Pediatric Pearls for the Occasional Pediatric Anesthetist (1 Class A CE)

Over 4 million pediatric surgeries are performed each year and 40% of these occur in predominately non-pediatric facilities. Anesthesia providers who perform less than one hundred pediatric cases per year are five times more likely to experience an anesthesia-related complication due to respiratory/airway events, cardiovascular events, medication errors, and handover/communication errors. Pediatric anesthesia requires a more tailored preoperative, intraoperative, and postoperative approach. The anesthesia provider must recognize this and be able to respond quickly and effectively even when outside their comfort zone.

Children are not small adults. They can obstruct easily, become hypoxic quickly, and this can lead to bradycardia and if not resolved – cardiac arrest. The anesthetist should be familiar with the differences in the pediatric airway and how this can affect adequate ventilation and oxygenation. The incidence of laryngospasm is higher in children than in adults. Anesthesia providers need to know the signs of a laryngospasm and the best ways to treat this potentially life-threatening complication.

Pediatric anesthesia requires weight-based dosing. Smaller doses/smaller volumes can be hard to administer and can lead to medication errors. The pharmacodynamics and pharmacokinetics of anesthesia medications on an immature nervous system can place these patients at risk for prolonged anesthesia and post-anesthesia recovery time and even an overdose that could require reversal or even more severe complications.

Children are one of our most vulnerable populations in anesthesia and are not simply small adults. The occasional pediatric anesthetist needs to know your limitations and be prepared when faced with the pediatric patient.

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