Pediatric Anesthesia: A Guide for the Non-Pediatric Anesthesia Provider Part I

Author(s): Aysha Hasan, Andrea Gomez-Morad and Arvind Chandrankantan

DOI: 10.2174/9789815036245122010007

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Induction, Maintenance, and Emergence

Pp: 141-155 (15)

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Abstract

SHS investigation development is considered from the geographical and historical viewpoint. 3 stages are described. Within Stage 1 the work was carried out in the Department of the Institute of Chemical Physics in Chernogolovka where the scientific discovery had been made. At Stage 2 the interest to SHS arose in different cities and towns of the former USSR. Within Stage 3 SHS entered the international scene. Now SHS processes and products are being studied in more than 50 countries.

Abstract

Induction of anesthesia in the pediatric population differs significantly
compared to adult care. Many pediatric inductions are performed with a mask-only
technique. Intravenous access is rapidly obtained prior to securing the airway in the
majority of cases. Maintenance of anesthesia can be achieved via an inhalational agent,
intravenous agent, or a combination of both. Fluid should be administered judiciously.
Multimodal pain management is superior to an opioid-only technique. Premature or
sick infants and neonates require added glucose to their fluids and frequent glucose
checks. Additional intravenous access, arterial access, or foley should be obtained once
the patient’s airway is secure and the patient is under a surgical plane of anesthesia.
Emergence includes reversal agents if muscle relaxant was administered. Regardless of
deep versus awake extubation, preparations for significant emergence delirium should
be made for children aged 2-12 years. Common postoperative sequelae such as
laryngospasm and emergence delirium are discussed.

Keywords:

Bronchospasm, Emergence delirium, Fluid management, Inhalational induction, Intravenous induction, Laryngospasm, Maintenance of anesthesia, Oxygen desaturation, Pain, Parental presence induction, Postintubation stridor, Postoperative nausea and vomiting, Pulmonary edema, Respiratory insufficiency, Temperature instability, Temperature regulation.

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