Anaes · Paediatric anaesthesia
The sick child: sepsis, resuscitation, and congenital heart disease for anaesthesia
Also known as Paediatric septic shock anaesthesia · Congenital heart disease anaesthesia · Balanced circulation shunt · Sick child induction
Anaesthesia for the critically ill child covering septic shock resuscitation (Surviving Sepsis Campaign paediatrics), induction of the septic child, and congenital heart disease principles including shunt balance, air precautions, and NAP7 high-risk context.
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Red flags
- Inhalational induction of a septic or duct-dependent neonate can cause profound collapse.
- Excessive oxygen or high SVR can reverse or unbalance shunts in CHD.
- Air bubbles in IV lines can cause paradoxical emboli with right-to-left shunt.
- Delayed antibiotics and source control kill — theatre does not replace resuscitation.
- Infants and CHD are highest-risk perioperative cardiac arrest groups (NAP7 context).
Meet the patient
A 2-year-old is brought to theatre at midnight for an emergency laparotomy for a perforated appendix. She is mottled, capillary refill is 4 seconds, her heart rate is 180, and her blood pressure is 70 over 40. The surgeon wants to go now. The registrar reaches for the sevoflurane.[1]
Stop. This child is in septic shock, and a pure inhalational induction will drop her blood pressure through the floor. The first job is resuscitation in parallel with theatre — fluids, antibiotics, vasoactives — and then a haemodynamically gentle IV induction with full monitoring. Theatre does not replace resuscitation; it is part of it.[1]
References4ShowHide
- [1]Weiss SL et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatric Critical Care Medicine, 2020.PMID 32032273
- [2]Weiss SL et al. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Pediatric Critical Care Medicine, 2026.PMID 41869844
- [3]Davidson AJ 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
- [4]Khalil M, Jux C, Rueblinger L, et al. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr, 2019.PMID 31161078