Understanding Anesthesiology - The Global Regional Anesthesia ...

example, it is common practice to allow clear fluids
from 2-4-hours pre-operatively in children under 12
years of age. Infants may be allowed breast milk up to
4 hours pre-operatively and formula up to 6 hours preoperatively,
breast milk being more readily digestible
than formula.
Central Nervous System, Behaviour
Anesthetic requirements (MAC) are higher in infants
and children, compared to adults, with the peak occurring
at 6 months of age.
to the child with this technique although the parents,
for the most part, seem to prefer it. Inhalation (“mask”)
inductions are often used in order to avoid having to
insert an IV in the awake child. However, for a struggling
child, a mask induction may be more traumatic
than an IV induction. The use of topical tetracaine (a local
anesthetic) has made awake IV starts more feasible
in this patient population.
By 6 months to a year of age, infants become sufficiently
aware of their surroundings to feel anxiety in
the immediate pre-operative period. They are generally
less inhibited about expressing their anxiety than their
adult counterparts. There are many different approaches
to minimizing this anxiety which must be individualized
according to the needs of the patient, her
parents and the anesthesiologist. Pediatric patients may
be pre-medicated with benzodiazepines, opioids or anticholinergics.
Unfortunately the administration of a premedication
(even orally) can be distressing for these patients.
Furthermore, depending on the agent chosen, recovery
may be delayed. In many centers a parent is allowed
in the operating room for induction to avoid
separation anxiety for the child. This requires additional
personnel to prepare and stay with the parent
throughout. Studies have failed to show a clear benefit
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