A simple approach to deciding what dose of propofol should be used for induction of anesthesia in children ages 3 to 17 years is to first establish the child's BMI on readily available gender-specific charts. Obese children (BMI >95th percentile for age and gender) require a lower weight-based dose of propofol for induction of anesthesia, than do normal-weight children.

Higher success rates and shorter intubation times with the Miller blade compared to either video-laryngoscope may reflect greater experience with direct laryngoscopy, need for more video-laryngoscopy training, or result from the manikin design. Individual practitioners may differ in their preference of device for intubating a child with anticipated difficult airway based on their previous experiences, self-assessment of their skills, and evaluation of the child's airway anatomy.

In this double-blind, double-dummy study, there was no difference in the efficacy of intranasal fentanyl, IM and IV morphine in controlling postoperative pain and emergence delirium in children undergoing BMT placement. The IM route is the simplest and avoids the potential for delays to establish vascular access for IV therapy and the risks of laryngospasm if intranasal drugs pass through the posterior nasopharynx and irritate the vocal cords.

O bese children present a challenge for anesthetists in terms of the appropriate dose of anesthetic drugs to administer. The dose of propofol that caused loss of consciousness in 95% (ED 95 ) of obese and nonobese children, as determined by loss of eyelash reflex, was studied in 80 children. Forty obese (body

Pediatric thyroid nodules are fairly uncommon. However, thyroid nodules that do exist in the pediatric population are more likely to be of a malignant nature compared to the adult population. Malignancy occurs anywhere from 16% to as high as 26% in pediatrics compared to 5% in the adult population. The thyroid mass poses several concepts to consider. Depending on the size of the mass, potential for discomfort, and respiratory compromise, the anesthesiologist must be able to identify patients who are at risk for cardiopulmonary complications and formulate an acceptable anesthetic plan. This chapter reviews the overall causes, studies, symptoms, and treatment of the pediatric patient with a thyroid mass.