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Canadian Journal of Anesthesia, Vol 5, 115-131, Copyright © 1958 by Canadian Anesthesiologists' Society

Difficulties in Paediatric Anaesthesia

P. B. PERCHESON M.D., F.R.C.P.(C)1 and JOHN J. CARROLL M.D.1

1 Department of Anaesthesia, Vancouver Grace and Burnaby General Hospitals, Vancouver British Columbia

The most serious difficulties in paediatric anaesthesia may not be directly related to the agents, techniques and abilities of the anaesthetist, as the sick child may be debilitated by electrolyte and fluid deficits of such magnitude that respiratory and circulatory collapse will occur even in the best of hands. More time, attention and care must be given to the clinical evaluation and correction of these factors in order to prevent disaster. It may take up to 24 hours to properly and adequately correct dehydration, acid-base disturbances, potassium loss, and calcium deficits. In these situations the paediatrician may be indispensable. The anaesthetist must have at least a working knowledge of these problems in order to be able to cope with them adequately in situations where paediatric or internist consultation is not available.

When electrolyte and fluid deficits have been corrected, difficulties can be better avoided by choosing methods, agents and anaesthetic techniques which are least disturbing to the labile respiratory, circulatory, metabolic and temperature regulating systems of the infant and child. In this respect, premedication must aim not only at reducing secretions, metabolism and oxygen requirements, but also at achieving a tranquil co-operative patient in whom vagal, sympathetic, motor and sensory pathways have been centrally obtunded. Likewise, maintenance of anaesthesia should incorporate versatility to the extent of permitting adequate oxygen, control of respiration, and, sufficient relaxation without undue circulatory and respiratory depression. We believe that the use of phenothiazine drugs in the premedication, and the administration of "controlled" blocks for the maintenance of anaesthesia may help to solve some of these difficulties.

Note:

An abridgement of this paper was presented at the Section of Anaesthesia, Canadian Medical Association, Edmonton, Alberta, June, 1957.






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Copyright © 1958 by the Canadian Anesthesiologists' Society.