5. Pediatric Anesthesia

Learning Objectives

• Explain how pediatric airway anatomy and respiratory physiology differ from adults and why these differences increase desaturation risk
• Describe the major developmental stages relevant to anesthetic planning (neonate, infant, toddler, child)
• Compare inhalational (mask) induction with IV induction and identify which children need which approach
• Recognize the classic anesthetic considerations for pyloric stenosis repair and congenital heart disease surgery
• Identify the most common pediatric perioperative complications — laryngospasm, emergence delirium, and malignant hyperthermia — and their management
• Apply weight-based dosing principles and fluid/fasting guidelines correctly for pediatric patients
• Recall the key monitoring and temperature-management priorities unique to children

Quick Answer

Pediatric anesthesia is the practice of safely anesthetizing patients from premature neonates through adolescents, a population that is not simply "small adults." Children have a proportionally larger head and tongue, a more cephalad and floppy epiglottis, a higher metabolic rate, and a much smaller functional residual capacity relative to oxygen consumption — which means they desaturate far faster than adults during any period of apnea. Anesthesiologists must scale every decision (drug dose, endotracheal tube size, fluid volume, temperature control) to the child's weight and developmental stage, anticipate anxiety-driven induction problems (most children get mask inductions, not awake IVs), and stay alert for pediatric-specific emergencies like laryngospasm and malignant hyperthermia. Getting this right matters because the margin for error is much narrower than in adults — a few minutes of unrecognized hypoxia or hypothermia has a much bigger physiologic impact on a small child.

Why Children Are Not Small Adults

This is the single idea that should organize everything else you learn in this chapter. Every anatomic and physiologic difference below exists because a 3 kg neonate and an 70 kg adult are running fundamentally different machines, not scaled copies of the same one.

Airway Anatomy

• Larger occiput — a neonate's head is proportionally huge, which naturally flexes the neck when lying supine and can obstruct the airway. A shoulder roll (not a pillow under the head, as in adults) helps achieve the "sniffing" position.
• Large tongue relative to the oral cavity — makes mask ventilation and laryngoscopy more difficult and predisposes to obstruction under sedation.
• Epiglottis is long, floppy, and omega-shaped, and sits higher (C1-C3 in infants vs. C4-C5 in adults) and angled over the airway — this is why a straight (Miller) laryngoscope blade, which lifts the epiglottis directly, is often preferred over a curved (Macintosh) blade in infants.
• Narrowest point of the airway is the subglottis (cricoid ring) in children under about 8 years old, versus the vocal cords in adults. This is why uncuffed endotracheal tubes were traditionally used in young children (the cricoid ring itself forms the seal) — though cuffed tubes are now standard even in infants when sized and pressure-checked correctly, because they reduce the number of laryngoscopy attempts and control leak more precisely.
• Larynx position is more anterior and cephalad, making direct visualization during laryngoscopy harder.

Respiratory Physiology

• Oxygen consumption is roughly double that of an adult per kilogram (6-8 mL/kg/min in infants vs. 3-4 mL/kg/min in adults).
• Functional residual capacity (FRC) is low relative to that high oxygen demand. The combination means an apneic infant desaturates in a fraction of the time an apneic adult would — often within 30-60 seconds after adequate preoxygenation is lost, versus several minutes in an adult. This is the single most important reason pediatric anesthesia is unforgiving of airway delays.
• Chest wall is highly compliant and the diaphragm does more of the work of breathing; when the diaphragm fatigues (e.g., during airway obstruction or with respiratory muscle immaturity in neonates), respiratory failure follows quickly.
• Obligate nose breathers until roughly 3-6 months of age — nasal obstruction (secretions, choanal issues) can cause significant respiratory distress.

Cardiovascular Physiology

• Cardiac output is heart-rate dependent, not stroke-volume dependent, because the neonatal myocardium has less contractile reserve (fewer contractile elements, less compliant ventricles). Bradycardia in an infant is a much bigger threat to cardiac output than in an adult — treat it aggressively and remember that in infants it is very often caused by hypoxia, so give oxygen and secure the airway first, then atropine if needed.
• Vagal tone is prominent, so laryngoscopy, ocular surgery (oculocardiac reflex), and volatile agent induction can all provoke bradycardia.

