[Anaesthesiological aspects of paediatric medical care in "non-specialised departments"]

Abstract

Paediatric perioperative care represents specific challenges related to the distinct developmental, anatomic and physiological characteristics of children, requiring specialised expertise, including pharmacology. A specially trained anaesthesia team, an appropriate environment and appropriate paediatric-sized equipment (endotracheal tubes, cannulas) represent key factors in determining the perioperative outcome for this population. Other important equipment that must be adapted to the paediatric population include: Non-invasive anaesthesia monitoring equipment (ECG, blood pressure cuff, pulse oximetry, capnography, oxygen monitor, volatile gas concentration monitor, peripheral nerve stimulator and temperature probe); as well as specialised ventilators that allow pressure- and volume-controlled ventilation with volumes as low as 20 ml, variable high frequency ventilation up to 60 breaths per minute and paediatric ventilator hose systems with automatic correction for compliance. Perioperative pain management is important in the paediatric population, with regional anaesthesia techniques (usually done under general anaesthesia) being increasingly accepted in all age groups. These techniques, however, should be performed by experienced anaesthesologists and surgeons only. If these conditions are not met, surgical procedures should not be performed except in the case of an emergency when transportation to a specialised paediatric facility cannot be done safely. This is particularly critical for premature babies, newborns, and infants up to 3 years of age.