Canadian Journal of Anesthesia, Vol 10, 616-633, Copyright © 1963 by Canadian Anesthesiologists' Society

Anaesthesia for Abdominal Emergencies in Children

¹ Anaesthetist-in-Chief, The Children's Hospital, and Assistant Professor of Surgery (Anaesthesia), University of Manitoba, Winnipeg, Manitoba

The anaesthetist dealing with abdominal emergencies in children must take into account the condition of the child or infant, the environment of the hospital, which is quite different in the evening and at night from during the usual operating hours, and the skill of the operator as well as the surgical procedure.

Before surgery, the anaesthetist must assure himself that preparation is adequate. Infants will often require blood during the more complicated procedures. Good judgment is required to decide when the patient is in the best and safest condition for surgery and anaesthesia. The anaesthetist must be capable of assessing the total picture.

Induction of anaesthesia must be done most gently in the case of the extremely frightened child. Light anaesthesia, with controlled respiration and muscle relaxation, is the essence of a good technique. In this way respiratory and metabolic acidosis are avoided, better operating Conditions are made available, and recovery is most rapid.

The danger of vomiting during all the stages of anaesthesia must be kept in mind. The endotracheal tube is not removed Until every possible precaution has been taken to see that the stomach is empty arid until the patient is as awake as possible.

Special problems are encountered in the new-born infant. His high body water content at birth and the fact that his total blood Volume is so small make intravenous fluids unnecessary or dangerous; blood is needed, however, for most operations to cure congenital anomalies. Acid-base balance is unstable and the lungs and probably the kidneys are less efficient than in the adult. A technique of light anaesthesia with controlled respiration and muscle relaxation is especially desirable.

Diaphragmatic hernias and omphaloceles create special difficulties. Muscle relaxants are dangerous, but their cautious use may be essential to prevent excessive tissue damage. Long-standing pyloric Stenosis demands very careful preparation, because of the compensated alkaloiic state, usually accompanied by severe hypokalaemia.

Children with abdominal injuries sometimes have associated damage to the thoracic cage, the lungs, the face and head, the pelvis and long bones. Blood loss may be far more than is suspected.

Note:

Presented at the Annual Meeting of the Canadian Medical Association, Toronto, June, 1963.