An overview of paediatric anaesthesia

Module overview

This module provides an overview of the nursing considerations for paediatric anaesthesia. It is aimed at newly qualified operating department practitioners and anaesthetic nurses, and those with limited experience in the care of paediatric patients. It explores the ways in which paediatric anatomy and physiology differ from those of adults and looks at the implications for treatment in the anaesthetic environment. It also discusses the equipment required and the rationale for its use.

Keywords

airway, anaesthesia, anaesthetics, child health, surgical

Pre-test questionnaire

Before starting this module, test your knowledge on this subject by answering ten multiple choice questions.

1. Which of the following is not a function of the respiratory system?a) To minimise the surface area for gas exchangeb) To produce soundc) To protect respiratory surfacesd) To move air to and from the exchange surfaces of the lungs

2. At what age might a child experience separation anxiety or anxiety related to unfamiliar surroundings or people?a) Under six monthsb) Up to four or five yearsc) Six to 12 yearsd) Adolescence

3. The renal system of a child usually reaches adult levels of performance by the age of:a) Two monthsb) Six monthsc) One yeard) Two years

4. Which statement is true?a) The paediatric larynx sits lower in the throat than the adult larynxb) Low body temperature can extend the duration of the action of drugsc) Infants are obligate oral breathersd) The resting metabolism of an infant is four times higher than that of an adult

5. A low body temperature in a paediatric patient may cause:a) Respiratory depressionb) Reduced cardiac outputc) Increased risk of infectiond) All of the Answer: d) All of the above

Rationale: Low body temperature in a paediatric patient causes respiratory depression, acidosis, decreased cardiac output, extended drug action and increased the risk of infection.

6. The normal heart rate for a child aged one to two years is:a) 110-160b) 100-150c) 95-140d) 80-120

7. What is the recommended fasting time before surgery for a two-year-old child?a) Two hoursb) Four hoursc) Five hoursd) Six 

Rationale: The recommended fasting time before surgery for a two-year-old child is six hours to prevent potential pulmonary aspiration during general anaesthesia

8. The agent of choice for paediatric anaesthesia is:a) Halothaneb) Isofluranec) Rationale: Sevoflurane is chosen for paediatric anaesthesia because it has a pleasant odour, it is the least irritant option and has smooth and rapid emergence.d) Nitrous oxide

9. Which calculation is used to determine the correct internal diameter of a paediatric endotracheal tube?a) (Age ÷ 4) + 4Rationale: Paediatric airways grow with age; it is critical to have a properly-sized tube inserted during intubation. The calculation used to determine the correct internal diameter of a paediatric endotracheal tube is tube size (internal diameter in mm) = (Age ÷ 4) + 4b) (Age + 4) ÷ 4c) (Age ÷ 2) + 12d) (Age + 12) ÷ 2

10. Which of the following does not increase the risk of laryngospasm?a) Use of inhalation inductionb) Presence of asthmac) Use of intravenous induction Rationale: Laryngospasm is caused by stimulation of the pharynx. The risk factors include patients with Down’s syndrome, use of inhalation induction, asthma and upper respiratory tract infection.d) Presence of upper respiratory tract infection

Aims

Between 20% and 25% of the UK population are children (James and Walker 2013, The Royal College of Anaesthetists 2015) and many children attend hospital for a general anaesthetic when undergoing surgery and/or investigations. Paediatric anaesthesia is a specialised area and requires particular competencies. This module aims to inform operating department practitioners and anaesthetic nurses who have limited experience of working with paediatric patients.

Intended learning outcomes

After reading this module and completing the time out activities you should be able to:

• Describe the requirements of your profession’s regulatory body in relation to proficiency to work with paediatric patients undergoing anaesthesia.
• Explain how a paediatric patient differs from an adult.
• List the main items of equipment required to manage paediatric anaesthesia.
• Determine the type of breathing circuit required for different age groups.
• Calculate the size of the airway required for a paediatric patient.
• Determine the preferred volatile agent for maintenance of paediatric general anaesthesia and explain why.

• Introduction

  Definition

  Paediatric anaesthesia is a specialised area with little margin for error (Phillips 2007), led and organised by anaesthetic consultants who are skilled in the peri-operative care of paediatric patients (The Royal College of Anaesthetists 2015).

  Guidelines from the Royal College of Anaesthetists (2015) state that anaesthetists should have a dedicated assistant with responsibility for the peri-operative care of paediatric patients. Healthcare professionals have a personal responsibility to ensure competency according to the Health and Care Professions Council and Nursing and Midwifery Council codes of conduct. Since paediatric anaesthesia is a complex subject, the main focus of this module is children aged over one year. It is limited to anaesthetic considerations only, and does not discuss recovery issues, consent or the role of the family.

  

  Complete time out activity 1

  Locate your professional code of conduct. What does it say about standards of proficiency? Think about whether you are acting in accordance with these guidelines in relation to care of paediatric patients.

  
  

  Once completed your time out activity is saved and stored in "My Modules".

  Definition of a paediatric patient

  The Royal College of Anaesthetists (2015) refers to the child as encompassing the age range from birth to 16 years old. Paediatric patients can be categorised as follows (Hatfield and Tronson 2009):

  • Premature baby: born before week 37 following conception.
  • Neonate: born within 44 weeks following conception.
  • Infant: under one year old.
  • Baby: neonates and infants.
  • Child: one year to 12 years.
  • Adolescent: 13-16 years.

  The way that you care for paediatric patients depends on their age and developmental stage, and it is important to be able to adapt your behaviour, communication skills and working style to suit the patient. A summary of child development is shown in Table 1.

  Table 1

  

  

  Learning points

  1. Paediatric anaesthesia is a specialised area with little margin for error led and organised by anaesthetic consultants who are skilled in the peri-operative care of paediatric patients.
  2. Anaesthetists should have a dedicated assistant with responsibility for the peri-operative care of paediatric patients.
  3. The way that you care for paediatric patients depends on their age and developmental stage.
  4. Children under six months old are not usually upset by separation from a parent or by being surrounded by strangers and those who are age four to five can experience separation anxiety and anxiety caused by being in unfamiliar surroundings. From age six they are not so distressed by unfamiliar faces. Adolescents may be shy about their bodies.