Paediatric anaesthesia

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Conclusions

  • The demands of paediatric anaesthesia can prove stressful for the operating department practitioner or anaesthetic nurse, especially those who are newly qualified.
  • Awareness of how the anaesthetic care needs of paediatric patients differ from those of adults, as well as adequate preparation of the anaesthetic environment and all equipment likely to be needed in an emergency, can help to alleviate this stress.
  • Operating department practitioners and anaesthetic nurses should be aware of the limited role of a blood pressure reading, and also aware of their patient’s baseline observations, as this allows them to recognise deterioration in the patient.

  • Acronyms

    AAGBI: Association of Anaesthetists of Great Britain and Ireland
    IV: intravenous

  • Glossary

    Anaesthesia: the absence of sensation, especially sensitivity to pain, as induced by an anaesthetic substance, by hypnosis, or occurring with traumatic or pathological damage to nerve tissue.
    Cyanosed: having a bluish discoloration of the skin, fingernails, and mucous membranes due to lack of oxygen in the blood.
    Defibrillator: an electronic device that gives an electric shock to the heart.
    Extubation: withdrawing a tube from an orifice or cavity of the body.
    Hartmann’s solution: a mixture containing sodium chloride, sodium lactate and phosphates of calcium and potassium. It is used intravenously as a systemic alkaliser and to replenish fluids and electrolytes.
    Hyperflexion: excessive bending of a joint.
    Intubation: placing a flexible plastic tube into the trachea to maintain an open airway or to serve as a conduit for administering drugs.
    Laryngoscope: an instrument used to examine the larynx.
    Laryngospasm: a brief spasm of the vocal cords that makes it difficult to speak or breathe.
    Obligate nasal breathers: physiologically having to breathe through the nose.
    Pathogen: a microorganism that produces disease.
    Peri-operative care: treatment before, during and after surgery.
    Supraglottic airway: oral passageway that facilitates unobstructed access of respiratory gases to the glottic opening by displacing tissue and sealing off the laryngeal area.
    Tachycardia: a heart rate greater than 100 beats per minute.
    Tachypnoea: abnormally rapid breathing, at a rate of greater than 20 breaths per minute.
    Thermoregulatory mechanism: the anatomical system that controls body temperature
    Vasoconstriction: the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, widening of blood vessels.

  • References

    Adewale L (2009) Anatomy and assessment of the pediatric airway. Pediatric Anaesthesia. 19, Suppl 1, 1-8.
    Allman KG, Wilson IH (2006) Oxford Handbook of Anaesthesia. Third edition. Oxford University Press, New York NY.
    Anaesthesia UK (2014) Breathing Circuits: Mapleson F. tinyurl.com/poontxc (Last accessed: October 12 2015.)
    Arun BG, Korula G (2013) Preoperative fasting in children: an audit and its implications in a tertiary care hospital. Journal of Anaesthesiology Clinical Pharmacology. 29, 1, 88-91.
    Davey A, Ince CS (Eds) (2004) Fundamentals of Operating Department Practice. Cambridge University Press, Cambridge.
    Disma N, Mameli L, Pistorio A et al (2014) A novel balanced isotonic sodium solution vs normal saline during major surgery in children up to 36 months: a multicenter RCT. Paediatric Anaesthesia. 24, 9, 980-986.
    Hardcastle T (2007) Intravenous induction versus inhalation induction for general anaesthesia in paediatrics. In Smith B, Rawling, P Wicker P, Jones C (Eds) Core Topics in Operating Department Practice: Anaesthesia and Critical Care. Cambridge University Press, New York NY, 102-109.
    Hatfield A, Tronson M (2009) The Complete Recovery Room Book. Fourth edition. Oxford University Press, New York NY.
    James I, Walker I (2013) Core Topics in Paediatric Anaesthesia. Cambridge University Press, New York NY.
    Litman RS (2013) Basics of Pediatric Anesthesia: Lite Edition. Ronald S Litman, Philadelphia PA.

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