Difficulties in paediatrig anaesthesia

Abstract

GENERAL CONSIDERATIONSIT m x TRtr~ that the e~tremes of life are the most hazardous periods of our existence. Of the two cxtremes, the infant or child presents the more incalculable and inscrutable physiologJc variations to challenge the skill and ingenuity of the anaesthetast.The relahve dearth of research in ths field (13) is understandable when .we consider that in infants and children we~are dealing with such rapidly changing physiologic states that separate studies at different ages are necessary. 'We are repeatedly faced with d~[culty in establishing the borderline between normality and abnormality. More attention must, therefore, be focused on t_he development of normal standards for this per:rod when homeostasis is either not yet developed or so easily upset.The anaesthetist raust de~ with paediatric patients in countless circumstances where speculation a_ad clhlical experience must take the place of knowledge and established fact. The life and welfare of these patients depend very largely on the anaesthetast's ability to exercise instantaneous and acc~rate clinical judgment, a judgment which must be tempered by the fact that the smaller the palaent the shorter the road to disasterIn order to minimize the difflcultaes m paediatric anaesthesia, it behooves us to acqu/re at least a working knowledge of the physiologic vacillations that the infant and child are hkely to manifest. Consultation with the paeHiatrician and the internist ~s most desirable when perplexing electrolyte, fluid balance, circulatory, r~spn'atory or metabolic upsets are present in the preoperative period. Moreover, the qualified paediatnc surgeon (5) is probably better equipped to deal with the surgical problems of this age group Pxeoperative consultation and correction of physiologic upsets will protect the anaesthetist against many of the anaesthetic dtt~culties w~dch may arise; because once the patient is anaesthetized, these difficulties do not permit xecourse to laboratory findings, consultation with a colleague, or t:o the policy" of watchful waiting-so common in the other specialties. Central Nervous SystemThe hypothalamic thermostat of the paediatric patient is unstable and has a tendency towards wide dSurna][ fluctuations. High temperatures increase the IDepartment of Anaesthesia, Vancouver Grace and Burnaby General Hospitals, Vancouver British Columbia. 2An abridgement of this paper was presented at