Pharmacokinetic and Thermoregulatory Differences

• Higher volume of distribution for water-soluble drugs (neonates are proportionally more total body water), so induction doses per kilogram are often higher, but drugs also linger longer if hepatic/renal clearance is immature.
• Immature hepatic enzyme systems and reduced renal clearance in neonates prolong the action of many drugs (opioids, benzodiazepines) — dosing intervals are often extended in the first weeks of life.
• Large surface-area-to-volume ratio and minimal subcutaneous fat mean children — especially neonates — lose heat rapidly by radiation, convection, and evaporation. Hypothermia worsens coagulopathy, delays emergence, increases infection risk, and can trigger apnea in former premature infants. Warm the OR, use forced-air warmers, warm IV fluids, and monitor temperature continuously in every pediatric case.

Developmental Stages and Their Anesthetic Relevance

Stage	Age Range	Key Anesthetic Relevance
Neonate	0-28 days	Highest anesthetic risk; immature organ function; former-premature infants at risk for postoperative apnea; obligate nose breathers
Infant	1-12 months	Rapid desaturation on apnea; separation anxiety less prominent; vagally mediated bradycardia common
Toddler/Early childhood	1-6 years	Peak separation anxiety and emergence delirium; mask induction is the norm; adenotonsillar hypertrophy common
Late childhood	7-12 years	Cooperative enough for preoperative teaching and sometimes awake IV placement; growth-related airway changes
Adolescent	13+ years	Physiology approaches adult; psychosocial/consent issues (assent, confidentiality) become important

A useful rule of thumb: the younger the child, the smaller the physiologic reserve and the faster things go wrong — but also, in general, the faster a well-managed problem resolves once corrected, because young hearts and lungs recover quickly when the underlying insult (hypoxia, hypovolemia) is fixed promptly.

Preoperative Assessment and Fasting

• History focused on prematurity, recent upper respiratory infection (URI), reactive airway disease/asthma, congenital anomalies, and family history of anesthetic problems (malignant hyperthermia, pseudocholinesterase deficiency).
• A recent URI is one of the most common reasons for case postponement or added risk — children with active URI symptoms have significantly higher rates of laryngospasm, bronchospasm, and desaturation. Many practices delay elective surgery 2-4 weeks after resolution of significant symptoms.
• Fasting (NPO) guidelines are age- and food-type specific and shorter than for adults, because prolonged fasting in small children risks hypoglycemia and dehydration:
  • Clear liquids: 2 hours
  • Breast milk: 4 hours
  • Infant formula/light meal: 6 hours
  • Solid/fatty meal: 8 hours
• Premedication: oral midazolam (0.3-0.5 mg/kg, max ~20 mg) 20-30 minutes before induction is the workhorse anxiolytic for toddlers who will be separated from parents; ketamine (oral, IM, or intranasal) is an alternative for uncooperative or developmentally delayed children.

Induction Techniques

Inhalational (Mask) Induction

The default technique for most healthy children without IV access, because most toddlers and young children fear needles far more than a mask.

• Sevoflurane is the agent of choice — non-pungent, does not irritate the airway, allows a smooth stepwise increase in concentration.
• Typically done with the child sitting on a parent's lap or lying on the table, sometimes with flavored mask scents or distraction techniques.
• Once the child loses consciousness, IV access is established, and the anesthetic transitions to a balanced or maintenance technique.
• Downsides: slower to secure a definitive airway if aspiration risk exists, and induction can trigger a brief excitement (Stage 2) phase with movement or breath-holding.

IV Induction

Preferred when IV access is already present, when rapid sequence induction is needed (full stomach, bowel obstruction, pyloric stenosis), or in older, cooperative children.

• Propofol 2.5-3.5 mg/kg IV (higher mg/kg than adults, reflecting a higher volume of distribution) is standard for healthy children.
• Ketamine (1-2 mg/kg IV) is favored in patients with hemodynamic instability or reactive airway disease because it preserves airway reflexes and causes bronchodilation.

Rapid Sequence Induction in Children

Indicated for full stomach, bowel obstruction, or symptomatic gastroesophageal reflux — classically the pyloric stenosis patient.

• Preoxygenate as tolerated (often difficult in a crying infant).
• Cricoid pressure is used more cautiously in infants (risk of airway distortion given a more pliable trachea).
• Rocuronium (high dose, ~1.2 mg/kg) has largely replaced succinylcholine for RSI in children because succinylcholine carries a boxed warning in pediatric patients for hyperkalemic cardiac arrest in children with undiagnosed myopathies (e.g., Duchenne muscular dystrophy) — succinylcholine is now reserved mainly for emergency airway rescue (e.g., laryngospasm not responding to positive pressure) rather than routine elective RSI.

