Induction Principles and Technics - 1
G. Gordon, MD
Students will be able to:
1. Explain how to choose a pediatric anesthetic induction technic.
2. List and describe proper conduct of several technics of pediatric anesthetic induction.
Classic Truths and General Principles
"Infants should preferably be anesthestized in the mother's or nurse's arms. Care should be taken in anesthestizing children to make the operation as informal as possible... Mental suggestion here plays a great part, as well as gentleness in voice and movement..."
-Gwathmey J: Anesthesia 1914
Pediatric anesthetic induction, especially of young infants and fearful toddlers, may be associated with significant stress for the patient as well as the anesthesiologist. With regular practice, however, pediatric inductions are generally safe and smooth if not fun and easy. The pediatric anesthesiologist learns to divide her/his attention appropriately among the technical aspects of the induction, the central nervous system and cardiorespiratory responses of the patient, and the provison of psychological support to the child and/or parent.
Psychological support is most easily provided by the anesthesiologist who has met and established rapport with the family well in advance of the procedure. In modern practice, this ideal is not always possible. Emotional support is more often now provided by informed parents and by an anesthesiologist who has gained the patient's confidence in the preoperative holding or waiting area. One useful technic involves beginning a conversation about a favorite toy or experience in the holding area and then continuing the discusson during anesthetic induction. It is often also helpful to encourage the child to bring a favorite toy or "security blanket" to the induction area. The very common fear of the unknown is largely alleviated by simple, honest communication colored by appropriate positive suggestion. In selected cases, especially if a parent will not be present for induction, pharmacologic premedication may be helpful.