Medical Conditions to Consider in the Pediatric Patient

Upper Respiratory Tract Infection
- Viral in 65% and bacterial in 34%
- Reasons to cancel elective surgery (see Table 42-7: Criteria to Cancel Anesthesia with an Upper Respiratory Tract Infection)
- Supraglottic airway less likely to trigger airway reflex responses than an endotracheal tube
Asthma
- Optimize condition before elective surgery
- Examine preoperatively for wheezing
- Administer preoperative bronchodilator therapy even if not wheezing
Obstructive Sleep Apnea
- Diagnosis most often based on clinical symptoms
- Recognize increased opioid sensitivity (use alternative pain management strategies)
Ex-premature Infants (<37 wks' gestation, <60 wks' postconceptual age)
- Require 12–24 hrs of postanesthesia monitoring for apnea and hemoglobin oxygen saturation (not needed if regional anesthesia)
Malignant Hyperthermia
Schedule as first case to minimize exposure to volatile anesthetics
Use dedicated anesthesia work station or flush to anesthetic concentration <10 ppm
Trigger-free anesthetic (e.g., propofol, opioids, benzodiazepines, nitrous oxide, regional anesthetic)
- Monitor end-tidal carbon dioxide and axillary temperature (reflects large muscle mass)
- IV dantrolene: 2.4 mg/kg IV as an initial dose; repeated as necessary
Myopathies
Sickle Cell Disease
- Consultation with the treating hematologist
Endocarditis Prophylaxis
- Need to ask consultant if prophylaxis needed
- Dental procedures (see Table 42-8: Sbe Prophylaxis Recommendations by The American Heart Associatoin)
Obesity
- Restrictive pulmonary pattern
- Hypertension
- Insulin resistance
- Gastric empty rates unchanged from nonobese

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Table 42-6