Core Topics in Paediatric Anaesthesia Core Topics in Paediatric Anaesthesia Edited by Ian James Consultant Anaesthetist, Great Ormond Street Hospital for Children NHS Foundation Trust; Honorary Senior Lecturer, Institute of Child Health, London, UK Isabeau Walker Consultant Anaesthetist, Great Ormond Street Hospital for Children NHS Foundation Trust; Honorary Senior Lecturer, Institute of Child Health, London, UK cambridge university press Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Mexico City Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521194174 © Cambridge University Press 2013 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2013 Printed and bound in the United Kingdom by the MPG Books Group A catalogue record for this publication is available from the British Library Library of Congress Cataloguing in Publication data Core topics in paediatric anaesthesia / edited by Ian James, consultant anaesthetist, Great Ormond Street Hospital for Children NHS Trust, honorary senior lecturer, Institute of Child Health, London, UK, Isabeau Walker, consultant anaesthetist, Great Ormond Street Hospital for Children NHS Trust, honorary senior lecturer, Institute of Child Health, London, UK. pages cm Includes bibliographical references and index. ISBN 978-0-521-19417-4 (Hardback) 1. Pediatric anesthesia. I. James, Ian (Ian Gordon) editor of compilation. II. Walker, Isabeau, editor of compilation. RD139.C67 2013 617.906798–dc23 2012044102 ISBN 978-0-521-19417-4 Hardback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Contents Preface vii List of contributors viii Section I – Introduction 10 Day-case anaesthesia in children 86 Peter A. Stoddart 1 Anatomical and physiological issues affecting 11 anaesthesia in neonates and young General principles and safe paediatric 96 children 1 anaesthesia Isabeau Walker Ian James 12 2 Pharmacological issues affecting anaesthesia Equipment and monitoring in paediatric 106 in neonates and young children 10 anaesthesia George H. Meakin Philippa Evans 13 119 3 Developmental psychology and Venous access in children communicating with children and David Chisholm 26 families 14 Peri-operative fluid management in Judith A. Short children 132 4 Consent and the law, including research and Isabeau Walker and Dan Taylor 35 restraint, in paediatric anaesthesia 15 Total intravenous anaesthesia (TIVA) in Lisa Flewin children 144 5 Safeguarding Children and the Vaithianadan Mani and Neil Morton 43 anaesthetist 16 Regional anaesthesia in children 153 Kathy A. Wilkinson Naveen Raj and Steve Roberts 17 Sedation for procedures in children 167 Section II – Peri-operative period: general Mike R. J. Sury principles 18 Peri-operative analgesia in children 174 Glyn Williams 6 Pre-operative assessment for paediatric anaesthesia 51 19 Prevention and treatment of post-operative Reema Nandi nausea and vomiting in children 184 Alison S. Carr 7 Anaesthesia for children with common medical conditions of childhood 60 Nargis Ahmad and Ian James Section III – Clinical anaesthesia: specialty 8 Congenital and inherited disorders affecting considerations anaesthesia in children 71 Nargis Ahmad and Ian James 20 Anaesthesia for general paediatric and neonatal surgery 191 9 79 The premature and ex-premature infant Mark Thomas Isabeau Walker v Contents 21 Anaesthesia for otorhinolaryngology in 33 Anaesthesia for children with heart disease children 202 undergoing non-cardiac surgery 322 Adrian R. Lloyd-Thomas Anthony Moriarty, Alet Jacobs and Ian James 22 The compromised paediatric airway 216 34 Anaesthesia for urological surgery in Stephanie Bew children 335 Angus McEwan 23 Anaesthesia for cleft lip and palate surgery in children 228 35 Anaesthesia for hepatic surgery, including Agnes Watson transplantation, in children 344 James Bennett and Peter Bromley 24 Anaesthesia for dental and maxillofacial surgery in children 238 36 Anaesthesia for radiology in children 355 Lola Adewale Jane Herod 25 Anaesthesia for craniofacial surgery in 37 Anaesthesia for oncology and other medical children 244 procedures in children 366 David de Beer Michael Broadhead and Isabeau Walker 26 Anaesthesia for neurosurgery in children 255 Su Mallory Section IV – The critically ill child 27 Anaesthesia for ophthalmic surgery in 38 Principles of paediatric resuscitation 377 children 265 Jonathan Smith Ian James 39 Trauma in children 390 28 Anaesthesia for plastic surgery in Karl C. Thies and Ben Stanhope children 273 Michael W. Frost 40 Burns in children 406 Bruce Emerson 29 Anaesthesia for orthopaedics, including scoliosis surgery, in children 281 41 Principles of paediatric intensive care 416 Steven Scuplak Ian A. Jenkins 30 Anaesthesia for thoracic surgery in 42 Stabilisation and safe transport of the children 290 critically ill child 429 Simon R. Haynes Daniel Lutman 31 Anaesthesia for cardiac surgery in children 299 Ian James and Sally Wilmshurst Index 438 32 Anaesthesia for cardiac catheterisation and The colour plate section can be found between other investigative procedures in pages 278 and 279. children 314 Ian James and Sally Wilmshurst vi Preface Children comprise almost a quarter of the population, of these are rare, and their salient features can quickly and many will require general anaesthesia for surgery and easily be obtained on the Internet. or an investigative procedure. It is important that the We hope that our book will also be useful for facilities and environment for such procedures are those anaesthetists who work in the general hospital, appropriate for a child, and it is crucial that those especially those who only see children presenting as administering anaesthesia are knowledgeable, compe- emergencies. Over the past 20 years or so a plethora tent and safe. It is an oft-repeated adage that the child of reports have espoused the benefits of centralisation is not a miniature adult, and nowhere is this more of paediatric surgery. Subsequent organisational true than in paediatric anaesthesia where there are changes have resulted in the transfer of much of this significant differences, for instance in pharmacology, work to specialised centres, particularly for children psychology, common clinical conditions and legal in the 0–4 year age range. For many anaesthetists issues such as consent. Our intention with this book working outside these specialist centres, this has has been to provide the core knowledge, both theor- resulted in reduced opportunity to maintain compe- etical and practical, necessary to assist all those regu- tence and, perhaps of equal importance, confidence in larly involved in anaesthetising children to do so anaesthetising small children, even though over half safely and competently. We hope that this text will of all procedures in children still take place in the be particularly useful to trainees aspiring to become District General Hospital. This book is no substitute specialist paediatric anaesthetists. for regular hands-on experience, but we hope that it We have tried to go further than just covering the will be helpful in providing core knowledge and tips core curriculum for training in paediatric anaesthesia. from established experts that can be used to supple- For the clinical chapters we asked our authors, who ment refresher courses and clinical attachments to are all recognised experts in their specialist areas, to maintain skills. share their experience by outlining in a succinct We would like to thank those who have helped in manner how they manage their patients. It seems to developing this book, particularly family and friends us particularly helpful to read how those who are who have been neglected during its long gestation. We regularly anaesthetising patients with specific dis- are also grateful to Cambridge University Press for their orders have fine-tuned their practice to minimise patience as the book’s post-conceptual age increased. problems and achieve good outcomes. We have Finally, we would like to thank Sally and Ash Suxena for included key references and additional reading for allowing Joseph to grace our front cover. all chapters.