Anaes · Paediatric anaesthesia
Paediatric anaesthesia
Also known as Paediatric anaesthesia · Neonatal anaesthesia · Paediatric airway · Emergence delirium children · SS_PA specialised study unit
Exam-pass paediatric anaesthesia hub (SS_PA): airway sizing formulae, induction choices, fluids/glucose, emergence delirium, sick-child pointers, laryngospasm ladder, GAS 2- and 5-year neurodevelopment, and NAP7 neonatal risk — with leaf links.
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Target exams
Red flags
- The neonate and infant desaturate fast after apnoea — reduced FRC, resting oxygen consumption more than double the adult value. Preoxygenate; expect bradycardia next if hypoxia is not reversed.
- Paediatric airway is high and anterior (taught: infant C3 to C4), narrowest anatomically subglottic and functionally at the cricoid, large tongue and floppy epiglottis. Have Miller blade, correctly sized cuffed tube, and laryngospasm plan ready.
- Laryngospasm is the canonical paediatric airway crisis that progresses to bradycardia and arrest (taught cascade). Escalate: stimulus off, CPAP and Larson, deepen with propofol, then suxamethonium (taught; local protocol governs doses).
- GAS trial is reassuring for just under one hour of sevoflurane in infancy (median 54 minutes); animal neurotoxicity models are not from GAS. Do not delay necessary surgery on speculative grounds alone.
- NAP7 title-level: high mortality risk in neonates, very low risk in children. Senior hands, full preparation, no casual solo neonatal lists.
Meet the patient
A four-week-old ex-preterm neonate presents for inguinal hernia repair. The list is short, the baby is small, and the apnoea clock starts the moment you take control of the airway. The NAP7 correspondence title states the shape of the risk — high mortality risk in neonates and very low risk in children (title-honest; the correspondence abstract itself carries no rates or mechanisms)[3] — which means the most experienced anaesthetist present does this case, not the most junior (taught).
The framework the examiner wants is not a textbook chapter but a hub map: physiology that links to action, a crisis bank that kills children in minutes, and the discipline to prioritise airway and oxygenation before everything else (taught). Every leaf topic below owns one crisis; the hub gives you the spine and the trial names.[6]
References10ShowHide
- [1]Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial Lancet, 2016.PMID 26507180
- [2]McCann ME, de Graaff JC, Dorris L, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial Lancet, 2019.PMID 30782342
- [3]Cook TM, Armstrong RA, Oglesby F NAP7: high mortality risk in neonates and very low risk in children Br J Anaesth, 2025.PMID 39645515
- [4]Haidar L, Abadi F, Sarieddine T, et al. EEG-Guided Anesthesia for the Prevention of Emergence Delirium in Children: A Systematic Review and Meta-Analysis JAMA Pediatr, 2026.PMID 41627803
- [5]Raphael CK, El Bcherawi N, Atallah F, et al. Sugammadex for reversing neuromuscular blockade in infants and children Cochrane Database Syst Rev, 2025.PMID 41257414
- [6]Di Cicco M, et al. Structural and functional development in airways throughout childhood: Children are not small adults. Pediatr Pulmonol, 2021.PMID 33179415
- [7]Park S, et al. Choice of the correct size of endotracheal tube in pediatric patients. Anesth Pain Med (Seoul), 2022.PMID 36317427
- [8]Shi F, Xiao Y, Xiong W, Zhou Q, Huang X Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis J Anesth, 2016.PMID 26296534
- [9]Black AE, et al. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth, 2015.PMID 25684039
- [10]Flick RP, Wilder RT, Pieper SF, et al. Risk factors for laryngospasm in children during general anesthesia Paediatr Anaesth, 2008.PMID 18315633