PEDIATRIC ANESTHESIA

MICHAEL ARITONANG MD

CHILDREN ARE NOT

SMALL ADULT
1. Specific anatomic
2. Developing physiologic
3. Physiologic issues
This distinctive features form the basis for
the techniques and pharmacologic outline

TERMINOLOGY

Newborn: first 24 hours

Neonates 28 days postnatal
Infants a child of up to 12 months of age
Toddler-1-3yr
Small children:4-12yr
Child 1 to 12 yrs
Adolescent 13 to 16 yrs
The differences between paediatric and adult
anaesthetic practice are reduced as the
patients become older

ANATOMIC AND PHYSIOLOGIC

DISTINCTIONS
1. Head size : much larger head size to
the body.

ANATOMIC AND PHYSIOLOGIC

DISTINCTIONS
2. Tongue size: Larger size relative to
mouth.
3. Airway shape: Narrowest diameter is
below the glottis at cricoid level in
children.

ANATOMIC AND PHYSIOLOGIC

DISTINCTIONS
4. Respiratory physiology: Oxygen
consumption is 2 to 3 times greater in
infants than adults. FRC ranges from
813 mL/kg < 1/3 as large as adults.
5. Cardiac physiology: Relatively fixed
stroke volume in neonates and infants

ANATOMIC AND PHYSIOLOGIC

DISTINCTIONS
6. Renal function Limited GFR at birth;
does not reach adult levels until infancy;
total body water and % extracellular
fluid are increased in the infant.
7. Hepatic function P450 system not fully
developed in neonates and infants; liver
blood flow decreased in newborns
8. Body surface area Larger surface-tobody ratio in newborns/infants/toddlers

ANATOMIC AND PHYSIOLOGIC

DISTINCTIONS
9. Psychological development
06 mostress on family
8 mo4 yrseparation anxiety
46 yrmisconceptions of surgical mutilation
613 yrfear of not waking up
13 yrfear of loss of control, body image
issues

PREOPERATIVE
EVALUATION

Pertinent maternal history

Birth and neonatal history
Review of systems
Physical examination: height, weight,
and vital signs.
Preoperative home use of
medications
Existence of malformations in the
child and family

PREOPERATIVE
EVALUATION
Issues such as anesthetic risks,
anesthetic plans, recovery
phenomena, postoperative
analgesia, and discharge criteria
have to be discussed in detail.

PREOPERATIVE
EVALUATION
COEXISTING HEALTH CONDITION
1. Upper Respiratory Infection
2. Obstructive Sleep Apnea
3. Asthma
4. The Former Preterm Infant

PREOPERATIVE
EVALUATION
Laboratory Evaluation
Current standard of care dictates that
healthy children undergoing elective minor
surgery require no laboratory evaluation
Hb : 10 g/dL ( for infant > 3 months of age)

Routine versus selective testing is a matter

of policy at individual facilities.

PREOPERATIVE
EVALUATION
Preoperative Fasting Period (ASA GUIDELINES)

Solids: 6 - 8
Formula: 6 hours
Breast milk: 4 hrs
Clear liquids: 2 hrs

Clear liquids such as apple or grape juice, flat cola, and

sugar water may be encouraged up to 2 hours prior to
the induction of anesthesia as their consumption has
been shown to decrease the gastric residual
volume.

PREOPERATIVE
EVALUATION

ANESTHETIC AGENTS
Potent Inhalation Agents
Mask Induction Pharmacology
Minimal Alveolar Concentration
Intracardiac Shunts
Inhaled Agents for Induction of
Anesthesia