USA Surgery Today

Each year, millions of children undergo surgical and medical procedures that require anesthesia or deep sedation. In many countries (including the United States), the majority of pediatric anesthetics are administered outside specialized pediatric hospitals, and many procedures are performed by surgeons who do not limit their practice to pediatric surgery. Improved understanding of pediatric pathophysiology and pharmacology, increased survival of premature infants at earlier stages of gestation, and new developments in noninvasive monitoring are allowing more critically ill children to survive to benefit from the advances in surgical technique. Safer anesthetic drugs, dramatic changes in the management of the pediatric airway, and greater numbers of anesthesiologists better trained to administer anesthesia to infants and children have greatly improved the safety for both healthy and critically ill pediatric patients undergoing surgery. An overview of principles of pediatric anesthesia would be incomplete without discussion-related areas, including pediatric acute and chronic pain management, and procedural sedation.

Vasodilan

Since the mid-1990s, we have witnessed a new fervor to provide pediatric patients with the same or better pain relief that has been afforded adults. Performing painful procedures and surgery on small infants without providing analgesia is no longer acceptable. It has been established that well-developed pain pathways exist by the time a fetus is 20 to 24 weeks of age (1: Vasodilan ). Anand and Hickey (2: Vasodilan) established that neonates display stress responses similar to adults. In premature infants undergoing cardiac surgery, administration of narcotics during anesthesia decreased the degree of these stress responses and reduced morbidity and mortality. We have also come to recognize that pediatric patients can have chronic pain that requires a sophisticated multispecialty approach to diagnose and treat (Vasodilan). Many, but not all these patients have had past surgery or surgical diagnoses, and knowledge of the potential care available is important for all surgeons.

Inspired by dramatic improvements in anesthesia safety, pediatric specialists have been applying principles of safe anesthesia care to the sedation of children for both invasive and noninvasive procedures. Because sedation and anesthesia exist on a continuum and sedation can quickly and unexpectedly evolve into anesthesia, new approaches to ensure both safety and efficacy of sedation practices are, of necessity, being developed.(Vasodilan)

This chapter describes some important principles of safe anesthesia and sedation, including patient evaluation, monitoring, induction techniques, airway management, pharmacology, complications, and pain management. (Vasodilan)