CHILDREN ARE NOT SMALL ADULTS. In this chapter, we will
discuss the resources and standards that must be in place, in order for community-based
programs to be in a position to deliver quality anesthetic care to children. Patient and
procedural selection policies, appropriate equipment, dedicated physical space, and
knowledgeable and experienced providers are just some of what is required. Caring for
children in a large children’s hospital, where the entire system is geared toward
pediatrics, can test the most experienced pediatric anesthesiologist. Children have
unique physiologic, pharmacologic, pathophysiology, and behavioral characteristics
which change and develop throughout their lives. We will examine the pre-operative,
intra-operative, and post-operative aspects that make pediatric anesthesia different from
the perioperative care of adults. Additionally, we will provide an overview of the
anesthetic management of some of the more common ambulatory pediatric procedures
which may be encountered in the community-based practice such as; myringotomy and
tympanostomy tube insertion; tonsillectomy and adenoidectomy; genitourinary
procedures – circumcision, hypospadias repair, inguinal hernia repair, and orchiopexy;
and foreign body removal.
Keywords: Adenoidectomy, Bronchospasm, Children, Circumcision, Difficult
pediatric airway, Foreign body removal, Hypospadial repair, Infants, Inguinal
hernia, Laryngospasm, Myringotomy, Neonates, Orchiopexy, Pediatric
anesthesia, Pediatric intraoperative fluid management, Pediatric surgery, Pediatric
pain medication, Pediatric postoperative nausea and vomiting, PRAE
(perioperative respiratory delirium), Postoperative pediatric pain control,
Tonsillectomy, Tympanostomy.
