Anaesthesia for children
In Germany, children under 14 years of age may only be narcotised with the consent of their parents. Between the ages of 14 and 18, children can decide for themselves whether or not to be given an anaesthetic, provided the doctor providing the information has no doubts about the child’s maturity. Since children cannot be seen as “little adults” from a medical point of view, there are some special features to be considered when it comes to anaesthesia.
In addition, one distinguishes between three subgroups: Premature babies, newborns and infants as well as toddlers, schoolchildren and adolescents. The anaesthetist must adapt his instruments and the dosage of narcotics to the physical characteristics of the patient. For example, smaller lungs and narrow airways, reduced cardiac output and a longer retention time of drugs in the body due to lower liver and kidney performance.
Especially for infants, warming pads and blankets or heat lamps are also used, as these cool down quite quickly at room temperature. Children should also be fasting before anaesthesia, i.e. the last food intake should not be less than 6 hours, the last fluid intake not less than 2 hours. Infants can be breastfed up to 4 hours before.
In the event that fasting is not possible, there is the “rapid-sequence-induction” (RSI). In this procedure, the processes of intravenous anaesthetic induction are modified with the aim of a faster sequence in order to keep the risk of suffocation of the stomach contents as low as possible. If necessary, leftover food can be removed via a stomach tube.
In children, in addition to the previous oxygen administration (pre-oxygenation), mild ventilation between muscle relaxation using so-called relaxants and the subsequent insertion of the ventilation probe (intubation) is recommended, since children suffer from oxygen deficiency earlier than adults. For small children, a popular form is the inhalation initiation. In the presence of their parents, the child inhales the anesthetic (e.g. sevoflurane) through a mask, falls asleep and only then can an indwelling venous cannula be inserted without pain.
This method becomes risky if complications occur during the fall asleep phase and there is no venous access available yet, through which drugs can be administered quickly. Alternatively, intravenous administration (e.g. with Propofol), which is recommended for children from 7 years of age or weighing 25 kg, offers a faster onset of action and thus a reduced risk. If the puncture site is anesthetized beforehand (lidocaine / aprilocaine patch or ointment), the cannula should be easy to insert.
In very small and exceptionally anxious children, the rectal introduction can be used. In this case the medication (Methohexital) is introduced into the child’s rectum. As soon as the child has reached the sleeping state, the anesthesia can be continued elsewhere.
In addition, there is the possibility of nasal or intramuscular introduction. In the case of nasal anaesthesia, the medication is introduced via the nose using syringes or a nebulizer, which promises a fast and reliable effect. In the other case, the drug is injected directly into a muscle. This method is rather an exception nowadays and is mainly used in emergency medicine.Once the anaesthesia has been successfully induced, a muscle relaxant is injected, similar to that used in adult patients, which relaxes the muscles and prevents the triggering of protective reflexes such as coughing, choking and vomiting during the subsequent airway securing procedure (intubation).
