Anesthetic Management of Common Pediatric Emergencies

Several issues must be considered when presented with a child for an emergency procedure. The airway must, of course, be managed along with ensuring adequate breathing and circulation. At the same time, the urgency of the proposed intervention needs to be determined. It is a great disservice to a patient when a thorough preoperative workup and attempts at optimizing nil per os (NPO) status have been abandoned for a procedure that is, in fact, elective. Intravenous (IV) access may also prove challenging in the pediatric patient undergoing emergency surgery. It would be extremely unlikely for an adult in an emergency situation to present to the operating room without an IV, whereas a child may be sent from a clinic or emergency department without an established one. Most emergency procedures dictate the presence of an IV before induction. Another consideration unique to children is the desire for parental presence at anesthetic induction. Consideration should be taken to determine whether having a parent present poses an unnecessary distraction and places the child at risk due to the emergent nature of the situation. Parental presence need not be an expectation in such cases.