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.

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.