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Chapter 25 - Pediatric Anesthesia

Published online by Cambridge University Press:  24 May 2023

By
Elyse M. Cornett ,
Alan David Kaye  and
Sonja A. Gennuso
Edited by
Alan David Kaye  and
Richard D. Urman
Alan David Kaye
Affiliation:
Louisiana State University School of Medicine
Richard D. Urman
Affiliation:
Brigham and Women’s Hospital, Boston
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Summary

Pediatric anesthesiology is a distinct subspecialty of anesthesia. It focuses on the perioperative care of preterm and term neonates, infants, children, and teenagers. The pediatric population is vastly different from adults, as the clinician must recognize variations in anatomy, physiology, pharmacodynamics, and pharmacokinetics. For example, infants and children under 3 years old have a greater rate of morbidity and mortality associated with anesthesia than adults [1, 2]. The American Society of Anesthesiologists Closed Claims Project reports almost half of malpractice litigation involving pediatric injuries have been related to adverse respiratory events associated with improper oxygenation and/or ventilation. It is important for anesthesiologists caring for children to have a detailed knowledge of the distinctions between pediatric and adult patients. This chapter will discuss anatomic, physiologic, and pharmacologic distinctions, as well as infection prevention and anesthetic considerations, in the pediatric population.

Type
Chapter
Information
Cambridge Handbook of Anesthesiology , pp. 399 - 410
Publisher: Cambridge University Press
Print publication year: 2023

