Anesthesiology complications in children

General anesthesia is defined by the American Society of Anesthesiologists as a “drug induced loss of consciousness during which patients are not arousable, even by painful stimulation”. The perioperative period, immediately before, during, and after surgery, is a particularly critical time for pediatric patients. Even though anesthesia today is much safer than it has ever been, all anesthesia has an element of risk. General anesthesia has been safely given to children for many years. Improvements in inhalational and intravenous agents have increased the safety profile of general anesthesia and complication rates are low. General anesthesia has also allowed children to undergo painful or anxiety inducing procedures. General anesthesia is a complete loss of consciousness with amnesia, analgesia and neuromuscular blockade. It can be divided into three phases: induction, maintenance and emergence. Induction usually occurs with inhalational anesthetic in children until intravenous access occurs. Propofol, etomidate and ketamine are often used for induction. Maintenance of anesthesia occurs with inhalational or intravenous medications. Common inhalational anesthetics include nitrous oxide, sevoflurane or desflurane. Common intravenous medications used for maintenance are propofol and remifentanil. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. Side effects of anesthesia may include nausea, vomiting, drowsiness, muscle soreness and sore throat. Rare but more serious complications include adverse reactions that affect breathing, allergic reactions and irregular heart rhythms. Airway and respiratory events are the most common perioperative complications in pediatric patients. Several studies have reported on the incidence of pediatric airway-related complications. Consistently reported risk factors for serious airway complications include very young age and multiple intubation attempts. Laryngospasm was the most common cause of respiratory related arrests. Other etiologies included airway obstruction, difficult intubation, esophageal intubation, and aspiration.