There have been dramatic improvements in the survival of neonates and
children with many diseases and disorders due to advancements in medicine over the
past several decades. These advances are attributed to the better understanding of these
disease processes, the advent of multidrug combinations, molecularly targeted
therapies, critical care and various surgical interventions. In the wake of this rapidly
developing wide range of treatment protocols, the anesthesiologist needs to have a clear
understanding of these disorders and their comorbidities, and stay abreast of the various
treatment modalities, including their safety and toxicity profiles. This review attempts
to emphasize some of the clinical conditions unique to these patients and special
considerations for the conduct of anesthesia in this population.
Some of the disease processes and comorbidities discussed here include anesthetic
considerations for ex-premature infants, diabetes mellitus, obesity, childhood cancer,
and children with congenital heart disease who present for non-cardiac surgery. The
objective of this discussion is to provide an updated and comprehensive review of
current perioperative anesthetic management of pediatric patients with these
conditions. We also delineate the effects of anesthesia during the perioperative course,
including major metabolic changes that may result in increased morbidity. We provide
guidelines for any anesthesia provider involved in the care of these vulnerable patients.
Special considerations need to be taken to promote the physical and mental wellbeing
of these children and their families. Collaborative coordination with all providers
involved in care is essential to provide safe and effective anesthesia to this subset of
patients.
Keywords: Apnea, Bronchopulmonary dysplasia, Cardiotoxicity, Chemotherapy, Congenital heart defects, Continuous glucose monitoring, Diabetes type 1, Diabetes type 2, Ex-premature, Fontan, Hyperglycemia, Hypoglycemia, Insulin, Insulin pumps, Left-to-right, Leukemias, Low birth weight, Lymphomas, Media-stinal mass, Obesity, Prematurity, Pulmonary vascular resistance, Respiratory distress syndrome, Right-to-left, Systemic vascular resistance