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References

Tay, CLM, Tan, GM, Ng, SBA. Critical incidents in pediatric anaesthesia: an audit of 10 000 anaesthetics in Singapore. Pediatr Anesth. 2001;11(6):711–18.CrossRefGoogle Scholar
Kaye, AD, Fox, CJ, Padnos, IW, et al. Pharmacologic considerations of anesthetic agents in pediatric patients: a comprehensive review. Anesthesiol Clin. 2017;35(2):e73–94.CrossRefGoogle ScholarPubMed
Höhne, C, Haack, M, Machotta, A, Kaisers, U. [Atemwegsmanagement in der kinderanästhesie]. Anaesthesist. 2006;55:809–19.CrossRefGoogle Scholar
Dalal, PG, Murray, D, Messner, AH, Feng, A, McAllister, J, Molter, D. Pediatric laryngeal dimensions: an age-based analysis. Anesth Analg. 2009;108(5):1475–9.Google Scholar
Butterworth, JF, Mackey, DC, Wasnick, JD, eds. Morgan & Mikhail’s Clinical Anesthesiology, 5th ed. New York, NY: McGraw Hill; 2013.Google Scholar
Trabalon, M, Schaal, B. It takes a mouth to eat and a nose to breathe: abnormal oral respiration affects neonates’ oral competence and systemic adaptation. Int J Pediatr. 2012;2012:1–10.Google Scholar
Vrancken, SL, van Heijst, AF, de Boode, WP. Neonatal hemodynamics: from developmental physiology to comprehensive monitoring. Front Pediatr. 2018;6:87.Google Scholar
Miller, RD, Pardo, MC Jr, eds. Basics of Anesthesia, 6th ed. Philadelphia, PA: Elsevier; 2011.Google Scholar
Bueva, A, Guignard, J-P. Renal function in preterm neonates. Pediatr Res. 1994;36:572–7.Google Scholar
Rodieux, F, Wilbaux, M, van den Anker, JN, Pfister, M. Effect of kidney function on drug kinetics and dosing in neonates, infants, and children. Clin Pharmacokinet. 2015;54:1183–204.Google Scholar
Musso, CG, Ghezzi, L, Ferraris, J. Renal physiology in newborns and old people: similar characteristics but different mechanisms. Int Urol Nephrol. 2004;36(2):273–5.Google Scholar
Sulemanji, M, Vakili, K. Neonatal renal physiology. Semin Pediatr Surg. 2013;22(4):195–8.CrossRefGoogle ScholarPubMed
Doherty, TM, Salik, I. Physiology, neonatal. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2022. Available from: www.ncbi.nlm.nih.gov/books/NBK539840/.Google Scholar
Hines, RN. Developmental expression of drug metabolizing enzymes: impact on disposition in neonates and young children. Int J Pharm. 2013;452:3–7.CrossRefGoogle ScholarPubMed
Figaji, AA. Anatomical and physiological differences between children and adults relevant to traumatic brain injury and the implications for clinical assessment and care. Front Neurol. 2017;8:685.Google Scholar
Szpecht, D, Szymankiewicz, M, Nowak, I, Gadzinowski, J. Intraventricular hemorrhage in neonates born before 32 weeks of gestation – retrospective analysis of risk factors. Childs Nerv Syst. 2016;32(8):1399–404.CrossRefGoogle ScholarPubMed
Beardsall, K, Dunger, D. The physiology and clinical management of glucose metabolism in the newborn. Endocrine Rev. 2007;12:124–37.Google Scholar
Zijlmans, WCWR, van Kempen, AAMW, Serlie, MJ, Sauerwein, HP. Glucose metabolism in children: influence of age, fasting, and infectious diseases. Metabolism. 2009;58:1356–65.Google Scholar
Bester, K, Pretorius, T. Intraoperative glucose management in children < 1 year or < 10 kg: an observational study. South Afr J Anaesth Analg. 2017;23(5):119–22.Google Scholar
Cowett, RM, Loughead, JL. Neonatal glucose metabolism: differential diagnoses, evaluation, and treatment of hypoglycemia. Neonatal Netw. 2002;21:9–19.Google Scholar
Tourneux, P, Libert, JP, Ghyselen, L, et al. [Échanges thermiques et thermorégulation chez le nouveau-né]. Arch Pediatr. 2009;16:1057–62.Google Scholar
Soll, RF. Heat loss prevention in neonates. J Perinatol. 2008;28:S57–9.Google Scholar
Kumar, V, Shearer, JC, Kumar, A, Darmstadt, GL. Neonatal hypothermia in low resource settings: a review. J Perinatol. 2009;29:401–12.CrossRefGoogle ScholarPubMed
Stoelting, RK, Hines, RL, Marschall, KE. Stoelting’s Anesthesia and Co-existing Disease. Philadelphia, PA: Saunders/Elsevier; 2012.Google Scholar
Olsson, GL. Inhalational anaesthesia at the extremes of age: paediatric anaesthesia. Anaesthesia. 1995;50(s10):34–6.Google Scholar
