Perioperative management of pediatric trauma patients

Abstract

Pediatric trauma presents significant challenges to the anesthesia provider.This review describes the current trends in perioperative anesthetic management, including airway management, choice of anesthesia agents, and fluid administration.The review is based on the PubMed search of literature on perioperative care of severely injured children.

Pediatric trauma center vs. adult trauma center: which is better?

“…Anesthesia providers play a critical role in pediatric trauma care, from the initial stabilization stage, to intraoperative sedation and monitoring, to perioperative management and pain control [7].…”

“…An IO is placed in the medial surface of the proximal tibia, 1-3 cm below the tibial tuberosity [8]. This allows infusion of volume expanders and necessary medications, and incidence of complications at the access site, such as osteomyelitis, is <1% [7].…”

“…Finally, adequate analgesia in the perioperative period can greatly facilitate extubation and recovery. While opioids should not be withheld in children, a multimodal pain regimen with acetaminophen, ibuprofen, and regional anesthesia, if possible, is highly effective [7].…”

Anesthetic considerations for extracranial injuries in patients with associated brain trauma

“…A brief history outlined by the mnemonic SAMPLE (Signs and symptoms, Allergies, Medications, Past medical/surgical history, Last oral intake, Events related to injury) along with relevant clinical examination (airway, breathing, circulation, neurological examination, and extracranial injuries) may be feasible and should suffice the necessary medical information. [9] Signs and symptoms of intracranial hypertension (ICH) or impending herniation, such as altered level of consciousness, pupillary dysfunction, lateralizing signs, extremity weakness, or Cushing's triad (hypertension, bradycardia, and irregular respirations) should alert the need for urgent interventions to control intracranial pressure (ICP). Of note, mild head injury or spinal injury is not associated with immediate life-threatening consequence.…”

Fluid therapy in neurotrauma: basic and clinical concepts

“…Rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure quickly is now the standard treatment for patients with combined TBI and HS [7,8]. Perioperative fluid administration is an important aspect of surgical care, but is often poorly understood [9][10][11][12][13], and continue to be an exercise in empiricism, with nagging questions about efficacy and complications [14]. Fluid therapy (FT), as the name implies is a treatment with fluids, thus, is a drug [15].…”