Principles and practice of paediatric anaesthesia

The anaesthetic risk is markedly higher for children than for adult surgical patients. For making correct decisions in daily clinical work, it is therefore imperative to possess basic knowledge of airway management, cardiovascular system and fluid therapy. Young children have a relatively active metabolism with high oxygen consumption. Apnoea tolerance is very limited. Desaturation can only be avoided by ventilating the child. The modified approach of rapid sequence induction is becoming generally accepted. Beyond neonatal age, cuffed tubes are widely used. When using a laryngeal mask airway, an L-shape is advantageous. Special attention should also be given to blood pressure and perfusion because hypotension may have serious consequences. If necessary, vasoactive drugs are indicated in paediatric patients as well. The normal values for blood pressure are age-dependent. The number of veins which can be easily punctured is often very limited, especially in infants and chronically ill children, but anaesthesia without venous access must remain an ultima ratio. Hyponatraemia is a latent threat, so that only solutions with a physiologic sodium concentration should be used. Altogether, daily paediatric anaesthesia practice can be markedly improved. A good anaesthesia" with perfection in every detail and maintained homeostasis is in the focus of interest; differences between compounds or techniques as well as the theoretical question of neurotoxicity are of minor importance.