Summary

In study session VII you have learnt

• The differences between the adult and child can be classified as: anatomical, physiological, pharmacological, psychological and pathological
• Children are small and they require special equipment of the appropriate size (the neonate is one twentieth the size of the adult). Drugs and fluids are given according to the weight of the child
• The surface area is large in relation to weight .This means the child loses heat more easily and loses more fluid from the skin. The veins may be difficult to cannulate.
• The respiratory tract shows many differences and the child has limited respiratory reserve
• The infant's head and tongue are large and the airway is easily obstructed.
• The airways are small and easily blocked by secretions.
• The basal metabolic rate is higher in the child than the adult
• The respiratory centre in newborns is immature and they are prone to stopping breathing (apnoeas) for the first few weeks of life, especially if they become hypoxic
• The heart in infants is immature and sensitive to the depressant effects of anaesthetic agents.
• Vagal tone is well developed in infants and they are prone to reflex bradycardias (intubation, hypoxia, drugs)
• Isotonic solutions (Ringer's or 0.9% saline) should be used during surgery for all children.
• Renal function in infants is immature. They produce large volumes of dilute urine and can become dehydrated if fasted for prolonged periods of time. Conversely fluid requirements may be small in absolute terms and fluid overload should be avoided
• Infants have immature thermoregulatory mechanisms and are prone to heat loss, especially under anaesthesia, due to vasodilatation and loss of shivering
• Both the actions and side effects of many drugs differ in children from adults. Doses are calculated on a weight basis
• Paediatric anaesthetic equipment should have minimal resistance to breathing, minimal dead space. They should be light (not bulky), simple to use and provide humidification of inspired gases
• The anaesthetic equipment used for Paediatrics include ; Ayre's T-piece, Jackson Rees modification, and Draw-over system with Paedivalve
• A wide range of laryngoscopes is available for paediatric use. The straight blade laryngoscope is useful in neonates and infants (up to the age of 1 year). The curved blade may be used for children above the age of 1 year but the choice of the blade depends on the anaesthetist's preference.
• Uncuffed tracheal tubes are usually used in children to prevent problems with sub-glottic oedema or stenosis.
• Regional techniques as the sole anaesthetic are better avoided in those less than 15 years of age.
• Inhalational induction is frequently used with children.
• Intravenous induction is perhaps the kindest and quickest method in children who have accessible veins or an infusion running
• Intramuscular induction may be carried out using ketamine IM in patients who have no accessible veins and in whom an inhalational induction is not possible
• Prolonged starvation should be avoided and free clear fluids can be given orally up to 2 hours before elective surgery.
• Fluid resuscitation may be required if the child is dehydrated or hypovolemic.
• Intra-operatively replacement fluid with isotonic solution (Ringers or 0.9% saline), colloid or blood should be administered as required.
• The patient is observed in the recovery ward until fully awake, with careful monitoring of analgesia, fluids and oxygen therapy
• Early postoperative complications in children include laryngeal edema and laryngospasm