Airway and Ventilation Management

• Endotracheal tube size is estimated by age: uncuffed ID (mm) ≈ (age/4) + 4; cuffed tubes are typically 0.5 mm smaller. Always have tubes one size up and one size down available.
• LMA (laryngeal mask airway) is widely used for short, low-risk procedures without significant aspiration risk — well tolerated and avoids the stimulus of intubation.
• Straight (Miller) blades are preferred in infants because they lift the long, floppy epiglottis directly rather than indirectly through the vallecula, which is less effective when the epiglottis is this large and pliable.
• Capnography, pulse oximetry, precordial/esophageal stethoscope, and continuous temperature monitoring are standard; EEG-based depth monitors and invasive lines are added for complex cases (cardiac, neurosurgical).

Fluid and Blood Management

• Maintenance fluid uses the 4-2-1 rule: 4 mL/kg/hr for the first 10 kg, plus 2 mL/kg/hr for the next 10 kg, plus 1 mL/kg/hr for each kg above 20.
• Neonates and infants are prone to hypoglycemia due to low glycogen reserves — dextrose-containing maintenance fluid is often used in this age group, unlike in most adult cases.
• Estimated blood volume is higher per kilogram than in adults (neonates ~90 mL/kg, infants ~80 mL/kg, older children ~70 mL/kg) but the absolute volume is tiny — a seemingly small blood loss can represent a large percentage of a neonate's total blood volume, so losses are tracked meticulously (weighed sponges, suction canister volumes) rather than estimated by eye.

Regional and Multimodal Analgesia

• Regional techniques (caudal epidural, ilioinguinal nerve blocks, penile blocks, TAP blocks) are increasingly used in children, usually placed after induction of general anesthesia (unlike adults, where regional blocks are often placed awake) since young children cannot cooperate with an awake block.
• Caudal blockade is one of the most common pediatric regional techniques, providing excellent analgesia for infra-umbilical surgery (circumcision, inguinal hernia repair, hypospadias repair) with a well-established safety record.
• Multimodal analgesia (acetaminophen, NSAIDs where appropriate, regional blocks) is emphasized to minimize opioid exposure, since children — especially neonates — are more sensitive to opioid-induced respiratory depression.

Classic Clinical Scenarios

Pyloric Stenosis Repair

A 3-6 week old presents with projectile non-bilious vomiting and a palpable "olive" mass. This is a medical emergency, not a surgical one — the priority before anesthesia is correcting the metabolic derangement (hypochloremic, hypokalemic metabolic alkalosis) with IV fluids and electrolytes over 24-48 hours. Once corrected:

• Full stomach precautions apply regardless of last meal time, since gastric outlet obstruction means the stomach never empties normally — RSI (or a modified, more gentle induction with suction of gastric contents first) is used.
• Rocuronium (not succinylcholine, given the boxed pediatric warning discussed above) is the typical muscle relaxant.
• Watch for postoperative apnea, especially if metabolic alkalosis has not fully resolved, since alkalosis blunts the respiratory drive.

Congenital Heart Disease Surgery

Children with congenital heart lesions (e.g., atrial or ventricular septal defects, tetralogy of Fallot) require anesthetic plans tailored to the specific lesion's physiology:

• Understanding shunt direction matters enormously — anesthetic and ventilator manipulations that change pulmonary vs. systemic vascular resistance can worsen a right-to-left shunt (increasing cyanosis) or a left-to-right shunt (increasing pulmonary overcirculation).
• Invasive arterial and central venous monitoring is standard for bypass cases.
• Anesthesiologists coordinate closely with cardiac surgery and perfusion teams, particularly around initiation and weaning from cardiopulmonary bypass.

Complications Unique to (or Amplified in) Pediatric Anesthesia

Laryngospasm

Reflexive, sustained closure of the vocal cords, most often triggered by airway irritation (secretions, blood, a light plane of anesthesia) during induction or emergence.

• Recognize by a high-pitched inspiratory stridor progressing to complete silence with paradoxical chest/abdominal movement and no air movement.
• Management: remove the stimulus, apply continuous positive airway pressure with 100% oxygen via mask, apply firm pressure at the "laryngospasm notch" behind the ear angle (Larson's maneuver), deepen anesthesia with IV propofol if venous access is present; if it doesn't resolve and desaturation is severe, give succinylcholine (small dose, IV or IM) to break the spasm — this is one of the accepted modern indications for succinylcholine in children.

