Medical specialties

This chapter describes the perioperative management of children presenting to the medical specialties, who often have comorbidities and frequent theatre episodes. Endoscopic procedures are the mainstay of diagnosis and treatment in gastroenterology. Endoscopy lists require an anaesthetist to plan for a high turnover, potentially in a remote site. Standard general anaesthetic (GA) techniques, along with alternative approaches, are discussed. Ingestion of caustic substances and foreign bodies in children and their management are discussed Children with oncological conditions commonly have GA for diagnostic and therapeutic procedures. Anaesthetists also need to provide assistance in siting tunnelled lines and in pain management. The salient clinical features, staging procedures, and treatment options of common childhood malignancies are considered, including bone marrow transplantation and managing an immunocompromised child. The multiple challenges of anaesthetizing children having radiotherapy are considered. Indications, contraindications, and equipment preparation for both diagnostic and therapeutic bronchoscopies are discussed. Children having these procedures usually have comorbidities and a high probability of significant decompensation during the procedure. Clinical aspects of juvenile idiopathic arthritis (JIA), including its definition, classification, diagnostic features, and salient treatment aspects, are discussed. Anaesthetic considerations for joint injections are described. Special attention is paid to careful assessment of anaesthetic-specific features such as difficult airway, unstable cervical spine, and systemic changes of JIA, and the respective anaesthetic precautions are discussed.