An Overview of Paediatric
Anaesthesia
Dr Anna Englin
Paediatric Anaesthetist, MMC
Overview


Equipment/room set up
Crises we see in kids
Equipment
 Airway
 Breathing
 Circulation
 Drugs
 Environment/ exposure
Anaesthesia checklist
 Airway
 Breathing
 Circulation
 Drugs
 Environment/ exposure
Airway


Infants and neonates have anatomical
differences cf adults
Different sized equipment
Face masks
Airways



Lift tongue and epiglottis away from upper
airway
Different sizes: measure from centre of
incisors to angle of jaw
Nasopharyngeal airways
LMA’s


Don’t forget in a difficult intubation!
Less reliable than in adults
Intubation

laryngoscopes
ETT size


ETT size = 4 +age/4
Cuffed vs uncuffed
Equipment
 Airway
 Breathing
 Circulation
 Drugs
 Environment/ exposure
Breathing


T piece vs closed circuit
Paediatric breathing circuit
Equipment
 Airway
 Breathing
 Circulation
 Drugs
 Environment/ exposure
Circulation



ECG sometimes not used, mainly
useful to detect bradycardia
Blood pressure lower
Arterial line setup is different
Equipment
 Airway
 Breathing
 Circulation
 Drugs
 Environment/ exposure
Exposure


Neonates especially prone to
hypothermia
Prevention of hypothermia
– Operating theatre
– Patient covering esp head
– Warming blankets/ overhead heaters
– Fluid warmers
– Monitoring
Paediatric crises
Laryngospasm
•Common and can be scary!
•Risk factors
•Active or recent URTI
•Reactive airways
•Airway surgery
•Stimulation during light anaesthesia
Features
Treatment of
laryngospasm




CPAP with 100%O2
Propofol
Lignocaine: topical or IV 2mg/kg
Sux: 2mg/kg IV or 4mg/kg IM
Bradycardia

Risk factors
–
–
–
–
–

Cardiac disease
Hypoxia
Drugs esp sux
CVP insertion
Reflex eg oculo-cardiac reflex
Treatment
– Treat cause
– Atropine: 20mcg/kg IV or IM

Chest compressions if persistent
The end
NB: no children were harmed in the
making of this talk