Emergence Delirium

A state of agitation, thrashing, and inconsolability on waking, most common in preschool-age children and strongly associated with sevoflurane use.

• Usually self-limited (resolves in 15-30 minutes) but distressing for families and can risk self-injury or dislodging lines/dressings.
• Prevention/treatment: adequate analgesia (pain is a major contributor and is often mistaken for pure delirium), dexmedetomidine, or a small dose of propofol at emergence.

Malignant Hyperthermia

A pharmacogenetic hypermetabolic crisis triggered by volatile anesthetics and succinylcholine, mediated by uncontrolled calcium release from the ryanodine receptor in skeletal muscle.

• Presents as rising end-tidal CO2, tachycardia, muscle rigidity, and (late finding) fever.
• Treatment is immediate: stop triggering agents, hyperventilate with 100% oxygen, give IV dantrolene 2.5 mg/kg (repeat as needed), cool the patient, treat hyperkalemia and arrhythmias.
• Children (and their families) with a personal or family history should have a TIVA (propofol-based, non-triggering) technique planned in advance.

Postoperative Apnea in Former Premature Infants

Infants born prematurely (especially under 60 weeks post-conceptional age) are at risk for central and obstructive apnea after any general anesthetic, even for minor procedures, due to immature central respiratory control. This drives a common exam point: these infants are admitted for apnea monitoring after anesthesia, regardless of how minor the surgery was.

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Key Terms

Term	Definition	Related Concept
Functional residual capacity (FRC)	Volume of air remaining in the lungs after normal exhalation; low relative to oxygen consumption in infants	Rapid desaturation on apnea
Laryngospasm	Reflexive, sustained vocal cord closure blocking the airway	Larson's maneuver, succinylcholine rescue
Emergence delirium	Post-anesthetic agitation/confusion, common with sevoflurane in preschoolers	Dexmedetomidine, adequate analgesia
Malignant hyperthermia	Hypermetabolic crisis from ryanodine receptor dysfunction triggered by volatile agents/succinylcholine	Dantrolene, TIVA
Rapid sequence induction (RSI)	Fast induction sequence to secure the airway before aspiration can occur	Pyloric stenosis, full stomach
Caudal block	Regional anesthetic technique injecting local anesthetic into the sacral epidural space	Infra-umbilical surgery analgesia
4-2-1 rule	Weight-based formula for calculating maintenance IV fluid rate	Pediatric fluid management
Postconceptional age	Gestational age at birth plus chronological age since birth	Apnea risk in former premature infants
Cricoid ring	Narrowest fixed point of the pediatric airway (below ~8 years)	Uncuffed vs. cuffed ETT selection
Sevoflurane	Non-pungent volatile agent used for mask induction in children	Inhalational induction, emergence delirium
Succinylcholine (pediatric use)	Depolarizing muscle relaxant with a boxed warning against routine elective pediatric use	Hyperkalemic arrest, laryngospasm rescue

Common Mistakes

Misconception: Pediatric anesthesia is just adult anesthesia with smaller doses.

Why it's wrong: Dosing is often higher per kilogram (e.g., propofol induction dose), not simply scaled down, because pharmacokinetics differ (higher volume of distribution, different organ maturity). More importantly, the physiologic margin for error is different — an apneic infant desaturates in under a minute due to low FRC and high oxygen consumption, a timeline that has no adult equivalent.

Correct understanding: Every drug and every airway decision must be reconsidered from first principles for the child's developmental stage, not derived by simple proportional scaling from adult practice.

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Misconception: Succinylcholine is the standard muscle relaxant for pediatric rapid sequence induction, just like in adults.

Why it's wrong: Succinylcholine carries a boxed warning for pediatric use because it can trigger fatal hyperkalemia and cardiac arrest in children with undiagnosed myopathies such as Duchenne muscular dystrophy, which may not yet be clinically apparent in a young child.

Correct understanding: High-dose rocuronium has become the standard agent for elective and most emergency pediatric RSI; succinylcholine is now reserved largely for emergency airway rescue situations, such as breaking a laryngospasm when IV access allows only a rapid-acting option.

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Misconception: A mask induction is only used because children are afraid of needles — it's purely a comfort measure.

