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  • Image not available.The small and limited number of alveoli in neonates and infants reduces lung compliance; in contrast, their cartilaginous rib cage makes their chest wall very compliant. The combination of these two characteristics promotes chest wall collapse during inspiration and relatively low residual lung volumes at expiration. The resulting decrease in functional residual capacity (FRC) is important because it limits oxygen reserves during periods of apnea (eg, intubation) and readily predisposes them to atelectasis and hypoxemia.
  • Image not available.Neonates and infants have a proportionately larger head and tongue, narrow nasal passages, an anterior and cephalad larynx, a long epiglottis, and a short trachea and neck. These anatomic features make neonates and most young infants obligate nasal breathers until about 5 months of age. The cricoid cartilage is the narrowest point of the airway in children younger than 5 years of age.
  • Image not available.Stroke volume is relatively fixed by a noncompliant and poorly developed left ventricle in neonates and infants. The cardiac output is therefore very dependent on heart rate.
  • Image not available.Thin skin, low fat content, and a higher surface relative to weight allow greater heat loss to the environment in neonates. This problem is compounded by cold operating rooms, wound exposure, intravenous fluid administration, dry anesthetic gases, and the direct effect of anesthetic agents on temperature regulation. Hypothermia has been associated with delayed awakening from anesthesia, cardiac irritability, respiratory depression, increased pulmonary vascular resistance, and altered drug responses.
  • Image not available.Neonates, infants, and young children have relatively higher alveolar ventilation and lower FRC compared with older children and adults. This higher minute ventilation-to-FRC ratio with relatively higher blood flow to vessel-rich organs contributes to a rapid rise in alveolar anesthetic concentration and speeds inhalation induction.
  • Image not available.Minimum alveolar concentration (MAC) is higher in infants than in neonates and adults for halogenated agents. Unlike other agents, sevoflurane has the same MAC in neonates and infants. Sevoflurane appears to have a greater therapeutic index than halothane and has become a preferred induction agent in pediatric anesthesia.
  • Image not available.Children are more susceptible than adults to cardiac arrhythmias, hyperkalemia, rhabdomyolysis, myoglobinemia, masseter spasm, and malignant hyperthermia (MH) after administration of succinylcholine. If a child unexpectedly experiences cardiac arrest following administration of succinylcholine, immediate treatment for hyperkalemia should be instituted.
  • Image not available.Unlike in adult patients, profound bradycardia and sinus node arrest can develop in pediatric patients following the first dose of succinylcholine without atropine pretreatment.
  • Image not available.A viral infection within 2–4 weeks before general anesthesia and endotracheal intubation appears to place the child at an increased risk for perioperative pulmonary complications, such as wheezing, laryngospasm, hypoxemia, and atelectasis.
  • Image not available.Temperature must be closely monitored in pediatric patients because of their higher risk for MH and the potential for both iatrogenic hypothermia and hyperthermia.
  • Image not available.Meticulous fluid management is required in small pediatric patients because of extremely limited margins of error. A programmable infusion pump or a buret with a microdrip chamber should be used for accurate measurements. Drugs are flushed through low dead-space tubing to minimize unnecessary fluid administration.
  • Image not available.Laryngospasm can usually be avoided by ...

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