Pediatric Anesthesiology
Induction Principles and Technics - 6
Rectal Induction
Rectal induction is appropriate for infants and children to about 5 years of age. The child may be held by a parent on the shoulder or positioned prone on a parent's lap or on a cart.
Methohexital (Brevital) 30 mg/kg of a 10% solution is used. This solution may be prepared by adding 5 ml of warm tap water to a 500 mg vial of methohexital. The methohexital may be gently and quickly
injected into the rectum through a lubricated plastic intravenous catheter or feeding tube.
About 90% of patients will be very sleepy within 10 minutes, and sleep for about an hour.
Beware, some minor defecation is not uncommon after rectal installation of methohexital.Intramuscular Induction
Especially useful as a back-up, "Plan B" induction technic for the child without an IV who becomes uncooperative. The experienced pediatric anesthesiologist keeps a vial of
10% ketamine available for this purpose. A dose of 3 to 4 mg/kg of 10% ketamine delivered rapidly through a 22 or 23 gauge needle into a deltoid muscle is almost always sufficient to induce an anesthetic state within 2 to 3 minutes.
Doubling or tripling this dose will provide complete anesthesia for performance of brief surgical procedures not requiring muscle relaxation although emergence may be unpredictably prolonged.