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

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Induction, Maintenance, and Emergence

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

Pp: 141-155 (15)

DOI: 10.2174/9789815036245122010007

* (Excluding Mailing and Handling)

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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