Pediatric Anesthesia
Core concepts
Understand age-related differences in airway anatomy, respiratory physiology, and pharmacology. Infants have a large head, short neck, large tongue, and a narrowest point at the cricoid (historically) with a compliant chest wall and high oxygen consumption. Know weight-based dosing, the importance of precise calculations, and the altered pharmacokinetics of neonates (immature hepatic and renal function, higher water content). Understand the management of common pediatric emergencies: laryngospasm, croup, epiglottitis, and foreign-body aspiration. Know the principles of pediatric fasting, fluid management, and temperature control. Recognize the risk of emergence delirium and the approach to the difficult pediatric airway.
Traps in questions
- Using adult doses or adult-sized equipment; pediatric dosing is weight-based and equipment is size-based.
- Forgetting that infants desaturate rapidly because of high oxygen consumption and low FRC.
- Missing that a child with epiglottitis should not be examined with a tongue depressor; keep the child calm and prepare the airway.
- Overlooking that neonates have immature drug metabolism and prolonged drug effects.
- Assuming a child with a barking cough and stridor needs immediate intubation; croup is often managed medically.
Worked example / rule of thumb
For a 10 kg child, a rough maintenance fluid rate is 4-2-1: 4 mL/kg/hr for the first 10 kg, 2 for the next 10, and 1 for the rest, giving 40 mL/hr. Rule of thumb: in pediatric airway emergencies, the child's distress is the guide; avoid agitating the child and prepare for controlled induction.
Exam framing
Questions often test the next step in a pediatric airway emergency. Prioritize keeping the child calm, avoiding unnecessary examination, and preparing the team and equipment before induction.