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.

Greg Gordon MD