AnesthesiaExam Podcast

Pediatric Anesthesia Considerations in the Orthopedic Patient


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Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries.

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Select Pediatric Perioperative Concerns:

  1. Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution.
  2. Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term.
  3.  

Anesthetic Management for Orthopedic Procedures:

  1. Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss.

  2. Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population.

Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being.

Reference

 Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179.

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Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address *   Ultrasound Block Course applicable in  Pediatric Anesthesia for Orthopedic Procedures includes:
  • Certificate of Completion
  • Ultrasound Guided Interventional Pain Atlas
  • Continuing Medical Education Credit
  • Online access to Webinar (additional CME Credit)

Regional Anesthesia:

 

Lower Extremity Nerve Blocks for 

  • Femoral Nerve Block
  •  
  • Genicular Nerve Block
  • Sciatic Nerve Block 
    • Popliteal Nerve Block
    • Common Peroneal Block
    • Tibial Nerve Block Block
  • Ankle Block

 

Upper Extremity Anesthesia for Fractures and Reductions

 

  • Brachial Plexus Block
  • Axillary Nerve Block
  • Suprascapular Nerve Blocks

Truncal and Fascial Plane Blockade

  • Transversus abdominis plane block
  • Paravertebral Nerve Block
  • Intercostal Nerve Block
  • Erector Spinae  Block
  • PENG Nerve Block
  • IPACK Nerve Block

and much more!

Caudal Epidural and Spine demonstrations available as well.

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Or Email [email protected] to arrange a private workshop with your Department.

NRAP Academy: Ultrasound Guided Regional Anesthesia and Interventional Pain Workshops

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