Children have special requirements for anaesthesia management because of their physical structure and function, which are still underdeveloped. Key aspects of management of paediatric anaesthesia are described below.
I. Pre-aesthetic assessment and preparation
A comprehensive and detailed pre-aesthesia assessment is the first step in ensuring the safety of infants. Detailed information is needed on the history of the childhood past, covering premature birth history, allergies, family genetic history and recent respiratory infections. For example, premature babies may suffer from lung stunting and respiratory infections increase the risk of anaesthesia. At the same time, medical examinations are carried out, focusing on the CPR function, gastrophagus, etc. Accurate weight measurement as most doses of narcotic drugs are based on weight. Based on the results of the assessment, an anaesthesia risk level was determined for the children and a personalized anaesthesia programme was developed.
II. Anaesthesia induction
The methods used to induce anaesthesia of a child are varied and are chosen according to the age, degree of co-operation and physical condition of the child. Inhalation induction is commonly used for heptafluoroethers, which have rapid induction, odour and small respiratory irritation characteristics, and are applied to children who do not cooperate with intravenous puncture. The intravenous induction guidelines require the first establishment of an intravenous route, with generic drugs such as propaphenol, itomethane, which are fast-activated but may affect the cycle, and atomethane is relatively small for cyclic inhibition. The joint use of opioids such as fentanyl or schofentanyl enhances anaesthesia and reduces intubation stress. In the induction process, the vital signs of children, such as heart rate, blood pressure, blood oxygen saturation, etc., need to be closely monitored to ensure that the induction is stable.
III. Anaesthesia maintenance
For the maintenance phase of anaesthesia, a combination of inhalation of anaesthesia (e.g., fluoroethers) and intravenous anaesthesia (e.g., propol, refentanyl) is used. This would ensure both the stability of the depth of the anesthesia and the reduction of the use of single drugs and their adverse effects. At the same time, the use of muscular lax medications, such as Shun Atracu ammonium, is justified according to the needs of the operation. The depth of anaesthesia is continuously monitored in the operation, and the BIS values are generally maintained at 40-60, with equipment such as the Brain Double Frequency Index (BIS), which is more appropriate, combined with a combination of clinical signs such as heart rate, blood pressure and response to surgical irritation, in order to adjust the drug dose in a timely manner.
IV. BREATH MANAGEMENT
Respiratory management is particularly important because of the narrowness and vulnerability of children to convulsions. Aerobics are usually supported by tube intubation or larynx. When intubated, the appropriate type of bronchial catheter is selected according to the age of the child and the accuracy of the weight, and is properly fixed to prevent the transfer or removal of the catheter. During mechanical air aerobics, appropriate tides, breathing frequencies and snorting ratios are set for infants of 8 – 10 ml/kg. Respiration frequency decreases with age, about 40 – 50 per cent for newborns, 30 – 40 per cent for infants and 20 – 30 per cent for children. (c) Closely monitor airway pressure and breather CO2 fractional pressure, timely detection and treatment of abnormalities such as airway barriers, bronchial convulsions and so as to ensure a smooth and efficient air flow.
V. Circulation management
Pediatric circulatory systems are sensitive to narcotic drugs and surgical stimuli. Indicators of continuous monitoring of heart rate, blood pressure, etc. in the surgery, the neonatal heart rate is usually 120 – 160 minutes, infants 110 – 150 minutes, children 80 – 120 minutes, and blood pressure varies with age. Maintain appropriate anaesthesia depth to avoid cycling fluctuations due to shallow or deep anaesthesia. Reasonable liquid management, accurate calculation of physiological needs, fasting deficiencies and surgical traumas and loss of the third gap, and selection of suitable crystall and adhesive fluids for replenishment to maintain cyclic stability and tissue infusion. When cycling instability occurs, if blood pressure drops, the capacity can be replenished first and, if necessary, vascularly active drugs such as ephedrine, deoxyadrenalin, etc.; when heart rate is abnormal, the reasons are analysed and appropriate measures are taken, e.g. too high heart rate can deepen anaesthesia or deal with induction factors, and too slow heart rate can be used to promote heart rate such as atropine.
VI. Temperature management
Young children ‘ s temperature adjustment centres are not well-developed and are vulnerable to ambient temperature. The temperature of the body is to be monitored in the operation, which can be monitored using a bronchial, rectal or drumming temperature. Normal body temperature is maintained by regulating operating room temperature, using heating equipment (e.g., heating blankets, liquid heaters) and infusion of hot and hot liquids. (c) Avoid complications such as condensation functional impairments and delayed awakening caused by low temperature, while also preventing high-heat convulsions, metabolic disorders, etc.
VII. Awakening Management
As the operation approached its end, it gradually reduced the depth of the anesthesia and contributed to the awakening of the children. Close observation of vital signs, in particular respiratory function recovery, including self-respiration recovery, adequate tidal capacity, and air reflection recovery. When the conditions for removal of the tube are met, care is taken to remove the catheter or larynx, and to prepare for re-intubation to prevent complications such as post-drive trachea and respiratory inhibition. In the case of children who have a nervous period of awakening, the causes, such as pain, urinal stimuli, etc., should be identified and dealt with accordingly, with appropriate pain and tranquillity measures to ensure their smooth passage through the waking period and their safe return to the ward.