Edginton, AM, Fotaki, N. Oral drug absorption in pediatric populations. In: Dressman, JB, Reppas, C, eds. Oral Drug Absorption: Prediction and Assessment, 2nd ed. (Vol. 193) (Drugs and the Pharmaceutical Sciences). Informa Healthcare; 2010, pp. 108–26.Google Scholar
Lu, H, Rosenbaum, S. Developmental pharmacokinetics in pediatric populations. J Pediatr Pharmacol Ther. 2014;19:262–76.Google Scholar
Kaye, AD, Fox, CJ, Padnos, IW, et al. Pharmacologic considerations of anesthetic agents in pediatric patients: a comprehensive review. Anesthesiol Clin. 2017;35(2):e73–94.Google Scholar
Pardo, MC Jr, Miller, RD, eds. Basics of Anesthesia, 7th ed. Philadelphia, PA: Elsevier; 2018.Google Scholar
Brooks, MR, Golianu, B. Perioperative management in children with chronic pain. Pediatr Anesth. 2016;26(8):794–806.CrossRefGoogle ScholarPubMed
Coté, CJ, Lerman, J, Anderson, BJ. The practice of pediatric anesthesia. In: Coté, CJ, Lerman, J, Anderson, BJ, eds. A Practice of Anesthesia for Infants and Children, 6th ed. Philadelphia, PA: Elsevier; 2019, pp. 1–7.Google Scholar
Macfarlane, F. Paediatric anatomy and physiology and the basics of paediatric anaesthesia. 2005. Available from: https://resources.wfsahq.org/atotw/paediatric-anatomy-and-physiology-and-the-basics-of-paediatric-anaesthesia/.Google Scholar
Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195–283.CrossRefGoogle ScholarPubMed
Sessler, DI. Perioperative thermoregulation and heat balance. Lancet. 2016;387:2655–64.Google Scholar
Morse, J, Blackburn, L, Hannam, JA, Voss, L, Anderson, BJ. Compliance with perioperative prophylaxis guidelines and the use of novel outcome measures. Pediatr Anesth. 2018;28(8):686–93.Google Scholar
Miller, MR, Griswold, M, Harris, JM, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics. 2010;125:206–13.Google Scholar
Samaranayake, L, Matsubara, VH. Normal oral flora and the oral ecosystem. Dent Clin North Am. 2017;61(2):199–215.Google Scholar
Martin, LD, Kallile, M, Kanmanthreddy, S, Zerr, DM. Infection prevention in pediatric anesthesia practice. Paediatr Anaesth. 2017;27:1077–83.Google Scholar
Tobias, JD. Preoperative anesthesia evaluation. Semin Pediatr Surg. 2018;27(2):67–74.Google Scholar
Ghazal, EA, Vadi, MG, Mason, LJ, Coté, CJ. Preoperative evaluation, premedication, and induction of anesthesia. In: Coté, CJ, Lerman, J, Anderson, BJ, eds. A Practice of Anesthesia for Infants and Children, 6th ed. Philadelphia, PA: Elsevier; 2019, pp. 35–68.CrossRefGoogle Scholar
Swartz, JS, Amos, KE, Brindas, M, Girling, LG, Ruth Graham, M. Benefits of an individualized perioperative plan for children with autism spectrum disorder. Pediatr Anesth. 2017;27(8):856–62.CrossRefGoogle ScholarPubMed
Lerman, J, Becke, K. Perioperative considerations for airway management and drug dosing in obese children. Curr Opin Anaesthesiol. 2018;31(3):320–6.CrossRefGoogle ScholarPubMed
Khurmi, N, Patel, P, Kraus, M, Trentman, T. Pharmacologic considerations for pediatric sedation and anesthesia outside the operating room: a review for anesthesia and non-anesthesia providers. Paediatr Drugs. 2017;19:435–46.Google Scholar
Jalili, M, Bahreini, M, Doosti-Irani, A, Masoomi, R, Arbab, M, Mirfazaelian, H. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis. Am J Emerg Med. 2016;34(3):558–69.Google Scholar
Roback, MG, Carlson, DW, Babl, FE, Kennedy, RM. Update on pharmacological management of procedural sedation for children. Curr Opin Anaesthesiol. 2016;29:S21–35.Google Scholar
Lien, C, Koff, H, Malhotra, V, Gadalla, F. Emergence and extubation: a systematic approach. Anesth Analg. 1997;85(5):1177.Google Scholar
Moore, AD, Anghelescu, DL. Emergence delirium in pediatric anesthesia. Paediatr Drugs. 2017;19(1):11–20.Google Scholar
Whitman, TM. Emergence delirium in children. J Pediatr Surg Nurs. 2018;7(2):41–6.Google Scholar
Di, M, Han, Y, Yang, Z, et al. Tracheal extubation in deeply anesthetized pediatric patients after tonsillectomy: a comparison of high-concentration sevoflurane alone and low-concentration sevoflurane in combination with dexmedetomidine pre-medication. BMC Anesthesiol. 2017;17(1):28.Google Scholar
Cravero, JP, Agarwal, R, Berde, C, et al. The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period. Paediatr Anaesth. 2019;29(6):547–71.Google Scholar

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