ANAESTHETIC CONSIDERATIONS IN PEDIATRIC EMERGENCIES
Hossam Saad Fetoh Ahmed Abdeen;
Abstract
Paediatric patients present unique anatomic, physiologic and pharmacologic considerations for the management of anaesthesia in the presence of diseases that occur exclusively or with increased frequency in this age group. Neonates (up to 28 days of age) and infants comprise the age group in which differences from adults are most marked. Neonates are more likely to experience adverse perioperative cardiopulmonary events. Pediatric patients deserve special considerations with respect to anatomic, physiologic and pharmacologic differences from adults (Bansal et al., 2013).
Paediatric anaesthesia involves perioperative critical care of patients of all ages ranging from preterm infants to teenagers. The differences in physiological characteristics makes anaesthetic management different and extremely challenging for the anaesthesiologist (Swamy et al., 2004).
It has long been recognised that anaesthesia-related complications, including anaesthesia-related cardiac arrest and mortality, occur more frequently in children, than in adults. While outcomes have improved over the last couple of decades, most likely as a result of better training and improved monitoring, and notably the introduction of pulse oximetry and capnography in the 1990s, paediatric anaesthesia-related cardiac arrests still occur. The incidence is 1.4-22:10 000 anaesthetics, and a subsequent mortality of approximately 30% (Lee, 2012).
Airway problems remain a leading cause of perioperative morbidity and mortality in children. Proficiency and expertise in airway management are, therefore, key elements for the safe conduct of anaesthesia in children. Clear strategies must be in place to successfully manage children with a normal, acutely impaired and expected difficult airway. Simple, forward only, easy to memorize and practice algorithms are essential in daily practice in preparation for the unexpected difficult paediatric airway. The child with the acutely impaired normal airway and known difficult airway is the domain of the experienced anaesthesiologist in an appropriately staffed and equipped paediatric setting (Engelhardt et al., 2013).
Paediatric anaesthesia involves perioperative critical care of patients of all ages ranging from preterm infants to teenagers. The differences in physiological characteristics makes anaesthetic management different and extremely challenging for the anaesthesiologist (Swamy et al., 2004).
It has long been recognised that anaesthesia-related complications, including anaesthesia-related cardiac arrest and mortality, occur more frequently in children, than in adults. While outcomes have improved over the last couple of decades, most likely as a result of better training and improved monitoring, and notably the introduction of pulse oximetry and capnography in the 1990s, paediatric anaesthesia-related cardiac arrests still occur. The incidence is 1.4-22:10 000 anaesthetics, and a subsequent mortality of approximately 30% (Lee, 2012).
Airway problems remain a leading cause of perioperative morbidity and mortality in children. Proficiency and expertise in airway management are, therefore, key elements for the safe conduct of anaesthesia in children. Clear strategies must be in place to successfully manage children with a normal, acutely impaired and expected difficult airway. Simple, forward only, easy to memorize and practice algorithms are essential in daily practice in preparation for the unexpected difficult paediatric airway. The child with the acutely impaired normal airway and known difficult airway is the domain of the experienced anaesthesiologist in an appropriately staffed and equipped paediatric setting (Engelhardt et al., 2013).
Other data
| Title | ANAESTHETIC CONSIDERATIONS IN PEDIATRIC EMERGENCIES | Other Titles | الاعتبارات التخديرية في عمليات الأطفال الطارئة | Authors | Hossam Saad Fetoh Ahmed Abdeen | Issue Date | 2015 |
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