Managing Complications in Paediatric Anaesthesia

Martin Jöhr was the leader of Paediatric Anaesthesia at the Department of Anaesthesiology at the Luzerner Kantonsspital, Lucerne, Switzerland. With over forty years of hands-on experience, he is now dedicated to teaching and writing extensively on the topic of paediatric anaesthesia.

Dedication; Acknowledgements; Abbreviations; 1. Introduction; 2. Concepts and strategy; 2.1. General safety rules: identification of the patient and the type of surgery; 2.2. Adequate anaesthetic plan; 2.3. Understanding the surgical procedure and the patient's physiology; 2.4. Organization and fasting times; 2.5. Anticipating massive bleeding; 2.6. Maintaining body temperature; 2.7. Unexpected laboratory results; 3. Airway related problems; 3.1. Breathing system; 3.2. Cannot intubate, cannot ventilate; 3.3. Can intubate, cannot ventilate; 3.4. Laryngospasm; 3.5. Size of the endotracheal tube; 3.6. Insertion depth of the endotracheal tube; 3.7. Laryngeal perforation; 3.8. Bronchial rupture; 3.9. Damage to teeth; 3.10. Damage related to a supraglottic airway; 3.11. Regurgitation during use of supraglottic airway; 3.12. Pneumothorax; 3.13. Pulmonary oedema e vacuo; 3.14. Pulmonary aspiration; 3.15. Bronchial foreign body; 3.16. Pharyngeal foreign body; 3.17. Oesophageal foreign body; 3.18. Un-anticipated tracheal stenosis; 3.19. Unknown pre-existing pathology; 3.20. Upper respiratory tract infection; 4. Vascular access; 4.1. Impossible venous access; 4.2. Paravasation; 4.3. Paravenous injection; 4.4. Intraarterial injection; 4.5. The 3-way stop cock phenomenon; 4.6. Vascular damage; 4.7. Malposition of the catheter tip; 4.8. Anomalies of the venous system; 4.9. Air embolism; 4.10. Venous thrombosis; 4.11. Ischaemic fingers; 5. Regional anaesthesia; 5.1. Wrong site block; 5.2. Inadequate technique; 5.3. Undesirable block extension; 5.4. Local anaesthetic toxicity; 5.5. Methaemoglobinaemia; 5.6. Total spinal anaesthesia; 5.7. Compartment syndrome; 5.8. Ischaemic extremity; 5.9. Needle damage; 5.10. Complications of caudal anaesthesia; 6. Medication related problems; 6.1. Medication error; 6.2. Drug overdose; 6.3. Inadvertent drug administration; 6.4. Drug administration during total intravenous anaesthesia; 6.5. Propofol infusion syndrome; 6.6. Systemic effect of local treatment (e.g. eye drops); 6.7. Hyponatraemia; 6.8. Hyperchloraemic acidosis; 6.9. Hyperkalaemia; 6.10. Prolonged paralysis; 6.11. Unexpected slow recovery; 6.12. Emergence delirium; 7. Pre-existing conditions; 7.1. Malignant hyperthermia; 7.2. Neuromuscular disease; 7.3. Down syndrome; 7.4. Oncologic disease; 7.5. The diabetic child; 7.6. Behavioural disorders; 7.7. Anaphylaxis; 7.8. Sepsis; 7.9. Pregnancy; 8. Miscellaneous; 8.1. Damage caused by pressure; 8.2. Damage related to positioning; 8.3. Iatrogenic burns; 8.4. Toxic skin necrosis; 8.5. Transfusion reaction.