Anesthesia

Abstract

The use of general anesthesia in pediatric patients has greatly increased as a result of a growing number of outpatient orthopedic surgical procedures. In children, upper extremity surgical procedures usually result from trauma, brachial plexus injuries related to birth injuries, congenital hand disorders, or joint contractures and are often conducted under general anesthesia. Despite its common use among children, general anesthesia-related neurotoxicity remains an issue of controversy. Much medical debate currently exists surrounding the safety and complication rates of general anesthesia, and thus, there has been a recent increase in the awareness of the need, success rates, and advantages of the use of regional anesthesia among the pediatric population during surgical procedures. Effective, safe, and prolonged postoperative pain control allowing early discharge from the hospital is an added benefit of the use of regional anesthesia, especially with the introduction of continuous peripheral nerve blocks. This chapter will focus on the preoperative anesthetic concerns and preparations; the several types of anesthesia and their applicability to various age groups; the anesthetic precautions surrounding different surgical procedures; the different regional anesthesia techniques, their appropriate selection and management for blockade, and their implementation into daily clinical practice; and finally postoperative pain management through both pharmacological and non-pharmacological interventions in children. A complete discussion of local, regional, and general anesthesia will also be provided along with the safety of each within the pediatric population in hopes of increasing knowledge of the various anesthetic techniques that currently exist within the field of medicine.