Why it's wrong: While reducing needle-related fear is a major benefit, mask induction with sevoflurane is also often the safer and more practical clinical choice in a child without existing IV access, because attempting awake IV placement in a struggling, uncooperative toddler carries its own risks (injury, prolonged distress, difficulty securing the line).

Correct understanding: The choice between mask and IV induction is a clinical decision balancing aspiration risk, hemodynamic stability, cooperation, and airway urgency — not simply a comfort accommodation.

Comparison and Connections

Feature	Neonate/Infant	Adult
Oxygen consumption	~6-8 mL/kg/min	~3-4 mL/kg/min
FRC relative to O2 demand	Low — desaturates in <1 minute of apnea	High — several minutes tolerance
Cardiac output determinant	Heart rate dependent	Stroke volume and heart rate
Narrowest airway point	Cricoid ring (subglottic)	Vocal cords (glottic)
Preferred laryngoscope blade	Straight (Miller) in infants	Curved (Macintosh) typically
Typical induction route	Inhalational mask (sevoflurane) if no IV	IV (propofol) almost always
RSI muscle relaxant of choice	Rocuronium (succinylcholine avoided electively)	Succinylcholine or rocuronium, either acceptable
Thermoregulation risk	High — large surface area, minimal fat	Lower, but still relevant in long cases
Emergence delirium risk	Common, especially preschool age with sevoflurane	Uncommon

Practice Questions

Recall

1. What is the formula for estimating uncuffed endotracheal tube size by age? Answer guidance: Uncuffed ID (mm) ≈ (age in years / 4) + 4. Cuffed tubes are typically 0.5 mm smaller in internal diameter.

2. What are the current NPO (fasting) guidelines for clear liquids, breast milk, and solids in pediatric patients? Answer guidance: Clear liquids 2 hours, breast milk 4 hours, infant formula/light meal 6 hours, solid/fatty meal 8 hours — all shorter than the traditional adult "nothing after midnight" approach.

Understanding

3. Explain why infants desaturate so much faster than adults during a period of apnea. Answer guidance: Infants have roughly double the oxygen consumption per kilogram compared with adults but a proportionally low functional residual capacity (oxygen reserve). The high demand against a small reserve means available oxygen is consumed within roughly 30-60 seconds of apnea, versus several minutes in an adult.

4. Why has rocuronium largely replaced succinylcholine for elective pediatric rapid sequence induction? Answer guidance: Succinylcholine carries a boxed warning in children because it can precipitate fatal hyperkalemia and cardiac arrest in children with undiagnosed skeletal myopathies (e.g., Duchenne muscular dystrophy), which often aren't clinically apparent yet in young children. High-dose rocuronium achieves comparably fast intubating conditions without that risk.

Application

5. A previously healthy 4-week-old presents for pyloromyotomy after several days of projectile vomiting. Labs show low chloride and potassium with a high bicarbonate. What must happen before this child goes to the OR, and what induction technique is used? Answer guidance: This metabolic derangement (hypochloremic, hypokalemic metabolic alkalosis) must be corrected with IV fluids and electrolyte repletion first — pyloric stenosis is a metabolic emergency, not a surgical one, and surgery should wait. Once corrected, a rapid sequence induction is used because the obstructed stomach never empties, regardless of fasting time.

6. During a routine tonsillectomy in a 4-year-old, the anesthesiologist notices high-pitched stridor at the end of the case that progresses to no air movement at all despite chest wall effort. What is happening and what are the first three steps in management? Answer guidance: This is laryngospasm. First steps: remove any airway stimulus (suction secretions/blood), apply CPAP with 100% oxygen by face mask while performing jaw thrust and firm pressure at the laryngospasm notch (Larson's maneuver), and deepen anesthesia with IV propofol if access is present; give IV/IM succinylcholine if it does not resolve and desaturation is worsening.

Analysis

7. Compare the anesthetic priorities for a child with a right-to-left cardiac shunt (e.g., tetralogy of Fallot) versus a child with a large left-to-right shunt undergoing non-cardiac surgery, in terms of ventilation strategy. Answer guidance: In right-to-left shunts, maneuvers that increase pulmonary vascular resistance or decrease systemic vascular resistance worsen the shunt and cyanosis, so the goal is to avoid hyperventilation-induced hypocarbia extremes that lower PVR excessively is less of a concern than avoiding hypoxia/hypercarbia that raises PVR; in practice, avoiding drops in SVR (e.g., from deep anesthesia or vasodilation) is critical. In left-to-right shunts, excessive lowering of PVR (e.g., hyperventilation, high FiO2) can worsen pulmonary overcirculation and heart failure, so ventilation is managed to avoid driving PVR too low.

