1. Inhalational induction (sevoflurane and nitrous oxide) is the most common technique for inducing anesthesia in children undergoing elective surgery.
2. Intravenous induction. A topical local anesthetic cream can be applied to the skin to prevent the pain of the needle puncture. Propofol is the most commonly used induction drug.
3. Problems during Induction of Anesthesia
   1. Oxygen Desaturation (SaO₂). Despite the use of oxygen-enriched inspired gases, many children, particularly those with a history of a mild upper respiratory infection or who become deeply anesthetized, hypoventilate or become apneic.
   2. Laryngospasm (Table 42-10: Factors Associated with Laryngospasm).
      1. The clinical findings in laryngospasm begin with faint inspiratory stridor, suprasternal and supraclavicular indrawing caused by increased inspiratory effort, increased diaphragmatic excursions, and flailing of the chest.
      2. Management of Laryngospasm (Fig. 42-3: Algorithm to diagnose and manage laryngospasm in children)
   3. Bradycardia. Because cardiac output of infants and children is heart rate dependent, a slow heart rate means a reduced cardiac output (100 beats/min for infants <1 year of age). Hypoxia is the foremost cause of bradycardia in children (Table 42-11: Causes of Bradycardia in Infants and Children).

Pediatric Anesthesia

1. Anatomy and Physiology
2. Pharmacology
3. Respiration
4. Cardiovascular
5. Central Nervous System
6. Renal
7. Hepatic
8. In Vivo Metabolism
9. Intravenous
10. Sedatives
11. Preoperative Assessment
12. Induction of Anesthesia
13. Preoperative Preparation
14. Induction Techniques
15. Maintenance of Anesthesia
16. Emergency and Recovery from Anesthesia
17. Transfer to the Postanesthesia Care Unit (PACU)