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  1. Serious adverse events are more common in the pediatric population, so proper understanding and implementation of monitoring tools are essential to prevent adverse outcomes.

  2. The American Society of Anesthesiology recommends that during all anesthetics the patient’s oxygenation, ventilation, circulation, and temperature should be continually evaluated.

  3. Due to the minimal dead space and resistance, Mapleson E and F are the circuit of choice for neonates and pediatric patients.

  4. Pediatric breathing systems have the same components as standard adult circuits, but are modified to decrease resistance to breathing and minimize dead space. These modifications include short and narrow tubing, valves that require reduced pressure to open and close, smaller reservoir bag, shorter Y connection, and more compact carbon dioxide absorbers.

  5. The primary resistance in a pediatric circuit is determined by the internal diameter of the endotracheal tube and by the length of the tube.1 The unidirectional valves and carbon dioxide absorber also increase breathing resistance.


Serious adverse events occur in the pediatric population in about 1.4 per 1000 anesthetics and the incidence of cardiac arrest is approximately 0.3 per 1000 anesthetics. This is significantly higher than in the adult population. The incidence of adverse events is inversely related to age with the highest incidence of adverse effects and cardiac arrest occurring in neonates.2 This data suggests that children are in a high-risk population for adverse events and need to be monitored closely during anesthetic procedures. The American Society of Anesthesiology (ASA) has developed a set of commonly used standards for basic monitoring that apply to both the adult and pediatric population. Qualified anesthesia personnel must be present during the entire anesthetic encounter, continually monitoring oxygenation, electrocardiography, temperature, and the adequacy of ventilation and circulation. Instruments that quantitatively measure oxygen levels should be employed, such as pulse oximeter and an oxygen analyzer to measure oxygen concentration in the breathing system. With regards to circulation, the arterial blood pressure needs to be monitored at least every 5 minutes and the electrocardiogram needs to be displayed from the beginning of every anesthetic until departing from the anesthetizing location. Tracheal intubation or laryngeal mask airway placement needs to be confirmed by clinical assessment and by qualitative detection of carbon dioxide in the exhaled gas. Finally, every patient receiving anesthesia should have their temperature monitored when clinically significant changes in body temperature are intended, anticipated, or suspected.2

Pulse Oximetry

Pulse oximetry has become the standard of care in measuring arterial oxygen saturation in the operating rooms and intensive care units. The oximetry probe contains two light-emitting diodes (LEDs) which produce both red and infrared light. The LEDs and the detectors should be transversely positioned to get the best readings. In neonates, this may require placing the probe across the palm of the hand or the foot. The pulse oximeter uses two wavelengths of light, so it ...

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