All precautions should be taken to
protect against a full stomach. The nasogastric tube should be aspirated
prior to induction of anesthesia. A rapid-sequence induction with
preoxygenation, cricoid pressure, thiopental, and succinylcholine is often
used. Inhalation induction with cricoid pressure applied until orotracheal intubation is achieved
is another alternative. Awake tracheal intubation is not
superior to anesthetized, paralyzed tracheal intubation technique in maintaining adequate
oxygenation and heart rate or in reducing complications. Most important for
the anesthesiologist is to use the airway management technique that he/she
is most comfortable with. It is not time to improvise! Blood loss usually is minimal. The infant should
have his/her trachea extubated fully awake at the end of the procedure in the left lateral position.
Postoperative analgesia can be provided by wound infiltration with local
anesthetics and administration of acetaminophen. Postoperative hypoglycemia
2 to 3 hours after the procedure and respiratory depression have been
described. Consequently, the child should be monitored closely in the
immediate postoperative period.