Inhalat ional anesthetic agent of choice in children is?
Ans. is 'a' i.e., Sevoflurane * Unlike desflurane, sevoflurane poses no problem in induction, acceptability is good even in pediatric patients.* Therefore, sevoflurane is the inhalational agent of choice for induction.Anesthesia in Children -InductionInhalational induction* Inhalational agent with mask is the induction method of choice in children.* Sevoflurane is the inhalation agent of choice for induction. Sevoflurane is used in N2O+O2 gas mixture. Halothane is second choice inhalational agent for induction. Isoflurane and desflurane are not used for induction as they are more pungent and associated with more coughing 8c laryngospasm.Intravenous induction* Intravenous induction is preferred when induction by mask is contraindicated i.e., in full stomach patients or of child comes in the operation theatre with IV line in situ.* Thiopentol or propofol are commonly used agents. Propofol is particularly suitable for out patient surgery. Ketamine is preferred in children with hypovolemia. Etomidate can be used in child with unstable cardiovascular status as it is most cardio-vascular stable intravenous inducing agent.Maintenance* As sevoflurane cause emergence delirium and agitation, it is not used for maintenance. After induction with sevoflurane anaesthesia, isoflurane or Halothane are used for maintenance anaesthesia. During maintenance, anaesthetic gas mixture contain N2O+O2 +Halothane or isoflurane. Halothane is commonly used for induction and maintenance in children.* If sevoflurane is continued for maintenance, administration of an opioid (Fentanyl) 15-20 min before the end of the procedure can reduce the incidence of emergence delirium and agitation.Muscle relaxantsDepolarizing blockers* Children are more susceptible to cardiac arrhythmia, Hyperkalemia and rhabdomyolysis after administration of succinylcholine. If a child unexpectedly experiences cardiac arrest following administration of sucinylcholine, immediate treatment for hyperkalemia should be instituted. For this reason, succinylcholine is best avoided for routine elective surgery in children.* Generally accepted indications for succinylcholine are1) Rapid sequence induction, 2) Laryngospasm, and 3) Rapid muscle relaxation prior to intravenous access (e.g., regurgitation).* Profound bradycardia and sinus node arrest can develop in pediatric patients following first dose of succinyl choline, if given without pretreatment with atropine. Therefore, atropine must always be administered prior to succinylcholine in children.* Children with muscular dystrophy are more prone to develop hyperkalemia: Arrhythmia and cardiac arrest may occur - Should be avoided in such patients.Non-depolarizing muscle relaxants* Functional maturation of NM junction is not complete unti 12 months of age, therefore new born sarevery sensitive to non-depolarizing muscle relaxants.* Kidney and liver functions are immature in neonate - Atracurium/cisatracurium is the muscle relaxant of choice in newborn as it does not require renal or hepatic elimination. For the same reason mivacurium can also be used.* In older children the choice of non-depolarizing muscle relaxant depends on the side effects, and onset & duration of action: -i) Mivacurium for procedures lasting 10-15 min.ii) Atracurium/cisatracurium for precedures lasting around 30 min.iii) Pancuronium when tachycardia is desired e.g., with fentanyliv) Vecuronium (fastest acting non-depolarizing NM blocker) for intubation in place of SCH.v) Atracurium/cisatracurium in patients with renal or hepatic disease.
Sevoflurane
Methoxyflurane
Desflurane
Isoflurane
General Anesthesia