Pharmacological agents used for induction, maintenance, and emergence from anaesthesia in paediatric patients are selected based on factors such as age, weight, medical history, surgical procedure, and individual patient response.
Indunil Karunarathna
Induction of Anaesthesia: Intravenous Induction Agents:Propofol: A rapid-acting intravenous anaesthetic agent commonly used for induction due to its rapid onset, smooth induction, and short duration of action. It provides sedation and hypnosis without significant respiratory depression. Thiopental: Although less commonly used in paediatric anaesthesia due to its slower onset and higher incidence of side effects compared to propofol, thiopental may still be used in certain clinical scenarios. Inhalational Induction Agents:Sevoflurane: An inhalational anaesthetic agent with a pleasant odor and minimal airway irritation, often used for inhalational induction in paediatric patients, particularly in those who may be anxious or uncooperative with intravenous access. Desflurane: Another inhalational anaesthetic agent with rapid onset and offset, suitable for inhalational induction in paediatric patients with a secure airway and appropriate equipment for administration. Maintenance of Anaesthesia: Intravenous Anaesthetic Agents:Propofol Infusion: Continuous infusion of propofol is commonly used for maintenance of anaesthesia in paediatric patients due to its titratable effect, rapid clearance, and favorable recovery profile. Remifentanil Infusion: A short-acting opioid analgesic with rapid onset and offset, often used as an adjunct to intravenous anaesthesia for maintenance of analgesia during surgery. Inhalational Anaesthetic Agents:Sevoflurane or Desflurane: Inhalational agents such as sevoflurane or desflurane may be used for maintenance of anaesthesia via a vaporizer or a closed-circuit anesthesia machine, providing a consistent depth of anaesthesia and easy titration. Emergence from Anaesthesia: Reversal Agents:Neostigmine and Glycopyrrolate: Commonly used to reverse neuromuscular blockade following the administration of non-depolarizing muscle relaxants such as rocuronium or vecuronium. Flumazenil: An antagonist of benzodiazepines, used to reverse the sedative effects of drugs such as midazolam. Opioid Analgesics:Morphine or Fentanyl: Opioid analgesics may be administered during emergence from anaesthesia to provide postoperative pain relief. Fentanyl is preferred for its rapid onset and short duration of action, while morphine may be used for longer-lasting analgesia. Inhalational Anaesthetic Agents:Sevoflurane or Desflurane: Inhalational agents can be titrated down gradually during emergence from anaesthesia to facilitate smooth recovery and minimize postoperative agitation. Antiemetic Agents:Ondansetron or Dexamethasone: Antiemetic agents may be administered prophylactically to prevent postoperative nausea and vomiting (PONV) during emergence from anaesthesia, particularly in paediatric patients at high risk for PONV.
Pharmacological agents used for induction, maintenance, and emergence from anaesthesia in paediatric patients are selected based on factors such as age, weight, medical history, surgical procedure, and individual patient response. Here's an overview of commonly used agents for each phase of anaesthesia:
These pharmacological agents are selected and administered by anaesthesia providers based on individual patient characteristics, surgical requirements, and institutional protocols to achieve optimal anaesthetic depth, analgesia, and recovery in paediatric patients undergoing surgery. Close monitoring and titration of anaesthetic agents are essential throughout the perioperative period to ensure patient safety and comfort.
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Saif Wahid
Pharmacological agents used in pediatric anesthesia, including a focus on safety and age-specific considerations:
Important Considerations for Pediatric Anesthesia
- Age and Physiology: Drug dosages and responses change with a child's age and developmental stage. Neonates and infants possess differences in metabolism and body composition that must be considered.
- Psychological Impact: Children can experience heightened anxiety around the concept of anesthesia. Careful pre-medication and a comforting environment are crucial.
Induction Agents
- Intravenous Agents
- Propofol: The most common induction agent due to rapid onset, short recovery, and antiemetic properties. Requires close monitoring of respiratory and cardiovascular function.
- Thiopental: A fast-acting barbiturate with potential for respiratory and cardiovascular depression. Less commonly used now.
- Ketamine: Useful for children with cardiovascular instability (maintains blood pressure) or difficult IV access situations. Can cause agitation and hallucinations during emergence.
- Inhalational Agents
- Sevoflurane: The preferred inhalational agent due to its fast onset/offset and low airway irritation.
- Halothane: Older inhalational agent, less frequently used now due to longer recovery time and potential for cardiac arrhythmias.
Maintenance Agents
- Inhalational Agents
- Sevoflurane, Isoflurane, Desflurane: Volatile anesthetics for both induction and maintenance, titrated based on the required depth of anesthesia.
- Intravenous Agents
- Propofol (infusion): Can be used as a sole agent for maintenance or in combination with inhalational agents.
- Opioids (Fentanyl, Remifentanil): Provide analgesia but require careful monitoring due to respiratory depression risk.
Emergence Agents
- Reversal of neuromuscular blockade:
- Neostigmine and Sugammadex: Used to reverse non-depolarizing and some depolarizing neuromuscular blocking agents to restore muscle function.
- Anti-emetics:
- Ondansetron, Dexamethasone: Help reduce postoperative nausea and vomiting.
- Pain Management:
- Opioids and NSAIDs: Address postoperative pain for a smooth recovery.
Additional Notes
- Local/Regional Anesthesia:
- Often used to supplement general anesthesia, reduce intraoperative opioid needs, and provide postoperative pain control.
- Benzodiazepines (Midazolam): Primarily used for premedication due to their anxiolytic and amnesic effect.
Age-Specific Considerations
- Neonates and Infants:
- Increased sensitivity to many drugs
- Higher risk for respiratory depression
- Careful monitoring of body temperature
- Older Children:
- Dosing requirements might be closer to adult values
- Psychological considerations for separation from parents or guardians.
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