8. A 34-week-former-premature infant, now 8 weeks old (44 weeks postconceptional age), needs an inguinal hernia repair. Why might the anesthesia team recommend overnight admission even though the surgery itself is minor? Answer guidance: Former premature infants have immature central respiratory control and are at risk for postoperative central and obstructive apnea after any general anesthetic, independent of how minor the procedure is, until sufficiently mature (commonly monitored until ~60 weeks postconceptional age or per institutional protocol). Overnight apnea monitoring is standard regardless of surgical complexity.

FAQ

Why do so many kids get "put to sleep with a mask" instead of an IV like adults? Most young children have no IV in place before surgery and are far more frightened of needles than of a mask with a slightly odd smell. Sevoflurane is non-irritating to the airway and can be delivered gradually while a child sits on a parent's lap, making mask induction both kinder and often clinically simpler than forcing an awake IV start. Once the child is unconscious, the team places the IV.

Is it true kids need higher anesthetic drug doses per kilogram than adults? For several drugs, yes. Propofol induction dose per kilogram is higher in children than adults, largely because children have a proportionally larger volume of distribution (more total body water and different tissue perfusion patterns). This is a classic point of confusion — it's not that kids are "more resistant," it's basic pharmacokinetics playing out differently at a smaller, more water-rich body composition.

Why is malignant hyperthermia discussed so much in pediatric anesthesia specifically? MH can occur at any age, but it often first manifests during a child's early anesthetic exposures, and volatile agents plus succinylcholine — historically common in pediatric practice — are the classic triggers. Because children may be having their first-ever general anesthetic, a family history may be the only clue available, making preoperative family history screening especially important in this population.

What is emergence delirium and is it dangerous? It's a period of disorientation, crying, and thrashing as a child wakes up from anesthesia, most common in preschool-age children and linked to sevoflurane. It is usually not medically dangerous and resolves within 15-30 minutes, but it is distressing for families and can risk a child pulling out lines or injuring themselves, so it's actively managed with adequate pain control and sometimes dexmedetomidine.

Why does a "minor" surgery in a former premature baby require overnight monitoring? Because the risk being monitored isn't from the surgery itself — it's from the anesthetic's effect on an immature respiratory control center. Former premature infants can have apnea spells hours after a completely uneventful anesthetic, so admission for cardiorespiratory monitoring is a standard safety precaution tied to postconceptional age, not surgical complexity.

Quick Revision

• Infants desaturate fast on apnea: high O2 consumption (6-8 mL/kg/min) + low FRC — often under a minute
• Airway differences: large occiput/tongue, floppy omega-shaped epiglottis, narrowest point is the subglottic cricoid ring (<8 years), straight blade preferred in infants
• Cardiac output in infants is heart-rate dependent — treat bradycardia aggressively, think hypoxia first
• Mask induction (sevoflurane) is standard without IV access; IV induction (propofol 2.5-3.5 mg/kg) when access exists or RSI needed
• Rocuronium has replaced succinylcholine for elective pediatric RSI due to hyperkalemic arrest risk in undiagnosed myopathies; succinylcholine reserved for emergency rescue (e.g., laryngospasm)
• Fasting guidelines: clear liquids 2h, breast milk 4h, formula/light meal 6h, solids 8h
• Fluid maintenance: 4-2-1 rule; watch for hypoglycemia in neonates/infants
• Pyloric stenosis: correct metabolic alkalosis first, then RSI — it's a medical emergency before it's a surgical one
• Laryngospasm: CPAP + 100% O2 + Larson's maneuver + deepen anesthesia; succinylcholine if refractory
• Emergence delirium: common with sevoflurane in preschoolers, self-limited, treat pain and consider dexmedetomidine
• Malignant hyperthermia: dantrolene, stop triggers, cool, treat hyperkalemia — TIVA if known/suspected risk
• Former premature infants need postoperative apnea monitoring regardless of how minor the surgery is

Related Topics

Prerequisites: General Anesthesia Techniques, basic pharmacology, respiratory and cardiovascular physiology, airway anatomy

Related Topics: Regional Anesthesia Techniques, Airway Management, Malignant Hyperthermia, Perioperative Monitoring

Next Topics: Regional Anesthesia Techniques, Anesthesia for Cardiac Surgery, Perioperative Pain Management