesthesia. Eur J Anaesthesiol. 2004;21:173–178.PubMedGoogle Scholar
  45. 45.
    DiMauro S, Schon EA. Mitochondrial respiratory-chain diseases. N Engl J Med. 2003;348:2656–2668.CrossRefPubMedGoogle Scholar
  46. 46.
    Morgan PG, Hoppel CL, Sedensky MM. Mitochondrial defects and anesthetic sensitivity. Anesthesiology. 2002;96:1268–1270.CrossRefPubMedGoogle Scholar
  47. 47.
    Yentis SM, Levine MF, Hartley EJ. Should all children with suspected or confirmed malignant hyperthermia susceptibility be admitted after surgery? A 10-year review. Anesth Analg. 1992;75:345–350.CrossRefPubMedGoogle Scholar
  48. 48.
    Pollock N, Langtont E, Stowell K, et al. Safe duration of postoperative monitoring for malignant hyperthermia susceptible patients. Anaesth Intensive Care. 2004;32:502–509.PubMedGoogle Scholar
  49. 49.
    Firth PG, Head CA. Sickle cell disease and anesthesia. Anesthesiology. 2004;101:766–785.CrossRefPubMedGoogle Scholar
  50. 50.
    Vichinsky EP, Haberkern CM, Neumayr L, et al. A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. N Engl J Med. 1995;333:206–213.CrossRefPubMedGoogle Scholar
  51. 51.
    Griffin TC, Buchanan GR. Elective surgery in children with sickle cell disease without preoperative blood transfusion. J Pediatr Surg. 1993;28:681–685.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Lucinda L. Everett
    • 1
  • Gennadiy Fuzaylov
    • 1
  1. 1.Harvard Medical School, Anesthesia and Critical CareMassachusetts General HospitalBostonUSA

Personalised recommendations