Indian Journal of Anaesthesia

EDITORIAL
Year
: 2019  |  Volume : 63  |  Issue : 9  |  Page : 688--689

The IJA postgraduate educational issue on current concepts in paediatric anaesthesia


Jeson R Doctor1, Anila Malde2, Sandhya Yaddanapudi3,  
1 Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
2 Department of Anaesthesiology, LTMMC and Sion Hospital, Mumbai, Maharashtra, India
3 Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India

Correspondence Address:
Jeson R Doctor
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra
India




How to cite this article:
Doctor JR, Malde A, Yaddanapudi S. The IJA postgraduate educational issue on current concepts in paediatric anaesthesia.Indian J Anaesth 2019;63:688-689


How to cite this URL:
Doctor JR, Malde A, Yaddanapudi S. The IJA postgraduate educational issue on current concepts in paediatric anaesthesia. Indian J Anaesth [serial online] 2019 [cited 2019 Oct 22 ];63:688-689
Available from: http://www.ijaweb.org/text.asp?2019/63/9/688/266812


Full Text



We are proud to present the September 2019 special postgraduate educational issue of the IJA, with the theme of 'Current concepts in Paediatric Anaesthesia'.

Children are a special population. They are not miniature adults. Their perioperative management must be based on a deep understanding of their anatomy, physiology and pathophysiology. This has led to the emergence of the super speciality of paediatric anaesthesiology.

Children's physiology is different from that of adults. Respiratory concerns such as lesser apnoea time tolerance, higher oxygen consumption and complications like apnoeic spells, breath-holding, and laryngospasm are unique to children. The rate-dependent cardiac output and the susceptibility to revert to foetal transitional circulation are concerns specific to this subpopulation and need attention.

The organ systems are still immature and developing in the paediatric age group. This affects the pharmacodynamics and pharmacokinetics of anaesthetic and other drugs and may have clinical implications. The effect of anaesthetic drugs on the developing brain and long-term neurodevelopment are some of the concerns getting widespread recognition.

Various studies, meta-analyses and guidelines have revolutionised preoperative fasting regimes. The 8-6-4-2 hour fasting regime has been further liberalised to 1 hour for clear liquids in children. The faster gastric transit time of water and clear liquids has been extensively studied and is documented with evidence from the ultrasound-based assessment of gastric residual volume. With the advent of Enhanced Recovery after Surgery (ERAS) protocols, postoperative feeding has also changed with resumption of fluids as early as possible and on demand.

Perioperative anxiety in children is associated with adverse clinical outcomes like emergence delirium, increased analgesic requirements and negative postoperative behavioural changes. Child-friendly practices such as non-pharmacological behavioural techniques, parental presence during anaesthetic induction and sedative premedication go a long way in improving the quality of the anaesthetic. This in turn makes the perioperative period a pleasurable experience for the child as well as the parents.

With the availability of newer airway devices in paediatric sizes [1] and the airway guidelines for the management of unanticipated difficult intubation in children by All India Difficult Airway Association,[2] the management of the paediatric airway has become a lot safer and protocolised. Newer videolaryngoscopes, supraglottic devices and oxygen delivery devices have revolutionised airway management in paediatrics.

The physiological differences between adults and children with respect to fluid homeostasis, the body water and blood volume cannot be overemphasised. The importance of using balanced solutions during the perioperative period and the risk of hyponatremia and hypoglycaemia need to be understood. Various guidelines have laid down recommendations for the management of perioperative fluids in children. The estimation of blood loss and administration of blood and blood products in children is challenging considering the narrow margin of safety.

Securing vascular access in children is an important and challenging clinical skill. Newer equipment using ultrasound, transillumination and near-infrared light have come to our rescue. The new intraosseous access device is life-saving in an emergency.

Regional anaesthesia techniques in children are very popular. The use of ultrasound with clear non-distorted anatomical planes, the availability of newer and safer local anaesthetics like ropivacaine and levobupivacaine, newer additives like dexmedetomidine have made regional anaesthesia safer and more predictable. Newer truncal blocks are also gaining popularity with practitioners moving away from central neuraxial blocks.

With the advent of newer diagnostic modalities, the demand for anaesthetic services for a variety of diagnostic and therapeutic procedures at a multitude of locations outside the safe confines of the operating room has increased manifold. There are various concerns at these Non-Operating Room Anaesthesia (NORA) locations in which the anaesthesiologist should be aware before providing services.

There is a need for education and training in the management of common postoperative problems such as analgesia, nausea and vomiting and emergence delirium due to the widening spectrum of activities of the anaesthesiologist as a perioperative physician.

Preemies and neonates are a special subpopulation even among children, with their own challenges and complications. Specific concerns include hypoglycaemia, hypothermia, apnoeic spells and transitional circulation among others. This makes their perioperative anaesthetic management challenging even for the experienced anaesthesiologist.

All these aspects of the paediatric anaesthesia have been dealt with in this issue by recognised experts from all over the country. We wish to extend our heartfelt thanks to our expert reviewers for their painstaking efforts. We hope that all readers of the IJA, students, practitioners and teachers alike, find it useful. We also hope that some of the readers will be encouraged to take up the speciality of paediatric anaesthesia as a career.

Jeson Doctor

Anila Malde

Sandhya Yaddanapudi

References

1Huang AS, Hajduk J, Rim C, Coffield S, Jagannathan N. Focused review on management of the difficult paediatric airway. Indian J Anaesth 2019;63:428-36.
2Pawar DK, Doctor JR, Raveendra US, Ramesh S, Shetty SR, Divatia JV, et al. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in paediatrics. Indian J Anaesth 2016;60:906-14.