Page 9 - CASA Bulletin of Anesthesiology Vol 9 (4) 2022 (3)

Vol. 9, No 4, 2022

本期开篇之言

Pediatric anesthesia Introduction

John Zhong, MD Associate Professor
University of Texas Southwestern Medical Center
Staff Anesthesiologist
Children’s Health of Dallas

Pediatric anesthesia is quite unique in the sense that on the same day a pediatric
anesthesiologist can go from anesthetizing a less than 800-gram preemie to an over 300-pound
high school football linebacker. Like adult anesthesia, ultrasound has enjoyed an increasing role
in pediatric anesthesia. Dr. Visoiu from UPMC has reported the cases on ultrasound guided
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sacral intervertebral catheter placement on sacral teratoma and sacral agenesis that were
considered contraindicated for regional anesthesia. Dr. Alrayashi from Boston Children's
Hospital reported ultrasound guided saline myelogram to confirm spinal placement on those
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otherwise dry taps . It has the potential to decrease the radiation exposure from traditional C-
arm assisted procedures. Dr. Cho from Korea published their trainee’s performance time for
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cricothyroid membrane identification and characteristics of cricothyroid membrane in pediatric
patients using ultrasonography. Although it is not an actual procedure, yet the 100% successful
identification rate and 28 seconds recognition after only 30 minutes of video did act time plus
explanation was still very impressive.

The proportion of anesthesia-related cardiac arrest is estimated to be 0.1–3.4 per 10 000
pediatric patients. Resuscitation of pediatric patients in the US has been guided by Pediatric
Advanced Life Support (PALS), Neonatal Life Support (NLS), and Society of Pediatric
Anesthesia’s Checklist. PALS and NLS have major updates every 10 years and minor ones every
5 years. Our European colleagues tend to follow guidelines for resuscitation developed by the
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European Resuscitation council. They had major updates in 2021. The highlights are: in
pediatric patients fluid bolus set at rate of 10 ml/kg, 2-thumb-encircling chest compression for
infants and age appropriate ventilation rate which are 25 for age less than 1; 20 for age 1-8 years
old, 15 for 8-12 years old and 10 for age older than 12. Their NLS updates are: delayed umbilical
cord clamping for at least 60 seconds; LMA is considered an acceptable alternative airway;
Starting FiO2 in preterm newborn infants with decreasing orders: 30% for less than 28 week old;
21-30%% for 28-32 week old, and 21% for 32 week because of a 27% reduction in short term
mortality with 21% compared to 100% FiO2; the initial peak inspiratory pressure is set at 25 cm
H2O for those less than 32 week old and 30 cm H2O for those older than 32 week. Earlier lower
airway pressure led to tidal volumes less than anatomic dead space.

With that in mind, this CASA pediatric anesthesia issue invited 7 authors both in the US and
China to share their clinical pearls. Dr. Xu’s article (Sichuan Provincial People’s Hospital) on
pediatric PONV is another example of pediatric anesthesia not a scaled down version of adult
anesthesia. Pediatric patients have their unique risk factors of PONV. Her article gives an
excellent summary on this topic.

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